David T Nash

• M.D.B.A.
• SUNY Upstate Medical University

Fueled in part by recent bestselling books that warn of the evils of gluten in our diets, a significant proportion of our population is now either avoiding foods that contain gluten or eliminating gluten entirely from their diets, and these numbers continue to grow. The gluten-free trend-and the accompanying multibillion-dollar industry it has crea...

Fueled in part by recent best-selling books that warn of the evils of gluten in our diets, a significant proportion of our population is now either avoiding foods that contain gluten or eliminating gluten entirely from their diets, and these numbers continue to grow. The gluten-free trend-and the accompanying multibillion dollar industry it has cre...

In this issue of the Archives, Beatty and colleagues1 demonstrate that the 6-minute walk test (6MWT) provided, at low cost, very useful prognostic information in ambulatory patients with coronary heart disease. In 556 patients with stable coronary heart disease followed up for 8 years, cardiovascular events (eg, heart failure, myocardial infarction...

Considerable knowledge has been gained from epidemiologic studies and randomized clinical trials regarding risk factors for dementia, including Alzheimer disease (AD) and vascular dementia (VaD). Most identified risk factors for dementia are similar to vascular disease risk factors for heart disease and stroke. In 2010, the National Institutes of H...

This article discussed the central role of the deposition of amyloid beta in the pathogenesis of Alzheimer disease. (AD), and the animal data which supports the role of cholesterol on its deposition. The effect of mid-life cholesterol is discussed, and the presence of cardiovascular disease risk factors in the patients with evidence for AD and vasc...

The morbidity and mortality benefits of lowering blood pressure (BP) in hypertensive patients are well established, with most individuals requiring multiple agents to achieve BP control. Considering the important role of the renin-angiotensin-aldosterone system (RAAS) in the pathophysiology of hypertension, a key component of combination therapy sh...

Every description of the world we inhabit embodies certain processes of describing. In Fieldnotes and Sketchbooks researchers from the fieldsof anthropology, architecture and fine art reflect on the descriptive practices characteristic of their respective disciplines, and the potential of alternative modalities of description to challenge the bound...

The increasing trend of obesity has been associated with a greater prevalence of type 2 diabetes mellitus and may lead to more vascular disease. Nuts, a rich source of monounsaturated fatty acids and fiber, have been shown to decrease the risk of cardiovascular disease and the risk of developing type 2 diabetes mellitus. Numerous studies have demon...

Ranolazine is a new and unique antianginal drug that has been approved for the treatment of chronic stable angina pectoris. The drug is administered as a sustained-release formulation. Although the drug's mechanism of action has not been fully elucidated, current thinking is that ranolazine, a selective inhibitor of late sodium influx, attenuates t...

Most patients with hypertension will require combination therapy to achieve blood pressure (BP) goals, especially the elderly, obese, or those with stage 2 hypertension. To assess BP response and time to achieve BP goals in a diverse population of hypertensive patients treated with hydrochlorothiazide, valsartan, or a combination. For this secondar...

Dementias, such as Alzheimer's disease (AD) and vascular dementia, are disorders of aging populations and represent a significant economic burden. Evidence is accumulating to suggest that cardiovascular disease (CVD) risk factors may be instrumental in the development of dementia. The goal of this review was to discuss the relationship between spec...

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Though progress has been made in the fight against cardiovascular disease (CVD), the increasing global prevalence of cardiovascular (CV) risk factors ensures that CVD rates remain high. In order to reduce CVD incidence, a huge effort has been made to uncover additional targets for therapy and novel methods of identifying patients at risk. A low lev...

According to recent evidence, our aging society is in the early phases of an epidemic of cognitive decline. Accordingly, efforts directed at reducing the risk of Alzheimer's disease and dementia will be an important goal of health care efforts. While there are a paucity of successful treatment options currently available, diet and other lifestyle c...

Despite recognition that hypertension is a major risk factor for cardiovascular events and mortality, blood pressure control rates remain low in the US population. Reflecting clinical trial results, hypertension management guidelines assert the clinical benefit of achieving current blood pressure goals and indicate that most patients will require 2...

Approximately one-third of the adult population has hypertension. Large-scale clinical trials have convincingly demonstrated that the treatment of isolated systolic and systolic/diastolic hypertension reduces rates of total mortality, cardiovascular mortality, and stroke in older adults, yet control of systolic hypertension remains poor. This artic...

Hypertension and dyslipidemia often coexist, increasing the risk of cardiovascular disease. Evidence suggesting that concomitant hypertension and dyslipidemia are compelling candidates for a unified approach to treating cardiovascular risk is reviewed in this article. The authors also discuss important new findings documenting the need for, and ben...

In replyI wish to thank Graboys and Lown for their supportive letter. I regret that I overlooked their original publication on the topic of medical therapy of myocardial ischemia from 1981. Their remarks in relation to their recent data are also supportive of my original thesis of the benefits of medical therapy. I especially agree with their comme...

The role of cardiovascular disease risk factors in the occurrence and progression of cognitive impairment has been the subject of a significant number of publications but has not achieved widespread recognition among many physicians and educated laymen. It is apparent that the active treatment of certain of these cardiovascular disease risk factors...

Atherosclerosis and the metabolic derangements of insulin resistance, metabolic syndrome and diabetes mellitus are all associated with underlying inflammatory processes. C-reactive protein (CRP), a marker of inflammation, has been shown to be a strong independent predictor of vascular events. It adds to cardiovascular disease risk at all levels of...

Dr King argues that medical treatment should be divided into therapies that stabilize atherosclerosis and prevent cardiovascular events and those that reduce angina by decreasing oxygen demand or improving hemodynamics to increase oxygen supply. I couldn’t agree more with these cogent comments but maintain that aggressive medical therapy rather tha...

High levels of low-density lipoprotein cholesterol (LDL-C) are an obvious culprit in coronary artery disease (CAD). However, the search for lipid factors that influence cardiovascular health does not end there. In this article, Dr Nash presents the various lipid factors involved, for better or worse, in CAD. He emphasizes that although studies have...

PREVIEWHigh levels of low-density lipoprotein cholesterol (LDL-C) are an obvious culprit in coronary artery disease (CAD). However, the search for lipid factors that influence cardiovascular health does not end there. In this article, Dr Nash presents the various lipid factors involved, for better or worse, in CAD. He emphasizes that although studi...

As the population ages, increasing numbers of older adults are becoming candidates for lipid-lowering therapy with HMG CoA reductase inhibitors (statins) and lifestyle modification. Available evidence shows that statins reduce cardiovascular events and invasive revascularization in older adults. Statins have not only been shown to be safe and effec...

Primary care physicians typically encounter patients who are not at obvious risk for CAD but who nonetheless need and can benefit from lipid-lowering therapy. Applying algorithms or scoring systems can be helpful in estimating an individual patient's risk, but the basic tools available in everyday clinical practice can be used to alert physicians t...

The article by Stühlinger et al1 in this issue of THE JOURNAL deserves to be read at least twice by physicians involved in the care of patients with cardiovascular disease. Two readings are needed not because the article is difficult to fathom, but because the study demonstrates a potentially important relationship between insulin resistance and pl...

Available evidence suggests that medical treatment of low-risk patients with stable coronary artery disease (CAD) may be at least equivalent in efficacy to percutaneous transluminal coronary angioplasty (PTCA) in reducing the occurrence of myocardial ischemic events.' Despite extensive use of this procedure, the superiority of PTCA over medical the...

Endothelial dysfunction is a harbinger of cardiovascular disease that needs to be addressed in clinical practice. Conditions associated with endothelial dysfunction include atherosclerosis, hypertension, hypercholesterolemia, hypertriglyceridemia, diabetes mellitus, chronic heart failure, and chest pain syndromes. Infusion of acetylcholine into the...

Objective To provide a direct comparison of agents that raise plasma levels of high-density lipoprotein cholesterol (HDL-C) to help devise strategies for coronary risk reduction.Methods In a multicenter, randomized, double-blind trial, we compared the effects of extended-release niacin (Niaspan), at doses increased sequentially from 1000 to 2000...

To provide a direct comparison of agents that raise plasma levels of high-density lipoprotein cholesterol (HDL-C) to help devise strategies for coronary risk reduction. In a multicenter, randomized, double-blind trial, we compared the effects of extended-release niacin (Niaspan), at doses increased sequentially from 1000 to 2000 mg at bedtime, with...

We sought to assess the influence of baseline lipid levels on coronary event rates and the effectiveness of pravastatin therapy in the Cholesterol And Recurrent Events (CARE) study. The CARE study cohort provided a relatively unique opportunity to examine the relation between lipid levels and clinical events in a post-myocardial infarction (MI) pop...

Although LDL lowering has been shown to reduce recurrent coronary events in patients with coronary heart disease, little direct information is available on the extent of LDL lowering required to achieve this outcome. The Cholesterol and Recurrent Events (CARE) trial compared pravastatin and placebo in patients who had experienced myocardial infarct...

An anger-provocation paradigm was used to assess coping and stress reactivity in 20 women with a positive parental history of cardiovascular disorders and 14 women whose parents had no cardiovascular disease. Frequency of seeking social support in the natural environment was assessed, as were systolic and diastolic blood pressures, while the women...

The available clinical data for 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors demonstrate their efficacy and safety in treating hypercholesterolemia and improving long-term morbidity and mortality related to coronary artery disease. Comparative studies among agents in this class support the general perception that, at the mos...

CARE will determine whether 5 years of cholesterol-lowering therapy reduces recurrent coronary disease events in 4,159 patients who have had an AMI. The mean total cholesterol and LDL-C levels in CARE (209 and 139 mg/dl) are similar to the average levels for the US population. The results of CARE will have relevance to the treatment of the majority...

The Expanded Clinical Evaluation of Lovastatin study, a randomized, double-blind, placebo- and diet-controlled multicenter trial, evaluated the efficacy and tolerability of lovastatin over 48 weeks in 8,245 patients with moderately severe hypercholesterolemia. During year 1 of follow-up of the full cohort, lovastatin at 20 or 40 mg/day, or 20 or 40...

To determine the dose-response efficacy of once-daily administration of placebo or a new long-acting calcium channel blocker amlodipine in patients with mild to moderate hypertension, a randomized, multicenter, placebo-controlled, double-blind trial was conducted. The study included 210 patients with diastolic hypertension (blood pressure 95 to 114...

To evaluate the efficacy and safety of lovastatin in women with moderate hypercholesterolemia. The Expanded Clinical Evaluation of Lovastatin (EXCEL) Study, a multicenter, double-blind, diet- and placebo-controlled trial, in which participants were randomly assigned to receive placebo or lovastatin at doses of 20 or 40 mg once daily, or 20 or 40 mg...

Lovastatin produces consistent dose-related reductions in plasma levels of low density lipoprotein (LDL) cholesterol along with variable decreases in triglycerides and increases in high density lipoprotein (HDL) cholesterol. Patient characteristics from the Expanded Clinical Evaluation of Lovastatin (EXCEL) study were examined to determine their as...

This review summarizes the evidence indicating that local synthesis of angiotensin II, and interference with this process by inhibition of angiotensin-converting enzyme (ACE), may be important in the treatment of hypertension. Inhibition of tissue converting enzyme generally has a stronger correlation with the hemodynamic effects of ACE inhibitors...

In the multicenter, double-blind EXCEL (Expanded Clinical Evaluation of Lovastatin) study the efficacy of lovastatin in modifying plasma lipids and lipoproteins in 8,245 participants with moderate primary hypercholesterolemia was evaluated. Patients were randomly assigned to 48 weeks of treatment with diet and placebo or diet and lovastatin 20 or 4...

This randomized, double-blind, multicenter, diet-and-placebo-controlled study was designed to clarify the dose-response relationship of lovastatin therapy to lipid-modifying efficacy and drug-related adverse events. Exclusion criteria were minimized so that study patients were representative of the majority of patients with moderate hypercholestero...

The sympathetic nervous system plays a major role in the pathogenesis of essential hypertension and is mediated by the alpha and beta receptors. The alpha receptor is divided into two types, alpha 1 and alpha 2, based on response to epinephrine and norepinephrine. alpha 1-Adrenergic receptors have a high affinity for drugs such as prazosin, doxazos...

To the Editor.— Kudos to Drs Naughton and Kaufman and their coworkers1,2 for their recent articles on the accuracy of portable cholesterol analyzers. Their findings of significant variations in test results among these devices in public and controlled settings apparently relate to a variety of factors that must be pursued.However, the importance o...

Patients today are more likely than ever to seek advice about reducing cholesterol levels. Physicians can help by teaching patients how to cut down on saturated fats. However, as Dr. Nash points out, eating habits are difficult to change, especially for those who think that healthy foods have an unpleasant taste. This article discusses several diet...

This report describes a community-based cardiovascular risk-reduction program which targeted high-risk individuals. A total of 1,471 individuals participated and were screened for blood pressure, fasting serum cholesterol, blood glucose level, and appearance of the serum. These individuals also completed a questionnaire regarding their knowledge of...

This multicenter study evaluated nitrendipine, a dihydropyridine calcium antagonist, alone or in combination with hydrochlorothiazide and/or propranolol in severe essential hypertension (baseline supine diastolic BP greater than or equal to 115 mm Hg). After an initial 3- to 7-day drug-free run-in, a 2- to 5-week titration phase, and a 4- to 6-week...

Twenty-six normolipidemic, nondiabetic patients with mild-to-moderate essential hypertension completed a 24-week, randomized, double-blind study to assess the long-term effects of hydrochlorothiazide (HCTZ), propranolol, and atenolol on lipid and carbohydrate metabolism. After a four-week, single-blind, placebo run-in, treatment began with an eight...

This multicenter study evaluated nitrendipme, a dihydropyridine calcium antagonist, alone or in combination with hydrochlorothiazide and/or propranolol in severe essential hypertension (baseline supine diastolic BP + 115 mm Hg). After an initial 3- to 7-day drug-tree run-in, a 2- to 5-week tutration phase, and a 4- to 6-week maintenance period, pat...

The factors involved in the progression of significant coronary artery disease have been previously documented. We studied 300 patients with coronary artery disease who underwent two or more coronary arteriograms at an average interval of 40 months. We defined coronary artery disease progression as a one-step increase in luminal narrowing at the fo...

The antihypertensive and lipid effects of doxazosin and atenolol were compared in a 10-week, double-blind, parallel, placebo-controlled study. The 129 adults enrolled had mild to moderate hypertension (average supine diastolic blood pressures for doxazosin, atenolol and placebo were 100.6, 101.0 and 99.7 mm Hg, respectively). Patients were randomly...

Lisinopril (LIS) is a lysine analog of enalaprilat, the active metabolite of enalapril, an angiotensin-converting enzyme inhibitor (ACEI). Unlike enalapril, the precursor of enalaprilat, LIS is not a prodrug but has equal ACEI efficacy and potency and a slightly longer duration of action after oral administration. Short-term (12 weeks) and long-ter...

The medical records of patients hospitalized in a teaching hospital between August 1981 and January 1983 were examined retrospectively, and 38 patients with elevated (greater than 350 mg/dl) serum cholesterol levels were identified. Follow-up information was obtained from the office records of attending physicians. Hyperlipidemia had been diagnosed...

Fifty-seven patients who had a significant (≥50%) narrowing of a nongrafted coronary artery and a baseline cholesterol level >250 mg/dl were studied. All patients underwent repeat coronary arteriography after two years. Thirty-six colestipol responders (cholesterol levels reduced at least 15 within one month of therapy) were compared to 21 nonre-sp...

In this very early report, Dr Nash shares his insights into a newly developing approach to hyperlipidemia therapy. Four severely hyperlipidemic patients in whom maximum dietary therapy had proved ineffective showed a dramatic reduction in cholesterol and triglyceride levels when treated with multiple drugs, including gemfibrozil. These cases demons...

I approach my responsibilities of teaching cardiology to medical students and house officers with some ambivalence. Of course, I have always enjoyed and usually learned something from my contacts with these young colleagues, but lately their emphasis seems to be entirely on technical procedures. Few of my charges express an interest in entering ful...

VERAPAMIL hydrochloride is a calcium channel-blocking drug used to treat supraventricular tachycardia and angina pectoris. Since it produces a reduction in vascular resistance, we studied it as an antihypertensive agent. This report describes a middle-aged woman who received verapamil therapy for hypertension and who experienced hepatic dysfunction...

Elevated levels of serum cholesterol have long been associated with an increased risk of both the occurrence and the progression of coronary atherosclerosis. The use of dietary therapy to reduce elevated lipid labels has received widespread attention, but like other therapy requiring behavioral modification has met with only partial success in most...

Improvements in diagnosis permit primary care physicians to identify lipid disorders. Until recently, most of the therapy for coronary artery disease was directed at the symptoms produced by the ischemic myocardium. As more studies reveal the close relationship between the presence of abnormal lipid levels and the prevalence and progression of coro...