Serum ferritin levels and other indicators of organic iron as risk factors / or markers in coronary artery disease

BACKGROUND: Several international studies have discussed whether serum ferritin is a risk marker in coronary heart disease. The objective of this study was to evaluate the importance of serum ferritin levels and other indicators of organic iron as possible risk factors or markers in coronary artery disease. Secondly, the classical factors were studied in order to identify possible associations with organic iron markers. METHODS AND RESULTS: In a medical institution, 1263 patients underwent cinecoronary arteriography from December 1997 to May 1998. A sample of 400 patients was separated, at random, to establish a comparative clinical study between two groups: group A, comprising 200 individuals with coronary atherosclerosis and group B, comprising 200 patients without coronary atherosclerosis, as confirmed by cinecoronary teriography. From group A,182 patients (130 males) and from group B, 157 (96 females) did not show any exclusion criteria and were considered eligible. All women were in the postmenopausal period. The blood samples were collected by a biologist,between 8.30 and 9.0 a.m., after a 12-hour fast and a 36-hour non-smoking period. In order to analyze all results, univariate analysis, the logistic regression technique and the interactive forward stepwise method were used in order to optimize the model and to predict the chances of coronary atherosclerosis. The results of the logistic regression with all the variables analyzed showed that male gender, age, smoking, triglycerides/VLDL interaction, increased serum LDL-C levels and decreased serum HDL-C levels are important to predict the chances of coronary atherogenesis. CONCLUSION: Serum levels of ferritin and of other organic iron indicators--transferrin saturation, total iron-binding capacity,hemoglobin and hematocrit--were neither risk factors nor risk markers for coronary atherosclerosis. Paradoxically, serum iron levels were higher in the group without atherosclerosis. In this study, variables classically considered as risk factors were similar to those in the literature

Valsartan alone and as part of combination therapy in general practice in Brazil.

The objective of this study was to assess the efficacy and tolerability of valsartan (Diovan) when given alone or as part of a combination regimen in normal clinical practice, in general practice patients in Brazil. In an open, multicentre post-marketing surveillance (PMS) study, 7256 hypertensive patients were evaluated. Therapy with valsartan either as monotherapy or in combination with 12.5 mg chlorthalidone was observed for up to six months. Assessments at baseline and study endpoints included analysis of adverse events and measurement of systolic and diastolic blood pressure (BP). A total of 3855 patients (53%) received valsartan as monotherapy (mostly as 80 mg once daily), 1162 (16%) received 80 mg valsartan + 12.5 mg chlorthalidone, and 347 (4.8%) received valsartan together with other antihypertensive agents; 858 patients were not evaluable because of inadequate records. A control group of 1034 patients received other antihypertensives. Overall tolerability was high, with 98.5% of patients receiving valsartan alone, 97.7% of those receiving valsartan + chlorthalidone and 92.4% of those receiving other antihypertensives giving tolerability ratings of 'excellent' or 'good'. In this large PMS study, valsartan alone and in combination with chlorthalidone was associated with excellent safety and tolerability in general practice patients in Brazil with primary hypertension, irrespective of age, sex or concomitant diseases.

Valsartan alone and as part of combination therapy in general practice in Brazil

The objective of this study was to access of efficacy and tolerability of valsartan (Diovan) when give alone or as part of a combination regimen in normal clinical practice, in gneral practice of patients in Brazil. In an open, multicentre post-marketing surveillance (PMS) study, 7256 hypertensive patients were evaluated. Therapy with valsartan either as monotherapy or in combination with 12.5mg chlorthalidone was observed for up to six months. Assessment at baseline and study endpoints includded analysis of adverse events and measurement of systolic and dyastolic blood pressures (bp). A total of 3855 patients(53%) received valsartan as monotherapy (mostly as 80 once daily), 1162 (16%) received 80 mg valsartan 12,5 mg chlorthalidone, and 347 (4,8%) received valsartan togheter with other antihypertensive agents.

[Multicenter comparative study of felodipine-ER and nifedipine-OROS in the treatment of mild-to-moderate arterial hypertension]. / Estudo multicêntrico comparativo da felodipina-ER e nifedipina-OROS no tratamento da hipertensão arterial leve e moderada.

PURPOSE: To compare the efficacy and tolerance of felodipine-ER and nifedipine OROS, both once daily, in the treatment of mild-to-moderate uncomplicated arterial hypertension (AH). METHODS: This was a multicentric, opened, randomized, paralled trial, that selected 121 patients with uncomplicated, mild to moderate essential AH (diastolic blood pressure (DBP) > or = 95 and < or = 110 mmHg; not under anti-hypertensive medication. All patients received placebo for two weeks. After that period, they would take either 5mg/day of felodipine, or 30mg/day of nifedipine OROS, both once daily, in a randomized fashion. Patients underwent laboratory tests and electrocardiogram (ECG) at the begining and at the end of the study, and heart rate and blood pressure (BP) measurements, nearly 24 hours after the last active drug dose. RESULTS: Completed the study 111 patients, 60 in the felodipine group and 51 in the nifedipine group. Compared to baseline, the average of systolic BP and DBP decreased from 162.5 +/- 14.3mmHg and from 102.2 +/- 5.1mmHg to 143.3 +/- 14.6 and 87.9 +/- 7.2mmHg, respectively, at the end of the treatment in the felodipine group; and from 160.5 +/- 16.3mmHg and 102.5 +/- 6.2mmHg to 136.1 +/- 14.2 and 86.7 +/- 7.0mmHg, respectively in nifedipine group (p < 0.0001 for all diferences). Adequate BP response to the treatment (DBP normalization or reduction > 10mmHg from baseline) occured in 47/60 (78.3%) patients in the felodipine group and in 38/51 (74.5%) in the nifedipine group (NS). Side effects, occured in approximately 15% of the cases, and were similar in both groups. These were usually moderate and transient, but were responsible for the withdrawal from the study of two cases in the felodipine group and of three cases in the nifedipine group. CONCLUSION: Felodipine-ER and nifedipine OROS, are similarly effective and generally well tolerated in patients with mild-to-moderate essential hypertension.

[Treatment of mild and moderate cardiac failure with captopril. A multicenter study]. / Tratamento da insuficiência cardíaca leve e moderada com captopril. Estudo multicêntrico.

PURPOSE: Evaluation of the clinical effects of captopril addition to the conventional therapy of functional class II and III (NYHA) congestive heart failure (CHF). METHODS: One hundred and fifteen patients with CHF, 46 (40%) class II and 69 (60%) class III, on conventional treatment (digitalis and diuretic) were the subject of this study. The age ranged from 22 to 75 years (mean 56.6 +/- 11); 67 were male and 66 were caucasians. The etiologies of the heart failure were: hypertensive heart disease 47 (40.9%), ischemic heart disease 27 (23.5%), Chagas cardiomyopathy 20 (17.4%), idiopathic cardiomyopathy 15 (13.0%), and other causes 6 (5.2%). Diuretic and digitalis were maintained in the same dosage during all the treatment. Captopril therapy was started with 6.25 mg b.i.d. or t.i.d., and the dosage was increased gradually to 25 mg b.i.d. or t.i.d. The duration of the study was 12 weeks. Clinical visits occurred every four weeks and laboratory tests were performed in the beginning and at the end of the study. RESULTS: The dosage of captopril ranged from 12.5 to 75 mg (mean 28.5 +/- 13.1 mg/day). The addition of captopril to the conventional therapy of CHF was associated with significant reduction (p < 0.01) of heart rate, systolic and diastolic blood pressure. In the end of the study 13 patients (11.3%) were in functional class III, 50 (43.5%) in class II and 52 (45.2%) in class I. Globally, functional class was improved in 98 (85.2%) patients and remained unchanged in 17 (14.8%) (p < 0.01). The side effects (dizziness, cough, hypotension and headache) were moderate and uncommon and did not need interruption of the treatment. CONCLUSION: The addition of captopril to the conventional therapy of class II and III CHF was associated with significant improvement of functional class and with good tolerability.

Clinical efficacy and tolerability of isradipine in the treatment of mild-to-moderate hypertension in young and elderly patients.

The clinical efficacy and tolerability of isradipine was evaluated in 63 patients with mild-to-moderate hypertension [supine systolic blood pressure (SBP) greater than or equal to 160 mm Hg and diastolic blood pressure (DBP) greater than or equal to 95 mm Hg]. Patients were divided into two groups according to age: group A (n = 41), aged 37-69 years (mean age of 54 +/- 7 years); group B (n = 22), aged 70-80 years (mean age of 72.8 +/- 2.4 years). After a 3-week washout period, group A received 2.5 mg of isradipine twice daily for 6 weeks. Group B received 1.25 mg of isradipine initially, increasing to 2.5 mg twice daily according to treatment response and tolerability. At the end of treatment (week 6), there were statistically significant decreases (p less than 0.01) in supine SBP and DBP in both groups compared with baseline values: the mean SBP in groups A and B decreased from 160.0 +/- 14.7 to 133.6 +/- 10.0 mm Hg and from 161.6 +/- 17.8 to 134.8 +/- 10.9 mm Hg, respectively; the mean DBP in groups A and B decreased from 101.3 +/- 3.0 to 83.6 +/- 5.5 mm Hg and from 101.3 +/- 8.4 to 84.2 +/- 3.6 mm Hg, respectively. Clinical and laboratory parameters did not change significantly during treatment. Side effects (headache, flushing, palpitations, and edema) were mild/moderate and disappeared after the first 2 weeks of treatment. In conclusion, 2.5 mg of isradipine twice daily is effective and well tolerated in the treatment of mild-to-moderate hypertension regardless of patient age.

[Effects of enalapril on left ventricular hypertrophy in patients with mild or moderate essential hypertension]. / Efeitos do enalapril na hipertrofia ventricular esquerda em pacientes com hipertensão essencial leve ou moderada.

PURPOSE: To evaluate the effects of enalapril maleate on the regression of left ventricular hypertrophy (LVH) associated to hypertension. PATIENTS AND METHODS: Fifteen male, age between 45 and 65 years (mean age = 56 y) with diagnosis of mild-to-moderate essential hypertension (greater than diastolic blood pressure [DBP] less than between 90 and 114 mmHg) and LHV at the echocardiogram. The administration of enalapril maleate was initiated with a 20 mg daily dosage and titrated up to a maximum of 40 mg daily, whenever DBP was maintained above 90 mmHg and no adverse experience occurred. RESULTS: Fourteen patients completed the clinical trial and all of them achieved satisfactory blood pressure (BP) control. The dosage of enalapril was 20 mg/day for 11 patients and 40 mg/day for the other three. The mean systolic blood pressure in supine position decreased from an initial value of 151.4 +/- 9.5 to 126.4 +/- 9.4 mmHg at the end of treatment and the mean diastolic blood pressure from 100.0 +/- 5.0 to 80.4 +/- 1.5 mmHg (p less than 0.001). There was a reduction of mean diastolic septal wall thickness from 11.5 +/- 0.05 to 10.1 +/- 0.05 mm and left ventricular posterior wall thickness from 11.2 +/- 0.7 to 9.8 +/- 0.6 mm (p less than 0.05). The diastolic dimension and left ventricular volume did not show significant changes. The mean of calculated left ventricular mass showed a decrease from 263.6 +/- 32.9 to 231.3 +/- 34.7 g at the end of treatment (p less than 0.05). Mean ejection fraction and fractional fiber shortening showed light, but non significant increase. The tolerability to the drug was satisfactory. Two patients complained of transient palpitations and two other, irritative cough, that determined the treatment discontinuation in one case. CONCLUSION: Enalapril maleate 20 to 40 mg daily, besides the satisfactory control of BP in patients with mild-to-moderate essential hypertension, promoted regression of left ventricular hypertrophy, without impairment of left ventricular function.

[Visualization of coronary artery obstructions by echocardiography]. / Visibilização de obstruções em artérias coronárias pela ecocardiografia.

PURPOSE: The purpose of this study was to determine the sensitivity and specificity of 2D ECO in identifying proximal and medial obstruction of the coronary artery. PATIENTS AND METHOD: Sixty five patients with coronary artery disease were studied. In thirty three patients with previous coronary angiography the echocardiographer had knowledge of the topography and the degree of the coronary obstruction (group I) but in thirty two patients he didn't (group II). The mean age of group I was 54.4 years (44 to 76) and the mean age of the group II was 58 years (42 to 74). Two-dimensional echocardiography was performed at short-axis cross-sectional of aortic valve and images were frozen at end-diastole and reject settings were used to best visualize the coronary artery. RESULTS: It was possible to observe by 2D ECO the left main coronary artery in all patients. It was also possible to identify the proximal segment of the three main arteries. The detection of obstruction was overestimated by 2D ECO when it was in the left main coronary artery. In the proximal segment, in group I, the detection of obstruction in LAD, RCA and CXA was 87.5%, 66.6% and 50% and in group II, 77.7%, 100% and 50% respectively. In the medial segment, in group I, the detection of obstruction in LAD and CXA was respectively 100% and 33.3% and in group II, 60% and 75%. These results show that the sensitivity and specificity to detect obstruction was highest in the LAD. The method overestimated the presence of obstruction in the medial segment of RCA in both groups. CONCLUSION: These findings indicate that 2D ECO is a feasible noninvasive method in assessing obstruction of the main coronary arteries with good sensitivity and specificity.