Utilization of peanut hull hydrochar /beta cyclodextrin/Fe3O4 magnetic composite for lead ion removal from water solution.

This study involves synthesizing peanut hull hydrochar (PHH) and a PHH/ß-CD/Fe3O4 magnetic composite through hydrothermal and chemical precipitation methods, respectively, to use as effective adsorbents for Pb2+ removal. Vibrating-sample magnetometry (VSM) and Brunauer-Emmett-Teller (BET) analyses revealed that the magnetic saturation value and specific active surface area of PHH/ß-CD/Fe3O4 are 31.543 emu/g and 32.123 m2/g, respectively. The impact of key variables on adsorption efficiency was evaluated using the response surface method - central composite design. ANOVA results (F-value: 166.22 and p-value: <0.05) demonstrated that the model effectively assesses the interaction of variables in the adsorption process. Additionally, R2, Adjusted R2, and Predicted R2 values were 0.999, 0.986, and 0.975, respectively, indicating the model's high adequacy in describing response changes. The maximum efficiency for Pb2+ adsorption was found to be 95.35% using PHH and 99.73% with the PHH/ß-CD/Fe3O4 magnetic composite. These measurements were taken at a temperature of 25 °C, an adsorbent dose of 1 g/L, a pH of 6, and a Pb2+ concentration of 5 mg/L, with respective contact times of 130 min and 50 min. Thermodynamic analysis revealed negative enthalpy and Gibbs free energy values, indicating that the adsorption process is exothermic and spontaneous. The negative entropy parameter suggests a reduction in random interactions during the process. The Pb2+ adsorption data for both PHH (R2: 0.982) and PHH/ß-CD/Fe3O4 (R2: 0.985) were best described by the Pseudo 2nd order kinetic model. Equilibrium data followed the Freundlich model, with R2 values of 0.981 for PHH and 0.990 for PHH/ß-CD/Fe3O4, highlighting the importance of heterogeneous surfaces in the removal process. The maximum adsorption capacities for Pb2+ were 26.72 mg/g for PHH and 33.88 mg/g for PHH/ß-CD/Fe3O4. Reuse and stability tests confirmed the structural stability and reusability of the adsorbents. Therefore, the PHH/ß-CD/Fe3O4 magnetic composite is a promising option for removing Pb2+ from aqueous solutions.

Efficient removal of RR2 dye by electro- Ce(III) process with its elegant arts and attractive charm in performance, energy consumption and mechanism.

Reactive red 2 (RR2) azo dye wastewater poses a serious hazard to the water environment health, so using a novel and efficient Electro- Ce(III) (E- Ce(III)) process takes on a critical significance in treating RR2 dye wastewater. In this study, the effects of a variety of single-factor conditions on RR2 removal efficiency were evaluated in depth. The results indicated that the optimal experimental conditions are as reaction temperature of 25 °C, Na2SO4 concentration of 25 mM, Ce(III) concentration of 0.3 mM, pH of 4.0, and current density of 40.0 mA/cm2. When the RR2 dye wastewater was treated for 40 min under the optimal experimental conditions, a high removal rate of 99.8% for RR2 was obtained. It is suggested that the background ion PO43- in the dye wastewater inhibits the E-Ce (III) process, whereas Cl- facilitates this process. Moreover, the yield of Ce(IV) increases with the increase of the current density. At the current density of 40.0 mA/cm2, a reasonable energy consumption of 3.85 kW h/gTOC for the process was obtained after the 3-h treatment. The effects of different degradation processes (including Direct Electrooxidation (DEO), single Ce(III), and E-Ce (III)) on RR2 removal efficiency and TOC change were compared. The types of oxidizing substances in the E-Ce (III) process were detected, and the mechanism of RR2 oxidative degradation in the E-Ce (III) process was summarized. The result suggests that the E-Ce (III) process has low power consumption. Meanwhile, in the E-Ce (III) process, free reactive Ce(IV) with strong oxidation is continuously generated, RR2 can be efficiently degraded. And the continuous cycle transformation between Ce(III) and Ce(IV) maintains the strong oxidation of the process. The contribution of free reactive Ce(IV) and DEO to RR2 degradation was obtained as 58.8% and 39.8%, respectively. The combined effect of Ce(IV) and DEO played a major role in the E-Ce (III) process, while ·OH exhibited a relatively weak effect (nearly 1.4%). RR2 was comprised of 13 major intermediates, and the biodegradability of wastewater was improved significantly after treatment, thus facilitating the further mineralization and biodegradation of the products. The E- Ce(III) process is novel, efficient, and environment-friendly, and has a large market application space, suggesting that it can be applied as an efficient, economic, and sustainable water treatment process.

Dronedarone in high-risk permanent atrial fibrillation.

BACKGROUND: Dronedarone restores sinus rhythm and reduces hospitalization or death in intermittent atrial fibrillation. It also lowers heart rate and blood pressure and has antiadrenergic and potential ventricular antiarrhythmic effects. We hypothesized that dronedarone would reduce major vascular events in high-risk permanent atrial fibrillation. METHODS: We assigned patients who were at least 65 years of age with at least a 6-month history of permanent atrial fibrillation and risk factors for major vascular events to receive dronedarone or placebo. The first coprimary outcome was stroke, myocardial infarction, systemic embolism, or death from cardiovascular causes. The second coprimary outcome was unplanned hospitalization for a cardiovascular cause or death. RESULTS: After the enrollment of 3236 patients, the study was stopped for safety reasons. The first coprimary outcome occurred in 43 patients receiving dronedarone and 19 receiving placebo (hazard ratio, 2.29; 95% confidence interval [CI], 1.34 to 3.94; P=0.002). There were 21 deaths from cardiovascular causes in the dronedarone group and 10 in the placebo group (hazard ratio, 2.11; 95% CI, 1.00 to 4.49; P=0.046), including death from arrhythmia in 13 patients and 4 patients, respectively (hazard ratio, 3.26; 95% CI, 1.06 to 10.00; P=0.03). Stroke occurred in 23 patients in the dronedarone group and 10 in the placebo group (hazard ratio, 2.32; 95% CI, 1.11 to 4.88; P=0.02). Hospitalization for heart failure occurred in 43 patients in the dronedarone group and 24 in the placebo group (hazard ratio, 1.81; 95% CI, 1.10 to 2.99; P=0.02). CONCLUSIONS: Dronedarone increased rates of heart failure, stroke, and death from cardiovascular causes in patients with permanent atrial fibrillation who were at risk for major vascular events. Our data show that this drug should not be used in such patients. (Funded by Sanofi-Aventis; PALLAS ClinicalTrials.gov number, NCT01151137.).

Residual macrovascular risk in 2013: what have we learned?

Cardiovascular disease poses a major challenge for the 21st century, exacerbated by the pandemics of obesity, metabolic syndrome and type 2 diabetes. While best standards of care, including high-dose statins, can ameliorate the risk of vascular complications, patients remain at high risk of cardiovascular events. The Residual Risk Reduction Initiative (R3i) has previously highlighted atherogenic dyslipidaemia, defined as the imbalance between proatherogenic triglyceride-rich apolipoprotein B-containing-lipoproteins and antiatherogenic apolipoprotein A-I-lipoproteins (as in high-density lipoprotein, HDL), as an important modifiable contributor to lipid-related residual cardiovascular risk, especially in insulin-resistant conditions. As part of its mission to improve awareness and clinical management of atherogenic dyslipidaemia, the R3i has identified three key priorities for action: i) to improve recognition of atherogenic dyslipidaemia in patients at high cardiometabolic risk with or without diabetes; ii) to improve implementation and adherence to guideline-based therapies; and iii) to improve therapeutic strategies for managing atherogenic dyslipidaemia. The R3i believes that monitoring of non-HDL cholesterol provides a simple, practical tool for treatment decisions regarding the management of lipid-related residual cardiovascular risk. Addition of a fibrate, niacin (North and South America), omega-3 fatty acids or ezetimibe are all options for combination with a statin to further reduce non-HDL cholesterol, although lacking in hard evidence for cardiovascular outcome benefits. Several emerging treatments may offer promise. These include the next generation peroxisome proliferator-activated receptorα agonists, cholesteryl ester transfer protein inhibitors and monoclonal antibody therapy targeting proprotein convertase subtilisin/kexin type 9. However, long-term outcomes and safety data are clearly needed. In conclusion, the R3i believes that ongoing trials with these novel treatments may help to define the optimal management of atherogenic dyslipidaemia to reduce the clinical and socioeconomic burden of residual cardiovascular risk.

Reduction of the morning blood pressure surge treated with olmesartan in Chinese patients with mild to moderate essential hypertension--a multicenter, open-label, single treatment group clinical study.

OBJECTIVE: To investigate the morning blood pressure surge (MBPS) in Chinese patients with mild to moderate essential hypertension treated with long-term administration of olmesartan, an angiotensin II receptor antagonist according to ambulatory blood pressure monitoring (ABPM). MATERIALS AND METHODS: In a multi-center, prospective study, we investigated the long-term efficacy of olmesartan by ABPM in 18-75 years-old Chinese patients with mild to moderate hypertension (clinic diastolic blood pressure [DBP] 90-109 mm Hg and systolic blood pressure [SBP] < 180 mmHg). After a 1 week placebo runin, 87 patients were treated with olmesartan 20 mg once daily in the morning for 24 weeks. Ambulatory blood pressure monitoring was conducted at baseline and at the end of 24 weeks. At baseline, patients with an MBPS > or = 23 mmHg were classified as the MBPS group (n = 41), and all other patients were classified as the non-MBPS group (n = 46). RESULTS: The mean systolic and diastolic blood pressures (SBP/DBP) over 24 hours were reduced from 141.78 +/- 12.8/91.17 +/- 7.34 to 128.35 +/- 15.86/83.58 +/- 9.53 mmHg (p < 0.01). The mean blood pressure in the final 6 hours of the dosing interval dropped from 135.75 +/- 5.84/87.29 +/- 4.80 mmHg to 122.98 +/- 6.46/80.49 +/- 4.31 mmHg (p < 0.01). The MBPS for SBP/ DBP were reduced from 35.68 +/- 8.85/29.77 +/- 17.19 mmHg to 28.62 +/- 15.08/19.08 +/- 11.01 mmHg in the MBPS group (p < 0.05). The reductions in MBPS after treament with olmesartan were significantly different between the two groups (p < 0.01). CONCLUSIONS: Olmesartan effectively reduces blood pressure in patients with essential hypertension, and olmesartan especially reduces the MBPS in MBPS-prone patients.

[Ultraviolet-initiated synthesis and characterization of anionic polyacrylamide].

APAM was prepared under the action of composite initiator and UV irradiation, using acryl amide (AM), 2-acrylamido-2-methyl propane sulfonic acid (AMPS) and acrylic acid (AA) as raw materials. The paper studied the effect of proportion between monomers, monomer ratio, initiator concentration and other factors on intrinsic viscosity of the polymer, and optimized preparation conditions. The chemical structure and thermal stability of APAM were characterized by UV, FTIR, SEM and DTA-TGA respectively. The results showed that the APAM with the intrinsic viscosity 1.6 x 10(3) mL x g(-1) can prepared when the proportion between monomers was 70 : 10 : 10, the monomer ratio was 40%, initiator concentration was 0.20%, pH was 9 and the illumination time was 60 min.

Improved neural network with least square support vector machine for wastewater treatment process.

This research offers a unique interval by using the predicting approach for discharge indicators of water quality data such as biochemical oxygen demand (BOD) and ammonia nitrogen (NH3-N). This is considered one of the significant quality metrics in wastewater treatment plants for water quality management as well as surveillance. To begin, the effluent information for BOD/NH3-N and their supplementary parameters are gathered. Hence BOD and NH3 are considered major feature sources for estimating water pollutants. BOD is high then oxygen level is very low in the water due to pollutants or algae. Ammonia nitrogen is an organic waste component in water from sewage. The significant characteristics with good correlation levels of BOD and NH3-N are examined and identified using a grey correlation analysis method after certain basic data pre-processing procedures. The BOD/NH3-N effluent information of a water treatment plant is predicted using an upgraded feed-forward neural network with the least square support vector machine (FFNN-LSSVM) method. An optimization approach for an enhanced feed-forward neural network (IFFNN) is built by Machine Learning Algorithms. The IFFNN used regular influent water quality, influent rate of flow, and Wastewater performance monitoring and operational conditions as input parameters. For future prediction, input variables were previous different wastewater quality measurements. Lastly, the analysis shows that, when compared to other current algorithms, the proposed methodology can forecast wastewater quality of water with high accuracy in predicting BOD and NH3 levels, limited computation duration, mean error less than 10% and R2 is 90% proves better than existing techniques.

Efficacy and tolerability of a single-pill combination of amlodipine/valsartan in Asian hypertensive patients not adequately controlled with valsartan monotherapy.

This randomized, double-blind study evaluated efficacy of a single-pill combination of amlodipine/valsartan (Aml/Val) in Asian patients with hypertension not responding to Val 80 mg. Patients with mean sitting diastolic blood pressure (DBP) ≥90-≤110 mmHg were randomized to Aml/Val 5/80, Val 80, or Val 160 mg for 8 weeks. At week-8 endpoint, significantly greater reductions in BP were seen with Aml/Val 5/80 mg than valsartan monotherapies (p < 0.0001). The BP control was greater with Aml/Val 5/80 (70.5%) than Val (44.1-58.6%) monotherapies. The combination was well tolerated. In conclusion, single-pill combination with Aml/Val provided significant additional BP reduction and control in hypertensive patients not responding to Val 80 mg.

A short-term, randomized, double-blind, parallel-group study to evaluate the efficacy and safety of dronedarone versus amiodarone in patients with persistent atrial fibrillation: the DIONYSOS study.

INTRODUCTION: We compared the efficacy and safety of amiodarone and dronedarone in patients with persistent atrial fibrillation (AF). METHODS: Five hundred and four amiodarone-naïve patients were randomized to receive dronedarone 400 mg bid (n = 249) or amiodarone 600 mg qd for 28 days then 200 mg qd (n = 255) for at least 6 months. Primary composite endpoint was recurrence of AF (including unsuccessful electrical cardioversion, no spontaneous conversion and no electrical cardioversion) or premature study discontinuation. Main safety endpoint (MSE) was occurrence of thyroid-, hepatic-, pulmonary-, neurologic-, skin-, eye-, or gastrointestinal-specific events, or premature study drug discontinuation following an adverse event. RESULTS: Median treatment duration was 7 months. The primary composite endpoint was 75.1 and 58.8% with dronedarone and amiodarone, respectively, at 12 months (hazard ratio [HR] 1.59; 95% confidence interval [CI] 1.28-1.98; P < 0.0001), mainly driven by AF recurrence with dronedarone compared with amiodarone (63.5 vs 42.0%). AF recurrence after successful cardioversion was 36.5 and 24.3% with dronedarone and amiodarone, respectively. Premature drug discontinuation tended to be less frequent with dronedarone (10.4 vs 13.3%). MSE was 39.3 and 44.5% with dronedarone and amiodarone, respectively, at 12 months (HR = 0.80; 95% CI 0.60-1.07; P = 0.129), and mainly driven by fewer thyroid, neurologic, skin, and ocular events in the dronedarone group. CONCLUSION: In this short-term study, dronedarone was less effective than amiodarone in decreasing AF recurrence, but had a better safety profile, specifically with regard to thyroid and neurologic events and a lack of interaction with oral anticoagulants.

The association between socioeconomic status of high-risk patients with coronary heart disease and the treatment rates of evidence-based medicine for coronary heart disease secondary prevention in China: Results from the Bridging the Gap on CHD Secondary Prevention in China (BRIG) Project.

BACKGROUND: In China, low socioeconomic status (SES) may be a barrier for patients with coronary heart disease (CHD) to receive adequate treatment because of their inadequate access to health resources. This study aims to evaluate whether and to what extent SES is associated with the treatment of CHD patients. METHODS: A cross-sectional survey was conducted among 2,803 CHD outpatients, a representative sample of China. An SES composite index was derived based on educational levels, monthly income, occupation, and access to medical insurance for each patient. The association between SES and treatment status of several key medications was analyzed. RESULTS: In total, 2,278 CHD outpatients with complete SES information were studied. The treatment rates of clopidogrel and statins were 6.7% and 34.2% in patients with the lowest SES and 41.7% and 75% in patients with the highest SES. In multiple logistic regression analyses, SES was independently associated with the use of aspirin, clopidogrel, statins and beta-blockers. Compared with the patients with the highest SES, the patients with the lowest SES had a 43.4% lower treatment rate for aspirin, a 76% lower rate for clopidogrel, a 70.2% lower rate for statins, and a 70.2% lower rate for beta-blockers after adjustment for various cofactors. CONCLUSIONS: Socioeconomic status is closely associated with the treatment status of secondary prevention in CHD high-risk patients in China. Policy makers and medical professionals urgently need to develop policies and strategies to improve medical care for patients of low SES.

[Efficacy and safety of the single pill combination of valsartan 80 mg plus amlodipine 5 mg in mild to moderate essential hypertensive patients without adequate blood pressure control by monotherapy].

OBJECTIVE: To evaluate the efficacy and safety of a once daily valsartan/amlodipine 80/5 mg combination tablet in Chinese mild to moderate hypertensive patients without adequate blood pressure control by monotherapy. METHODS: Two multicenter, randomized, double-blind, double dummy, active-controlled, parallel group trials were conducted. After a washout period (no medication) of 1-4 weeks, patients with Mean Sitting Diastolic Blood Pressure (MSDBP) > or = 95 mm Hg (1 mm Hg = 0.133 kPa) and < 110 mm Hg received a monotherapy of either Amlodipine 5 mg (in study 1) or valsartan 80 mg (in study 2) for 4 weeks. Patients with MSDBP > or = 90 mm Hg and < 110 mm Hg at the end of the monotherapy period were randomized to receive valsartan/amlodipine 80/5 mg treatment, or continue with the monotherapy. RESULTS: In study 1, compared with amlodipine 5 mg, valsartan/amlodipine 80/5 mg once daily further reduced mean sitting systolic blood pressure (MSSBP)/MSDBP 4.4/3 mm Hg (P < 0.0001). In study 2, compared with valsartan 80 mg, valsartan/amlodipine 80/5 mg once daily further reduced MSSBP/MSDBP 6.4/4.2 mm Hg (P < 0.0001). The blood pressure (BP) control rates (BP < 140/90 mm Hg) of combination treatment group were 71.0% and 71.2% respectively, and significantly higher than the monotherapy groups in both trials. Incidence of adverse events was comparable in monotherapy and combination therapy groups. CONCLUSION: Our results showed that valsartan/amlodipine 80/5 mg was superior to amlodipine 5 mg or valsartan 80 mg alone in lowering blood pressure and BP control in patients with mild to moderate hypertension not adequately controlled with amlodipine 5 mg or valsartan 80 mg monotherapy. No new or unexpected safety issues were identified with valsartan/amlodipine combination therapy compared with monotherapy.

[Differences in goal attainment in clinical management of dyslipidemia in China evaluated by different guidelines].

OBJECTIVE: To better understand the similarities and disparities between the newly issued Chinese Guidelines on Prevention and Treatment of Dyslipidemia in Adults (CG) and exist relevant guidelines by comparing the actual effect on assessment of current clinical management of dyslipidemia in China, in order to promote the use of CG in clinical practice. METHODS: Study participants included 2094 patients from the Second Multi-center Survey of Dyslipidemia Management in China. The goal attainment rate was defined as the proportion of participants who achieved their target low-density lipoprotein cholesterol (LDL-C) levels specified by CG, the Chinese Expert Recommendations on Prevention and Treatment of Dyslipidemia (CR), the updated Adult Treatment Panel III of the National Cholesterol Education Program (ATP III), respectively. RESULTS: (1) The overall goal attainment rates were 62%, 34% and 50% according to CR, ATP III and CG, respectively. (2) With reference to the CG risk stratifications, the risk of nearly 40% of high risk patients and all very high risk patients were underestimated by CR, whereas the risk of more than 40% of patients in any risk groups were overestimated by ATP III. (3) The disparities in risk stratifications accounted for 90% of the difference in overall goal attainment rate (12%) between CR and CG, while the disparities in the risk stratifications and that in LDL-C target levels were responsible for 29% and 71% of the difference (16%) , respectively, between ATP III and CG. CONCLUSIONS: There were significant differences in goal attainment rates assessed by different clinical practice guidelines. CG is more aggressive in risk stratification than CR but simpler and easier to use than ATP III, and hence more appropriate to Chinese patients and should be widely promoted in China.

[Therapeutic efficacy of valsartan and valsartan/HCTZ in mild to moderate hypertensive patients].

OBJECTIVE: To assess the efficacy and safety of valsartan/hydrochlorothiazide (HCTZ) 80/12.5 mg once daily (o.d.) in Chinese patients with mild to moderate essential hypertension who was not adequately controlled by valsartan 80 mg o.d. monotherapy. METHODS: In this multi-center, double-blind, randomized, active controlled, parallel group trial, 1051 out of 1175 Chinese patients with mild to moderate essential hypertension [DBP >or= 95 mm Hg and < 110 mm Hg (1 mm Hg = 0.133 kPa)] completed single-blind run-in period (valsartan 80 mg o.d. therapy for 4 weeks) after 2 week's wash-out period. At the end of the single-blind run-in period, those patients with DBP >or= 95 mm Hg (n = 864) were randomized in 1:1 ratio to Valsartan and Valsartan 80 mg (n = 429)/HCTZ80/12.5 mg (n = 435) treatment o.d. for 8 weeks. Safety and efficacy was assessed every 4 weeks during double blind phase. RESULTS: At the end of study, valsartan/HCTZ 80/12.5 mg combination treatment further reduced systolic (-3.5 mm Hg) and diastolic (-2.2 mm Hg) pressures and increased the rate of patients reaching goal BP level (53.9% vs. 40.9%) compared to valsartan 80 mg o.d. monotherapy. Incidence of side effects was similar between the combination therapy and monotherapy groups (8.9% vs. 5.1%, P > 0.05). CONCLUSION: Efficacy of Valsartan 80 mg/HCTZ 12.5 mg compound was superior to valsartan 80 mg on BP reduction and goal BP control rate in Chinese patients with mild to moderate essential hypertension. The combination of Valsartan 80 mg/hydrochlorothiazide (HCTZ) 12.5 mg provides a suitable treatment for Chinese patients who are not adequately controlled by valsartan 80 mg o.d. monotherapy.

[Cut offs and risk stratification of dyslipidemia in Chinese adults].

OBJECTIVE: To establish cut offs and risk stratification of dyslipidemia in Chinese adults. METHODS: Data from 2 widely cited studies: the PRC-US Collaborative Study of Cardiovascular and Cardiopulmonary Epidemiology and the China Multi-Provincial Cardiovascular Cohort Study, with a total of 40 719 Chinese adults, age 35 to 64 at baseline, about half men and half women, followed up for a total of 345 140.5 person years, were used to analyze the relationship between dyslipidemia and ischemic cardiovascular diseases (ICVD, including coronary heart events and ischemic stroke events) using a common data analysis protocol co-developed by the scientists from the 2 studies. The relative risk was estimated with the Cox proportional hazard model adjusting for other conventional cardiovascular risk factors. The 10-year absolute risk of ICVD for a 50 years-old person at different risk factor combinations was used to develop the risk stratification. RESULTS: (1) There was a continuous linear relationship between baseline TC (or LDL-C) and ICVD risk without a threshold; (2) The incidence (absolute risk) of ICVD was similar for LDL-C < 3.37 mmol/L (130 mg/dl) and for TC < 5.18 mmol/L (200 mg/dl); and similar for LDL-C < 4.14 mmol/L (160 mg/dl) and for TC < 6.22 mmol/L (240 mg/dl); (3) The absolute ICVD risk for TC > or = 6.22 mmol/L (240 mg/dl) was slightly less but close to that for grade 1 hypertension; (4) ICVD risk increased as HDL-C decreased; (5) No significant association was found between baseline TG and subsequent ICVD; (6) At any TC level, the absolute ICVD risk for those having only hypertension was higher than that for those having 3 other risk factors. CONCLUSION: The cut offs for diagnosis of dyslipidemia in Chinese adults can refer to those used in relevant international guidelines: TC < 5.18 mmol/L (200 mg/dl) [or LDL-C < 3.37 mmol/L (130 mg/dl)] as normal, TC 5.18 - 6.19 mmol/L (200 - 239 mg/dl) [or LDL-C 3.37 - 4.12 mmol/L (130 - 159 mg/dl)] as borderline high, and TC > or = 6.22 mmol/L (240 mg/dl) [or LDL-C > or = 4.14 mmol/L (160 mg/dl)] as high; HDL-C < 1.04 mmol/L (40 mg/dl) as low, 1.04 - 1.53 mmol/L (40 - 59 mg/dl) as normal and > or = 1.55 mmol/L (60 mg/dl) as optimal. In risk stratification scheme, hypertension plays a role that equals to that of any other 3 risk factors.

[The angiographic features of exercise-induced ST-segment elevation in patients without myocardial infarction].

OBJECTIVE: To explore the incidence and angiographic features of exercise-induced ST-segment elevation in patients without prior myocardial infarction. METHODS: Exercise-induced ST-segment elevation occurred in 15 out of 4601 consecutive patients without prior myocardial infarction underwent treadmill exercise testing during a 2-year period. The coronary angiographic features of the 15 patients (13 males, aged between 40 - 75 years) were analyzed. RESULTS: Coronary angiography revealed one hemodynamically relevant stenotic vessel in 6 patients, two hemodynamically relevant stenotic vessels in 6 patients, three hemodynamically relevant stenotic vessels in 3 patients. Left anterior descending (LAD) coronary artery was affected in 12 patients. Left main coronary artery (LMCA) stenosis was evidenced in 1 patient and right coronary artery stenosis in 7 patients. Severe (90% - 100%) occlusions were visualized in 8 out of 13 patients with LAD or LMCA lesions. Elevated ST-segment leads were consistent with the ischemic area where the blood supply of myocardium was affected by diseased vessels. CONCLUSIONS: The incidence of exercise induced ST-segment elevation in patients without prior myocardial infarction is very low and mostly due to severe fixed coronary artery stenosis, especially in LAD. The location of ischemic myocardium can be suggested by ST-segment elevation leads during exercise.

Tolerability of beta-blockers in elderly patients with chronic heart failure: the COLA II study.

BACKGROUND: Beta-blockers are recommended therapy for patients with chronic heart failure (CHF). However, there remains concern regarding tolerability of these agents in the elderly, which has contributed to the limited uptake of these agents in clinical practice. AIMS: We conducted a multi-national, prospective evaluation of tolerability to carvedilol in 1030 CHF patients aged >70 years selected by their treating physician to receive this agent in everyday practice. METHODS AND RESULTS: NYHA Class II-IV CHF patients were assessed at baseline for key demographic parameters that may predict tolerability, then followed for 6 months after starting carvedilol. Tolerability was defined as being on >or=6.25 mg bd of carvedilol at 6 months having received a total of >or=3 months therapy. Tolerability overall was 80% with age 70-75 years 84.3%, 76-80 years 76.8% and >80 years 76.8%. Mean carvedilol dose achieved was 31.2 mg. In multivariate analysis, advanced age, low diastolic BP, LVEF, obstructive airways disease and presence of diabetes were predictors of tolerability. CONCLUSIONS: Carvedilol appears to be well tolerated in this elderly CHF patient cohort. Therefore, elderly CHF patients should not be denied treatment with carvedilol because of concerns regarding tolerability.

[Efficacy and safety of olmesartan medoxomil versus losartan potassium in Chinese patients with mild to moderate essential hypertension].

OBJECTIVE: To evaluate the efficacy and safety of olmesartan medoxomil compared with losartan potassium in patients with mild to moderate essential hypertension. METHOD: This is a randomized, double-blind, double-dummy, active-controlled, parallel, multi-center study. After a 2-week placebo run-in period, a total of 287 eligible subjects were randomized at 1:1 ratio to receive olmesartan medoxomil 20 mg or losartan potassium 50 mg, once daily for 8 weeks. The blood pressure was assessed after 4 weeks treatment. If the subject's seating diastolic blood pressure (SeDBP) was still >or=90 mm Hg, the dosage was doubled for another 4 weeks; for those subjects whose SeDBP was <90 mm Hg after 4-week treatment, the initial dosage remained unchanged and the treatment continued until completion of the study. RESULTS: (1) The mean trough reduction in SeDBP from baseline in olmesartan group was significantly greater than that in losartan group after 4 weeks (11.72 mm Hg vs 9.23 mm Hg, P=0.004) and 8 weeks treatment (12.94 mm Hg vs 11.01 mm Hg, P=0.035). (2) The number and percentage of responders in olmesartan group (81, 65.3%) were statistically higher than those (68, 52.7%) in losartan group (P=0.028) after 4 weeks treatment and were similar between the two groups after 8 weeks treatment (P>0.05). (3) Individual and overall trough/peak ratios of DBP and SBP in 24-hour ambulatory blood pressure monitoring were higher in olmesartan group than losartan group. The hypotensive effect of olmesartan was more durable than losartan at 24 hour interval. (4) The incidence of study drug-related adverse events (AEs) in olmesartan group (10.5%) was similar as that in losartan group (13.9%, P>0.05). Most of these AEs were mild and transient. CONCLUSION: This study shows that olmesartan medoxomil, at oral dose of 20 mg-40 mg once daily was effective and safe for hypertension treatment and the hypotensive effect was superior to losartan potassium (50 mg-100 mg once daily).

Efficacy and safety of simvastatin in Asian and non-Asian coronary heart disease patients: a comparison of the GOALLS and STATT studies.

BACKGROUND: Asians are thought to be more responsive to the lipid-lowering effects of statins than non-Asians although there are no head-to-head trials that examine this perception. OBJECTIVE: To compare the results of the GOALLS and STATT studies that used similar titrate-to-goal protocols with 20 mg up to 80 mg simvastatin in Asian and non-Asian coronary heart disease (CHD) patients. METHODS: GOALLS (N = 198; included non-Asians and Asians) and STATT (N = 133; included Asians only) were both multi-center, open-label 14-week studies in CHD patients with serum low density lipoprotein cholesterol (LDL-C) levels 115 mg/dL-180 mg/dL and triglycerides (TG) levels < or = 400 mg/dL. Simvastatin was titrated from 20 mg/day up to 80 mg/day in order to achieve the National Cholesterol Education Program (NCEP) LDL-C target < or = 100 mg/dL. The primary efficacy variable was the percentage of patients attaining the NCEP LDL-C target at Week 14. Secondary endpoints included proportion of patients achieving the European Society of Cardiology/European Atherosclerosis Society/European Society of Hypertension (European) LDL-C target < or = 115 mg/dL at Week 14 and percentage change in lipid parameters. Safety and tolerability were assessed by monitoring adverse experiences and safety laboratory tests. Fifteen Asian patients were part of the GOALLS cohort and their data were compared separately with results of non-Asians from GOALLS and Asians from the STATT study. RESULTS: After 14 weeks of simvastatin treatment, 87.1% of GOALLS non-Asians, 85.7% of GOALLS Asians, and 78.2% of STATT patients attained the NCEP LDL-C target. At Week 14, 94.4%, 92.9%, and 91.7% of the GOALLS non-Asians, GOALLS Asians, and STATT patients achieved the European LDL-C target, respectively. The average treatment doses to attain NCEP and European targets were comparable among groups. The percentage reductions in lipid parameters from baseline to week 14 were similar among groups except, changes in high density lipoprotein cholesterol and apolipoprotein A-I favored Asian subjects. There was also a greater reduction in TG in the STATT study, but this was not consistent with TG reductions experienced by Asians in the GOALLS study. In both studies, simvastatin was generally well tolerated by all patients across the dosage range of 20 mg-80 mg. No cases of rhabdomyolysis or myopathy were reported in either study. CONCLUSIONS: A great majority of CHD patients is able to achieve LDL-C treatment goals (up to 90%) on simvastatin regardless of racial background. Simvastatin treatment at doses of 20 mg-80 mg is well-tolerated in Asian and non-Asian CHD patients. This side-by-side comparison provides evidence that Asian and non-Asian CHD populations respond similarly to comparable doses of simvastatin.

A survey on the efficacy and tolerability of micronized fenofibrate in patients with dyslipidemia.

OBJECTIVE: To demonstrate the clinical efficacy of micronized fenofibrate on mildly-moderately elevated LDL-C levels and reduced HDL-C levels. METHODS: During 1998 - 1999, 2358 patients with type IIa, IIb and IV hyperlipidemia were monitored in 16 cities in China. They were treated daily with micronized fenofibrate (micronized lipanthyl) 200 mg for 8 weeks. Lipid levels before and after the treatment were measured and analyzed. RESULTS: Micronized fenofibrate significantly increased HDL-C levels by 12.7%, the effect being inversely correlated to the baseline level of HDL-C. Out of the total patient population, a baseline level of HDL-C < 1.0 mmol/L was found in 837 patients: amongst this group, 510 patients (60.9%) were observed to have an increase in the level of HDL-C to > 1.0 mmol/L with a mean of 1.3 mmol/L, after 8-week micronized fenofibrate therapy. Furthermore, the mean LDL-C level decreased by 15.9% following an 8-week treatment of micronized fenofibrate, an effect positively correlated to the baseline level of LDL. In general, all patients tolerated the drug comfortably. CONCLUSIONS: Short-term treatment of micronized fenofibrate in patients with dyslipidemia significantly increases HDL-C level and reduces mildly-moderately elevated LDL-C level. As expected, it also reduces triglyceride levels.