Интересные ссылки

[thorn]

Вроде еще не было...
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[Chevychelov]

ACCF/AHA Pocket Guideline November 2011
Management of Patients With Peripheral Artery Disease (Lower Extremity,
Renal, Mesenteric, and Abdominal Aortic)
Adapted from the 2005 ACCF/AHA Guideline and the 2011 ACCF/AHA Focused Update
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[cactus1972]

Кто пьет грейпфрутовый сок (будет строен и высок ), снижает риск развития ишемического инсульта

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[Gilarov]

Сообщение от cactus1972

Кто пьет грейпфрутовый сок (будет строен и высок ), снижает риск развития ишемического инсульта

А также ингибирует цитохромы...

[Nastydoc]

им категорически нельзя лекарства запивать, впрочем остальными соками тоже не надо

[Chevychelov]

Сообщение от Nastydoc

им категорически нельзя лекарства запивать, впрочем остальными соками тоже не надо

Хотелось бы узнать почему? С соответствующей аргументацией.

[Nastydoc]

Сообщение от Gilarov

А также ингибирует цитохромы...

[Ссылки доступны только зарегистрированным пользователям ]
выдержки
грейпфрутовый сок - наиболее проблематичный продукт питания в плане сочетания с медикаментами. Дело в том, что он конкурирует с некоторыми лекарствами за один из печеночных микросомальных ферментов - цитохром Р450 3А4 - который метаболизирует (разрушает) и вещества, содержащиеся в соке, и лекарственный препарат.

Причем конкурирует весьма успешно. Результатом этого становится существенное изменение фармакокинетики лекарства (т.е. то, что организм делает с препаратом), а это незамедлительно сказывается на длительности его действия и оказываемых эффектах.

Ситуация настолько серьезна, что Управление по контролю за пищевыми продуктами и лекарственными средствами США (Food & Drug Administration, FDA), в обязательном порядке требует проверять все новые препараты на совместимость именно с грейпфрутовым соком.

[dmblok]

Initial Coronary Stent Implantation With Medical Therapy vs Medical Therapy Alone for Stable Coronary Artery Disease
Meta-analysis of Randomized Controlled Trials

Kathleen Stergiopoulos, MD, PhD; David L. Brown, MD
Arch Intern Med.*2012;172(4):312-319. doi:10.1001/archinternmed.2011.1484

Background* Prior meta-analyses have yielded conflicting results regarding the outcomes of treatment of stable coronary artery disease (CAD) with initial percutaneous coronary intervention (PCI) vs medical therapy. However, most of the studies in prior systematic reviews used balloon angioplasty as well as medical therapies that do not reflect current interventional or medical practices. We therefore performed a meta-analysis of all randomized clinical trials comparing initial coronary stent implantation with medical therapy to determine the effect on death, nonfatal myocardial infarction (MI), unplanned revascularization, and persistent angina.

Methods* Prospective randomized trials were identified by searches of the MEDLINE database from 1970 to September 2011. Trials in which stents were used in less than 50% of PCI procedures were excluded. Data were extracted from each study, and summary odds ratios (ORs) were obtained using a random effects model.

Results* Eight trials enrolling 7229 patients were identified. Three trials enrolled stable patients after MI, whereas 5 studies enrolled patients with stable angina and/or ischemia on stress testing. Mean weighted follow-up was 4.3 years. The respective event rates for death with stent implantation and medical therapy were 8.9% and 9.1% (OR, 0.98; 95% CI, 0.84-1.16); for nonfatal MI, 8.9% and 8.1% (OR, 1.12; 95% CI, 0.93-1.34); for unplanned revascularization, 21.4% and 30.7% (OR, 0.78; 95% CI, 0.57-1.06); and for persistent angina, 29% and 33% (OR, 0.80; 95% CI, 0.60-1.05).

Conclusion* Initial stent implantation for stable CAD shows no evidence of benefit compared with initial medical therapy for prevention of death, nonfatal MI, unplanned revascularization, or angina.


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Может у кого есть полный вариант? Заранее спасибо.

[Chevychelov]

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[Yariko]

Safety Announcement

[2-28-2012] The U.S. Food and Drug Administration (FDA) has approved important safety label changes for the class of cholesterol-lowering drugs known as statins. These changes were made to provide the public with more information for the safe and effective use of statins and are based on FDA’s comprehensive review of the statin class of drugs (see Data Summary below). The changes include the following:
Monitoring Liver Enzymes
Labels have been revised to remove the need for routine periodic monitoring of liver enzymes in patients taking statins. The labels now recommend that liver enzyme tests should be performed before starting statin therapy and as clinically indicated thereafter. FDA has concluded that serious liver injury with statins is rare and unpredictable in individual patients, and that routine periodic monitoring of liver enzymes does not appear to be effective in detecting or preventing serious liver injury.

Adverse Event Information
Information about the potential for generally non-serious and reversible cognitive side effects (memory loss, confusion, etc.) and reports of increased blood sugar and glycosylated hemoglobin (HbA1c) levels has been added to the statin labels. FDA continues to believe that the cardiovascular benefits of statins outweigh these small increased risks.

Drug Interactions
The lovastatin label has been extensively updated with new contraindications (situations when the drug should not be used) and dose limitations when it is taken with certain medicines that can increase the risk for muscle injury (see Lovastatin Dose Limitations below).

Healthcare professionals should refer to the drug labels for the latest recommendations for prescribing statins (also see Additional Information for Healthcare Professionals below). Patients should contact their healthcare professional if they have any questions or concerns about statins.

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[dmblok]

Initial Coronary Stent Implantation With MedicalTherapy vs Medical Therapy Alone for Stable Coronary Artery Disease

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[Igor73]

Characteristics and long-term outcomes of percutaneous revascularization of unprotected left main coronary artery stenosis in the United States a report from the national cardiovascular data registry, 2004 to 2008.

[Ссылки доступны только зарегистрированным пользователям ] 2012 Feb 14;59(7):648-54.
OBJECTIVES:

This study sought to assess percutaneous coronary intervention (PCI) for unprotected left main coronary artery (ULMCA) stenosis in routine U.S. clinical practice.
BACKGROUND:

Percutaneous coronary intervention for ULMCA stenosis is controversial; however, current use and outcomes of ULMCA PCI in routine U.S. clinical practice have not been described.
METHODS:

We evaluated 5,627 patients undergoing ULMCA PCI at 693 centers within the National Cardiovascular Data Registry Catheterization Percutaneous Coronary Intervention Registry for temporal trends in PCI use (2004 to 2008), patient characteristics, and in-hospital mortality. Thirty-month mortality and composite major adverse events (death, myocardial infarction, and revascularization) with drug-eluting versus bare-metal stents were compared using inverse probability weighted (IPW) hazard ratios (HRs) in a nonrandomized Medicare-linked (age ≥65 years) patient cohort (n = 2,765).
RESULTS:

ULMCA PCI was performed in 4.3% of patients with ULMCA stenosis. Unadjusted in-hospital mortality rates ranged from 2.9% for elective cases to 45.1% for emergent/salvage cases. By 30 months, 57.9% of the elderly ULMCA PCI population experienced death, myocardial infarction, or revascularization, and 42.7% died. Patients receiving drug-eluting stents (versus bare-metal stents) had a lower 30-month mortality (IPW HR: 0.84, 95% confidence interval [CI]: 0.73 to 0.96), but the composite of major adverse events were similar (IPW HR: 0.95, 95% CI: 0.84 to 1.06).
CONCLUSIONS:

In the United States, ULMCA PCI is performed in <5% of patients with ULMCA disease and is generally reserved for those at high procedural risk. Adverse events are common in elderly patients and are related to patient and procedural characteristics, including stent type.

[BMB]

Association of Proton Pump Inhibitor Use on Cardiovascular Outcomes With Clopidogrel and Ticagrelor : Insights From the Platelet Inhibition and Patient Outcomes Trial.
The clinical significance of the interaction between clopidogrel and proton pump inhibitors (PPIs) remains unclear.
Methods and Results—We examined the relationship between PPI use and 1-year cardiovascular events (cardiovascular death, myocardial infarction, or stroke) in patients with acute coronary syndrome randomized to clopidogrel or ticagrelor in a prespecified, nonrandomized subgroup analysis of the Platelet Inhibition and Patient Outcomes PLATO) trial. The primary end point rates were higher for individuals on a PPI (n
6539) compared with those not on a PPI (n
12 060) at randomization in both the clopidogrel (13.0% versus 10.9%; adjusted hazard ratio [HR], 1.20; 95% confidence interval [CI], 1.04 –1.38) and ticagrelor (11.0% versus 9.2%; HR, 1.24; 95% CI, 1.07–1.45) groups. Patients on non-PPI gastrointestinal drugs had similar primary end point rates compared with those on a PPI (PPI versus non-PPI gastrointestinal treatment: clopidogrel, HR, 0.98; 95% CI, 0.79 –1.23; ticagrelor, HR, 0.89; 95% CI, 0.73–1.10). In contrast, patients on no gastric therapy had a significantly lower primary end point rate (PPI versus no gastrointestinal treatment: clopidogrel, HR, 1.29; 95% CI, 1.12–1.49; ticagrelor, HR, 1.30; 95% CI, 1.14 –1.49). Conclusions—The use of a PPI was independently associated with a higher rate of cardiovascular events in patients with acute coronary syndrome receiving clopidogrel. However, a similar association was observed between cardiovascular events and PPI use during ticagrelor treatment and with other non-PPI gastrointestinal treatment. Therefore, in the PLATO trial, the association between PPI use and adverse events may be due to confounding, with PPI use more of a marker for, than a cause of, higher rates of cardiovascular events.
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[Nastydoc]

Therefore, in the PLATO trial, the association between PPI use and adverse events may be due to confounding, with PPI use more of a marker for, than a cause of, higher rates of cardiovascular events.

не могу разобраться в каком контексте воспринимать эту фразу и как она соотносится с выводами статьи?

[sense]

Применение ингибиторов протонной помпы является скорее не причиной, а маркером более высокого риска СС событий (как-то так)