Showing papers by "Henry R. Black published in 2009"

Adverse cardiovascular outcomes in women with nonobstructive coronary artery disease: a report from the Women's Ischemia Syndrome Evaluation study and the St James Women Take Heart Project.

Abstract: Symptoms of angina in the absence of clinically significant coronary artery disease (CAD) constitute a relatively common clinical scenario in women and remain a challenge for physicians caring for such patients. Until recently, the prognosis of women with signs and symptoms suggestive of myocardial ischemia in the absence of obstructive CAD was thought to be benign,1–3 and such women have been offered little more than reassurance that they do not have heart disease, despite signs and symptoms that have required them to undergo coronary angiography.4 More recently, the notion of its benign nature has been challenged, with evidence showing that women with chest pain in the setting of normal or nonobstructive coronary arteries have a high risk of future cardiac events.5–9 To our knowledge, there have been no prospective studies examining the implications of chest pain in the absence of obstructive CAD in women, relative to a population of asymptomatic women. Chest pain and other equivalent cardiac symptoms that are suggestive of myocardial ischemia, even in the absence of obstructive CAD, have important functional and economic implications to women and society. A recent retrospective study of men and women with suspected ischemia resulting in referral for angiography showed that women were more often found to have angiographically normal coronary arteries. These same women were 4 times more likely to be readmitted for chest pain or for acute coronary syndrome within the next 180 days.9 Data from the Women’s Ischemia Syndrome Evaluation (WISE) study estimate that, among the approximately 500 000 US women who undergo coronary angiography annually, half will have no obstructive lesions (where obstruction is considered ≥50% narrowing in any coronary artery) in contrast to 7% to 17% of men who undergo angiography.9–13 Given this high rate of nonobstructive coronary angiograms, until recently such women were usually offered little in terms of treatment, despite recurrent symptoms requiring hospitalization, repeated procedures, functional disabilities, and future cardiac events that translate to a heavy economic burden with average lifetime costs estimated to be greater than $750 000.14 Despite being a common clinical scenario with important public health consequences, the prevalence of chest pain in the absence of obstructive CAD has not declined since it was first reported.15–18 We sought to investigate the prognostic implications of cardiac symptoms in women with nonobstructive CAD compared with community-dwelling women without cardiac symptoms. We investigated this prospectively in a cohort of symptomatic women referred for clinically indicated coronary angiography and compared them with a cohort of asymptomatic women free of known CAD at baseline.

Ambulatory Monitoring Detects Sorafenib-Induced Blood Pressure Elevations on the First Day of Treatment

Abstract: Purpose: Hypertension is a mechanism-based toxicity of sorafenib and other cancer therapeutics that inhibit the vascular endothelial growth factor (VEGF) signaling pathway. This prospective, single-center, cohort study characterized ambulatory blood pressure monitoring as an early pharmacodynamic biomarker of VEGF signaling pathway inhibition by sorafenib. Experimental Design: Fifty-four normotensive advanced cancer patients underwent 24-hour ambulatory blood pressure monitoring before and between days 6 and 10 of sorafenib therapy. After blood pressure changes were detected among the first cohort within 10 days, ambulatory blood pressure monitoring was done during the first 24 hours of treatment for the second cohort. Results: For the entire patient population, the blood pressure increase [mean systolic, +10.8 mm Hg; 95% confidence interval (95% CI), 8.6-13.0; range, −5.2 to +28.7 mm Hg; mean diastolic, +8.0 mm Hg; 95% CI, 6.3-9.7; range, −4.4 to +27.1 mm Hg] was detected between days 6 and 10 ( P P Conclusions: Ambulatory blood pressure monitoring detects the blood pressure response to VEGF signaling pathway inhibition by sorafenib during the first 24 hours of treatment. The magnitude of blood pressure elevation is highly variable and unpredictable but could be important in optimizing the therapeutic index of VEGF signaling pathway inhibitor therapy. (Clin Cancer Res 2009;15(19):6250–7)

ACCF/AHA/ACP 2009 Competence and Training Statement: A Curriculum on Prevention of Cardiovascular Disease: A Report of the American College of Cardiology Foundation/American Heart Association/American College of Physicians Task Force on Competence and Training (Writing Committee to Develop a Competence and Training Statement on Prevention of Cardiovascular Disease)

Abstract: The mission of many organizations is the optimal care to those with or at risk for developing CVD (primary and secondary prevention) Over the past two decades, there have been dramatic increases in knowledge concerning specific risk factors in atherosclerosis, hypertension, thrombosis, and other forms of vascular dysfunction Clinical trials have proven that strategies aimed at the appropriate detection and modification of risk factors can slow progression of atherosclerosis, diabetes mellitus, and hypertension and reduce the occurrence of clinical cardiovascular events in both primary and secondary prevention settings More recently, it has been shown that atherosclerosis can be stabilized or even modestly reversed Finally, a new and growing knowledge base of molecular genetics applied to the study of the cardiovascular system has potential relevance to the clinical practice of preventive cardiovascular medicine Despite the fact that clinical outcomes can be improved by promotion of favorable life habits and behaviors and by the proper use of drug treatment, the application of primary and secondary preventive interventions in clinical practice is not optimal Prevention of CVD in both the primary and secondary prevention setting, while dominantly the responsibility of the primary care provider, is increasingly challenged given this ever expanding new knowledge as well as the ongoing problems related to adherence to recommendations New knowledge in the area of pre-clinical disease detection has presented increasingly challenging scenarios to primary care healthcare providers relative to the decisions regarding the need for further risk stratification and aggressive medical regimens Furthermore, increasingly complex patients are surviving with CVD, many of whom can benefit from advanced knowledge and expertise with regard to risk factor management and rehabilitation that is beyond traditional general primary and cardiology practitioner's scope of practice The prevention of cardiovascular morbidity and mortality is a shared responsibility among all health professionals involved in the care of people at risk of developing cardiovascular disease This document is directed at those individuals seeking expertise at a leadership level in this field, and includes opportunities for formal training and alternative routes to competence and maintenance of competence in prevention of cardiovascular disease (Table 2), and educational resources for acquisition and maintenance of competence in the prevention of cardiovascular disease (Table 3) To address the expanding fund of knowledge in the area and to ensure that an adequately trained force of preventive cardiovascular leaders will be available to primary care providers, as well as provide a pool of providers with expertise in running rehabilitation and other programs designed to address the ongoing issue of adherence, the formulation of clinical competency criteria for the cardiovascular preventive specialist is needed These competency criteria are expected to address issues of expert clinical and scientific leadership, specialty patient care and consultation, and directorship of primary and secondary preventive cardiac programs Of note and similar to other subspecialty areas of medicine, cardiovascular preventive specialists will have varying areas of expertise and will not necessarily achieve all the outlined areas of competencies These clinical competency criteria in the area of specialty treatment and prevention of CVD are needed given the current setting of a rapidly growing field of knowledge ranging from molecular and cellular mechanisms to clinical outcomes in order to translate into improved patient care Table 2 Opportunities for Formal Training and Alternative Routes to Competence and Maintenance of Competence in Prevention of Cardiovascular Disease Table 3 Educational Resources for Acquisition and Maintenance of Competence in the Prevention of Cardiovascular Disease C Noel Bairey Merz, MD, FACC, FAHA Chair, ACCF/AHA/ACP Clinical Competence Statement on Prevention of CVD

Angiotensin-Converting Enzyme Inhibitor Use and Incident Frailty in Women Aged 65 and Older: Prospective Findings from the Women's Health Initiative Observational Study

Abstract: OBJECTIVES: Angiotensin-converting enzyme (ACE) inhibitor medications have the potential to preserve skeletal muscle and thus may be targets to prevent frailty in older adults. Our objective was to examine the associations between current use, duration, and potency of ACE inhibitors and incident frailty in women ages 65 and older who are not frail at baseline. DESIGN: Data are from the Women's Health Initiative Observational Study (WHI-OS), a prospective study conducted at 40 United States clinical centers. PARTICIPANTS: Women between the ages of 65-79 years at baseline who were not frail (n=27,378).

Evidence for a lower target blood pressure for people with heart disease.

Abstract: Purpose of reviewThe review assesses the evidence for the benefit of lower blood pressure (BP) targets in hypertension management.Recent findingsThe current consensus target for the treatment of hypertension is a BP of below 140/90 mmHg for all patients, and a BP of below 130/80 mmHg for those with