普伐他汀对9014例冠心病患者的长期疗效和安全性及平均胆固醇水平:LIPID试验随访

普伐他汀对冠心病的长期干预试验(LIPID)于1997年结束,已证明增加存活率。大样本HMG-CoA还原酶抑制剂治疗,无超过5～6年的长期疗效和安全性的证据。因此在LIPID试验结束后,该研究对所有患者予以普伐他汀治疗,以评价其长期疗效和安全性,并了解在一些主要的亚组人群中的疗效。     

普伐他汀在长期临床试验中的安全性和耐受性：普伐他汀前瞻性汇集计划

长期的调脂治疗必须既考虑药物的有效性又要考虑药物的安全性和耐受性。西苏格兰冠心病预防研究(WOSCOPS),胆固醇和再发事件研究(CARE),普伐他汀长期治疗缺血性疾病研究(LIPID)是3项普伐他汀(40mg,每日一次)与安     

全心缺血(77)

<正>ST段抬高型心肌梗死多数局限于一组导联的ST段抬高,提示某支大的冠脉单支闭塞。当冠脉左主干阻塞或多条大冠脉同时闭塞时,心电图将出现     

缺血向量(49)

缺血向量(Vector of ischemia)表现在心电图为ST段的偏移,用于评价闭塞冠脉的部位及心肌缺血的范围,近年来,受到越来越高的重视。     

普伐他汀治疗糖尿病高脂血症30例(摘要)

普伐他汀治疗糖尿病高脂血症３０例（摘要）于棉荣林卫张佩文张少时我科用普伐他汀治疗糖尿病引起的继发性高脂血症３０例，取得了较满意的疗效。１．对象和方法：病例选择经临床和实验室确诊的糖尿病３０例住院病人，其中男２３例，女７例。选择对象均达到以下规定：（１...     

HMG-CoA还原酶抑制剂在急性冠脉综合征中的早期应用:普伐他汀在急性缺血综合征(PAIS)研究中的初步结果

在所有大型的HMG-CoA还原酶抑制剂对冠心病(CAD)干预性研究中,治疗总在事件发生数月后进行。我们则致力于研究在急性CAD病人事件发作的危险期应用普伐他汀是否有益。 方法 PAIS研究是一项随机、双盲、安慰剂对照试验,目的是通过对心血管事件中     

急性心肌梗死中普伐他汀与溶栓治疗的联合应用:普伐他汀土耳其试验(PPT)

近来以溶栓方法治疗梗死相关损害显示了再梗死的倾向性。该研究是在急性心梗(AMI)中,将普伐他汀与溶栓治疗(TT)联合应用,以提高早期斑块稳定性。6个月后通过临床观察及血管造影检查评价其对死亡率、心血管事件、梗死相关动脉(IRA)狭窄和冠脉血管重建术(PTCA)后再狭窄的作用。     

Effect of pravastatin on cardiovascular events and mortality in 1516 women with coronary heart disease: results from the Long-Term Intervention with Pravastatin in Ischemic Disease (LIPID) study

Background The Long-Term Intervention with Pravastatin in Ischaemic Disease (LIPID) study showed that cholesterol-lowering therapy prevented further events in patients with coronary heart disease and average cholesterol levels. The aim of this subgroup analysis was to assess the effects of pravastatin in women. Methods A total of 1516 women (756 assigned to take pravastatin) in a cohort of 9014 patients with previous myocardial infarction or unstable angina and a baseline plasma cholesterol level of 4.0 to 7.0 mmol/L (155-271 mg/dL) were assigned to receive pravastatin (40 mg/d) or placebo. Major cardiovascular disease events in 6 years were measured. Results Women were at a lesser risk than men for death from any cause (10.3% vs 14.8%, P < .01), death from coronary heart disease (6.6% vs 8.6%, P = .04), and coronary revascularization (13.6% vs 16.2%, P = .05) and at a similar risk of myocardial infarction (9.2% vs 10.5%, P = .26), stroke (3.6% vs 4.7%, P =.11), and hospitalization for unstable angina (25.1% vs 24.5%, P = 0.90). Pravastatin significantly reduced the risk of all prespecified cardiovascular events in all LIPID patients. Relative treatment effects in women did not differ significantly from those in men (P > .05) for any events except hospitalization for unstable angina. There were too few events to demonstrate separately significant effects in women; the estimated relative risk reduction with pravastatin was 11% (95% CI -18%-33%) for coronary heart disease death or nonfatal myocardial infarction, 18% (95% CI -25%-46%) for coronary heart disease death, 16% (95% CI -19%-41%) for myocardial infarction, and 17% (95% CI -2%-33%) for coronary heart disease death, myocardial infarction, or coronary revascularization. Conclusions The study had the largest secondary-prevention female cohort studied thus far, but was not adequately powered to show separate effects in women. Nevertheless, the results were consistent with the main results of this and other trials in showing reduced risks with cholesterol-lowering treatment. (Am Heart J 2003;145:643-51.)     

Thyroxine Replacement and Ischaemic Heart Disease in the Elderly

Abstract. Elderly patients with coronary artery disease and hypothyroidism should be treated cautiously with thyroid hormone replacement to avoid precipitating or exacerbating angina pectoris, precipitating acute myocardial infarction, and precipitating or aggravating ventricular arrhythmias or congestive cardiac failure. However, despite this, 7% will develop angina at the time of starting thyroxine replacement therapy and nearly half of these will not respond to standard antianginal therapy. We present a case of thyroxine replacement induced angina and its management as well as a review of the medical literature concerning the potential therapeutic options in the management of unmasked ischaemic heart disease, hypothyroidism and thyroxine replacement therapy.     

Arachidonic Acid-induced Platelet Aggregation ex vivo in Patients with Acute Ischaemic Heart Disease

The threshold concentrations of arachidonic acid (AA) required to induce platelet aggregation were measured in platelet-rich plasma (PRP) from patients with acute ischaemic heart disease and healthy controls. The analytical precision of the test was very good (coefficient of variation 0-4%). Analytical accuracy was evaluated by comparing the results with threshold values for collagen-induced platelet aggregation, and a significant correlation was found (r = 0.56; p<0.01). When comparing the serum levels of thromboxane B(2) to threshold values for AA-induced platelet aggregation an inverse relationship was found (r = -0.37; p<0.01). In the clinical study significantly increased aggregability to AA was seen in patients with unstable angina pectoris (n = 13) compared to patients with stable angina pectoris (n = 14), (p<0.01), and both groups had hyperaggregating platelets compared to healthy controls (n = 27), (p<0.01). The patients with acute myocardial infarction (n = 10) had nearly normoaggregating platelets for the first 2-3 days after admission, but after a week and at day 14 their platelets showed significant hyperaggregability compared to healthy controls (p<0.01). Thus studies of AA-induced aggregation ex vivo suggest that patients with unstable angina pectoris and acute myocardial infarction, in whom coronary thrombus is frequently present, have increased platelet aggregability compared to patients with stable angina pectoris and healthy controls.     

干细胞治疗缺血性心脏病的主要问题

干细胞治疗是缺血性心脏病治疗的一种新的治疗策略,是心血管疾病治疗研究的前沿。国内外大量研究显示出细胞移植能够修复受损心肌,减少梗死面积,改善心脏功能。但目前细胞治疗仍处于早期阶段,各种问题尚待解决,如种子细胞类型的选择、细胞分化、梗死区细胞存活、最佳移植途径、安全性等问题还需深入探讨。为此,现总结前期干细胞治疗基础及临床研究结果,就目前存在的问题进行阐述。     

Long-Term Outcome of Infants with Severe Chronic Kidney Disease

Background and objectives: In 2000, we reported the outcome of 101 children with a GFR <20 ml/min per 1.73 m² at 0.3 yr of age (range 0.0 to 1.5 yr). Long-term data on such young children are scarce.Design, setting, participants, & measurements: Mortality, treatment modalities, and growth were reanalyzed 9.9 yr later.Results: Of the 101 patients, 28 died and three were lost to follow-up during 13.90 yr (range 0.03 to 22.90 yr). One-, 2-, 5-, 10-, 15-, 20-, and 22-yr survivals were 87, 81, 77, 75, 73, 72, and 64%, respectively. Fifty-one children had comorbidities. Sixty-six percent were tube fed for 1.7 yr (range 0.1 to 6.9 yr), 37% had a gastrostomy, and 13% had a Nissen fundoplication. Mean height SD score (SD) was −0.42 (2.33) at birth (n = 40), −2.07 (1.34) at 0.5 (n = 62), −1.93 (1.38) at 1 (n = 72), −1.14 (1.14) at 5 (n = 67), −1.04 (1.15) at 10 (n = 62), −1.84 (1.32) at 15 (n = 40), and −1.68 (1.52) at age ≥18 yr (n = 32). Comorbidities adversely influenced growth (P < 0.01) and final height (P = 0.02): Mean height SD score (SD) was −1.16 (1.38) in otherwise normal adults.Conclusions: Growth and final height in infants with severe chronic kidney disease are influenced by comorbidity. Intensive feeding and early transplantation resulted in a mean adult height within the normal range in patients without comorbidities. Overall mortality is comparable to that of older children.In the past 25 yr, renal replacement therapy (RRT) for infants who have other challenging treatment issues, such as prematurity and comorbid conditions, has become increasingly accepted. Medium-term data demonstrate satisfactory outcomes for growth, development, and transplantation (1–3), although comorbidity is recognized as a factor that affects success of treatment (1,4–6). Long-term outcome is unknown for infants who are treated from the inception of such programs. In 2000, we published the survival and growth of 101 children who were aged <2 yr and had severe chronic kidney disease (CKD) after up to 13 yr of follow-up (1). We present the outcome of these patients after up to 22.9 yr of follow-up. We hope that these unique data will help doctors inform families about the prognosis for similarly affected infants.