American heart journal
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American heart journal · Jul 2006
Review Meta Analysis Comparative StudyGlycemic control and macrovascular disease in types 1 and 2 diabetes mellitus: Meta-analysis of randomized trials.
Uncertainty persists concerning the effect of improved long-term glycemic control on macrovascular disease in diabetes mellitus (DM). ⋯ Our data suggest that attempts to improve glycemic control reduce the incidence of macrovascular events both in type 1 and type 2 DM. In absolute terms, benefits are comparable, although effects on specific manifestations of macrovascular disease differ.
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American heart journal · Jul 2006
Review Historical ArticleCurrent status of the total artificial heart.
Although heart transplantation remains the gold standard for patients who remain in advanced heart failure despite optimal medical therapy, limited donor supplies allows for just >2000 transplant each year in the United States. Recent enthusiasm has developed for the role of mechanical circulatory support for this ever-growing population of sick patients. ⋯ Indeed, efforts in this latter technology have allowed the relatively recent deployment of a variety of complete circulatory assist devices. The purpose of this article is to review the historical development, current use, and future role of total artificial hearts.
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American heart journal · Jun 2006
ReviewRole of fibrinolytic therapy in the current era of ST-segment elevation myocardial infarction management.
In patients presenting with ST-elevation myocardial infarction, early, effective reperfusion of the culprit artery is needed to salvage myocardium, maintain left ventricular function, and reduce mortality. According to American College of Cardiology/American Heart Association guidelines for the treatment of these patients, the time from medical contact (i.e., firm ST-elevation myocardial infarction diagnosis) to initiation of fibrinolytic therapy (door-to-needle time) should be 30 minutes, and the time from medical contact to percutaneous coronary intervention (PCI) (door-to-balloon time) should be 90 minutes. Because many patients present to hospitals that are not equipped to administer PCI, door-to-balloon time often falls far short of the ideal. When PCI is not readily available, efficient prehospital treatment with t-PA-based fibrinolytic agent formulations that can be delivered in a bolus and do not require weight-based adjustment may reduce mortality rates and result in outcomes similar to PCI when administered promptly.
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Overweight and obesity rates continue to increase nationally, generating significant interest in weight-loss therapies to address both the burden of obesity-associated chronic disease and individual concerns about appearance. Effective obesity therapies also have the potential for off-label use and unintended consequences. ⋯ The behavioral, pharmacologic, and surgical therapies for obesity are reviewed. Clinical trial issues common to chronic disease states and issues specific to obesity trials are examined. Finally, study designs for obesity therapy, including populations, control arms, sample size, and duration of therapy, are discussed.
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American heart journal · Feb 2006
ReviewAre statins created equal? Evidence from randomized trials of pravastatin, simvastatin, and atorvastatin for cardiovascular disease prevention.
The relative efficacy of different statins for long-term cardiovascular prevention remains largely undetermined. ⋯ Evidence from published statin randomized placebo-controlled trials suggests that pravastatin, simvastatin, and atorvastatin, when used at their standard dosages, show no statistically significant difference in their effect on long-term cardiovascular prevention.