This study evaluated the association between changes in serum levels of high- density lipoprotein(HDL) cholesterol that occur under bezafibrate therapy and cardiac mortality in patients with coronary heart disease(CHD...This study evaluated the association between changes in serum levels of high- density lipoprotein(HDL) cholesterol that occur under bezafibrate therapy and cardiac mortality in patients with coronary heart disease(CHD) who were enrolled in the Bezafibrate Infarction Prevention trial. We compared serum levels of HDL cholesterol in 1,509 patients in tertiles of on- treatment increments with those of 1,517 patients in the placebo group. Long- term follow- up showed that cardiac mortality decreased significantly with increasing tertiles of on- treatment change in HDL cholesterol(9.5% , 6.6% , and 6.3% of patients tertiles 1, 2, and 3, respectively, died of cardiac causes, p for trend=0.02). In multivariate analysis, the magnitude of on- treatment increment of HDL cholesterol was independently associated with a decreased risk of cardiac death(hazard ratio 1.05, 95% confidence interval 0.74 to 1.47, for tertile 1; hazard ratio 0.73, 95% confidence interval 0.50 to 1.07, for tertile 2; hazard ratio 0.65, 95% confidence interval 0.43 to 0.97, for tertile 3, compared with placebo- allocated patients, p for trend=0.02). Analyzing the association with change in HDL cholesterol as a continuous variable showed that the risk of cardiac mortality was decreased by 27% for every 5- mg/dl increase in on- treatment change in HDL cholesterol(p< 0.001). In conclusion, although a definite secondary prevention effect of bezafibrate could not be found when examining the intervention group as a whole, our findings are consistent with a possible independent association between an increase in HDL cholesterol with bezafibrate therapy and a decrease in cardiac mortality. In appropriately selected patients, monitoring short- term response to bezafibrate therapy through change in HDL cholesterol may indicate the potential long- term benefit of the drug.展开更多
Background: Transesophageal echocardiography(TEE) gui-ded cardioversion to restoration of sinus rhythm is a therapeutic option in patients with atrial fibrillation(AF). Anticoagulation at the time of and after cardiov...Background: Transesophageal echocardiography(TEE) gui-ded cardioversion to restoration of sinus rhythm is a therapeutic option in patients with atrial fibrillation(AF). Anticoagulation at the time of and after cardioversion is necessary to prevent formation of new thrombus during atrial stunning period. We aimed to evaluate the efficacy and safety to TEE guided cardioversion with low molecular weight heparin(LMWH)in patients with atrial fibrillation. Methods: We followed up 208 patients with persistent AF(mean age: 65.5±10.2 years) who were attempted TEE guided cardioversion. LMWH were used as an anticoagulant and warfarin therapy was continued. Results: Cardioversion were performed in 183 patients. Sinus rhythm restored in 144 patients(78.7%). Mean follow up duration was 155 days. No cardiac death occurred. In the early follow up period(within 30 day) one thromboembolic event(0.54%) occurred in a patient who was cardioverted. Two patients who had not been cardioverted because of left atrial thrombus presented embolic stroke, one in early and another in late followup period. All embolic complications occurred in patients who had been taking warfarin and whose INR level was subtherapeutic at the time of stroke. Sinus rhythm was maintained in 64%and total hemorrhagic complications occurred in 4.8%of the patients in long-term follow-up. Conclusion: TEE guided cardioversion with a short-term anticoagulation protocol using low molecular weight heparin is a safe and effective method in restoring and maintaining sinus rhythm and enables us to make earlier cardioversion in atrial fibrillation.展开更多
文摘This study evaluated the association between changes in serum levels of high- density lipoprotein(HDL) cholesterol that occur under bezafibrate therapy and cardiac mortality in patients with coronary heart disease(CHD) who were enrolled in the Bezafibrate Infarction Prevention trial. We compared serum levels of HDL cholesterol in 1,509 patients in tertiles of on- treatment increments with those of 1,517 patients in the placebo group. Long- term follow- up showed that cardiac mortality decreased significantly with increasing tertiles of on- treatment change in HDL cholesterol(9.5% , 6.6% , and 6.3% of patients tertiles 1, 2, and 3, respectively, died of cardiac causes, p for trend=0.02). In multivariate analysis, the magnitude of on- treatment increment of HDL cholesterol was independently associated with a decreased risk of cardiac death(hazard ratio 1.05, 95% confidence interval 0.74 to 1.47, for tertile 1; hazard ratio 0.73, 95% confidence interval 0.50 to 1.07, for tertile 2; hazard ratio 0.65, 95% confidence interval 0.43 to 0.97, for tertile 3, compared with placebo- allocated patients, p for trend=0.02). Analyzing the association with change in HDL cholesterol as a continuous variable showed that the risk of cardiac mortality was decreased by 27% for every 5- mg/dl increase in on- treatment change in HDL cholesterol(p< 0.001). In conclusion, although a definite secondary prevention effect of bezafibrate could not be found when examining the intervention group as a whole, our findings are consistent with a possible independent association between an increase in HDL cholesterol with bezafibrate therapy and a decrease in cardiac mortality. In appropriately selected patients, monitoring short- term response to bezafibrate therapy through change in HDL cholesterol may indicate the potential long- term benefit of the drug.
文摘阻塞性睡眠呼吸暂停（OSA）与致命、非致命性心血管事件的增加有关。对经皮冠状动脉介入治疗干预（PCI）后患者的OSA进行治疗，是否可改善预后，尚不清楚。美国的Andrew Cassar等比较了PCI后OSA患者有无治疗的结局，证实积极治疗OSA可减少心脏性死亡事件。研究结果发表在J Am Coll Cardiol上。
文摘Background: Transesophageal echocardiography(TEE) gui-ded cardioversion to restoration of sinus rhythm is a therapeutic option in patients with atrial fibrillation(AF). Anticoagulation at the time of and after cardioversion is necessary to prevent formation of new thrombus during atrial stunning period. We aimed to evaluate the efficacy and safety to TEE guided cardioversion with low molecular weight heparin(LMWH)in patients with atrial fibrillation. Methods: We followed up 208 patients with persistent AF(mean age: 65.5±10.2 years) who were attempted TEE guided cardioversion. LMWH were used as an anticoagulant and warfarin therapy was continued. Results: Cardioversion were performed in 183 patients. Sinus rhythm restored in 144 patients(78.7%). Mean follow up duration was 155 days. No cardiac death occurred. In the early follow up period(within 30 day) one thromboembolic event(0.54%) occurred in a patient who was cardioverted. Two patients who had not been cardioverted because of left atrial thrombus presented embolic stroke, one in early and another in late followup period. All embolic complications occurred in patients who had been taking warfarin and whose INR level was subtherapeutic at the time of stroke. Sinus rhythm was maintained in 64%and total hemorrhagic complications occurred in 4.8%of the patients in long-term follow-up. Conclusion: TEE guided cardioversion with a short-term anticoagulation protocol using low molecular weight heparin is a safe and effective method in restoring and maintaining sinus rhythm and enables us to make earlier cardioversion in atrial fibrillation.
