The Canadian journal of cardiology

Publisher: Pulsus


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    • All articles are available from PubMed Central 12 months after publication
    • Papers funded by CIHR are made open access 6 months after publication
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Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: The optimal timing of valve surgery remains controversial. Biomarkers can be serially monitored and are objective laboratory measurements. Plasma B-type natriuretic peptide (BNP) and its N-terminal pro-form are well known predictors in heart failure. Diastolic stretch induces cardiomyocyte BNP expression in volume-loaded conditions like aortic or mitral regurgitation (MR) or pressure-loaded conditions like aortic stenosis (AS). Here, we review the value of natriuretic peptide measurements in valve disease. Cardiac decompensation is reflected by increased BNP in AS and in MR. Repeated marked increases in natriuretic peptides are a potential indication for valve replacement in severe asymptomatic AS with normal ejection fraction and exercise test results. High BNP level also predicts postoperative outcome. Increased BNP level is associated with low-flow AS, impaired left ventricular longitudinal strain, and myocardial fibrosis. The BNP ratio to the reference value for age and sex incrementally predicts mortality in AS. Increased BNP reflects the hemodynamic consequences of MR and is associated with exercise-induced pulmonary-arterial hypertension and reduced contractile reserve. In severe primary MR, increased and serially increasing BNP or N-terminal pro-form BNP might be helpful in guiding early mitral replacement. In conclusion, baseline (N-terminal pro-form) BNP should be obtained in all severe valve disease patients and interpreted together with clinical and echocardiography findings. Very high BNP values are associated with increased mortality and should lead to close monitoring peri- and postoperatively. Progressively increasing BNP in asymptomatic patients points to advancing valve disease. BNP adds important incremental prognostic information that is useful for valve patient management and for optimal timing of surgery in particular.
    The Canadian journal of cardiology 09/2014; 30(9):1027-1034.
  • The Canadian journal of cardiology 08/2014; 30(8):957.e7.
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    ABSTRACT: Aboriginals have more cardiovascular risk factors than do non-Aboriginals that predispose them to the development of heart failure (HF). Whether long-term mortality outcomes and health care use differ between Aboriginals and whites with HF is unknown.
    The Canadian journal of cardiology 06/2014; 30(6):619-26.
  • The Canadian journal of cardiology 06/2014; 30(6):697.e3-4.
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    ABSTRACT: There is a paucity of data regarding the type of anaesthesia used and the perception toward anaesthesia among cardiologists, anaesthesiologists, and nurses. Our objective was to describe the use of sedation during nonsurgical cardiac procedures.
    The Canadian journal of cardiology 06/2014; 30(6):627-33.
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    ABSTRACT: Neutrophil/lymphocyte ratio (NLR) is a novel biomarker that can single out individuals at risk for vascular events. We assessed whether NLR provides additive prognostic value in patients with ST-elevation myocardial infarction (STEMI).
    The Canadian journal of cardiology 05/2014;
  • The Canadian journal of cardiology 05/2014;
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    ABSTRACT: The patented Optim coating was designed to prevent insulation abrasions on the Durata lead (St Jude Medical, St Paul, Minnesota) and avoid the problems that had afflicted its predecessor, the Riata silicone lead (St Jude Medical). We report a case of external insulation failure 8 months after implantation of a dual-coil Durata lead and consider the potential causes of the failure.
    The Canadian journal of cardiology 05/2014;
  • The Canadian journal of cardiology 05/2014;
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    ABSTRACT: β-adrenergic blocking agents, a pharmacologically diverse class of cardiovascular medications, are recommended as first-line treatment for patients with hypertension and concomitant structural heart disease, and for angina and heart failure. Many within-class differences exist, from pharmacokinetics and pharmacodynamics to ancillary effects, such as intrinsic sympathomimetic activity, antiarrhythmic activity, α-1 adrenergic receptor blockade affinity, and direct vasodilation. Nebivolol is a third-generation, β1 selective, long acting β-blocker, which causes direct vasodilation via endothelium-dependent nitric oxide stimulation. The vasodilatory actions of nebivolol might result in clinical effects with some distinct properties. Differences from other β-blockers might include improvement of endothelial function, enhancement of forward flow in muscular resistance arteries, maintenance of exercise tolerance, and overall improved tolerability, side effect profile, and adherence. Nebivolol has been shown to be a clinically effective β-blocker for treatment as initial or add-on therapy for systemic hypertension, as an antianginal agent, and as therapy for patients with heart failure. These properties position nebivolol as a treatment option for patients with hypertension and/or structural heart disease, although its precise role in the therapeutic armamentarium remains to be clarified.
    The Canadian journal of cardiology 05/2014; 30(5S):S29-S37.
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    ABSTRACT: High blood pressure is the leading cause of premature mortality worldwide. Reducing salt intake lowers blood pressure and blood pressure-lowering reduces vascular disease. There is a very high likelihood that reducing dietary salt intake will prevent vascular disease and no evidence to suggest it will cause harm. With average population salt consumption levels typically 5-10 times greater than physiological requirements, even moderately effective community-wide salt reduction programs offer the potential for very large health gains. This opportunity has been recognized and adopted by the World Health Organization as a priority action to combat chronic diseases.
    The Canadian journal of cardiology 05/2014; 30(5):502-506.
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    ABSTRACT: Policy positions on salt consumption (based largely on the association of sodium and blood pressure [BP]) has remained unchanged since the 1970s, until recently. However, this is beginning to change as new evidence emerges. The evidence supports a strong association of sodium with BP and cardiovascular disease events in hypertensive individuals, the elderly, and those who consume > 6 g/d of sodium. However, there is no association of sodium with clinical events at 3 to 6 g/day and a paradoxical higher rate of events at < 3 g/day. Therefore, until new evidence emerges, the optimal range of sodium consumption should be considered to be between 3 and 6 g/d. Population-wide sodium reduction is not justified in countries such as Canada.
    The Canadian journal of cardiology 05/2014; 30(5):507-512.
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    ABSTRACT: Ischemic heart disease and stroke are the leading causes of death worldwide. What was once thought to be an endemic disease of high income countries has become a global epidemic, as low and middle income countries have adopted Western lifestyles, to the point that noncommunicable diseases are now the main cause of death in these regions, above and beyond communicable diseases, malnutrition, and injury. As a result, a large proportion of individuals at high 10-year risk of a cardiovascular event live in low- and middle-income countries, and the most of all cardiovascular events occur in developing countries. A large amount of evidence supports the use of pharmacological treatment for the prevention of cardiovascular death in this population, including antiplatelet drugs, β-blockers, lipid-lowering agents, and angiotensin-converting enzyme inhibitors, however, the efficacy of cardiovascular event prevention is hampered by several problems, including inadequate prescription of medication, poor adherence to treatment, limited availability of medications, and unaffordable cost of treatment. Here we examine the use of fixed-dose combination therapy, and how this therapy could improve adherence to treatment, reduce the cost, and improve treatment affordability in low-income countries.
    The Canadian journal of cardiology 05/2014; 30(5):520-526.
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    ABSTRACT: β-Blockers are among the most commonly used medications in the treatment of hypertension. However, 45 years after their initial indication for that treatment, their place in the treatment of hypertensive patients is under evaluation and their usefulness has been questioned based on evidence from meta-analyses of clinical trials. The β-blocker class consists of various agents with diverse pharmacokinetic and pharmacodynamic properties including lipo- and hydrophilicity, duration of action, intrinsic sympathomimetic activity, vasodilation, and metabolism linked to genetic polymorphisms. Because of their various properties, some β-blockers are indicated for cardiovascular conditions such as angina, rate control of atrial fibrillation, chronic heart failure, and after myocardial infarction, and other indications such as migraine and essential tremor. There have been more than 17 large trials influencing the recommendations on the use of these agents in the treatment of hypertension. The results of these trials initially led to the widespread recommendation for the use of β-blockers in the management of hypertension. However, the recent multiple meta-analyses using these trials have raised a controversy on their place in that treatment. The Canadian Hypertension Education Program recommendations have included β-blockers as a first-line treatment option for patients younger than 60 years of age based on the evidence from these large trials, and this has been supported by 2 of the meta-analyses. This article reviews these studies to help clinicians better understand the role of β-blockers in managing hypertension.
    The Canadian journal of cardiology 05/2014; 30(5S):S16-S22.
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    ABSTRACT: Previous reviews have shown that β-blocker use for the treatment of hypertension without compelling indications was associated with increased risk of stroke in the elderly. It remains unclear whether this increased risk was driven by the type of β-blocker. We sought to compare the efficacy of atenolol vs nonatenolol β-blockers in clinical trials enrolling young (< 60 years) and older patients with hypertension. The Cochrane and MEDLINE databases were searched (January 2006-May 2013) for randomized trials evaluating stroke, myocardial infarction, death, or composite cardiovascular end points. Twenty-one hypertension trials with data on 145,811 participants were identified: 15 used atenolol, 7 were placebo-controlled trials, and 14 were active comparator trials. There were no trials of newer generation β-blockers identified. Among the elderly, atenolol was associated with an increased risk of stroke (relative risk [RR], 1.17; 95% confidence interval [CI], 1.05-1.30) compared with other antihypertensive agents. The risk of stroke for nonatenolol β-blockers compared with other agents (RR, 1.22; 95% CI, 0.99-1.50) did not reach statistical significance in the elderly. In the young, atenolol was associated with reduced risk of stroke compared with other agents (RR, 0.78; 95% CI, 0.64-0.95), whereas nonatenolol β-blockers were associated with a lower risk of composite cardiac events (RR, 0.86; 95% CI, 0.75-0.996) compared with placebo, with no significant difference in events compared with active controls. In the young, both atenolol and nonatenolol β-blockers are effective in reducing cardiovascular end points for hypertension without compelling indications. Atenolol is associated with increased stroke in the elderly but whether this extends to nonatenolol β-blockers remains uncertain.
    The Canadian journal of cardiology 05/2014; 30(5S):S47-S53.
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    ABSTRACT: Hypertension is a major concern in women, contributing to the risk for morbidity and mortality and the development of cardiovascular disease (CVD), heart attack, and stroke. A woman's risk for the development of hypertension increases with age. Although it also affects younger women, hypertension is prevalent in approximately 60% of women >65 years of age. In addition to age, there are specific risk factors and lifestyle contributors for the development of hypertension in women, including obesity, ethnicity, diabetes, and chronic kidney disease. Risk reduction strategies need to be used to help reduce hypertension; maintaining a healthy body weight through diet and exercise, reduced sodium intake, and lower alcohol intake are a few of the approaches for hypertension risk reduction in women. There are several proposed mechanisms for the development of hypertension that are unique to women and pertain to the aging-related elevated risk for hypertension resulting from falling estrogen levels during menopause. Oral contraceptives, pre-eclampsia and polycystic ovary syndrome are special considerations concerning the development and progression of hypertension in women. There are significant awareness issues and care gaps in the treatment of hypertension in women. Therefore, these problems must be faced and efforts need to be taken to resolve the issues surrounding the treatment and control of hypertension in women.
    The Canadian journal of cardiology 05/2014; 30(5):553-559.
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    ABSTRACT: The polypill concept for atherosclerosis is based on the notion that a single pill containing multiple products that attack frequently encountered risk factors will provide important advantages as a preventive strategy, particularly in the developing world. Potential benefits include improved efficacy and greater compliance because of simplicity and reduced costs. Here, we briefly review the rationale for the polypill and the evidence supporting its value. We consider the polypill to be a major advance in combat against cardiovascular disease, with enormous benefits to global health to be expected from its use.
    The Canadian journal of cardiology 05/2014; 30(5):517-519.
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    ABSTRACT: Pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) are serious and often fatal diseases. The pathophysiology of both diseases is complex and in part is attributed to alterations in the nitric oxide (NO)-soluble guanylate cyclase (sGC)-cyclic guanosine monophosphate pathway. Riociguat, a novel sGC stimulator, acts on this pathway through a dual mechanism of action by directly stimulating sGC in a NO-independent manner and also increasing the sensitivity of sGC to NO. Based on benefits from clinical trials for both PAH and CTEPH, riociguat was approved by Health Canada and the US Food and Drug Administration as the first medical therapy for patients with CTEPH who are deemed inoperable or have residual/recurrent PH after pulmonary endarterectomy (PEA), and as a novel treatment option for patients with PAH. This article reviews the key findings from the phase III trials for riociguat that led to these approvals and the implications this has for the treatment of patients with PAH and CTEPH.
    The Canadian journal of cardiology 04/2014;

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