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Introduction
Publications
Publications (589)
Atherosclerosis is increasingly viewed as an inflammatory process. A number of infectious agents have been implicated in the pathogenesis of coronary artery disease. Chlamydia pneumoniae has been the most popular and well-studied of these pathogens. It is difficult to prove a causal relationship which requires the fulfillment of Koch's postulates,...
Pulse pressure, an index of large artery stiffness, has been associated with coronary events. However, mechanisms for this association remain unclear. In this study, we examined the relationship between pulse pressure and the progression of coronary atherosclerosis and the effects of hormone replacement therapy (HRT) on pulse pressure in postmenopa...
To evaluate the contribution of hematologic factors and long-term inflammation to the development of myocardial infarction at a young age, we measured hematologic variables, including soluble fibrin and high-sensitivity C-reactive protein, in 90 patients who had myocardial infarction and 138 controls </=45 years of age. Plasma levels of soluble fib...
The Pravastatin or Atorvastatin Evaluation and Infection Therapy trial (PROVE-IT/TIMI-22) showed that in patients with acute coronary syndromes, aggressive lipid-lowering using atorvastatin 80 mg/day provided greater protection against death or major cardiovascular events than did moderate lipid-lowering using pravastatin 40 mg/day. Lowering the lo...
Abnormal glucose tolerance (AGT; diabetes or impaired glucose tolerance) is associated with increased risk of cardiovascular disease, especially in women. Cardiovascular disease rates in women increase after menopause. The Women's Health Initiative found that postmenopausal hormone therapy (PHT) increased the risk of cardiovascular disease and that...
Clinical trials have shown that the lowering of total cholesterol or low-density lipoprotein cholesterol levels substantially reduces the risk of morbidity and mortality due to coronary heart disease. However, the benefits of lipid lowering in patients with acute coronary syndromes have been less well studied. The majority of statin trials excluded...
There is a growing body of literature concerning the contribution of hemostatic factors to the development of cardiovascular disease. The mechanisms of the coagulation/fibrinolytic system are complicated and one factor is intimately interrelated with another; thus the contribution of each factor cannot be clearly understood, unless hemostatic facto...
HIV-infected patients may be at increased risk for coronary events. The purpose of this study was to identify predictors of carotid intima-media thickness (IMT) in HIV patients at baseline and to measure IMT progression over 1 year.
We measured blood lipids, inflammatory markers, and IMT in 148 HIV-infected adults (mean age, 45+/-8 years) and in 63...
Patients with HIV infection exhibit increased rates of coronary events; however, the clinical features of acute coronary syndromes (ACS) in HIV-infected patients have not been well defined.
Between 1993 and 2003, 68 HIV-infected patients were hospitalized with ACS. We compared the clinical features and outcome of these patients with those of 68 ran...
The Treating to New Targets (TNT) trial is a parallel-group study that has randomized 10,003 patients from 14 countries to double-blind treatment with either atorvastatin 10 or 80 mg. During the double-blind period, low-density lipoprotein (LDL) cholesterol levels are expected to reach approximate mean values of 100 mg/dl (2.6 mmol/L) for the low-d...
Objetivo
Evaluar el efecto de dosis altas de vitamina E y C, solas o en combinación con tratamiento hormonal sustitutivo (THS), en mujeres posmenopáusicas con enfermedad coronaria (EC) establecida.
Diseño
Ensayo clínico aleatorizado doble ciego de 4,5 años de seguimiento, con diseño 2 × 2.
Emplazamiento
Siete clínicas de Estados Unidos y Canadá....
An economic analysis was conducted using clinical outcomes in the MIRACL trial that evaluated high-dose atorvastatin versus placebo for 16 weeks after acute coronary syndrome. The direct cost of atorvastatin was largely offset by the associated decrease in cardiovascular events. The net incremental cost of atorvastatin treatment was 157 dollars/pat...
The risk of cardiovascular mortality is higher among black women than white women, and the reasons for this disparity are largely unexplored. We sought to evaluate differences in medical care and clinical outcomes among black and white women with established coronary artery disease.
Among the 2699 women enrolled in the Heart and Estrogen/progestin...
Smokers differ from nonsmokers in the way they present with acute coronary syndromes and in how they respond to treatment. Although smoking increases the risk of a coronary event and accelerates the progression of established atherosclerosis, paradoxically, smokers have better short-term survival after an acute myocardial infarction, mainly because...
Despite the fact that neither hormone replacement therapy (HRT) nor antioxidant vitamins have been demonstrated to benefit postmenopausal women with coronary artery disease (CAD), both measures are widely used as secondary prevention. The Women's Angiographic Vitamin and Estrogen (WAVE) trial was designed to show whether either of these measures or...
This study was designed to determine how long nuclear myocardial perfusion imaging (MPI) remains abnormal following transient myocardial ischemia.
Acute rest MPI identifies myocardial ischemia with a high sensitivity when the radionuclide is injected during chest pain. However, the sensitivity of this technique is uncertain when the radionuclide is...
The Women's Angiographic Vitamin and Estrogen trial was a randomized, double-blind, placebo-controlled study designed to test the efficacy of estrogen replacement and antioxidant vitamins for preventing angiographic progression of coronary artery disease. Postmenopausal women with one or more angiographically documented coronary stenoses of 15-75%...
Cardiovascular disease is the leading cause of morbidity and mortality among women in industrialized nations. Optimizing cardiovascular risk reduction is therefore of paramount importance, particularly among postmenopausal women, in whom the incidence of cardiovascular disease is highest. Accumulated data from a series of landmark trials unequivoca...
Impaired coronary blood flow (CF) or flow reserve with incomplete and delayed recovery of left ventricular (LV) function after revascularization is common in severe ischemic LV dysfunction. The underlying mechanism is not fully known. We studied structural changes of small intramyocardial coronary arteries (SIMCAs) in a pig model of chronic coronar...
Hormone replacement therapy (HRT) and antioxidant vitamins are widely used for secondary prevention in postmenopausal women with coronary disease, but no clinical trials have demonstrated benefit to support their use.
To determine whether HRT or antioxidant vitamin supplements, alone or in combination, influence the progression of coronary artery d...
This report describes the effect of intensive cholesterol lowering with atorvastatin on the incidence of nonfatal stroke, a secondary end point, in a randomized, placebo-controlled trial of patients with unstable angina or non-Q-wave myocardial infarction. The primary end point, a composite of death, nonfatal myocardial infarction, resuscitated car...
Clinical trial data available since the publication of these guidelines supported increased focus on patients' coronary heart disease risk to determine lipid-lowering treatment, even when lipid levels appear to be appropriate. Other data support use of more aggressive lipid-lowering strategies in the settings of acute coronary syndromes and mixed d...
Background-Although single case reports have described acute aortic dissection in relation to cocaine use, this condition is not widely recognized, and the features of cocaine-related aortic dissection have not begin defined. Methods and Results-We reviewed all available hospital charts from 1981 to 2001 with the ICD-9 diagnosis of aortic: dissecti...
The Heart and Estrogen/progestin Replacement Study (HERS) found no overall reduction in risk of coronary heart disease (CHD) events among postmenopausal women with CHD. However, in the hormone group, findings did suggest a higher risk of CHD events during the first year, and a decreased risk during years 3 to 5.
To determine if the risk reduction o...
Context
The Heart and Estrogen/progestin Replacement Study (HERS) found no overall
reduction in risk of coronary heart disease (CHD) events among postmenopausal
women with CHD. However, in the hormone group, findings did suggest a higher
risk of CHD events during the first year, and a decreased risk during years
3 to 5.Objective
To determine if t...
Cardiologists have traditionally focused on coronary narrowing as seen on angiography and have orientated treatment towards bypassing these lesions or widening them with angioplasty. In patients with stable coronary artery disease, percutaneous coronary interventions reliably relieve angina and myocardial ischemia, but do not prevent myocardial inf...
Although single case reports have described acute aortic dissection in relation to cocaine use, this condition is not widely recognized, and the features of cocaine-related aortic dissection have not been defined.
We reviewed all available hospital charts from 1981 to 2001 with the ICD-9 diagnosis of aortic dissection. Among the 38 cases of acute a...
Hydroxy-methyl-glutaryl co-enzyme A reductase inhibitors (HMG CoA RIs) markedly improve the lipid profile of patients with hypercholesterolemia, but the magnitude and time course of the effect of these drugs on other risk factors for atherosclerosis are not well defined.
We employed a random assignment, double-blind design to compare the effect of...
Methods. Study materiel consisted of 44 patients (21 diabetic) with SAP. All of the patients had single vessel disease with more than 70% narrowing and underwent stent implantation to this vessel. Total and subtotal occlusions were excluded. After angiography, fiber-optic pressure monitoring guide-wire was advanced to the stanosis to be dilated. My...
Description
Background:
Previous randomized trials have involved too few strokes to assess the effects of cholesterol lowering, and of antioxidant vitamins, reliably.
Methods:
A wide range of people at increased risk of coronary and other occlusive vascular events were randomly allocated to receive 40 mg simvastatin daily, or matching placebo table...
Coronary artery disease can develop prematurely and is the leading cause of death among diabetics, making noninvasive risk stratification desirable.
Patients with symptoms of coronary artery disease who were undergoing stress myocardial perfusion imaging (MPI) from 5 centers were prospectively followed (2.5+/-1.5 years) for the subsequent occurrenc...
Contexto
Los pacientes presentan la mayor tasa de mortalidad y episodios isquémicos recurrentes durante el período temprano después de un síndrome coronario agudo, pero se desconoce si el inicio precoz del tratamiento con una estatina reduciría la incidencia de dichos episodios tempranos. Objetivo. Determinar si el tratamiento con 80 mg/día de ator...
Remarkable therapeutic advances in the treatment of acute coronary syndromes (ACS) have been made with antiplatelet and antithrombotic therapy. However, these therapies alone do not appear to completely stabilize culprit lesions. Evidence from a variety of sources suggests that intensive cholesterol lowering with statins favorably influences culpri...
Cholesterol lowering with statins reduces coronary events in a primary-prevention setting and in patients with stable coronary disease. However, where the risk of a coronary event is highest, in the early months after an episode of unstable angina or non-Q-wave infarction, the effect of statin therapy has not been evaluated until recently. The lack...
To date, 5 major randomized, placebo-controlled statin trials--the Scandinavian Simvastatin Survival Study, West of Scotland Coronary Prevention Study, Cholesterol and Recurrent Events trial, Long-term Intervention with Pravastatin in Ischaemic Disease, and Air Force/Texas Coronary Atherosclerosis Prevention Study--have convincingly shown that tota...
The editorial by Waters and Azar1 that appeared in the July 11, 2000, issue of Circulation summarized reasons for more aggressive cholesterol-lowering therapy both after coronary bypass grafting and for the primary and secondary prevention of coronary disease. In the same issue, Lemieux et al2 suggested triglyceride determinations and waist measure...
This document has been developed as a Clinical Expert Consensus Document (CECD), combining the resources of the American College of Cardiology (ACC) and the Society for Cardiac Angiography and Interventions (SCA&I). It is intended to provide a perspective on the current state of cardiac
A. The Cardiac Catheterization Laboratory Environment: Cardiac catheterizations are currently performed safely in hospitals with and without cardiac surgical backup. The latest information from the SCA & I lists >2,100 cardiac catheterization laboratories in the U.S. (including Puerto Rico and the Virgin Islands) (1). Of these, 72% provided on-site...
Patients experience the highest rate of death and recurrent ischemic events during the early period after an acute coronary syndrome, but it is not known whether early initiation of treatment with a statin can reduce the occurrence of these early events.
To determine whether treatment with atorvastatin, 80 mg/d, initiated 24 to 96 hours after an ac...
Preamble......1479
The present document is an Expert Consensus Document that includes evidence about the standards for the acquisition, measurement, and reporting of intravascular ultrasound studies (IVUS). This document is intended to inform practitioners, payers, and other interested parties of
The Myocardial Ischemia Reduction with Acute Cholesterol Lowering (MIRACL) Trial tested the hypothesis that intensive lowering of cholesterol with atorvastatin (80 mg/day) initiated 24-96 h after an acute coronary syndrome would, over 4 months, reduce the incidence of the composite endpoint of death, nonfatal infarction, resuscitated cardiac arrest...
In addition to medical therapy, we would recommend revascularization of the left anterior descending artery and the right coronary artery. We recommend this because the patient has at least a moderately limited exercise capacity and a large amount of myocardium at risk. Studies comparing bypass surgery to medical therapy alone have shown a survival...
The purpose of this study was to assess the efficacy of antiinflammatory therapy with methylprednisolone during the acute phase of unstable angina.
This is a randomized 'prospective' double-blind, placebo-controlled trial. Patients with the diagnosis of unstable angina were randomized to a 48-h course of methylprednisolone (n=81) or placebo (n=85)....
Percutaneous coronary revascularization techniques are widely considered to be the definitive therapies for patients with coronary artery disease (CAD). However, in the last decade the beneficial effects of lipid-lowering therapy in reducing CAD morbidity and mortality have also been reported in large-scale clinical trials. In 1997, the Post-Corona...
Background: Previous trials have demonstrated that treatment with conventional doses of statins, initiated in patients with stable coronary heart disease, reduces death and non-fatal ischemic events over periods of years. The Myocardial Ischemia Reduction with Aggressive Cholesterol Lowering (MIRACL) trial tested the hypothesis that intensive treat...
The phenomenon of left ventricular (LV) remodeling with dilatation, wall thinning, and increased muscle mass has previously been reported in pigs with 7-day myocardial hibernation. This study investigated cellular and extracellular basis and reversibility of the structural LV remodeling with hibernating myocardium. Five groups of pigs were included...
Although several large, well-controlled trials with 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) demonstrate the benefits of cholesterol lowering on cardiovascular morbidity and mortality, these trials excluded patients with recent unstable angina or myocardial infarction. Thus, the potentially beneficial effects that may ac...
Heart disease is a major cause of illness and death in women. To understand better the role of estrogen in the treatment and prevention of heart disease, more information is needed about its effects on coronary atherosclerosis and the extent to which concomitant progestin therapy may modify these effects.
We randomly assigned a total of 309 women w...
This study examined 650 consecutive patients who presented with an acute myocardial infarction and were treated with primary angioplasty within 12 hours of symptom onset between August 1995 and December 1998. Patients were placed into 4 treatment groups depending on the adjunctive therapy they received: group 1, percutaneous transluminal coronary a...
Recent studies have implicated inflammation in the pathogenesis of coronary artery disease and of acute coronary syndromes.1‐3 Systemic markers of inflammation such as C-reactive protein (CRP) are elevated in patients with coronary atherosclerosis, 4 and increase significantly in patients with unstable angina or acute myocardial infarction.5 CRP le...
The addition of a postscript to a letter usually indicates that the writer has additional important information to impart. The new information may either reinforce the original message or contradict it and produce a quandary. The postscript from the Post-Coronary Artery Bypass Graft trial (Post-CABG) reported in this issue does both.1 At the end of...
Women presenting with acute myocardial infarction (AMI) have a higher mortality with conventional medical and thrombolytic therapy when compared with men. The outcome after primary percutaneous transluminal mechanical revascularization has not yet been fully investigated. This study was performed to compare the characteristics and the short- and me...
Although the combined assessment of perfusion and function using rest electrocardiographic (ECG)-gated technetium-99m (Tc-99m) sestamibi single-photon emission computed tomographic (SPECT) imaging has been shown to improve sensitivity and accuracy over perfusion alone in the prediction of myocardial viability, no data are available comparing this t...
A diagnostic test that could distinguish between stable and unstable coronary atherosclerotic plaques would be useful. We tested the ability of a new glycoprotein IIb/IIIa platelet inhibitor DMP-444, labeled with technetium (Tc)-99 m, to identify platelet-rich thrombus by nuclear imaging in a canine model.
Combinations of a flow-limiting stenosis a...
Smoking cessation after myocardial infarction (MI) has been associated with a 50% reduction in mortality but in-hospital smoking cessation interventions are rarely part of routine clinical practice.
One hundred cigarette smokers consecutively admitted during 1996 with MI were assigned to minimal care or to a hospital-based smoking cessation program...
Unlabelled:
This study examined the effect of delayed reperfusion of myocardial hibernation from 24 hours to 7 days on myocardial ultrastructural and functional changes and their recoveries after reperfusion.
Background:
We have previously shown in pigs that after reperfusion the functional and structural alterations in short-term myocardial hib...
Although previous studies have shown that angioplasty improves exercise performance and reduces symptoms better than standard medical therapy in low risk, stable patients with coronary disease, none of these studies used aggressive cholesterol-lowering medical therapy. In addition, the event rate of death from myocardial infarction and other corona...
In the Atorvastatin Versus Revascularization Treatments (AVERT) Trial, 341 patients without severe symptoms referred for coronary angioplasty, with a low density lipoprotein cholesterol of at least 115 mg/dL and one or two coronary stenoses of at least 50%, were randomized to atorvastatin 80 mg/day and no angioplasty, or to angioplasty plus usual c...
Vigorous physical exertion transiently increases the risk of acute myocardial infarction (MI), but little is known about the clinical characteristics of exertion-related MI.
To compare the clinical and angiographic characteristics of patients who had an exertion-related acute MI vs those who experienced an MI not related to exertion.
Prospective ob...
Newer diagnostic modalities such as serum markers and acute rest myocardial perfusion imaging (MPI) have been evaluated diagnostically in patients with chest pain in the emergency department (ED), but never concurrently. We compared these two modalities in distinguishing patients in the ED with symptomatic myocardial ischemia from those with non-ca...
Unstable coronary artery disease continues to pose a major challenge to clinicians. The advent of new therapies, such as percutaneous transluminal coronary angioplasty, low-molecular-weight heparins, and glycoprotein IIb/IIIa inhibitors, provides new management options for this indication but also raises new questions with regard to optimal managem...
The efficacy of local drug delivery in the treatment of coronary artery disease is limited by the relatively low delivery efficiency of the available devices. A unique local drug delivery device, the Infiltrator catheter (InterVentional Technologies, Inc.), has been designed specifically to enhance efficiency by injecting drugs directly into the ar...
Unstable coronary artery disease continues to pose a major challenge to clinicians. The advent of new therapies, such as percutaneous transluminal coronary angioplasty, low-molecular-weight heparins, and glycoprotein IIb/IIIa inhibitors, provides new management options for this indication but also raises new questions with regard to optimal managem...
Percutaneous coronary revascularization is widely used in improving symptoms and exercise performance in patients with ischemic heart disease and stable angina pectoris. In this study, we compared percutaneous coronary revascularization with lipid-lowering treatment for reducing the incidence of ischemic events.
We studied 341 patients with stable...
Limited exercise combined with dipyridamole increases myocardial perfusion defect severity compared with dipyridamole alone. The impact of limited exercise combined with adenosine on myocardial perfusion defect severity is unknown. This study compares myocardial perfusion defect severity with adenosine alone and adenosine combined with limited exer...
rupture with subsequent healing of the plaque is probably a more important mechanism of progression than the slow accretion of lipids and cellular components into the plaque. Studies in nonhuman primates5 and extrapolations from autopsy data indicate that cholesterol lowering reduces foam cell and cholesterol ester content of plaques and increases...
Purpose:
The purpose of this study was to compare defect extent and severity and myocardial uptake with exercise and pharmacologic stress with technetium-99m (Tc-99m) tetrofosmin tomographic myocardial perfusion imaging.
Background:
Detection of stress-induced myocardial perfusion defects depends on both a disparity in blood flow between normal...
This study evaluates the use of electrocardiographic (ECG) gated single-photon emission computed tomographic (SPECT) myocardial perfusion imaging for the prediction of viability in patients undergoing revascularization, who have coronary disease and left ventricular dysfunction. Fifty patients underwent technectium-99m (Tc-99m) sestamibi ECG gated...