Association of Testosterone Replacement With Cardiovascular Outcomes Among Men With Androgen Deficiency.

Importance: Controversy exists regarding the safety of testosterone replacement therapy (TRT) following recent reports of an increased risk of adverse cardiovascular events. Objective: To investigate the association between TRT and cardiovascular outcomes in men with androgen deficiency. Design, Setting, and Participants: A retrospective cohort study was conducted within an integrated health care delivery system. Men at least 40 years old with evidence of androgen deficiency either by a coded diagnosis and/or a morning serum total testosterone level of less than 300 ng/dL were included. The eligibility window was January 1, 1999, to December 31, 2010, with follow-up through December 31, 2012. Exposures: Any prescribed TRT given by injection, orally, or topically. Main Outcomes and Measures: The primary outcome was a composite of cardiovascular end points that included acute myocardial infarction (AMI), coronary revascularization, unstable angina, stroke, transient ischemic attack (TIA), and sudden cardiac death (SCD). Multivariable Cox proportional hazards models were used to investigate the association between TRT and cardiovascular outcomes. An inverse probability of treatment weight, propensity score methodology, was used to balance baseline characteristics. Results: The cohorts consisted of 8808 men (19.8%) ever dispensed testosterone (ever-TRT) (mean age, 58.4 years; 1.4% with prior cardiovascular events) and 35 527 men (80.2%) never dispensed testosterone (never-TRT) (mean age, 59.8 years; 2.0% with prior cardiovascular events). Median follow was 3.2 years (interquartile range [IQR], 1.7-6.6 years) in the never-TRT group vs 4.2 (IQR, 2.1-7.8) years in the ever-TRT group. The rates of the composite cardiovascular end point were 23.9 vs 16.9 per 1000 person-years in the never-TRT and ever-TRT groups, respectively. The adjusted hazard ratio (HR) for the composite cardiovascular end point in the ever-TRT group was 0.67 (95% CI, 0.62-0.73. Similar results were seen when the outcome was restricted to combined stroke events (stroke and TIA) (HR, 0.72; 95% CI, 0.62-0.84) and combined cardiac events (AMI, SCD, unstable angina, revascularization procedures) (HR, 0.66; 95% CI, 0.60-0.72). Conclusions and Relevance: Among men with androgen deficiency, dispensed testosterone prescriptions were associated with a lower risk of cardiovascular outcomes over a median follow-up of 3.4 years.

Efecto reductor del colesterol de una combinación de levadura roja de arroz y policosanol / Efeito de reduçao do colesterol de uma combinaçao de arroz vermelho fermentado e policosanol / Cholesterol lowering effect of a combination of red yeast rice and polycosanol

Es ampliamente conocido que los niveles altos de colesterol están relacionados con el riesgo cardiovascular. La levadura de arroz rojo o levadura roja de arroz es un producto obtenido a partir de una levadura (Monascus purpureus Went.), que crece sobre este cereal. Entre sus componentes destaca la monacolina K, también conocida como lovastatina, sustancia relacionada con la disminución del colesterol mediante la inhibición de la HMG-CoA reductasa. El policosanol, mezcla de alcoholes alifáticos, obtenido de la caña de azúcar (Saccharum officinarum L.), además de modular dicha enzima, aumenta la actividad de los receptores LDL y tiene un efecto antioxidante y antiagregante. Mediante este trabajo se aportan los resultados de 65 pacientes en los cuales se ha observado una disminución media, estadísticamente significativa, de los niveles de colesterol (22% del colesterol total y 29% del LDL) y una disminución del 22% de los triglicéridos, tras tomar durante 2 meses un producto compuesto por: levadura roja de arroz con un contenido diario de 10 mg monacolina K y 14 mg de policosanol extraído de la caña de azúcar. La combinación de la monacolina K y el policosanol se plantean como una opción en pacientes con riesgo cardiovascular bajo o moderado (AU)

É amplamente conhecido que os níveis elevados de colesterol estão associados a um risco acrescido de doença cardiovascular. O arroz vermelho fermentado (ou levedura de arroz vermelho) é um produto obtido a partir de uma levedura (Monascus purpureus Went.), que cresce no arroz. Entre os seus componentes destaca-se a monacolina K, também conhecida como lovastatina, substância relacionada com a redução do colesterol através da inibição da HMG-CoA redutase. O policosanol, que consiste numa mistura de álcoois alifáticos de cadeia longa obtida a partir da cana-de-açúcar (Saccharum officinarum L.), além de modular a mesma enzima (HMG-CoA redutase), aumenta a actividade de receptores de LDL e tem efeitos antioxidantes e antiagregantes plaquetários. Este trabalho reporta os resultados de 65 participantes nos quais se observou uma diminuição média estatisticamente significativa do valor de colesterol (22% do colesterol total e 29% do LDL), assim como uma diminuição de 22% do valor dos triglicéridos, após a toma, durante dois meses, de um produto composto por arroz vermelho fermentado e policosanol, correspondendo a uma toma diária de 10 mg de monacolina K e 14 mg de policosanol. Assim, a associação de monacolina K, e policosanol apresenta-se como uma opção para doentes com risco cardiovascular baixo ou moderado (AU)

It is widely known that high cholesterol levels are associated with cardiovascular risk. Red yeast rice or red rice yeast is a product obtained from a yeast (Monascus purpureus Went.), which grows on rice. Among its constituents, it stand out monacolin K, also known as lovastatin, compound related to the cholesterol lowering effect through the inhibition of the HMG-CoA reductase. Polycosanol is a mixture of long chain aliphatic alcohols obtained from sugar cane (Saccharum officinarum L.). In addition of modulating that enzyme, it increases the activity of LDL receptors and has antioxidant and antiplatelet effect. In the present work, results in 65 patients treated for 2 mounts with a product combining red yeast rice (providing 10 mg/day of monacolin K) and policosanol from sugar cane (14 mg/day). An average decrease, statistically significant, of blood cholesterol (22% of total cholesterol and 29% of LDL) and triglycerides (22% ) has been observed. The combination of monacolin K and polycosanol is considered an option for patients with low or moderate cardiovascular risk (AU)

Potencial terapéutico de la sumidad de agripalma (Leonurus cardiaca L) / Potencial terapeutico da sumidade florida de agripalma (Leonurus cardiaca L) / Therapeutic potential of motherwort (Leonurus cardiaca L)

La agripalma (Leonurus cardiaca L.) es una planta herbácea, perteneciente a la familia de las Lamiáceas, originaria de Europa. En su composición destacan los terpenoides como el ajugol y la leocardina, los heterósidos fenilpropánicos como el lavandulifoliósido y los alcaloides como la estaquidrina. En Europa esta descrita desde el siglo XV la utilización de la sumidad florida de agripalma para tratar la ansiedad y alteraciones cardíacas de tipo nervioso. A nivel experimental se han descrito efectos sedantes y una acción inotrópica leve, sin embargo los estudios clínicos destinados a probar su eficacia sobre afecciones cardiovasculares son muy escasos y la mayoría antiguos. Hoy en día tiene una comercializacion muy reducida pese a tener un elevado grado de seguridad y a la posibilidad de su registro tanto en forma de medicamento tradicional a base de plantas (MTP), ya que cuenta con monografía de la Agencia Europea del Medicamento (EMA), como en la de complemento alimenticio (CA) (AU)

Motherwort (Leenurus cardiaca L.) is a herbaceous plant native to Europe, belonging to the family of Lamiaceae. lts composition include terpenoids as ajugol and leocardin, phenilpropane glycosides as lavandulifolioside and alkaloids as stachydrine. In Europe, the use of motherwort flowering tops for treating anxiety disorders and heart diseases of nervous origin is known from the fifteenth century. Experimentally, sedative activity and mild inotropic action have been described, however clinical studies to prove its effectiveness on cardiovascular disorders are scarce and mostly ancient. Nowadays, it has a small market, despite having a high degree of safety and the possibility of registration both as a traditional herbal medicinal product (TMP), since it has monograph of the European Medicines Agency (EMA), or as food supplement (CA) (AU)

A agripalma (Leonurus cardiaca L.) é uma planta herbécea, pertencente a familia das Lamiaceae, originária da Europa. Na sua composigao destacam-se os terpenóides como ajugol e leocardina, os heterósidos fenilpropánicos come lavandulifoliósido e os alcalóides como estaquidrina. Na Europa está descrita desde o seculo XV a utilizaçao da sumidade florida de agripalma para a ansiedade e alteraçoes cardíacas de tipo nervoso. A nível experimental estao descritos efeitos sedativos e açao inotropica leve, porem os estudos clínicos destinades a prevar a sua eficácia sobre as doenças cardiovasculares sao rares e a maioria antigos. Actualmente tem uma comercializaçao muito pequena, apesar de ter um alto grau de segurança e tem a possibilidade de ser registada tanto na forma de medicamento tradicional a base de plantas (MTP), por ter monografia da Agencia Eurepeia de Medicamentos (EMA), como na forma de suplemente alimentar (SA) (AU)

Vitamin D and periodontal health in older men.

Vitamin D, an anti-inflammatory mediator, has potential benefits for physical and oral health. Although it is produced endogenously, some individuals have a greater need for dietary and supplemental sources. This repeated-measures cross-sectional study assessed associations between total vitamin D intake and periodontal health in older men. Participants were 562 members of the Department of Veterans Affairs Dental Longitudinal Study, mean age 62.9 years, who were examined 1 to 4 times between 1986 and 1998. A calibrated examiner measured probing pocket depth (PPD) and attachment loss (AL) on each tooth. Alveolar bone loss (ABL) was determined from radiographs. Severe periodontal disease was defined as PPD ≥ 5 mm on ≥ 1 tooth and AL ≥ 6 mm at ≥ 2 sites (not on same tooth), and moderate-to-severe alveolar bone loss as ABL ≥ 40% at ≥ 3 sites. Generalized estimating equations were used to compute the odds ratios (OR) and 95% confidence intervals (95% CI) of having periodontal disease by level of vitamin D intake. Total vitamin D intake ≥ 800 IU was associated with lower odds of severe periodontal disease (OR = 0.67, 95% CI = 0.55-0.81) and moderate-to-severe ABL (OR = 0.54, 95% CI = 0.30-0.96) relative to intake < 400 IU/day. Vitamin D intake may protect against periodontal disease progression.

COPD and incident cardiovascular disease hospitalizations and mortality: Kaiser Permanente Medical Care Program.

STUDY OBJECTIVES: To determine the relationship between diagnosed and treated COPD and the incidence of cardiovascular disease (CVD) hospitalization and mortality. DESIGN: Retrospective matched cohort study. SETTING: Northern California Kaiser Permanente Medical Care Program (KPNC), a comprehensive prepaid integrated health-care system. PATIENTS OR PARTICIPANTS: Case patients (n = 45,966) were all KPNC members with COPD who were identified during a 4-year period from January 1996 through December 1999. An equal number of control subjects without COPD were selected from KPNC membership and were matched for gender, year of birth, and length of KPNC membership. MEASUREMENTS AND RESULTS: Follow-up conducted for hospitalization and mortality from CVD end points through December 31, 2000. CVD study end points included cardiac arrhythmias, angina pectoris, acute myocardial infarction, congestive heart failure (CHF), stroke, pulmonary embolism, all of the aforementioned study end points combined, other CVD, and all CVD end points. The mean follow-up time was 2.75 years for case patients and 2.99 years for control subjects. The risk of hospitalization was higher in COPD case patients than in control subjects for all CVD hospitalization and mortality end points. The relative risk (RR) for hospitalization for the composite measure of all study end points was 2.09 (95% confidence interval [CI], 1.99 to 2.20) after adjustment for gender, preexisting CVD study end points, hypertension, hyperlipidemia, and diabetes, and ranged from 1.33 (stroke) to 3.75 (CHF). The adjusted RR for mortality for the composite measure of all study end points was 1.68 (95% CI, 1.50 to 1.88), ranging from 1.25 (stroke) to 3.53 (CHF). Younger patients (ie, age < 65 years) and female patients had higher risks than older and male participants. CONCLUSIONS: COPD was a predictor of CVD hospitalization and mortality over an average follow-up time of nearly 3 years. The finding of a stronger relationship of COPD to CVD outcomes in patients < 65 years of age suggests that CVD risk should be monitored and treated with particular care in younger adults with COPD.

[Cardiovascular medicine in the updated German diagnosis-related groups (G-DRG) for the year 2004]. / Abbildung der Herz-Kreislauf-Medizin im deutschen Fallpauschalen-(G-DRG)-System 2004.

Based on the medical and economical data of 137 German hospitals including 12 university hospitals, the Institut für das Entgeltsystem im Krankenhaus (InEK) was again authorized by the German Ministry of Health to calculate and develop a refined version of the German diagnosis related groups (G-DRG) for the year 2004. The catalogue of these updated GDRGs was published on October 15' 2003. Furthermore, the grouper programs containing the current algorithms and the cost data on which the new G-DRGs were based have been published in the last few weeks. With regard to cardiovascular DRGs, a number of changes have been introduced in the G-DRG system which have profound consequences for all departments that treat patients with these diseases. In this review, we want to present in detail the key points of this update concerning the DRGs, extra reimbursement for special interventions, and new codes for diagnoses and procedures. Furthermore, the new rules for readmissions of patients in the same hospital are summarized. In conclusion, a number of improvements have been implemented in the updated G-DRG system which had in part been suggested by several national medical societies. These provide the basis for more precise and detailed DRGs but require on the other hand, a precise and complete coding to allow correct grouping procedures. From an economical point of view, it could hardly be summarized whether these improvements would lead to an adequate reimbursement for the treatment costs of patients with cardiovascular diseases since the case-mix of the various departments may vary widely.

Empirical comparison of DRG variants using cardiovascular surgery data: initial results of a project at 18 German hospitals.

In 2000, the responsibility for selecting a DRG variant for use in Germany was assigned to a body comprising representatives of hospitals and insurers called the Self-Administration Board (or Board in this paper). To help the Board, we applied cardiac surgery data from 18 German hospitals to eight different DRG variants. The error caused by bad coding quality could be minimized this way, since all diagnoses and procedures in cardiac surgery must be recorded for quality assurance purposes. To match the German code to the appropriate code required by the DRG variant, we created mapping tables whenever needed. As far as cardiac surgery is concerned, the Australian AR-DRG and the French GHM variants provided the best medical relevance, while the AR-DRG variant considered the level of severity better. Other variants would have to be updated to better reflect the level of medical complexity. Three main causes for wrong grouping could be identified for all systems: incomplete mapping, not enough reference to multidisciplinary treatments, and system construction problems.

Intercessory prayer and cardiovascular disease progression in a coronary care unit population: a randomized controlled trial.

OBJECTIVE: To determine the effect of intercessory prayer, a widely practiced complementary therapy, on cardiovascular disease progression after hospital discharge. PATIENTS AND METHODS: In this randomized controlled trial conducted between 1997 and 1999, a total of 799 coronary care unit patients were randomized at hospital discharge to the intercessory prayer group or to the control group. Intercessory prayer, ie, prayer by 1 or more persons on behalf of another, was administered at least once a week for 26 weeks by 5 intercessors per patient. The primary end point after 26 weeks was any of the following: death, cardiac arrest, rehospitalization for cardiovascular disease, coronary revascularization, or an emergency department visit for cardiovascular disease. Patients were divided into a high-risk group based on the presence of any of 5 risk factors (age = or >70 years, diabetes mellitus, prior myocardial infarction, cerebrovascular disease, or peripheral vascular disease) or a low-risk group (absence of risk factors) for subsequent primary events. RESULTS: At 26 weeks, a primary end point had occurred in 25.6% of the intercessory prayer group and 29.3% of the control group (odds ratio [OR], 0.83 [95% confidence interval (CI), 0.60-1.14]; P=.25). Among high-risk patients, 31.0% in the prayer group vs 33.3% in the control group (OR, 0.90 [95% CI, 0.60-1.34]; P=.60) experienced a primary end point. Among low-risk patients, a primary end point occurred in 17.0% in the prayer group vs 24.1% in the control group (OR, 0.65 [95% CI, 0.20-1.36]; P=.12). CONCLUSIONS: As delivered in this study, intercessory prayer had no significant effect on medical outcomes after hospitalization in a coronary care unit.