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C-Reactive Protein: A New Tool for Cardiovascular Disease Risk PredictionRecent research into the use of markers of inflammation to aid in cardiovascular risk assessment has focused on C-reactive protein, an acute-phase reactant found in atherosclerotic lesions. Serum levels of C-reactive protein are strongly associated with cardiovascular disease risk. Several clinical trials have shown that elevated C-reactive protein concentration predicts increased risk in persons with average or even below-normal levels of low-density lipoprotein cholesterol. When measured with the high-sensitivity assay, C-reactive protein has been shown to add to the predictive power of traditional cardiovascular risk factors and can enhance the 10-year Framingham Risk Score risk prediction. This article reviews the available evidence and addresses the potential for lowering C-reactive protein levels to reduce the risk of cardiovascular disease.
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Insight into a Forgotten Disease: Lemierre's SyndromeLemierre's syndrome is characterized by oropharyngeal infection, usually by Fusobacterium necrophorum, followed by septic thrombophlebitis of the internal jugular vein with embolization to the lungs and other organs. Since the introduction of antibiotics, Lemierre's syndrome has become relatively rare and is usually unsuspected until blood culture results are available. In the preantibiotic era, ligation of the internal jugular vein on the affected side to prevent septicemia was the only recognized treatment. Current therapy is a 4- to 6-week course of antibiotics, such as penicillin G, clindamycin, or metronidazole, directed against F necrophorum. The use of anticoagulation is still controversial.
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Combining warfarin and antiplatelet therapy after coronary stentingWe conducted an observational study to compare singleantiplatelet therapy with dualantiplatelet therapy among patients requiring long-term warfarin therapy after coronary stenting. Results showed that there was no difference in mortality or myocardial infarction between the 2 treatment regimens at 6 months, with no excess in-hospital bleeding; however, larger trials are needed to determine firm recommendations.
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Bisphosphonates' Growing Role in Breast CancerIntravenous bisphosphonates, often used to treat metastases and bone pain in breast cancer patients, are now being used by clinicians for osteoporosis in these patients—pharmacists need to recommend appropriate screening and treatment.
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Different means to the same end, or just different?The study by Schuijf and Bax, which compares multislice computed tomography (CT) versus myocardial perfusion imaging, is very timely, as this new cardiac imaging modality has gained rapid acceptance by cardiologists for managing patients.
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Reduction of inflammatory biomarkers through the use of hyperlipidemia drugs in patients with diabetesDiabetes and inflammation influence the development of atherosclerosis. We performed a study that showed the inflammatory markers high-sensitivity C-reactive protein and lipoprotein-associated phospholipase A2 were lowered with the use of fenofibrate, simvastatin, and combination therapy. The anti-inflammatory effects were most pronounced among patients with elevated baseline inflammatory markers. Combination therapy significantly altered lipid concentrations and exerted a greater positive effect on low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglycerides than monotherapy with either drug.
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Cardiac resynchronization in a patient with Class IV heart failure and narrow QRS-the role of mechanical dyssynchronyCardiac resynchronization treatment (CRT) has moved into the mainstream of patient care after several randomized studies have demonstrated improved quality of life, reversed remodeling, and decreased heart failure hospitalizations. More recently, 2 large studies have demonstrated a mortality benefit of CRT independent of implantable cardioverter defibrillator
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Did you see it move?The lack of a reliable quantitative measurement analysis package for regional left ventricular wall motion is not new.
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Prevalent atherosclerosis-Choose your biomarkerCirculating biomarkers have been used in cardiovascular medicine as predictors of incident or prevalent disease.
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REMS Doesn't Have to Be a ‘Four-letter Word'Risk management with patients on opioid therapy offers the opportunity to improve communication and strengthen the physician-patient relationship.
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Venetoclax Approved for Older Patients With AMLThe drug is approved as a treatment for adult patients with newly-diagnosed acute myeloid leukemia (AML) who are 75 years or older, or who have comorbidities that preclude the use of intensive induction chemotherapy.
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Leprosy: Forgotten in America?Leprosy was well recognized in antiquity and was often associated with social stigma. In 1873, Dr G. Hansen first identified Mycobacterium leprae as the cause for this condition, which was then named Hansen's disease. Not until the 20th century was specific treatment developed. Leprosy remains endemic to certain areas in the world, especially tropical and subtropical zones. Overall prevalence has decreased, but the reported incidence of leprosy has remained steady, even in the United States. In light of the significant morbidity associated with the disease, physicians must remain vigilant for its signs and symptoms even in developed countries, especially with increasing travel to and from endemic areas.
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Mestinon and Other Ways to Treat Myasthenia GravisIn this video, Beth Stein, M.D., and myasthenia gravis patient Anaya Mitchell discuss mestinon, steroids, and other treatment methods for myasthenia gravis.
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Doctors to Go to Jail for Asking Patients about Guns in the HomeIf psychiatrists are involved in restoration of gun rights, why could they be banned from asking questions about ownership?
