Background Lowering the blood cholesterol level may reduce the risk of coronary heart disease This double-blind study was designed to determine whether the administration of pravastatin to men with hypercho- lesterolemia and no history of myocardial infarction re- duced the combined incidence of nonfatal myocardial in- farction and death from coronary heart disease Methods We randomly assigned 6595 men, 45 to 64 years of age, with a mean ( � SD) plasma cholesterol lev- el of 272 � 23 mg per deciliter (70 � 06 mmol per liter) to receive pravastatin (40 mg each evening) or placebo The average follow-up period was 49 years Medical rec- ords, electrocardiographic recordings, and the national death registry were used to determine the clinical end points Results Pravastatin lowered plasma cholesterol lev- els by 20 percent and low-density lipoprotein cholesterol levels by 26 percent, whereas there was no change with placebo There were 248 definite coronary events (speci- fied as nonfatal myocardial infarction or death from coro- nary heart disease) in the placebo group, and 174 in the pravastatin group (relative reduction in risk with prava- statin, 31 percent; 95 percent confidence interval, 17 to 43 percent; P � 0001) There were similar reductions in the risk of definite nonfatal myocardial infarctions (31 percent reduction, P � 0001), death from coronary heart disease (definite cases alone: 28 percent reduction, P � 013; definite plus suspected cases: 33 percent reduc- tion, P � 0042), and death from all cardiovascular causes (32 percent reduction, P � 0033) There was no excess of deaths from noncardiovascular causes in the pravastatin group We observed a 22 percent reduction in the risk of death from any cause in the pravastatin group (95 percent confidence interval, 0 to 40 percent; P � 0051) Conclusions Treatment with pravastatin significantly reduced the incidence of myocardial infarction and death from cardiovascular causes without adversely affecting the risk of death from noncardiovascular causes in men with moderate hypercholesterolemia and no history of myocardial infarction (N Engl J Med 1995;333:1301-7)

http://www.columbiamedicine.org/education/r/Cardiology/Outpatient-Prevention/HTN%20and%20Hyperlipidemia/Coronary%20Prevention%20Study.pdf

Prevention of coronary heart disease with pravastatin in men with hypercholesterolemia

Prevention of Coronary Heart Disease with Pravastatin in Men with Hypercholesterolemia

Recommendations for the Standardization and Interpretation of the Electrocardiogram

https://www.heartrhythmjournal.com/article/S1547-5271(07)00105-1/pdf

Recommendations for the Standardization and Interpretation of the Electrocardiogram: Part I: The Electrocardiogram and Its Technology A Scientific Statement From the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society Endorsed by the International Society for Computerized Electrocardiology

Recommendations for the standardization and interpretation of the electrocardiogram. Part I: The electrocardiogram and its technology. A scientific statement from the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society.

The Casper project-an enforced mass-culture streptococcic control program.

A unique, legally enforced, mass-culture program for detection and treatment of streptococcal pharyngitis has been in effect in Natrona County, Wyoming, since 1954. To evaluate the impact of such a program on the streptococcal milieu, the Streptococcal Disease Section, Ecological Investigations Division, Public Health Service, studied a randomized sample of the children under surveillance. The study revealed an extremely low total streptococcal isolation rate (1.8%), as well as antibody levels consistent with a low level of streptococcal infection. The percentage of students with group A antibody was half that of comparable groups in the region; type-specific antibody titers against six streptococcal types revealed values significantly lower than in uncontrolled schoolchild groups in the Rocky Mountain region. The control measures appear to have altered the streptococcal milieu in a favorable manner.

https://jamanetwork.com/HttpHandlers/ArticlePdfHandler.ashx?journal=jama&articleId=358492&pdfFileName=jama_214_11_006.pdf

A community-wide streptococcal control project. The Natrona County Primary Prevention Program, Casper, Wyo.

A case is presented in which an ectopic atrial pacemaker manifested "pacemaker block," a phenomenon analogous to sinoatrial block in the sinoatrial node. This is believed to be the first recorded instance of such a phenomenon.

Paroxysmal Atrial Tachycardia with Block Around the Ectopic Pacemaker Report of a Case

In this study, ultra low frequency force ballistocardiograms were recorded throughout the course of various types of acute cardiomyopathy. Conditions studied included rheumatic carditis, lupus myocarditis, sarcoid carditis, viral myocarditis, acute glomerulonephritis, idiopathic myocarditis, and familial fibrous disease of the myocardium. The instrument used was characterized by an unusually light platform and a very high performance accelerometer. In 14 of the 15 cases studied, tracings were abnormal initially; the recorded force pattern subsequently manifested progressive change which appeared to parallel the clinical course of the disease. Changes included appearance of abnormal forces in early ventricular systole, progressive change in amplitude of acceleration and deceleration forces, appearance of abnormal high frequency components in various portions of the complex, and appearance of abnormal footward forces in late systole.

The alterations thus recorded appear to offer a useful means of diagnosing and following the course of such disease entities. In some cases, this type of recording appears to provide information not available through any other conventional means.

Brendan Phibbs

Papers

The Casper project-an enforced mass-culture streptococcic control program.

A community-wide streptococcal control project. The Natrona County Primary Prevention Program, Casper, Wyo.

Paroxysmal Atrial Tachycardia with Block Around the Ectopic Pacemaker Report of a Case

The Ultra Low Frequency Force Ballistocardiograph in Acute Cardiomyopathy

A community-wide streptococcal control project.