[show abstract][hide abstract] ABSTRACT: Thiazide diuretics and beta-blockers are first-line therapies for hypertension unless there are compelling indications for other drug classes. Diuretics and beta-blockers, however, may worsen dyslipidemia and glucose tolerance whereas antihypertensive agents in other drug classes may have neutral or beneficial effects. Initial clinical trials of antihypertensive regimens suggested that blood pressure lowering was the most important aspect of therapy and that the adverse effects on lipids and glucose tolerance did not impact clinical outcomes. Newer trials, however, question this finding and implicate these pleotropic effects as contributing to the results of the trials. Patients with cardiometabolic risk factors may have compelling indications for agents that inhibit the renin-angiotensin-aldosterone system, relegating diuretics and beta-blockers to third-line therapy.
Current Atherosclerosis Reports 02/2012; 14(1):70-7. · 2.92 Impact Factor
[show abstract][hide abstract] ABSTRACT: The patient is a 44-year-old Caucasian male who developed chest discomfort while playing ice hockey. He was seen at his local
emergency department where an EKG showed evidence for an acute inferior wall myocardial infarction. Cardiac catheterization
documented an occluded right coronary artery which was opened with a percutaneous intervention. In addition, he had a significant
coronary stenosis in his left anterior descending and circumflex arteries that eventually led to a three-vessel coronary bypass
surgery. His past medical history was otherwise unremarkable. He has a family history of coronary artery disease in his father
also at a younger age.
[show abstract][hide abstract] ABSTRACT: A high serum cholesterol is a well-established major risk factor for coronary heart disease (CHD). Evidence that supports
the lipid hypothesis includes research in animal models, epidemiological studies, studies of genetic forms of hyperlipidemia,
and laboratory and clinical trials of cholesterol-lowering therapy. Low-density lipoprotein cholesterol (LDL-C) is the major
atherogenic lipoprotein and has been designated the primary target of therapy by the National Cholesterol Education Program
KeywordsDirect LDL-LDL phenotyping-Apolipoprotein B-Lipoprotein(a)-High-sensitivity C-reactive protein-Lp-PLA2
[show abstract][hide abstract] ABSTRACT: Coronary heart disease (CHD) remains the number one cause of death for men and women in the USA and is rapidly becoming a
major cause of morbidity and mortality in developing nations as well. The recognition and treatment of coronary risk factors
such as dyslipidemia, hypertension, smoking, obesity, and diabetes has made a substantial impact on reducing CHD events. The
National Cholesterol Education Program guidelines recommend that low-density lipoprotein cholesterol (LDL-C) should be the
primary target of therapy to reduce cardiovascular events. The HMG CoA reductase inhibitors or statins are effective in lowering
LDL-C and have become some of the most prescribed medications in the world. Recent studies have extended the boundaries of
treatment to different risk groups and have shown that this treatment strategy is beneficial across the cardiovascular risk
[show abstract][hide abstract] ABSTRACT: A 54-year-old African American male patient comes to the office for a preoperative assessment prior to the placement of an
A-V fistula for hemodialysis. He was recently diagnosed with end-stage renal disease and started on hemodialysis through a
temporary catheter. He has a long standing history of hypertension which has been poorly controlled due in part to lack of
compliance with medications because of side effects. In the office, he has no complaints except for fatigue and pain in his
legs when he walks. He has no chest pain. There is no history of prior cardiac disease or diabetes.
KeywordsChronic kidney disease-Microalbuminuria-Proteinuria-Nephrotic syndrome-Statins
[show abstract][hide abstract] ABSTRACT: Metabolic syndrome is the designation given to a clustering of interrelated metabolic factors that increase the future risk
of the development of diabetes mellitus and cardiovascular disease. Intraabdominal or visceral obesity appears to be the underlying
component of the syndrome that leads to the development of an atherogenic dyslipidemia, endothelial dysfunction and hypertension,
insulin resistance, a prothrombotic, and a proinflammatory state. The risk attributed to the metabolic syndrome is likely
due to the sum of its individual components. As such, the designation of the metabolic syndrome is an easy and convenient
way of characterizing individuals who may be at increased risk for developing diabetes and cardiovascular disease.
KeywordsWaist circumference-Abdominal obesity-Impaired fasting glucose-HDL-cholesterol-Triglycerides
[show abstract][hide abstract] ABSTRACT: Cardiovascular disease remains the number one cause of death for men and women in this country. Despite this fact, great progress
has been made over the past few decades in reducing the number of deaths due to myocardial infarction and stroke. Data from
the National Center for Health Statistics from 1970 through 2002 have shown a decline in age-adjusted death rates with the
largest percentage decreases in death rates from strokes (63%) and heart disease (52%) . Approximately half of the decline
in US deaths from coronary artery disease can be attributable to reductions in major cardiovascular disease (CVD) risk factors
including reductions in total cholesterol (24%), systolic blood pressure (20%), smoking (12%), and physical inactivity (5%)
. Unfortunately, these reductions were partially offset by the increase in obesity and diabetes which accounted for an
increased number of deaths (8% and 10%, respectively) due to heart disease.
KeywordsFramingham risk score-Reynolds risk score-High-sensitivity C-reactive protein-Family history
[show abstract][hide abstract] ABSTRACT: Factors influencing hypertension (HTN) control in the United States are not well understood. The authors utilized a newly designed survey instrument to interview patients presenting to a diverse, general cardiology practice at a tertiary care center in order to identify factors associated with HTN control. The study was completed in 154 participants, and 121 (78.6%) had HTN. Of those, 111 (91.7%) had awareness of HTN, and 72 (59.5%) had HTN control, defined as <140/90 mm Hg. In a multivariate analysis, race/ethnicity was not associated with HTN control, but private insurance (odds ratio [OR] 3.40, 95% confidence interval [CI] 1.25-9.28), nonsmoker status (OR 4.36, CI 1.22-15.51), and number of medications used (OR 1.32, CI 1.12-1.56) were associated with HTN control. Correct recognition of systolic blood pressure goal and knowledge of one's current state of HTN control were also associated with control. In conclusion, in a general cardiology practice where patients had a high degree of healthcare access, race/ethnicity was not associated with HTN control, while type of insurance, nonsmoker status, and increased number of medications used were associated. In addition, 2 novel predictors of HTN control, recognition of systolic blood pressure goal and knowledge of HTN control, were identified that can be utilized in creating new HTN treatment interventions.
Journal of Clinical Hypertension 08/2010; 12(8):570-7. · 2.36 Impact Factor
[show abstract][hide abstract] ABSTRACT: Patients with chronic kidney disease (CKD) are at high cardiovascular risk and we can consider them to have a risk equivalent to coronary heart disease, putting them into the high-risk category. A mixed dyslipidemia with high triglyceride levels; low high-density lipoprotein (HDL) levels; and small, dense low-density lipoprotein (LDL) particles is a common pattern in patients with CKD, contributing to their high cardiovascular disease (CVD) risk. A treatment strategy to reduce LDL cholesterol to the current high-risk category goals reduces risk similar to patients without CKD. Emerging evidence suggests that targeting non-HDL cholesterol can have the potential to bring about further CVD risk reduction. Non-HDL cholesterol should be a secondary target for all patients with CKD. Further studies are needed to determine the magnitude of the risk reduction we can expect to gain by targeting non-HDL cholesterol and the most effective way to treat this target.
[show abstract][hide abstract] ABSTRACT: Chronic lymphocytic leukemia is an indolent disease that often presents with complaints of lymphadenopathy or is detected as an incidental laboratory finding. It is rarely considered in the differential diagnosis of patients presenting with tamponade or a large, bloody pericardial effusion. In patients without known cancer, a large, bloody pericardial effusion raises the possibility of tuberculosis, particularly in patients from endemic areas. However, the signs, symptoms and laboratory findings of pericarditis related to chronic lymphocytic leukemia can mimic tuberculosis.
We report the case of a 58-year-old African American-Nigerian woman with a history of travel to Nigeria and a positive tuberculin skin test who presented with cardiac tamponade. She had a mild fever, lymphocytosis and a bloody pericardial effusion, but cultures and stains were negative for acid-fast bacteria. Assessment of blood by flow cytometry and pericardial biopsy by immunohistochemistry revealed CD5 (+) and CD20 (+) lymphocytes in both tissues, demonstrating this to be an unusual manifestation of early stage chronic lymphocytic leukemia.
Although most malignancies that involve the pericardium clinically manifest elsewhere before presenting with tamponade, this case illustrates the potential for early stage chronic lymphocytic leukemia to present as a large pericardial effusion with tamponade. Moreover, the presentation mimicked tuberculosis. This case also demonstrates that it is possible to treat chronic lymphocytic leukemia-related pericardial tamponade by removal of the fluid without chemotherapy.