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Find video protocols related to scientific articles indexed in Pubmed.
Contrasting Cholesterol Management Guidelines for Adults with CKD.
J. Am. Soc. Nephrol.
PUBLISHED: 11-15-2014
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The Kidney Disease Improving Global Outcomes Lipid Work Group recommends statins for adults ?50 years old with CKD. The American College of Cardiology/American Heart Association endorses statins for adults with atherosclerotic cardiovascular disease, adults with LDL cholesterol?190 mg/dl, and adults 40-79 years old with LDL cholesterol=70-189 mg/dl and diabetes or a 10-year predicted risk for atherosclerotic cardiovascular disease ?7.5% estimated using the Pooled Cohort risk equations. Using data from the Reasons for Geographic and Racial Differences in Stroke Study, we calculated the agreement for statin treatment between these two guidelines for adults 50-79 years old with CKD (eGFR<60 ml/min per 1.73 m(2) or albuminuria?30 mg/g) not on dialysis. We assessed the validity of the Pooled Cohort risk equations in individuals with CKD. Study participants were enrolled between 2003 and 2007, and we report incident cardiovascular disease events (stroke and coronary heart disease) through December of 2010. Among 4726 participants with CKD, 2366 (50%) were taking statins, and 1984 (42%) were recommended statins by the American College of Cardiology/American Heart Association guideline but not taking them. Overall, 376 (8%) participants did not meet the American College of Cardiology/American Heart Association criteria for initiating statin treatment. Cardiovascular disease incidence was low (3.0/1000 person-years; 95% confidence interval, 0.1 to 5.9) among these participants. The Pooled Cohort risk equations were well calibrated (Hosmer-Lemeshow chi-squared=2.7, P=0.45) with moderately good discrimination (C index, 0.71; 95% confidence interval, 0.65 to 0.77). In conclusion, these guidelines show high concordance for statin treatment for adults with CKD.
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Liraglutide Reduces Oxidative Stress And Restores Heme Oxygenase-1 And Ghrelin Levels In Patients With Type 2 Diabetes: a prospective pilot study.
J. Clin. Endocrinol. Metab.
PUBLISHED: 11-14-2014
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Context: Liraglutide is a glucagon-like peptide-1 analog and glucose-lowering agent whose effects on cardiovascular risk markers have not been fully elucidated. Objective: We evaluated the impact of liraglutide on markers of oxidative stress, heme oxygenase-1 (HO-1), and plasma ghrelin levels in patients with type-2 diabetes (T2DM). Design and setting: A prospective pilot study of two months' duration performed at the Unit of Diabetes and Cardiovascular Prevention at University of Palermo, Italy. Patients and Intervention(s): 20 subjects with T2DM (10 men and 10 women, mean age: 57±13 years) were treated with liraglutide subcutaneously (0.6mg/daily for 2 weeks, followed by 1.2mg/daily) in addition to metformin (1500 mg/daily orally) for 2 months. Patients with liver disorders or renal failure were excluded. Main Outcome Measure(s): Plasma ghrelin concentrations, oxidative stress markers, and heat-shock proteins, including HO-1. Results: The addition of liraglutide resulted in a significant decrease in glycated hemoglobin (HbA1c) (8.5±0.4 vs. 7.5±0.4%, p<0.0001). In addition, plasma ghrelin and glutathione (GSH) concentrations increased (8.2±4.1 vs. 13.6±7.3 pg/ml, p=0.0007 and 0.36±0.06 vs. 0.44±0.07 nmol/ml, p=0.0002, respectively), while serum lipid hydroperoxides and HO-1 decreased (0.11±0.05 vs. 0.04±0.07 pg/ml, p=0.0487 and 7.7±7.7 vs. 3.6±1.8 pg/ml, p=0.0445, respectively). These changes were not correlated with changes in fasting glycemia or HbA1c. Conclusions: In a 2-months prospective pilot study, the addition of liraglutide to metformin resulted in improvement in oxidative stress as well as plasma ghrelin and HO-1 concentrations in patients with T2DM. These findings appeared to be independent of the known effects of liraglutide on glucose metabolism.
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Red blood cell transfusion is a determinant of neurological complications after cardiac surgery.
Interact Cardiovasc Thorac Surg
PUBLISHED: 11-05-2014
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The aim of this study was to evaluate the impact of red blood cell (RBC) transfusions on the occurrence of stroke and transient ischaemic attack (TIA) after cardiac surgery.
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Markers of increased cardiovascular risk in patients with chronic kidney disease.
Lipids Health Dis
PUBLISHED: 08-21-2014
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Epidemiological studies have shown that chronic kidney disease (CKD) is an important risk factor for atherosclerosis and cardiovascular disease (CAD). The aim of the study was to determine markers of increased risk of CAD and to achieve a better understanding of agents implicated in the process of atherosclerosis in CKD patients.
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Blood pressure and LDL-cholesterol targets for prevention of recurrent strokes and cognitive decline in the hypertensive patient: design of the European Society of Hypertension-Chinese Hypertension League Stroke in Hypertension Optimal Treatment randomized trial.
J. Hypertens.
PUBLISHED: 07-01-2014
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The SBP values to be achieved by antihypertensive therapy in order to maximize reduction of cardiovascular outcomes are unknown; neither is it clear whether in patients with a previous cardiovascular event, the optimal values are lower than in the low-to-moderate risk hypertensive patients, or a more cautious blood pressure (BP) reduction should be obtained. Because of the uncertainty whether 'the lower the better' or the 'J-curve' hypothesis is correct, the European Society of Hypertension and the Chinese Hypertension League have promoted a randomized trial comparing antihypertensive treatment strategies aiming at three different SBP targets in hypertensive patients with a recent stroke or transient ischaemic attack. As the optimal level of low-density lipoprotein cholesterol (LDL-C) level is also unknown in these patients, LDL-C-lowering has been included in the design.
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Blood pressure and low-density lipoprotein-cholesterol lowering for prevention of strokes and cognitive decline: a review of available trial evidence.
J. Hypertens.
PUBLISHED: 07-01-2014
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It is well established by a large number of randomized controlled trials that lowering blood pressure (BP) and low-density lipoprotein cholesterol (LDL-C) by drugs are powerful means to reduce stroke incidence, but the optimal BP and LDL-C levels to be achieved are largely uncertain. Concerning BP targets, two hypotheses are being confronted: first, the lower the BP, the better the treatment outcome, and second, the hypothesis that too low BP values are accompanied by a lower benefit and even higher risk. It is also unknown whether BP lowering and LDL-C lowering have additive beneficial effects for the primary and secondary prevention of stroke, and whether these treatments can prevent cognitive decline after stroke.
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Proprotein Convertase Subtilisin/Kexin 9 Inhibitors: An Emerging Lipid-Lowering Therapy?
J. Cardiovasc. Pharmacol. Ther.
PUBLISHED: 06-19-2014
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Proprotein convertase subtilisin/kexin 9 (PCSK9) is part of the proteinase K subfamily of subtilases and plays a key role in lipid metabolism. It increases degradation of the low-density lipoprotein receptor (LDL-R), modulates cholesterol metabolism and transport, and contributes to the production of apolipoprotein B (apoB) in intestinal cells. Exogenous PCSK9 modifies the activity of 3-hydroxy-3-methylglutaryl-coenzyme A reductase and acyl coenzyme A:cholesterol acyltransferase and enhances secretion of chylomicrons by modulating production of lipids and apoB-48. Statins increase PCSK9 messenger RNA expression and attenuate the capacity to increase LDL-R levels. Therefore, the inhibition of PCSK9 in combination with statins provides a promising approach for lowering low-density lipoprotein cholesterol (LDL-C) concentrations. This review will address new therapeutic strategies targeting PCSK9, including monoclonal antibodies, antisense oligonucleotides, small interfering RNAs, and other small molecule inhibitors. Further studies are still needed to determine the efficacy and safety of the PCSK9 inhibitors not only to decrease LDL-C but also to investigate the potential underlying mechanisms involved and to test whether these compounds actually reduce cardiovascular end points and mortality.
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Association of systolic blood pressure levels with cardiovascular events and all-cause mortality among older adults taking antihypertensive medication.
Int. J. Cardiol.
PUBLISHED: 06-07-2014
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The aim of the study was to identify the association of systolic blood pressure (SBP) levels with cardiovascular events, all-cause mortality, and falls among elderly persons taking antihypertensive medication.
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Defining the role of trimetazidine in the treatment of cardiovascular disorders: some insights on its role in heart failure and peripheral artery disease.
Drugs
PUBLISHED: 06-07-2014
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Trimetazidine is a cytoprotective drug whose cardiovascular effectiveness, especially in patients with stable ischemic heart disease, has been the source of much controversy in recent years; some have gone so far as to treat the medication as a 'placebo drug' whose new side effects, such as Parkinsonian symptoms, outweigh its benefits. This article is an attempt to present the recent key studies, including meta-analyses, on the use of trimetazidine in chronic heart failure, also in patients with diabetes mellitus and arrhythmia, as well as in peripheral artery disease. This paper also includes the most recent European Society of Cardiology guidelines, including those of 2013, on the use of trimetazidine in cardiovascular disease.
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Emerging therapies for raising high-density lipoprotein cholesterol (HDL-C) and augmenting HDL particle functionality.
Best Pract. Res. Clin. Endocrinol. Metab.
PUBLISHED: 05-21-2014
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High-density lipoprotein (HDL) particles are highly complex polymolecular aggregates capable of performing a remarkable range of atheroprotective functions. Considerable research is being performed throughout the world to develop novel pharmacologic approaches to: (1) promote apoprotein A-I and HDL particle biosynthesis; (2) augment capacity for reverse cholesterol transport so as to reduce risk for the development and progression of atherosclerotic disease; and (3) modulate the functionality of HDL particles in order to increase their capacity to antagonize oxidation, inflammation, thrombosis, endothelial dysfunction, insulin resistance, and other processes that participate in arterial wall injury. HDL metabolism and the molecular constitution of HDL particles are highly complex and can change in response to both acute and chronic alterations in the metabolic milieu. To date, some of these interventions have been shown to positively impact rates of coronary artery disease progression. However, none of them have as yet been shown to significantly reduce risk for cardiovascular events. In the next 3-5 years a variety of pharmacologic interventions for modulating HDL metabolism and functionality will be tested in large, randomized, prospective outcomes trials. It is hoped that one or more of these therapeutic approaches will result in the ability to further reduce risk for cardiovascular events once low-density lipoprotein cholesterol and non-HDL-cholesterol targets have been attained.
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Should low high-density lipoprotein cholesterol (HDL-C) be treated?
Best Pract. Res. Clin. Endocrinol. Metab.
PUBLISHED: 05-21-2014
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The first observations linking a low serum level of HDL-C to increased risk for cardiovascular disease were made over 50 years ago. High serum levels of HDL-C appear to protect against the development of atherosclerotic disease, while low serum levels of this lipoprotein are among the most important predictors of atherosclerotic disease in both men and women and people of all racial and ethnic groups throughout the world. It has long been assumed that therapeutic interventions targeted at raising HDL-C levels would lower risk for such cardiovascular events as myocardial infarction, ischemic stroke, and death. Even after five decades of intensive investigation, evidence to support this assumption has been fleeting. A number of post hoc analyses of randomized controlled trials and meta-analyses suggest that HDL-C raising, particularly when coupled with aggressive LDL-C reduction, impacts risk for cardiovascular events and rates of progression of atherosclerotic disease. Unfortunately, four recent prospective trials performed with the intent of testing the "HDL hypothesis" (ILLUMINATE, dal-OUTCOMES, AIM-HIGH, and HPS2-THRIVE) failed to meet their primary composite endpoints. These results have lead many clinicians and investigators to question the validity of the assumption that HDL-C raising reduces risk for cardiovascular events. Additional trials with other drugs are underway. In the meantime, HDL-C cannot be considered a target of therapy. Given the complexity of the HDL proteome and lipidome, there is biological plausibility for how HDL particles might exert atheroprotection. We explore the evidence supporting the inverse relationship between HDL-C and cardiovascular disease risk, documented mechanisms by which HDL particles may exert atheroprotection, and the findings either supporting or negating specific therapeutic interventions in patients afflicted with low HDL-C.
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Bedside tool for predicting the risk of postoperative atrial fibrillation after cardiac surgery: the POAF score.
J Am Heart Assoc
PUBLISHED: 03-26-2014
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Atrial fibrillation (AF) remains the most common complication after cardiac surgery. The present study aim was to derive an effective bedside tool to predict postoperative AF and its related complications.
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Less but better: cardioprotective lipid profile of patients with GCK-MODY despite lower HDL cholesterol level.
Acta Diabetol
PUBLISHED: 01-29-2014
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Patients with diabetes caused by single-gene mutations generally exhibit an altered course of diabetes. Those with mutations of the glucokinase gene (GCK-MODY) show good metabolic control and low risk of cardiovascular complications despite paradoxically lowered high-density lipoprotein (HDL) cholesterol levels. In order to investigate the matter, we analyzed the composition of low-density lipoprotein (LDL) and HDL subpopulations in such individuals. The LipoPrint(©) system (Quantimetrix, USA) based on non-denaturing, linear polyacrylamide gel electrophoresis was used to separate and measure LDL and HDL subclasses in fresh-frozen serum samples from patients with mutations of glucokinase or HNF1A, type 1 diabetes (T1DM) and healthy controls. Fresh serum samples from a total of 37 monogenic diabetes patients (21 from GCK-MODY and 16 from HNF1A-MODY), 22 T1DM patients and 15 healthy individuals were measured in this study. Concentrations of the small, highly atherogenic LDL subpopulation were similar among the compared groups. Large HDL percentage was significantly higher in GCK-MODY than in control (p = 0.0003), T1DM (p = 0.0006) and HNF1A-MODY groups (p = 0.0246). Patients with GCK-MODY were characterized by significantly lower intermediate HDL levels than controls (p = 0.0003) and T1DM (p = 0.0005). Small, potentially atherogenic HDL content differed significantly with the GCK-MODY group showing concentrations of that subfraction from control (p = 0.0096), T1DM (p = 0.0193) and HNF1A-MODY (p = 0.0057) groups. Within-group heterogeneity suggested the existence of potential gene-gene or gene-environment interactions. GCK-MODY is characterized by a strongly protective profile of HDL cholesterol subpopulations. A degree of heterogeneity within the groups suggests the existence of interactions with other genetic or clinical factors.
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Lipid, blood pressure and kidney update 2013.
Int Urol Nephrol
PUBLISHED: 01-28-2014
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The year 2013 proved to be very exciting as far as landmark trials and new guidelines in the field of lipid disorders, blood pressure and kidney diseases. Among these are the International Atherosclerosis Society Global Recommendations for the Management of Dyslipidemia, European Society of Cardiology (ESC)/European Society of Hypertension Guidelines for the Management of Arterial Hypertension, American Diabetes Association Clinical Practice Recommendations, the Kidney Disease: Improving Global Outcomes Clinical Practice Guidelines for Managing Dyslipidemias in Chronic Kidney Disease (CKD) Patients, the American College of Cardiology/American Heart Association Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults, the Joint National Committee Expert Panel (JNC 8) Evidence-Based Guideline for the Management of High Blood Pressure in Adults, the American Society of Hypertension/International Society of Hypertension Clinical Practice Guidelines for the Management of Hypertension in the Community, the American College of Physicians Clinical Practice Guideline on Screening, Monitoring, and Treatment of Stage 1-3 CKD and many important trials presented among others during the ESC Annual Congress in Amsterdam and the American Society of Nephrology Annual Meeting--Kidney Week in Atlanta, GA. The paper is an attempt to summarize the most important events and reports in the mentioned areas in the passing year.
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Obesity indices and inflammatory markers in obese non-diabetic normo- and hypertensive patients: a comparative pilot study.
Lipids Health Dis
PUBLISHED: 01-23-2014
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The aim of this study was to estimate associations between inflammatory markers and obesity indices in normo- and hypertensive subjects.
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The effect of timing of cardiac catheterization on acute kidney injury after cardiac surgery is influenced by the type of operation.
Int. J. Cardiol.
PUBLISHED: 01-06-2014
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Acute kidney injury (AKI) is a vexing complication of cardiac surgery. Since exposure to contrast agents is a relevant contributing factor in the development of postoperative AKI, the optimal timing between cardiac catheterization and surgery is decisive.
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Management of familial hypercholesterolemia in children and adolescents. Position paper of the Polish Lipid Expert Forum.
J Clin Lipidol
PUBLISHED: 01-03-2014
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Familial hypercholesterolemia (FH) affects on average 1 in 500 individuals in European countries, and it is estimated that FH in Poland may affect more than 80,000 people. However, in Poland, only about 20% of the population is estimated to have been diagnosed with FH, of which only a small number receive adequate treatment. FH results in more rapid development of atherosclerosis and is associated with a high risk of cardiovascular events. Atherosclerosis develops beginning in childhood in patients with FH and reaches advanced stages before clinical manifestations develop. Inadequate diagnostics and treatment of FH in Polish children suggests a need for raising the level of awareness and understanding of the condition in both society and among health professionals. These recommendations present the current epidemiological status, guidelines for diagnosing FH in Polish children and adolescents, and effective treatment options.
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Rationale of statin therapy in septic patients.
Curr Vasc Pharmacol
PUBLISHED: 12-18-2013
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Statins are well-established and effective drugs in the treatment of hyperlipidemias. However the effects of statins extend beyond lipid-lowering. The pleiotropic effects of statins have been shown to modify inflammatory cell signaling of the immune response to infection. Statins have emerged as potential immunomodulatory and antioxidant agents that might impact on sepsis outcomes. It was postulated that statins may be candidates for the treatment of sepsis. Recent animal and human data suggest that statin therapy might be beneficial in patients before the onset of sepsis or in its initial period, but should be used with care when patients are diagnosed with severe sepsis or septic shock. Some analyses also provide evidence for statins as an adjuvant therapy in sepsis. Because of the divergent results of studies, the potential benefit needs to be validated in randomized, controlled trials. In this review, we describe current evidence on the use of statins in the prevention and treatment of sepsis.
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Acute coronary syndromes in patients with chronic kidney disease.
Curr Vasc Pharmacol
PUBLISHED: 12-18-2013
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Chronic kidney disease (CKD) is associated with high cardiovascular morbidity and mortality. The available data suggest that efforts to reduce mortality in the CKD population should be focused on treatment and prevention of, among others, coronary artery disease and congestive heart failure. Accelerated atherosclerosis present in CKD patients also leads to a decline in renal function. Definite data concerning the treatment of heart failure in CKD patients are lacking, because patients with significant renal impairment have mostly been excluded from randomized studies. Nevertheless, it seems that CKD patients should receive similar cardiovascular treatment to that used in patients with normal kidney function, but the doses of drugs ought to be titrated to achieve an optimal effect while avoiding adverse events. Several studies have also shown that despite the high risk, in patients with acute coronary syndrome (ACS), revascularization procedures in patients with CKD appear to be advantageous in the long run and are therefore justified. However, large clinical trials are needed to confirm the benefits and to identify possible disadvantages associated with various methods of treatment.
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Obesity indices and adipokines in non-diabetic obese patients with early stages of chronic kidney disease.
Med. Sci. Monit.
PUBLISHED: 11-28-2013
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Background The aim of this study was to estimate obesity parameters: waist circumference (WC), waist-to-hip ratio (WHR), weight-to-height ratio (WHtR), visceral adiposity index (VAI), body adiposity index (BAI), and serum adipokines (leptin, adiponectin, resistin) and their associations with estimated glomerular filtration rate (eGFR), serum creatinine, and microalbuminuria (MA) in patients with early stages of CKD and in non-CKD obese patients. Material and Methods 67 non-diabetic obese (BMI ?30 mg/kg2) out-clinic patients (25 males, 42 females), aged from 36.5 to 64 years were divided into 2 groups: Group A (n=15) - patients with early stages of CKD (eGFR between 30 and 60 ml/min/1.73 m2 or with MA >20 mg/l in morning urine sample independently from GFR) and Group B - patients without chronic CKD (n=52). Results In Group A compared to Group B, BAI and leptin were higher (42.2±7.1 vs. 37.5±7.0; p<0.05 and 51.8±26.7 ng/mL vs. 35.3±24.9 ng/mL; p<0.05; respectively) and negative correlations occurred between eGFR and BAI (r=-0.709; p=0.003), leptin (r=-0.68; p=0.005), and resistin (r=-0.528; p<0.05). In Group B, negative correlations occurred between creatinine and VAI (r=-0.332; p<0.05), BAI (r=-0.619; p<0.0001), leptin (r=-0.676; p<0.0001), and adiponectin (r=-0.423; p=0.002), and between eGFR and resistin (r=-0.276; p<0.05). Conclusions BAI may be a valuable obesity parameter as a predictor of early stages of CKD in patients with obesity. Leptin may be an important pathogenic factor in obese patients with early stages of CKD. Resistin is associated with eGFR in obese patients, independently of CKD.
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Effect of methoxy polyethylene glycol-epoetin beta on oxidative stress in predialysis patients with chronic kidney disease.
Med. Sci. Monit.
PUBLISHED: 11-09-2013
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There is data in the literature indicating increased oxidative stress in chronic kidney disease (CKD). Erythropoiesisstimulating agents (ESAs), which are commonly used to treat anemia in patients with CKD, seem to have an antioxidant action, which could be a part of nephroprotection. The aim of the current study was to investigate the effect of a long half-life ESA, methoxy polyethylene glycol-epoetin beta (Mircera), on some markers of oxidative stress in predialysis patients with CKD.
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Blood Pressure Levels and Stroke: J-curve Phenomenon?
Curr. Hypertens. Rep.
PUBLISHED: 10-26-2013
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The blood pressure J-curve discussion has been ongoing for more than 30 years, yet there are still questions in need of definitive answers. On one hand, existing antihypertensive therapy studies provide strong evidence for J-curve-shaped relationships between both diastolic and systolic blood pressure and primary outcomes in the general hypertensive patient population, as well as in high-risk populations, including subjects with coronary artery disease, diabetes mellitus, left ventricular hypertrophy, and the elderly. On the other hand, we have very limited data on the relationship between systolic and diastolic blood pressure and stroke prevention. Moreover, it seems that this outcome is more a case of "the lower the better." Further large, well-designed studies are necessary in order to clarify this issue, especially as existing available studies are observational, and randomized trials either did not have or lost statistical power and were thus inconclusive.
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Effect of Atorvastatin on Low-Density Lipoprotein Subpopulations and Comparison Between Indicators of Plasma Atherogenicity: A Pilot Study.
Angiology
PUBLISHED: 10-24-2013
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Treatment with statins to achieve target low-density lipoprotein cholesterol (LDL-C) levels is still associated with residual risk. Lipoprotein subfraction evaluation can provide additional information regarding atherogenicity in these individuals. Patients (n = 40) with hypercholesterolemia (29 females, mean age 63 years), without previous hypolipemic treatment, were treated with atorvastatin 40 mg/d for 3 months. Atorvastatin significantly reduced total cholesterol (6.7 ± 1.0 vs 4.6 ± 1.3 mmol/L, P < .001), LDL-C (4.3 ± 1.0 vs 2.6 ± 0.9 mmol/L, P < .001), triglycerides (1.8 ± 0.9 vs 1.5 ± 1.00 mmol/L, P < .05), small-dense LDL (sdLDL) fraction 3 to 7 (0.22 ± 0.37 vs 0.09 ± 0.16 mmol/L, P < .001), and apolipoprotein B (apoB; 1.0 ± 0.2 vs 0.74 ± 0.2 g/L, P < .001). There was a negative correlation of atherogenic index of plasma (AIP) with buoyant LDL-1 and LDL-2 (r = -.35; P < .05) and positive with sdLDL-3 to sdLDL-7 (r = .52, P < .001). Administration of atorvastatin 40 mg/d in patients with hypercholesterolemia caused a shift in sdLDL subfractions to large, buoyant subfractions. The AIP better correlated with sdLDL than apoB levels.
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Heart remodeling induced by adjuvant trastuzumab-containing chemotherapy for breast cancer overexpressing human epidermal growth factor receptor type 2: A prospective study.
Pharmacol. Res.
PUBLISHED: 10-05-2013
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We aimed to investigate the cardiac changes in patients with human epidermal growth factor receptor 2 (HER2)-positive breast cancer treated with trastuzumab in an adjuvant setting. Two hundred and fifty-three women with HER2-positive breast cancer were included. The assessment of cardiovascular system and echocardiography were performed and compared at baseline, at the termination of trastuzumab therapy and 6 months latter. Left heart remodeling was defined arbitrary as the change in at least one of the analyzed echocardiographic parameters of ?standard deviation (SD) (in model I) or ?2×SD (in model II) after 6-month follow-up. After 6-month follow-up 39 (31.7%), 27 (22%), 14 (11.4%), 10 (8.1%), 5 (4.1%) and 1 (0.8%), women had at least one parameter with a change exceeding mean difference ?SD, respectively; and 30 (24.4%), 9 (7.5%), 3 (2.4%), 2 (1.6%) 1 (0.8%) exceeding mean difference ?2SD. In stepwise multivariate regression analysis sedentary life style (OR16.7, p=0.003), positive cardiovascular family history (OR 6,9; p=0.013) and left ventricular ejection fraction change after 3 months (OR 1.2; p=0.007) were independent predictors of left heart remodeling in model I, whereas hypertension (OR 5.6; p=0.06) and positive cardiovascular family history (OR 3.9; p=0.032) were independent predictors of heart remodeling in model II. In conclusion, trastuzumab induces LV and left atrial cavity dilatation together with LV systolic function impairment.
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Medication management of chronic heart failure in older adults.
Drugs Aging
PUBLISHED: 08-06-2013
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Heart failure (HF) is a common problem in older adults. Individuals aged 65 years or older are at a higher risk for developing HF, especially diastolic HF or HF with preserved ejection fraction (HFpEF). HF can be seen in up to 20 % of adults aged 85 years or older. In contrast to middle-aged (40-64 years) HF patients, multiple cardiac, non-cardiac and geriatric syndrome co-morbidities are seen in elderly HF patients. Additionally, age-related changes in pharmacokinetics and pharmacodynamics influence medication therapy. Hence, the management of older patients with HF is challenging and treatment should be modified in the light of the above-mentioned conditions. This article discusses the current evidence for medication management in both systolic HF or HF with reduced ejection fraction (HFrEF) and HFpEF, noting, however, the limited data for HFpEF and HFrEF in those 80 years of age or older. The objective of this article is to discuss evidence-based and outcomes-driven pharmacologic management strategies for chronic HF in the older adults for whom functional and other patient-centered outcomes might be more than or as important as clinical outcomes. Optimal management would be expected to help to reduce illness burden, reduce mortality and hospitalizations, and improve function and quality of life.
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A meta-analysis of the role of statins on renal outcomes in patients with chronic kidney disease. Is the duration of therapy important?
Int. J. Cardiol.
PUBLISHED: 07-10-2013
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The efficacy of statin treatment in chronic kidney disease (CKD) patients remains controversial. Therefore, we performed a meta-analysis to investigate whether statins modulate renal function in patients with CKD.
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The Knowledge and Awareness of Hypertension Among Patients With Hypertension in Central Poland: A Pilot Registry.
Angiology
PUBLISHED: 05-06-2013
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We assessed the differences in the knowledge and level of awareness of hypertension among patients with hypertension from Central Poland; 248 (57.6% females) patients diagnosed with hypertension completed a questionnaire. Most (79%) of the patients were unaware of the optimal blood pressure (BP) range. The elderly patients did not know the symptoms of hypertension (23.7%), were not willing to make lifestyle changes (57%-65%), and had a poor awareness of hypertension therapy in the absence of symptoms (28.7%). Poor BP control occurred mainly in rural residents (10.7%) and in people with higher education (39.3%). Untreated patients with hypertension did not know the symptoms of hypertension (29.2%), rarely measured BP (37.5%), but were more likely to engage in regular physical activity (70.8%). Efforts should be made to improve knowledge of hypertension, especially among the rural population, the elderly patients, those with a low-education level, and in young males who had the highest BP.
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New Obesity Indices and Adipokines in Normotensive Patients and Patients With Hypertension: Comparative Pilot Analysis.
Angiology
PUBLISHED: 05-01-2013
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We compared the obesity parameters and selected adipokines-leptin, adiponectin, and resistin-in obese patients with hypertension and normotensive patients. A total of 67 nondiabetic obese outpatients were divided into 2 groups: A-hypertensive and B-normotensive. Serum levels of leptin, adiponectin, resistin, and insulin were measured. Weight, height, waist circumference, and hip circumference were measured to calculate waist-to-hip ratio (WHR), weight-to-height ratio, visceral adiposity index, and body adiposity index (BAI). Among patients with hypertension, significant positive correlations were observed between leptin and body mass index and BAI (r = .31 and r = .63, respectively). In normotensive patients, leptin positively correlated with BAI (r = .73, P < .01) and negatively with WHR (r = -.55, P < .0001); adiponectin negatively correlated with WHR (r = .38, P < .01) and BAI (r = .52; P < .0001), and resistin negatively correlated with WHR (r = -.36, P < .05). In conclusion, visceral obesity and leptin are associated with hypertension in obese patients.
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The influence of atorvastatin on parameters of inflammation left ventricular function, hospitalizations and mortality in patients with dilated cardiomyopathy -- 5-year follow-up.
Lipids Health Dis
PUBLISHED: 03-23-2013
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BACKGROUND: We assessed the influence of atorvastatin on selected indicators of an inflammatory condition, left ventricular function, hospitalizations and mortality in patients with dilated cardiomyopathy (DCM). METHODS: We included 68 DCM patients with left ventricular ejection fraction (LVEF) <=40% treated optimally in a prospective, randomized study. They were observed for 5 years. Patients were divided into two groups: patients who were commenced on atorvastatin 40 mg daily for two months followed by an individually matched dose of 10 or 20 mg/day (group A), and patients who were treated according to current recommendations without statin therapy (group B). RESULTS: After 5-year follow-up we assessed 45 patients of mean age 59 +/- 11 years - 22 patients in group A (77% male) and 23 patients in group B (82% male). Interleukin-6, tumor necrosis factor alpha, and uric acid concentrations were significantly lower in the statin group than in group B (14.96 +/- 4.76 vs. 19.02 +/- 3.94 pg/ml, p = 0.012; 19.10 +/- 6.39 vs. 27.53 +/- 7.39 pg/ml, p = 0.001, and 5.28 +/- 0.48 vs. 6.53 +/- 0.46 mg/dl, p = 0.001, respectively). In patients on statin therapy a reduction of N-terminal pro-brain natriuretic peptide concentration (from 1425.28 +/- 1264.48 to 1098.01 +/- 1483.86 pg/ml, p = 0.045), decrease in left ventricular diastolic (from 7.15 +/- 0.90 to 6.67 +/- 0.88 cm, p = 0.001) and systolic diameters (from 5.87 +/- 0.92 to 5.17 +/- 0.97, p = 0.001) in comparison to initial values were observed. We also showed the significant increase of LVEF in patients after statin therapy (from 32.0 +/- 6.4 to 38.8 +/- 8.8%, p = 0.016). Based on a comparison of curves using the log-rank test, the probability of survival to 5 years was significantly higher in patients receiving statins (p = 0.005). CONCLUSIONS: Atorvastatin in a small dose significantly reduce levels of inflammatory cytokines and uric acid, improve hemodynamic parameters and improve 5-year survival in patients with DCM.
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Highlights of mechanistic and therapeutic cachexia and sarcopenia research 2010 to 2012 and their relevance for cardiology.
Arch Med Sci
PUBLISHED: 03-22-2013
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Sarcopenia and cachexia are significant medical problems with a high disease-related burden in cardiovascular illness. Muscle wasting and weight loss are very frequent particularly in chronic heart failure and they relate to poor prognosis. Although clinically largely underestimated, the fields of cachexia and sarcopenia are of great relevance to cardiologists. In cachexia and sarcopenia a significant number of research publications related to basic science questions of muscle wasting and lipolysis were published between 2010 and 2012. Recently, the two processes of muscle wasting and lipolysis were found to be closely linked. Treatment research in pre-clinical models involves studies on a number of different therapeutic entities, including ghrelin, selective androgen receptor modulators (SARMs), as well as drugs targeting myostatin or melanocortin-4. In the human setting, studies using enobosarm (a SARM) and anamorelin (ghrelin) are in phase III. The last 3 years have seen significant efforts to define the field using consensus statements. In the future, these definitions should also be considered for guidelines and treatment trials in cardiovascular medicine. The current review aims to summarize important information and development in the fields of muscle wasting, sarcopenia and cachexia, focusing on findings in cardiovascular research, in order for cardiologists to have a better understanding of the progress in this still insufficiently known field.
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Effects of statins on lipid profile in chronic kidney disease patients: a meta-analysis of randomized controlled trials.
Curr Med Res Opin
PUBLISHED: 03-11-2013
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The available data on statin effects in chronic kidney disease (CKD) patients are still conflicting. We investigated the impact of short- and long-term statin therapy on lipid profiles in CKD patients requiring or not requiring dialysis.
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Statins decrease all-cause mortality only in CKD patients not requiring dialysis therapy--a meta-analysis of 11 randomized controlled trials involving 21,295 participants.
Pharmacol. Res.
PUBLISHED: 03-07-2013
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The available studies have reported the benefits of statins on all-cause and cardiovascular mortality in chronic kidney disease (CKD) patients. However studies in end-stage renal disease patients on dialysis yielded conflicting results. Therefore, we performed a meta-analysis and provide the most reliable trial data to date on the impact of statin therapy on cardiovascular events and death from all causes in CKD patients. Data from PubMed, Web of Science, Cochrane Library, and Scopus for the years 1966 to October 2012 were searched. The final meta-analysis included 11 randomized controlled trials involving 21,295 participants with CKD. Among them 6857 were on dialysis. The use of statins in subjects with non-dialysis-dependent CKD resulted in a marked reduction in death from all causes (relative risk [RR]: 0.66; 95% confidence interval [CI]: 0.55-0.79; p<0.0001), cardiac causes (RR: 0.69; 95%CI: 0.55-0.68; p=0.0012), cardiovascular events (RR: 0.55; 95%CI: 0.4-0.75; p=0.0001) and stroke (RR: 0.66; 95%CI: 0.5-0.88; p=0.0022). The use of statins in dialysis-dependent CKD patients resulted in a non-significant effect on death from all causes (RR: 0.99; 95%CI: 0.88-1.11; p=0.85) and stroke (RR: 1.31; 95%CI: 0.9-1.89; p>0.05), but had the effect of reducing death from cardiac causes (RR: 0.79; 95%CI: 0.64-0.98; p<0.05) and cardiovascular events (RR: 0.81; 95%CI: 0.7-0.94; p<0.05). In conclusion, the use of statins should be indicated in cardiovascular disease prevention especially in patients with non-dialysis-dependent CKD. According to the very limited data the obtained results suggest caution in expecting a reduction in cardiovascular events in patients on dialysis.
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The effects of statins on blood pressure in normotensive or hypertensive subjects--a meta-analysis of randomized controlled trials.
Int. J. Cardiol.
PUBLISHED: 02-26-2013
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The aim of this meta-analysis was to investigate whether statin therapy is associated with blood pressure (BP)-lowering in patients with or without hypertension.
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The risk of atherosclerosis in patients with chronic kidney disease.
Int Urol Nephrol
PUBLISHED: 02-19-2013
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Chronic kidney disease (CKD) is becoming a serious health problem; the number of people with impaired renal function is rapidly rising, especially in industrialized countries. A major complication of CKD is cardiovascular disease. Accelerated atherosclerosis has been observed in early stages of renal dysfunction. The purpose of this study was to examine the relationship between the degree of renal insufficiency and both the prevalence and intensity of coronary artery disease (assessed on the basis of number of vessels with stenosis).
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Prevention of heart failure in older adults may require higher levels of physical activity than needed for other cardiovascular events.
Int. J. Cardiol.
PUBLISHED: 02-04-2013
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Little is known if the levels of physical activity required for the prevention of incident heart failure (HF) and other cardiovascular events vary in community-dwelling older adults.
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Management of familial heterozygous hypercholesterolemia: Position Paper of the Polish Lipid Expert Forum.
J Clin Lipidol
PUBLISHED: 01-28-2013
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Heterozygous familial hypercholesterolemia (HFH) affects on average 1 in 500 individuals in European countries, and it is estimated that HeFH in Poland may affect more than 80,000 people. Cardiovascular mortality in individuals with FH between 20 and 39 years of age is 100 times higher than in the general population. HFH is a relatively common lipid disorder, but usually still remaining undiagnosed and untreated. A very high risk of cardiovascular diseases and a shortened lifespan in patients with this condition require early diagnosis and intensive treatment. The aim of the position paper was to present the importance and scale of this problem in Poland, which has not been raised enough so far, as well as the recommendations of diagnosis, treatment and prevention methods.
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Heart failure biomarkers in patients with dilated cardiomyopathy.
Int. J. Cardiol.
PUBLISHED: 01-20-2013
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We set out to evaluate the utility of selected heart failure (HF) biomarkers in patients with dilated cardiomyopathy (DCM).
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Rate-control versus rhythm-control strategies and outcomes in septuagenarians with atrial fibrillation.
Am. J. Med.
PUBLISHED: 01-19-2013
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The prevalence of atrial fibrillation substantially increases after 70 years of age. However, the effect of rate-control versus rhythm-control strategies on outcomes in these patients remains unclear.
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The role of fibrate treatment in dyslipidemia: an overview.
Curr. Pharm. Des.
PUBLISHED: 01-08-2013
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Dyslipidemia, and especially atherogenic dyslipidemia, a combination of small low-density lipoproteins cholesterol (LDL-C), decreased high-density lipoprotein cholesterol (HDL-C) and increased triglyceride (TG) concentrations, represents a major cardiovascular (CV) risk factor. Nuclear receptor peroxisome proliferator-activated receptors (PPARs) are involved in the regulation of lipid metabolism; PPAR ligands are used to treat dyslipidemias. Fibrates have a major impact on TG metabolism as well as on modulating LDL size and subclasses. Fibrates target atherogenic dyslipidemia by increasing plasma HDL-C concentrations and decreasing small dense LDL (sdLDL) particles and TGs, thus contributing to dyslipidemia management, particularly in patients with diabetes (DM) or the metabolic syndrome (MetS). Furthermore, fibrates exert beneficial effects on adipokines, inflammation and oxidative stress as well as neuroprotective properties. However, further studies are needed to define the role of fibrates in the prevention of CV events. We review the effects of fibrates on atherogenic dyslipidemia and CV risk reduction.
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Combined dyslipidemia: should the focus be LDL cholesterol or atherogenic dyslipidemia?
Curr. Pharm. Des.
PUBLISHED: 01-05-2013
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As the population becomes more obese and the prevalence of diabetes and the metabolic syndrome increases, low-density lipoprotein-cholesterol (LDL-C) may lose its value as a sole predictor for cardiovascular risk among lipids. Combined dyslipidemia is typically characterized by elevations in LDL-C and triglyceride levels, often accompanied by decreased high-density lipoproteincholesterol (HDL-C) concentrations and increased levels of small, dense LDL. This common disorder results from overproduction of hepatically synthesized apolipoprotein B in very low-density lipoproteins. In the last few years most of the international scientific guidelines as well as several expert panels have confirmed that LDL-C represents the primary or even the only target of treatment. Yet, increasing evidence suggests moving away from a LDL-C target-based approach to a more tailored treatment approach. For example, non- HDL-C has been introduced in the last few years as a target of treatment.
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PCSK9 inhibition - a novel mechanism to treat lipid disorders?
Curr. Pharm. Des.
PUBLISHED: 01-05-2013
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Plasma low-density lipoprotein cholesterol (LDL-C) is one of the biomarkers of cardiovascular disease (CVD) risk. LDL is cleared from the circulation preferentially through the LDL receptor (LDLR) pathway. Proprotein convertase subtilisin/kexin 9 (PCSK9) promotes the degradation of the LDLR. PCSK9 inhibition is attractive as a new strategy for lowering LDL-C levels, especially in combination with lipid lowering drugs such as statins. We review data from the available studies which focus on PCSK9 as a potential target in the treatment of hyperlipidemia. Further studies are still necessary to investigate the potential underlying mechanisms involved.
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Anticoagulant prevention in patients with atrial fibrillation: alternatives to vitamin K antagonists.
Curr. Pharm. Des.
PUBLISHED: 01-05-2013
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Patients with nonvalvular atrial fibrillation (AF) and risk factors for stroke need anticoagulation to avoid thromboembolic complications. Vitamin K antagonists (VKAs) are an established pharmacological group the use of which is recommended by guidelines. However, VKAs (like warfarin) have major disadvantages, such as a variable dose-effect relationship, drug and food interactions, the need for regular blood testing and dose titration, and, finally, a substantial risk of bleeding. New oral anticoagulants are intended to replace warfarin, being at least as safe and effective, and lacking some of the disadvantages of VKAs. Clinical data for dabigatran, rivaroxaban, apixaban and edoxaban, and other new drugs, are discussed in this article with special focus on their use in nonvalvular AF.
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Statin therapy and new-onset diabetes: molecular mechanisms and clinical relevance.
Curr. Pharm. Des.
PUBLISHED: 01-03-2013
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Despite positive effects on the plasma lipid profile and vascular events, statin use is associated with various side effects. Among these, statins might cause a disruption of a number of regulatory pathways including insulin signaling. This may affect insulin sensitivity, pancreatic beta-cell function and adipokine secretion. The statin-associated risk of new-onset diabetes (NOD) appears to be a dose-dependent class effect. It still remains unclear whether statin treatment is associated with increased risk of NOD in the general population or if there are groups of individuals at particular risk. However, according to the available data it seems that cardiovascular (CV) benefits in high-risk individuals strongly favor statin therapy since it outweighs other risks. Whether statins should be used for primary prevention among patients with a relatively low baseline CV risk is still questionable, however the results of primary prevention trials have shown reductions in mortality in this population. Thus, there is a need for randomized, placebo-controlled statin studies with carefully selected groups of patients and NOD as a key end point in order to resolve queries concerning this issue.
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Current perspectives on treatment of hypertensive patients with chronic obstructive pulmonary disease.
Integr Blood Press Control
PUBLISHED: 01-01-2013
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Systemic hypertension and chronic obstructive pulmonary disease (COPD) frequently coexist in the same patient, especially in the elderly. Today, a wide variety of antihypertensive drugs with different mechanisms of action are available to the prescribing physician. In addition, combination drugs for hypertension are becoming increasingly popular. Certain antihypertensive drugs can affect pulmonary function. Therefore the management of such patients can present therapeutic challenges. We have examined the literature pertaining to the use of antihypertensive drugs in patients with systemic hypertension and coexisting COPD. Although data are often limited or of poor quality, we have attempted to review and then provide recommendations regarding the use of all the specific classes of antihypertensive drug therapies including combination drugs in patients with COPD. The antihypertensive agents reviewed include diuretics, aldosterone receptor blockers, beta blockers, combined alpha and beta blockers, angiotensin-converting enzyme inhibitors, angiotensin II antagonists, calcium channel blockers, alpha-1 blockers, centrally acting drugs, direct vasodilators, and combinations of these drugs. Of these classes, calcium channel blockers and angiotensin II antagonists appear to be the best initial choices if hypertension is the only indication for treatment. However, the limited data available on many of these drugs suggest that additional studies are needed to more precisely determine the best treatment choices in this widely prevalent patient group.
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Erythropoietin update 2011.
Med. Sci. Monit.
PUBLISHED: 11-01-2011
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Traditionally, erythropoietin (EPO) is described as a hematopoietic cytokine, regulating proliferation and differentiation and survival of the erythroid progenitors. The recent finding of new sites of EPO production and the wide spread distribution of EPO receptors (EPO-R) on endothelial cells, cardiomyocytes, renal cells as well as the central and peripheral nervous system raised the possibility that EPO may exert pleiotropic actions on several targets. Indeed studies (mainly preclinical) have documented protective, non-hematopoietic, abilities of EPO in a variety of tissue. However, the data obtained from clinical studies are more skeptical about these properties. This article provides a comprehensive overview of EPO and its derivatives.
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Waist circumference, ghrelin and selected adipose tissue-derived adipokines as predictors of insulin resistance in obese patients: preliminary results.
Med. Sci. Monit.
PUBLISHED: 11-01-2011
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The aim of the study was to estimate the association between anthropometric obesity parameters, serum concentrations of ghrelin, resistin, leptin, adiponectin and homeostasis model assessment (HOMA-IR) in obese non-diabetic insulin-sensitive and insulin-resistant patients.
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Optimal timing of discontinuation of clopidogrel and risk of blood transfusion after coronary surgery. Propensity score analysis.
Circ. J.
PUBLISHED: 10-22-2011
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The optimal time delay between last clopidogrel dose and surgery is controversial. The aim of the present study was to analyze the impact of preoperative clopidogrel on the need for blood transfusions with reference to the proper timing of discontinuation.
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Ten most important things to learn from the ACCF/AHA 2011 expert consensus document on hypertension in the elderly.
Blood Press.
PUBLISHED: 10-13-2011
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The American College of Cardiology Foundation/American Heart Association 2011 Expert Consensus Document on Hypertension in the Elderly has been published in the Journal of the American College of Cardiology and in Circulation, and will be published in the Journal of the American Society of Hypertension and the Journal of Geriatric Cardiology. This document has also been developed in collaboration with the American Academy of Neurology, the American Geriatrics Society, the American Society of Preventive Cardiology, the American Society of Hypertension, the American Society of Nephrology, the Association of Black Cardiologists, and the European Society of Hypertension. The present article is a short summary emphasizing the 10 most important things to learn from this document.
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Lipids, blood pressure, kidney - what was new in 2011?
Arch Med Sci
PUBLISHED: 10-11-2011
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The year 2011 was very interesting regarding new studies, trials and guidelines in the field of lipidology, hypertensiology and nephrology. Suffice it to mention the new European Society of Cardiology (ESC)/European Atherosclerosis Society (EAS) guidelines on the management of dyslipidaemias, American College of Cardiology Foundation (ACCF)/American Heart Association (AHA) guidelines on hypertension in the elderly, and many important trials presented among others during the American Society of Nephrology (ASN) Annual Congress in Philadelphia and the AHA Annual Congress in Orlando. The paper is an attempt to summarize the most important events and reports in the mentioned areas in the passing year.
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Prognostic value of plasma N-terminal pro-B-type natriuretic peptide concentration in patients with normal and impaired left ventricular systolic function undergoing surgery for abdominal aortic aneurysm.
Arch Med Sci
PUBLISHED: 09-02-2011
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Implantation of an aortic-bifemoral prosthesis is characterised by a high (> 5%) rate of perioperative cardiovascular events. The main aim of the study is to demonstrate the usefulness of the determination of NT-proBNP concentration as a method of risk stratification of left ventricular dysfunction in patients subjected to surgery for aortic-bifemoral prosthesis implantation.
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Left atrial size in hypertension and stroke.
J. Hypertens.
PUBLISHED: 09-02-2011
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An enlarged left atrium is associated with increased risk for stroke. However, there are controversies regarding how left atrial size should be measured.
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Should we have any doubts about hypertension therapy in elderly patients?: ACCF/AHA 2011 expert consensus document on hypertension in the elderly.
Pol. Arch. Med. Wewn.
PUBLISHED: 09-01-2011
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Hypertension therapy in elderly patients still constitutes a considerable challenge. Its importance is also emphasized by the fact that, nowadays, many international organizations focus on the problem of an aging society (in 2030, life expectancy at birth in the European Union 27 is expected to rise to 85.3 years for women and 80.0 years for men). They discuss not only the optimal therapy in elderly patients, the problem of compliance and polypragmasy, but also the quality of life as well as the social, economic, and psychological challenges associated with this patient group. However, neither the available trials nor the European Society of Hypertension guidelines (2009) finally answered all important questions on hypertension management in elderly people. Thus, the first official recommendations on hypertension therapy in this patient group were much expected. The American College of Cardiology Foundation/American Heart Association 2011 Expert Consensus Document on Hypertension in the Elderly was published on April 25, 2011. The present article summarizes the most important issues discussed in this document.
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Ferumoxytol: a new era of iron deficiency anemia treatment for patients with chronic kidney disease.
J. Nephrol.
PUBLISHED: 08-08-2011
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Ferumoxytol is a new product approved for intravenous use by the US Food and Drug Administration (FDA) in the treatment of iron deficiency anemia in adults with chronic kidney disease. This approval was based on data from 3 open-label, randomized, controlled clinical trials. In all of these trials, ferumoxytol was well tolerated, and hemoglobin levels were significantly increased compared with those achieved by orally administered iron. Ferumoxytol, a superparamagnetic iron oxide coated with a carbohydrate shell, is also used as a magnetic resonance imaging (MRI) agent due to its magnetic properties. In addition, it has demonstrated a greater T1 relaxation time than MRI gadolinium-contrast agents. Currently, the Ferumoxytol Compared to Iron Sucrose Trial (FIRST) has started. This is a multicenter randomized trial of ferumoxytol compared with iron sucrose for the treatment of iron deficiency anemia in adult subjects with chronic kidney disease, where intravenous ferumoxytol is being compared with other intravenous agents to evaluate the safety of ferumoxytol and assess changes in hemoglobin level.
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What is the risk of hyperkalaemia in heart failure?
Expert Opin Pharmacother
PUBLISHED: 07-19-2011
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Chronic heart failure (CHF) is the only major cardiovascular disease whose prevalence and incidence are thought to be increasing. Potassium balance may be lost both through the neurohormonal mechanisms involved in cardiovascular diseases and through the drugs used in their treatment. Avoiding both hypo- and hyperkalemia is difficult but beneficial in CHF.
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Dronedarone: an overview.
Ann. Med.
PUBLISHED: 07-11-2011
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Atrial fibrillation (AF) is the most common arrhythmia encountered in clinical practice. Until recently, a rhythm control strategy for AF has been limited by drug toxicity and side-effects, and landmark AF trials have shown that such a strategy is not superior to a rate control one. New antiarrhythmic drugs, free of undesired effects, would enhance the rhythm control strategy, with the possibility of sinus rhythm restoration and maintenance. One of the promising drugs recently approved for clinical use is dronedarone. This drug has amiodarone-like antiarrhythmic and electrophysiological properties, despite it having a modified structure and lacking an iodine moiety. Thus, dronedarone lacks amiodarones organ toxicity (including adverse thyroid and pulmonary effects). The efficacy of dronedarone has been investigated in several clinical trials, proving its effect in the prevention of AF recurrence, rate control in paroxysmal/persistent and permanent AF, reduction of cardiovascular hospitalization or death from any cause, and others. Indirect comparisons with amiodarone, as well as one head-to-head study of the two drugs, indicate that the relative safety of dronedarone may be at a cost of its lower antiarrhythmic efficacy compared with amiodarone.
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What should be the optimal levels of blood pressure: Does the J-curve phenomenon really exist?
Expert Opin Pharmacother
PUBLISHED: 04-25-2011
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The blood pressure (BP) J-curve debate has lasted for over 30 years and we still cannot definitively answer all the questions. However, recent studies suggest that BP should be reduced carefully in patients with hypertension and coronary artery disease. BP should not fall below 110 - 115/70 - 75 mmHg, because this may be associated with more cardiovascular events.
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Relevance of I-BMIPP delayed scintigraphic imaging for patients with angina pectoris - a pilot study.
Arch Med Sci
PUBLISHED: 04-19-2011
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The study was designed to clarify the role of (123)I-?-methyl-iodophenylpentadecanoic acid ((123)I-BMIPP) in the evaluation of myocardial fatty acid metabolism in patients with stable angina pectoris (AP) before and after percutaneous coronary intervention (PCI).
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The meaning of hypokalemia in heart failure.
Int. J. Cardiol.
PUBLISHED: 03-09-2011
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Maintenance of normal potassium (K(+)) homeostasis has become an increasingly important limiting factor in the therapy of heart failure (HF). With the application of loop diuretics and digoxin, hypokalemia has become a frequent and feared side effect of treatment. Low serum K(+) in HF may be also a marker of increased neurohormonal activity and disease progression. To gain the maximum benefit from treatment, we need to individualize drug use and carefully monitor electrolytes. Symptomatic HF patients (New York Heart Association class III-IV) should be prescribed the lowest dose of diuretic necessary to maintain euvolemia. Mild hypokalemia may be corrected by the use of aldosterone receptor antagonists such as spironolactone or eplerenone. However, a more severe hypokalemia should preferably be corrected using K(+) supplement. Serum K levels should be frequently checked and maintained between 4.0 and 5.5 mEq/l (mmol/l).
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Significance of 99mTc-sestamibi myocardial scintigraphy after percutaneous coronary intervention in patients with acute myocardial infarction.
Med. Sci. Monit.
PUBLISHED: 03-02-2011
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This study was designed to clarify the significance of washout rate (WR) determined from 99mTc-sestamibi myocardial scintigraphic images and the levels of cardiac enzymes in patients with acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI).
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Correlation of the severity of diabetic retinopathy and the heart muscle perfusion in patients with type 2 diabetes.
J. Diabetes Complicat.
PUBLISHED: 02-08-2011
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The objective was to investigate whether microvascular disturbances in patients with type 2 diabetes (DM) as defined by retinal examination predict the existence of macrovascular disturbances found on radioisotopic perfusion examinations of the heart muscle.
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Relation of baseline systolic blood pressure and long-term outcomes in ambulatory patients with chronic mild to moderate heart failure.
Am. J. Cardiol.
PUBLISHED: 02-04-2011
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We studied the impact of baseline systolic blood pressure (SBP) on outcomes in patients with mild to moderate chronic systolic and diastolic heart failure (HF) in the Digitalis Investigation Group trial using a propensity-matched design. Of 7,788 patients, 7,785 had baseline SBP data and 3,538 had SBP ? 120 mm Hg. Propensity scores for SBP ? 120 mm Hg, calculated for each of the 7,785 patients, were used to assemble a matched cohort of 3,738 patients with SBP ? 120 and >120 mm Hg who were well-balanced in 32 baseline characteristics. All-cause mortality occurred in 35% and 32% of matched patients with SBPs ? 120 and >120 mm Hg respectively, during 5 years of follow-up (hazard ratio [HR] when SBP ? 120 was compared to >120 mm Hg 1.10, 95% confidence interval [CI] 0.99 to 1.23, p = 0.088). HRs for cardiovascular and HF mortalities associated with SBP ? 120 mm Hg were 1.15 (95% CI 1.01 to 1.30, p = 0.031) and 1.30 (95% CI 1.08 to 1.57, p = 0.006). Cardiovascular hospitalization occurred in 53% and 49% of matched patients with SBPs ? 120 and > 120 mm Hg, respectively (HR 1.13, 95% CI 1.03 to 1.24, p = 0.008). HRs for all-cause and HF hospitalizations associated with SBP ? 120 mm Hg were 1.10 (95% CI 1.02 to 1.194, p = 0.017) and 1.21 (95% CI 1.07 to 1.36, p = 0.002). In conclusion, in patients with mild to moderate long-term systolic and diastolic HF, baseline SBP ? 120 mm Hg was associated with increased cardiovascular and HF mortalities and all-cause, cardiovascular, and HF hospitalizations that was independent of other baseline characteristics.
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Right ventricular ejection fraction <20% is an independent predictor of mortality but not of hospitalization in older systolic heart failure patients.
Int. J. Cardiol.
PUBLISHED: 01-29-2011
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Reduced right ventricular ejection fraction (RVEF) is associated with poor outcomes in patients with chronic systolic heart failure (HF). Although most HF patients are older adults, little is known about the relationship between low RVEF and outcomes in older adults with systolic HF.
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The Rise and Fall of Hypertension: Lessons Learned from Eastern Europe.
Curr Cardiovasc Risk Rep
PUBLISHED: 01-06-2011
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Hypertension is a progressive cardiovascular syndrome that arises from many differing, but interrelated, etiologies. Hypertension is the most prevalent cardiovascular disorder, affecting 20% to 50% of the adult population in developed countries. Arterial hypertension is a major risk factor for cardiovascular diseases and death. Epidemiologic data have shown that control of hypertension is achieved in only a small percentage of hypertensive patients. Findings from the World Health Organization project Monitoring Trends and Determinants in Cardiovascular Diseases (MONICA) showed a remarkably high prevalence (about 65%) of hypertension in Eastern Europeans. There is virtually no difference however, between the success rate in controlling hypertension when comparing Eastern and Western European populations. Diagnosing hypertension depends on both population awareness of the dangers of hypertension and medical interventions aimed at the detecting elevated blood pressure, even in asymptomatic patients. Medical compliance with guidelines for the treatment of hypertension is variable throughout Eastern Europe. Prevalence of hypertension increases with age, and the management of hypertension in elderly is a significant problem. The treatment of hypertension demands a comprehensive approach to the patient with regard to cardiovascular risk and individualization of hypertensive therapy.
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Gender differences in the treatment of ischemic heart disease.
Curr. Pharm. Des.
PUBLISHED: 01-06-2011
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Ischemic heart disease (IHD) is a leading cause of mortality and morbidity in most developed countries. Many studies revealed gender differences in the presentation, prevalence, and clinical outcomes of IHD. Compared with females, ST-segment elevation myocardial infarction is more often diagnosed in men. They also have a higher prevalence of IHD. These findings indicate that gender may have an important influence on IHD. Appropriate prevention, rapid diagnosis, and optimal treatment may essentially improve the care of all patients. It is therefore necessary to take into account gender differences in the features of IHD between males and females.
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Statins and dilated cardiomyopathy: do we have enough data?
Expert Opin Investig Drugs
PUBLISHED: 01-06-2011
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Dilated cardiomyopathy (DCM) is a multifactorial disease in which there is enlargement and systolic dysfunction of one or both ventricles. The exhaustion of compensatory mechanisms leads to the symptoms of congestive heart failure (CHF). Despite treatment, CHF is a progressive disease with high morbidity and mortality, suggesting that important pathogenic mechanisms remain active and unmodified by currently available treatment.
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Malignancy-associated dyslipidemia.
Open Cardiovasc Med J
PUBLISHED: 01-05-2011
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Cholesterol and triglycerides, important lipid constituents of cell, are essential to carry out several vital physiological functions. Lipids might be associated with cancers because they play a key role in the maintenance of cell integrity. The pathway for cholesterol synthesis may also produce various tumorigenic compounds and cholesterol serves as a precursor for the synthesis of many sex hormones linked to increased risk of various cancers. In some malignant diseases, blood cholesterol undergoes early and significant changes. The mechanism for the link between cancer and cholesterol remains controversial. The dates from studies are confusing because both hypolipidemia and hypercholesterolemia might be connected with malignancy. Not only cancers but also antineoplastic therapies have an influence on lipid profile. There are also dates suggesting that antihyperlipemic drugs might nfluenced malignancy.
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The use of DSM-IV and ICD-10 criteria and diagnostic scales for delirium among cardiac surgery patients: results from the IPDACS study.
J Neuropsychiatry Clin Neurosci
PUBLISHED: 11-02-2010
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Diagnostic accuracy of different diagnostic systems in estimating the incidence of delirium among surgery patients has not been investigated to date. Therefore, the authors evaluated the frequency of delirium according to DSM-IV and ICD-10 criteria and the cutoff values of the Memorial Delirium Assessment Scale (MDAS) and Delirium Index in 563 patients undergoing cardiac surgery. DSM-IV criteria were found as more inclusive, while ICD-10 criteria were more restrictive in establishing a diagnosis of postoperative delirium. The cutoff scores of 10 on the MDAS and 7 on the Delirium Index were optimal to the presence or absence of delirium.
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Statins in patients with chronic kidney disease: why, who and when?
Expert Opin Pharmacother
PUBLISHED: 10-28-2010
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Patients with end-stage renal disease are at high risk of developing cardiovascular disease, which is characterized by early onset and rapid progression of atherosclerosis. Some analyses of large clinical trials have revealed that statins might reduce all-cause mortality and cardiovascular (CV) events in patients with chronic kidney disease (CKD). Preliminary studies have also suggested that they can reduce contrast-induced nephropathy (CIN) and the rate of loss of kidney function. However, the results concerning the efficacy and safety of statin therapy in patients with CKD, especially in those on renal replacement therapy, are still controversial.
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Current problems in hypertension and nephrology.
Expert Opin Pharmacother
PUBLISHED: 10-28-2010
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The aim of this issue of Expert Opinion on Pharmacotherapy is to present the most important and controversial problems in hypertension and nephrology. To this end, the most important points of the current (2009) recommendations of the European Society of Hypertension (ESH) are discussed, including aspects related to the treatment of hypertension - the role of beta-blockers, combined therapy with angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) the treatment of hypertension in elderly patients, and role of destiffening therapy. The authors also present current recommendations for the management of dyslipidemia in hypertensive and chronic kidney disease (CKD) patients, and new strategies to prevent cardiovascular risk in CKD patients, the optimal level of blood pressure in patients with hypertensive nephropathy and which hypotensive drugs are the most nephroprotective. The Editors are aware that many other important problems have not been addressed in this issue of the journal; however, they hope the readers find it interesting and useful.
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In developing our video relationships, we compare around 5 million PubMed articles to our library of over 4,500 methods videos. In some cases the language used in the PubMed abstracts makes matching that content to a JoVE video difficult. In other cases, there happens not to be any content in our video library that is relevant to the topic of a given abstract. In these cases, our algorithms are trying their best to display videos with relevant content, which can sometimes result in matched videos with only a slight relation.