Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 14 de 14
Filtrar
Mais filtros

Tipo de documento
Intervalo de ano de publicação
1.
Am J Cardiol ; 134: 62-68, 2020 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-32933754

RESUMO

The reduction of cardiovascular events with icosapent ethyl-intervention (REDUCE-IT) trial showed in persons with prior cardiovascular disease (CVD) or diabetes mellitus (DM) that icosapent ethyl (IPE) reduced CVD events by 25%. We projected the preventable initial and total CVD events if REDUCE-IT trial eligibility criteria were applied to US adults. We identified US adults with available REDUCE-IT inclusion criteria from NHANES Surveys 1999-2016 and estimated primary (CVD death, nonfatal myocardial infarction, stroke, revascularization, or unstable angina) and secondary composite (CVD death, nonfatal MI or stroke) events using REDUCE-IT published event rates in the IPE and placebo groups, the difference being the number of preventable events. From 11,445 adults aged ≥45 years (representing 111.1 million [M]), a total of 319 persons (3.0 M) fit key REDUCE-IT eligibility criteria: triglycerides of 135 to 499 mg/dL, HbA1c <10%, blood pressure <200/100 mm Hg, and on a statin with LDL-C of 40 to 99 mg/dL. 63% had prior CVD and 37% had DM + ≥1 risk factor (primary prevention cohort). If these persons are given IPE for the REDUCE-IT median trial period of 4.9 years, we estimated preventing a total 349,817 (71,391/year) primary CVD outcomes of which 146,011 (29,798/year) were initial events. Most (24,151) preventable events were from the secondary prevention cohort. Using FDA eligibility criteria, an estimated 4.6 million persons would be eligible for IPE, with 60,544 preventable primary CVD outcomes annually from REDUCE-IT USA event rates. In conclusion, many CVD events in US adults with known CVD or DM and well-controlled LDL-C on statin therapy can be prevented with IPE.


Assuntos
Doenças Cardiovasculares/prevenção & controle , Diabetes Mellitus/tratamento farmacológico , Ácido Eicosapentaenoico/análogos & derivados , Definição da Elegibilidade , Reguladores do Metabolismo de Lipídeos/uso terapêutico , Revascularização Miocárdica/estatística & dados numéricos , Idoso , Angina Instável/prevenção & controle , Doenças Cardiovasculares/tratamento farmacológico , Doenças Cardiovasculares/mortalidade , Ácido Eicosapentaenoico/uso terapêutico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/prevenção & controle , Inquéritos Nutricionais , Prevenção Primária , Prevenção Secundária , Acidente Vascular Cerebral/prevenção & controle
2.
Eur J Intern Med ; 23(8): 745-54, 2012 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-22884409

RESUMO

BACKGROUND: In observational studies, lower serum homocysteine levels are associated with a lower incidence of cardiovascular disease (CVD). However, individual randomized controlled trials (RCTs) have yielded mixed findings regarding the efficacy of therapeutic homocysteine in lowering cardiovascular risk. Our aim was to perform an updated meta-analysis of relevant RCTs to assess the efficacy of folic acid supplementation in the prevention of CVD, coronary heart disease (CHD), and stroke. METHODS: We performed systematic search to identify RCTs reported at least one of the CVD, CHD, or stroke as outcomes. Relative risk (RR) with 95% confidence interval was used as a measure of the association between folic acid supplementation and risk of CVD, CHD, stroke, and all-cause mortality. The analysis was further stratified by factors that could affect the treatment effects. RESULTS: The systematic search identified 26 RCTs enrolling 58,804 participants. Pooling the RRs showed that folic acid supplementation was not associated with any significant change in the risk of CVD (RR 0.98, 0.95 to 1.02; p=0.36), CHD (RR 1.03, 0.98 to 1.08; p=0.23), and all-cause mortality (RR 1.00, 0.96 to 1.04; p=0.92), but was linked to a decreasing trend in stroke risk (RR 0.93, 0.86 to 1.00; p=0.05). In stratified analyses, the only heterogeneity was found for stroke risk reduction among groups with (RR 1.07, 0.92 to 1.25) vs. without (RR 0.88, 0.81 to 0.96) mandatory grain fortification (P for heterogeneity=0.03). CONCLUSIONS: This meta-analysis suggests that there might be a potentially modest benefit of folic acid supplementation in stroke prevention.


Assuntos
Doenças Cardiovasculares/mortalidade , Doenças Cardiovasculares/prevenção & controle , Ácido Fólico/uso terapêutico , Complexo Vitamínico B/uso terapêutico , Adulto , Idoso , Angina Instável/mortalidade , Angina Instável/prevenção & controle , Doença das Coronárias/mortalidade , Doença das Coronárias/prevenção & controle , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/mortalidade , Infarto do Miocárdio/prevenção & controle , Ensaios Clínicos Controlados Aleatórios como Assunto , Medição de Risco/métodos , Fatores de Risco , Acidente Vascular Cerebral/mortalidade , Acidente Vascular Cerebral/prevenção & controle
3.
Lancet ; 376(9738): 333-9, 2010 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-20655105

RESUMO

BACKGROUND: HDL-cholesterol concentrations are inversely associated with occurrence of cardiovascular events. We addressed, using the JUPITER trial cohort, whether this association remains when LDL-cholesterol concentrations are reduced to the very low ranges with high-dose statin treatment. METHODS: Participants in the randomised placebo-controlled JUPITER trial were adults without diabetes or previous cardiovascular disease, and had baseline concentrations of LDL cholesterol of less than 3.37 mmol/L and high-sensitivity C-reactive protein of 2 mg/L or more. Participants were randomly allocated by a computer-generated sequence to receive rosuvastatin 20 mg per day or placebo, with participants and adjudicators masked to treatment assignment. In the present analysis, we divided the participants into quartiles of HDL-cholesterol or apolipoprotein A1 and sought evidence of association between these quartiles and the JUPITER primary endpoint of first non-fatal myocardial infarction or stroke, hospitalisation for unstable angina, arterial revascularisation, or cardiovascular death. This trial is registered with ClinicalTrials.gov, number NCT00239681. FINDINGS: For 17,802 patients in the JUPITER trial, rosuvastatin 20 mg per day reduced the incidence of the primary endpoint by 44% (p<0.0001). In 8901 (50%) patients given placebo (who had a median on-treatment LDL-cholesterol concentration of 2.80 mmol/L [IQR 2.43-3.24]), HDL-cholesterol concentrations were inversely related to vascular risk both at baseline (top quartile vs bottom quartile hazard ratio [HR] 0.54, 95% CI 0.35-0.83, p=0.0039) and on-treatment (0.55, 0.35-0.87, p=0.0047). By contrast, among the 8900 (50%) patients given rosuvastatin 20 mg (who had a median on-treatment LDL-cholesterol concentration of 1.42 mmol/L [IQR 1.14-1.86]), no significant relationships were noted between quartiles of HDL-cholesterol concentration and vascular risk either at baseline (1.12, 0.62-2.03, p=0.82) or on-treatment (1.03, 0.57-1.87, p=0.97). Our analyses for apolipoprotein A1 showed an equivalent strong relation to frequency of primary outcomes in the placebo group but little association in the rosuvastatin group. INTERPRETATION: Although measurement of HDL-cholesterol concentration is useful as part of initial cardiovascular risk assessment, HDL-cholesterol concentrations are not predictive of residual vascular risk among patients treated with potent statin therapy who attain very low concentrations of LDL cholesterol. FUNDING: AstraZeneca.


Assuntos
Angina Instável/prevenção & controle , Angioplastia/estatística & dados numéricos , HDL-Colesterol/sangue , LDL-Colesterol/sangue , LDL-Colesterol/efeitos dos fármacos , Fluorbenzenos/uso terapêutico , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Infarto do Miocárdio/prevenção & controle , Pirimidinas/uso terapêutico , Acidente Vascular Cerebral/prevenção & controle , Sulfonamidas/uso terapêutico , Adulto , Idoso , Angina Instável/etiologia , Biomarcadores/sangue , Proteína C-Reativa/metabolismo , Método Duplo-Cego , Esquema de Medicação , Feminino , Fluorbenzenos/administração & dosagem , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/administração & dosagem , Incidência , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/sangue , Prevenção Primária/métodos , Pirimidinas/administração & dosagem , Fatores de Risco , Rosuvastatina Cálcica , Acidente Vascular Cerebral/sangue , Sulfonamidas/administração & dosagem , Resultado do Tratamento
4.
J Am Coll Cardiol ; 54(25): 2353-7, 2009 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-20082922

RESUMO

OBJECTIVES: This post-hoc analysis of the IDEAL (Incremental Decrease in End Points Through Aggressive Lipid Lowering) trial was designed to assess the comparative treatment efficacy of high-dose atorvastatin and usual-dose simvastatin for the prevention of events subsequent to the first event, using the Wei, Lin, and Weissfeld method. BACKGROUND: Time-to-first-event analysis of data is frequently utilized to provide efficacy outcome information in coronary heart disease prevention trials. However, during the course of such long-term trials, a large number of events occur subsequent to the first event, the analysis of which will be precluded by this approach. METHODS: The Wei, Lin, and Weissfeld method allows the analysis of repeated occurrence of events of the same type or of entirely different natures. It regards the recurrence times as multivariate event (failure) times, and models the marginal (individual) distribution for each event with the Cox proportional hazards model. RESULTS: In the IDEAL trial, compared with patients taking simvastatin 20 to 40 mg daily, patients receiving atorvastatin 80 mg daily had their relative risk of a first cardiovascular event reduced by 17% (p < 0.0001), of a second by 24% (p < 0.0001), of a third by 19% (p = 0.035), of a fourth by 24% (p = 0.058), and of a fifth by 28% (p = 0.117). CONCLUSIONS: Our results indicate that intensive statin therapy continues to be more effective than standard statin therapy, even beyond the first event, and suggest that clinicians should not hesitate to prescribe high-dose statin therapy for patients experiencing multiple recurrent cardiovascular events.


Assuntos
Angina Instável/prevenção & controle , Doença das Coronárias/tratamento farmacológico , Ácidos Heptanoicos/administração & dosagem , Inibidores de Hidroximetilglutaril-CoA Redutases/administração & dosagem , Infarto do Miocárdio/prevenção & controle , Revascularização Miocárdica/estatística & dados numéricos , Pirróis/administração & dosagem , Atorvastatina , Doença das Coronárias/sangue , Relação Dose-Resposta a Droga , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Modelos de Riscos Proporcionais
5.
J Am Coll Cardiol ; 54(25): 2358-62, 2009 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-20082923

RESUMO

OBJECTIVES: In addition to reducing first events in patients after an acute coronary syndrome (ACS), we hypothesized that high-dose atorvastatin 80 mg would also reduce recurrent cardiovascular events, and therefore total events, compared with pravastatin 40 mg during the 2-year follow-up. BACKGROUND: In the PROVE IT-TIMI 22 (Pravastatin or Atorvastatin Evaluation and Infection Therapy-Thrombolysis In Myocardial Infarction 22) trial, more intensive lipid lowering with high-dose atorvastatin reduced the first occurrence of the primary end point (death, myocardial infarction, unstable angina requiring rehospitalization, stroke, or revascularization > or = 30 days) compared with moderate lipid lowering with pravastatin. METHODS: Poisson regression analysis was performed to compare the number of occurrences of the primary end point between high-dose atorvastatin and pravastatin in the PROVE IT-TIMI 22 trial. RESULTS: As previously reported, first primary end point events were reduced by 16% with atorvastatin 80 mg versus pravastatin 40 mg (n = 464 vs. n = 537, respectively; p = 0.005). Additional events were also reduced by 19% with atorvastatin 80 mg (n = 275 vs. n = 340, respectively; p = 0.009). Overall, there were 138 fewer primary efficacy events with atorvastatin 80 mg versus pravastatin 40 mg (n = 739 vs. n = 877, respectively; rate ratio: 0.85, 95% confidence interval: 0.77 to 0.94, p = 0.001). CONCLUSIONS: Although analytic techniques commonly used in clinical outcomes trials censor patients who experience a component of the primary composite end point, total cardiovascular events are important to patients, clinicians, and health care payers. Maintaining low levels of low-density lipoprotein cholesterol is central to preventing additional atherosclerotic development and subsequent cardiovascular events. Atorvastatin 80 mg, a more intensive low-density lipoprotein cholesterol lowering agent, reduced both first and subsequent primary end point events compared with pravastatin 40 mg after ACS.


Assuntos
Síndrome Coronariana Aguda/tratamento farmacológico , Ácidos Heptanoicos/administração & dosagem , Inibidores de Hidroximetilglutaril-CoA Redutases/administração & dosagem , Pravastatina/administração & dosagem , Pirróis/administração & dosagem , Idoso , Angina Instável/prevenção & controle , Atorvastatina , Proteína C-Reativa/análise , Colesterol/sangue , Relação Dose-Resposta a Droga , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Infarto do Miocárdio/prevenção & controle , Revascularização Miocárdica/estatística & dados numéricos , Análise de Regressão , Prevenção Secundária , Acidente Vascular Cerebral/prevenção & controle
6.
J Altern Complement Med ; 13(5): 571-6, 2007 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-17604562

RESUMO

OBJECTIVES: To investigate the effects of the Traditional Chinese Medicine (TCM) Quyu Xiaoban capsules (QYXB) on clinical outcomes and platelet activation and aggregation in patients with unstable angina pectoris (UAP) and phlegm and blood stasis syndrome. DESIGN: Ninety (90) UAP patients were randomly divided into two groups: the control group received a loading dose of 300 mg aspirin and a maintenance dose of 100 mg of aspirin plus baseline therapy for 4 weeks, and the trial group received the same doses of aspirin and baseline therapy plus QYXB for 4 weeks. The severity of anginal attacks, alterations of TCM symptoms and signs, and electrocardiographic (ECG) changes were observed in all patients before and after treatment. Plasma platelet aggregation (PAG) rate and P-selectin level were measured in all patients at baseline and at the end of the fourth week. RESULTS: After treatment for 4 weeks, both group of patients showed improvement in the severity of angina pectoris and TCM symptoms and signs, and there was a significant difference of the total effective rate in clinical improvement between the two groups, whereas no difference of the total effective rate in ECG improvement between the two groups was found. Compared with the baseline level, PAG rate in both groups decreased significantly at the end of the fourth week (63.74 +/- 11.18% versus 55.69 +/- 10.40 % in the control group, and 63.83 +/- 12.70% versus 50.04 +/- 8.91% in the trial group). Similar changes of P-selectin levels were observed in both groups (9.40 +/- 1.25 ng/mL versus 8.90 +/- 1.34 ng/mL in the control group and 9.56 +/- 1.16 ng/mL versus 7.80 +/- 0.98 ng/mL in the trial group). However, both PAG rate and P-selectin level decreased to a greater extent in the trial group than in the control group after treatment, and the difference between treatment was significant (both p<0.05). Nevertheless, these biochemical changes were too small to explain fully the beneficial clinical outcomes achieved by QYXB capsules. CONCLUSIONS: On the background of baseline and aspirin therapy, QYXB capsules significantly attenuated anginal attacks and improved TCM symptoms and signs in patients with UAP, and the exact mechanisms underlying these therapeutic effects remain to be explored.


Assuntos
Angina Instável/tratamento farmacológico , Aspirina/uso terapêutico , Medicamentos de Ervas Chinesas/uso terapêutico , Fitoterapia , Inibidores da Agregação Plaquetária/uso terapêutico , Agregação Plaquetária , Adulto , Angina Instável/prevenção & controle , Relação Dose-Resposta a Droga , Método Duplo-Cego , Quimioterapia Combinada , Eletrocardiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Selectina-P/sangue , Agregação Plaquetária/efeitos dos fármacos , Resultado do Tratamento
7.
J Altern Complement Med ; 13(3): 369-74, 2007 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-17480139

RESUMO

OBJECTIVES: To investigate the effects of the Traditional Chinese Medicine (TCM) Quyu Xiaoban capsules (QYXB) on clinical outcomes and platelet activation and aggregation in patients with unstable angina pectoris (UAP) and phlegm and blood stasis syndrome. DESIGN: Ninety patients with UAP were randomly divided into two groups: a control group that received a loading dose of 300 mg aspirin and a maintenance dose of 100 mg of aspirin plus baseline therapy for 4 weeks, and a trial group that received the same doses of aspirin and baseline therapy plus QYXB for 4 weeks. The severity of anginal attacks, alterations of TCM symptoms and signs, and electrocardiographic (ECG) changes were assessed in all patients before and after treatment. The plasma platelet aggregation (PAG) rate and P-selectin level were measured in all patients at baseline and at the end of the fourth week of treatment. RESULTS: After treatment for 4 weeks, both group of patients showed improvement in the severity of angina pectoris and TCM symptoms and signs, but there was a significant difference in the two groups' rates of clinical improvement, whereas the rate of ECG improvement of the two groups showed no difference. As compared with the baseline value, the PAG rate in both groups decreased significantly at the end of the fourth week (63.74 +/- 11.18% vs. 55.69 +/- 10.40% in the control group, and 63.83 +/- 12.70% vs. 50.04 +/- 8.91% in the trial group). Similar changes in P-selectin levels were observed in the two groups (9.40 +/- 1.25 ng/mL vs. 8.90 +/- 1.34 ng/mL in the control group, and 9.56 +/- 1.16 ng/mL vs. 7.80 +/- 0.98 ng/mL in the trial group). However, both the PAG rate and P-selectin level decreased to a greater extent in the trial group than in the control group after treatment, and the difference between the two groups was significant (both p < 0.05). Nevertheless, these biochemical changes were too small to fully explain the beneficial clinical outcomes achieved with QYXB capsules. CONCLUSIONS: In comparison with both the respective baseline values and with aspirin therapy, QYXB capsules significantly attenuated anginal attacks and improved TCM symptoms and signs in patients with UAP. The exact mechanisms underlying these therapeutic effects remain to be explored.


Assuntos
Angina Instável/tratamento farmacológico , Aspirina/uso terapêutico , Medicamentos de Ervas Chinesas/uso terapêutico , Fitoterapia , Inibidores da Agregação Plaquetária/uso terapêutico , Agregação Plaquetária/efeitos dos fármacos , Angina Instável/prevenção & controle , Relação Dose-Resposta a Droga , Método Duplo-Cego , Quimioterapia Combinada , Eletrocardiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Selectina-P/sangue , Resultado do Tratamento
8.
Am J Cardiol ; 92(9): 1109-12, 2003 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-14583367
9.
Zhongguo Zhong Xi Yi Jie He Za Zhi ; 23(5): 338-40, 2003 May.
Artigo em Chinês | MEDLINE | ID: mdl-12800413

RESUMO

OBJECTIVE: To analyze the current status of clinical studies of TCM in preventing and treating angina pectoris of coronary heart disease. METHODS: A statistical analysis of articles regarding the use of TCM in preventing and treating angina pectoris, published in TCM core journals or journals of TCM university (college) from January 2001 to June 2002 was conducted, the items analyzed included the differentiation of stable angina (SA) and unstable angina (UA), the grading or stratifying, standard for therapeutic efficacy evaluation, standardized drug therapy of UA (according to the "Suggestion on the diagnosis and treatment of UA" formulated by Society of Cardiovascular Disease, Chinese Medical Association, etc. RESULTS: From the 44 articles that retrieved, UA and SA was not differed in 29 articles (65.9%), among which 11 articles came from provincial, national TCM institute or hospital affiliated to TCM university (college). In the 34 articles dealing with UA, only 3 articles mentioned the standardized drug therapy. Standard of therapeutic efficacy evaluation announced in 1979 was used in 35 articles (79.5%). CONCLUSION: Most articles dealing with clinical study on TCM prevention and treatment of angina pectoris, UA and SA, have the flaws of un-standardized, lacking in compact and insufficient science. Improvement of related standard for clinical therapeutic efficacy evaluation needs to be further perfected.


Assuntos
Angina Instável/tratamento farmacológico , Medicamentos de Ervas Chinesas/uso terapêutico , Fitoterapia , Angina Pectoris/tratamento farmacológico , Angina Pectoris/prevenção & controle , Angina Instável/prevenção & controle , Feminino , Humanos , Masculino , Padrões de Referência , Projetos de Pesquisa
10.
Rev. med. Tucumán ; 6(1): 27-37, ene.-mar. 2000. tab
Artigo em Espanhol | LILACS | ID: lil-282876

RESUMO

Antecentes. Los calciantagonistas (CA) deberían ser eficaces en reducir la mortalidad y el infarto (IAM) no fatal en la angina inestable (AI). Se ha demostrado que los CA proporcionan alivio sintomático y mejor evolución. Objetivo. Investigar si los CA en la AI disminuyen la muerte y el IAM no fatal, previenen la recurrencia de la angina y mejoran la evolución. Material y métodos. Análisis en la base de datos del estudio ENAI (Enalapril en la Angina Inestable) que sigue durante 7 días a 1022 pacientes con AI. Indicación de betabloqueantes (BB) y CA a criterio de los participantes. Resultados. La angina recurrente y los procedimientos invasivos no son diferentes en la AI previamente tratada con CA (RR 1,02; IC95 0,74 - 1,40; P 0,8958). En 1022 pacientes los eventos secundarios aumentan en los no tratados (53,3 por ciento en 629) en relación a los tratados con CA cuando se asocian a los BB (46,7 por ciento en 392; RR 1,39; IC95 1,19 - 1,62; P 0,00003) Para Diltiazem-BB los eventos secundarios disminuyen desde un 61,3 por ciento al 38,7 por ciento (RR 1,74; ; IC95 1,39 - 2,18; P 0,0000), similar con otros CA-BB. Reducen los eventos secundarios del 66 por ciento al 34 por ciento en el grupo con SD del ST/ST normal (RR del 1,92; IC95 1,05 - 3,51; P 0,0335). Conclusiones. La indicación de CA sin BB en AI no disminuye los eventos isquémicos secundarios ni el desarrollo de insuficiencia cardíaca. Indicados en AI con SD del ST.


Assuntos
Humanos , Atenolol/uso terapêutico , Bloqueadores dos Canais de Cálcio/uso terapêutico , Enalapril/uso terapêutico , Angina Instável/mortalidade , Angina Instável/prevenção & controle , Angina Instável/terapia , Infarto do Miocárdio/prevenção & controle , Análise Multivariada , Propranolol/uso terapêutico , Diltiazem/uso terapêutico , Diltiazem/farmacocinética , Nifedipino/uso terapêutico , Nifedipino/farmacocinética , Verapamil/uso terapêutico , Verapamil/farmacocinética
11.
Rev. med. Tucumán ; 6(1): 27-37, ene.-mar. 2000. tab
Artigo em Espanhol | BINACIS | ID: bin-10777

RESUMO

Antecentes. Los calciantagonistas (CA) deberían ser eficaces en reducir la mortalidad y el infarto (IAM) no fatal en la angina inestable (AI). Se ha demostrado que los CA proporcionan alivio sintomático y mejor evolución. Objetivo. Investigar si los CA en la AI disminuyen la muerte y el IAM no fatal, previenen la recurrencia de la angina y mejoran la evolución. Material y métodos. Análisis en la base de datos del estudio ENAI (Enalapril en la Angina Inestable) que sigue durante 7 días a 1022 pacientes con AI. Indicación de betabloqueantes (BB) y CA a criterio de los participantes. Resultados. La angina recurrente y los procedimientos invasivos no son diferentes en la AI previamente tratada con CA (RR 1,02; IC95 0,74 - 1,40; P 0,8958). En 1022 pacientes los eventos secundarios aumentan en los no tratados (53,3 por ciento en 629) en relación a los tratados con CA cuando se asocian a los BB (46,7 por ciento en 392; RR 1,39; IC95 1,19 - 1,62; P 0,00003) Para Diltiazem-BB los eventos secundarios disminuyen desde un 61,3 por ciento al 38,7 por ciento (RR 1,74; ; IC95 1,39 - 2,18; P 0,0000), similar con otros CA-BB. Reducen los eventos secundarios del 66 por ciento al 34 por ciento en el grupo con SD del ST/ST normal (RR del 1,92; IC95 1,05 - 3,51; P 0,0335). Conclusiones. La indicación de CA sin BB en AI no disminuye los eventos isquémicos secundarios ni el desarrollo de insuficiencia cardíaca. Indicados en AI con SD del ST. (AU)


Assuntos
Humanos , Angina Instável/terapia , Angina Instável/prevenção & controle , Angina Instável/mortalidade , Bloqueadores dos Canais de Cálcio/uso terapêutico , Enalapril/uso terapêutico , Infarto do Miocárdio/prevenção & controle , Atenolol/uso terapêutico , Análise Multivariada , Nifedipino/farmacocinética , Nifedipino/uso terapêutico , Propranolol/uso terapêutico , Diltiazem/farmacocinética , Diltiazem/uso terapêutico , Verapamil/farmacocinética , Verapamil/uso terapêutico
12.
Am J Cardiol ; 84(5A): 26M-31M, 1999 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-10505540

RESUMO

Although unfractionated heparin is widely used for thrombin inhibition in the management of unstable coronary artery disease, clinical and experimental evidence suggests that it is suboptimal. Recent pharmaceutical strategies to improve upon unfractionated heparin's efficacy profile have centered on the development of 2 major classifications of thrombin inhibition medications: the naturally occurring leech protein hirudin (and synthetic analogs) and low-molecular-weight (LMW) heparins. In the Organisation to Assess Strategies for Ischaemic Syndromes-2 (OASIS-2) trial, hirudin was demonstrably more effective than heparin in diminishing rates of death, myocardial infarction (MI), and angina at both 72 hours and 7 days after unstable coronary artery disease index events, with risk ratios on the order of 0.8. Similarly, in the Efficacy and Safety of Subcutaneous Enoxaparin in Non-Q-Wave Coronary Events (ESSENCE) study, the LMW heparin enoxaparin emerged superior to unfractionated heparin in attenuating rates of unstable coronary artery disease at 14 days, 30 days, and 1 year. On the other hand, findings involving other LMW heparins (dalteparin sodium, Fragmin, and fraxaparin) are equivocal. Although the Fragmin During Instability in Coronary Artery Disease (FRISC) study demonstrated statistically significant superiority of this LMW heparin over aspirin/placebo in driving down death/MI/revascularization rates, the Fragmin in Unstable Coronary Artery Disease (FRIC) trial showed no such superiority, but had wide confidence intervals. Similarly, the Fraxaparin Versus Unfractionated Heparin in Acute Coronary Syndromes (FRAXIS) trial with fraxaparin failed to show superiority over unfractionated heparin. The favorable efficacy findings associated with hirudin and enoxaparin regimens, compared with unfractionated heparin, accrued without significant increases in the incidences of life-threatening bleeding events (e.g., hemorrhagic stroke), but did include more frequent lesser bleeding events. In summary, both hirudin and enoxaparin have demonstrated clinically important improvements in outcome compared with standard treatments in unstable coronary artery disease.


Assuntos
Anticoagulantes/uso terapêutico , Heparina/uso terapêutico , Terapia com Hirudina , Isquemia Miocárdica/tratamento farmacológico , Complexo Glicoproteico GPIb-IX de Plaquetas , Glicoproteínas da Membrana de Plaquetas , Angina Instável/etiologia , Angina Instável/prevenção & controle , Ensaios Clínicos como Assunto , Dalteparina/uso terapêutico , Morte Súbita Cardíaca/etiologia , Morte Súbita Cardíaca/prevenção & controle , Enoxaparina/uso terapêutico , Heparina de Baixo Peso Molecular/uso terapêutico , Humanos , Infarto do Miocárdio/etiologia , Infarto do Miocárdio/prevenção & controle , Isquemia Miocárdica/complicações , Isquemia Miocárdica/metabolismo , Receptores de Superfície Celular/antagonistas & inibidores , Sistema de Registros , Risco , Resultado do Tratamento
13.
Prescrire Int ; 7(35): 71-3, 1998 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-10342920

RESUMO

The efficacy of sustained-release osmotic tablets of nifedipine in the symptomatic treatment of stable angina is poorly documented. The safety of nifedipine remains uncertain, as high-dose treatment with immediate-release preparations increased mortality in trials involving coronary patients. In angina, nifedipine can be used only in combination with a betablocker, and only to treat patients with no recent history of myocardial infarction, or unstable angina. In stable angina with inadequate symptom control by betablockers, it is no more effective than other dihydropyridines also indicated in the treatment of angina, i.e. amlodipine and felodipine. Furthermore, medium-term data on amlodipine are relatively reassuring. Nifedipine appears a little more effective than sustained-release nitrate derivatives, but less safe.


Assuntos
Angina Pectoris/tratamento farmacológico , Angina Instável/tratamento farmacológico , Bloqueadores dos Canais de Cálcio , Avaliação de Medicamentos , Nifedipino/uso terapêutico , Antagonistas Adrenérgicos beta/efeitos adversos , Antagonistas Adrenérgicos beta/uso terapêutico , Angina Pectoris/prevenção & controle , Angina Instável/prevenção & controle , Bloqueadores dos Canais de Cálcio/efeitos adversos , Preparações de Ação Retardada , Di-Hidropiridinas/uso terapêutico , Diltiazem/uso terapêutico , Feminino , Humanos , Dinitrato de Isossorbida/análogos & derivados , Dinitrato de Isossorbida/uso terapêutico , Masculino , Infarto do Miocárdio , Nifedipino/efeitos adversos , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento , Vasodilatadores/uso terapêutico
14.
J Am Coll Cardiol ; 26(2): 313-8, 1995 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-7608429

RESUMO

OBJECTIVES: This study was designed to test the hypothesis that low molecular weight heparin may lessen the severity of ischemic events in patients with unstable angina. BACKGROUND: Unstable angina is a thrombotic process that requires intensive medical treatment. Although current treatments can reduce the number of complications, serious bleeding continues to occur. Nadroparin calcium, a low molecular weight heparin, seems to be a safe therapeutic agent that does not require laboratory monitoring. METHODS: A total of 219 patients with unstable angina entered the study at a mean time of 6.17 h after the last episode of rest pain. Patients were randomized to receive aspirin (200 mg/day [group A]), aspirin plus regular heparin (400 IU/kg body weight per day intravenously and titered by activated partial thromboplastin time [group B]) and aspirin plus low molecular weight heparin (214 UIC/kg anti-Xa twice daily subcutaneously [group C]). The major end points determined for the in-hospital period were 1) recurrent angina, 2) myocardial infarction, 3) urgent revascularization, 4) major bleeding, and 5) death. Minor end points were 1) silent myocardial ischemia, and 2) minor bleeding. Event rates were tested by chi-square analysis. RESULTS: Recurrent angina occurred in 37%, 44% and 21% of patients in groups A, B and C, respectively, and was significantly less frequent in group C than in either group A (odds ratio 2.26, 95% confidence interval [CI] 1 to 5.18, p = 0.03) or group B (odds ratio, 3.07, 95% CI 1.36 to 7.00, p = 0.002). Nonfatal myocardial infarction was present in seven patients in group A, four in group B and none in group C (group B vs. A, p = 0.5; group C vs. A, p = 0.01). Urgent revascularization was performed in nine patients in group A, seven in group B and one in group C (C vs. A, p = 0.01). Two episodes of major bleeding occurred in group B. Silent myocardial ischemia was present in 38%, 41% and 25% of patients in groups A, B and C, respectively, and was significantly less frequent in group C than group B (odds ratio 2.12, 95% CI 0.97 to 4.69, p = 0.04). Minor bleeding was detected in 10 patients in group B, 1 patient in group C (B vs. C, p = 0.01) and no patient in group A (A vs. B, p = 0.003). CONCLUSIONS: In this study, treatment with aspirin plus a high dose of low molecular weight heparin during the acute phase of unstable angina was significantly better than treatment with aspirin alone or aspirin plus regular heparin.


Assuntos
Angina Instável/tratamento farmacológico , Aspirina/uso terapêutico , Heparina de Baixo Peso Molecular/uso terapêutico , Heparina/uso terapêutico , Isquemia Miocárdica/tratamento farmacológico , Adulto , Idoso , Angina Instável/prevenção & controle , Aspirina/efeitos adversos , Distribuição de Qui-Quadrado , Quimioterapia Combinada , Feminino , Hemorragia/induzido quimicamente , Heparina/efeitos adversos , Heparina de Baixo Peso Molecular/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/prevenção & controle , Isquemia Miocárdica/prevenção & controle , Razão de Chances , Estudos Prospectivos , Recidiva , Método Simples-Cego , Resultado do Tratamento
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA