Showing papers by "James B. Young published in 2011"
TL;DR: The third annual report of the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) provides documentation of the current landscape of durable mechanical circulatory support in the United States.
Abstract: The third annual report of the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) provides documentation of the current landscape of durable mechanical circulatory support in the United States. With nearly 3,000 patients entered into the database, the transition to continuous-flow pump technology is evident and dramatic. This report focuses on the rapidly expanding experience with mechanical circulatory support as destination therapy. The current 1-year survival of 75% with continuous-flow destination therapy provides a benchmark for the evolving application of this therapy.
325 citations
TL;DR: Although patients with the lowest systolic blood pressure had the greatest preservation of cognitive function, meta-regression analyses did not show any benefits of blood-pressure lowering on cognition over several years of treatment.
Abstract: Summary Background Cardiovascular risk factors are associated with dementia and cognitive decline. We investigated the effects of renin-angiotensin system blockade on cognitive function in patients aged 55 years and older with established atherosclerotic cardiovascular disease or diabetes with end-organ damage in two clinical trials. Methods In the main study, ONTARGET, a double-blind, double-dummy, randomised controlled trial, the effects on cardiovascular outcomes of standard doses of an angiotensin-converting enzyme (ACE) inhibitor (ramipril), an angiotensin-receptor blocker (telmisartan), and a combination of the drugs were evaluated in 25 620 participants. In the parallel TRANSCEND trial, the effects of telmisartan were compared with those of placebo in 5926 participants intolerant to ACE inhibitors. Secondary outcomes included cognitive impairment (defined by investigator-reported diagnosis of dementia or significant cognitive dysfunction, or a score of ≤23 on the Mini-Mental State Examination [MMSE]) and cognitive decline (a decrease of ≤3 points on the MMSE from baseline during follow-up). Analyses were by intention to treat. We pooled data from these studies to identify baseline predictors of cognitive impairment and its frequency according to mean systolic blood pressure during follow-up. These studies were registered with ClinicalTrials.gov, number NCT00153101. Findings During a median duration of 56 months (IQR 51–64) of follow-up in ONTARGET, cognitive impairment occurred in 652 (8%) of 7865 patients allocated ramipril, 584 (7%) of 7797 allocated telmisartan, and 618 (8%) of 7807 allocated combination treatment (combination vs ramipril, odds ratio [OR] 0·95, 95% CI 0·85–1·07, p=0·39; telmisartan vs ramipril, OR 0·90, 0·80–1·01, p=0·06). Corresponding figures for cognitive decline were 1314 (17%), 1279 (17%), and 1240 (17%) in each of the groups, respectively (telmisartan vs ramipril, OR 0·97, 0·89–1·06, p=0·53; combination vs ramipril, OR 0·95, 0·88–1·04, p=0·28). In TRANSCEND, cognitive impairment occurred in 239 (9%) of 2694 participants allocated telmisartan compared with 245 (9%) of 2689 allocated placebo (OR 0·97, 0·81–1·17, p=0·76). The corresponding figures for cognitive decline were 454 (17%) and 412 (16%; OR 1·10, 0·95–1·27, p=0·22). Interpretation In patients with cardiovascular disease or diabetes, different approaches to blocking of the renin-angiotensin system had no clear effects on cognitive outcomes. Although patients with the lowest systolic blood pressure had the greatest preservation of cognitive function, meta-regression analyses did not show any benefits of blood-pressure lowering on cognition over several years of treatment. Funding Boehringer-Ingelheim.
171 citations
TL;DR: A systematic review of the published research provided further evidence to support surgical treatment of obesity to achieve CVD risk reduction and highlighted the benefits of bariatric surgery in reducing or eliminating risk factors for CVD.
Abstract: Obesity is associated with increased risk for cardiovascular (CV) disease (CVD) and CV mortality. Bariatric surgery has been shown to resolve or improve CVD risk factors, to varying degrees. The objective of this systematic review was to determine the impact of bariatric surgery on CV risk factors and mortality. A systematic review of the published research was performed to evaluate evidence regarding CV outcomes in morbidly obese bariatric patients. Two major databases (PubMed and the Cochrane Library) were searched. The review included all original reports reporting outcomes after bariatric surgery, published in English, from January 1950 to July 2010. In total, 637 studies were identified from the initial screen. After applying inclusion and exclusion criteria, 52 studies involving 16,867 patients were included (mean age 42 years, 78% women). The baseline prevalence of hypertension, diabetes, and dyslipidemia was 49%, 28%, and 46%, respectively. Mean follow-up was 34 months (range 3 to 155), and the average excess weight loss was 52% (range 16% to 87%). Most studies reported significant decreases postoperatively in the prevalence of CV risk factors, including hypertension, diabetes, and dyslipidemia. Mean systolic pressure reduced from to 139 to 124 mm Hg and diastolic pressure from 87 to 77 mm Hg. C-reactive protein decreased, endothelial function improved, and a 40% relative risk reduction for 10-year coronary heart disease risk was observed, as determined by the Framingham risk score. In conclusion, this review highlights the benefits of bariatric surgery in reducing or eliminating risk factors for CVD. It provides further evidence to support surgical treatment of obesity to achieve CVD risk reduction.
151 citations
TL;DR: It is suggested that for the ONTARGET patients, the use of telmisartan instead of ramipril increases costs by 6.3%.
Abstract: Background:The recently published ONTARGET trial found that telmisartan was non-inferior to ramipril in reducing CV death, MI, stroke, or heart failure in patients with vascular disease or high-risk diabetes. The cost implications of ramipril and telmisartan monotherapy use based on the ONTARGET study are reported here.Methods and Results:Only healthcare system costs were considered. Healthcare resource utilization was collected for each patient during the trial. The authors obtained country-specific unit costs to the different healthcare care resources consumed (i.e., hospitalizations events, procedures, non-study, and study drugs) for all enrolled patients. Purchasing power parities were used to convert country-specific costs into US dollars (US$ 2008). The total undiscounted costs of the study for the telmisartan group was $12,762 per patient and is higher than the ramipril group at $12,007 per patient, an un-discounted difference of $755 (95% confidence interval [CI], $218–$1292); The discount...
10 citations
01 Jan 2011
TL;DR: Short-term clinical improve-ment in event-free survivors after PLV is observed in patients with idiopathicdilated cardiomyopathy referred for heart transplantation: short-term results.
Abstract: Summary. We have observed short-term clinical improve-ment in event-free survivors after PLV. Physiologic vari-ables (echocardiographic and hemodynamics) measured se-rially show that cardiac function and anatomy remainmarkedly abnormal. Partial left ventriculectomy does notprovide normalization of cardiac structure or function. Acknowledgments We sincerely thank Douglas L. Mann, MD, for providingthe tumor necrosis factor-alpha and interleukin-6 levels thatwere processed in his laboratory. We acknowledge JenniferA. White, MS, for statistical review and analyses. Reprint requests and correspondence: Randall C. Starling,Department of Cardiology, The Cleveland Clinic Foundation,9500 Euclid Avenue, Desk F25, Cleveland, Ohio 44195. E-mail:starlir@ccf.org. REFERENCES 1. Ho KKL, Pinsky JL, Kannel WB, Levy D. The epidemiology of heartfailure: the Framingham study. J Am Coll Cardiol 1993;224 SupplA:6A–13A.2. Kannel WB, Belanger AJ. Epidemiology of heart failure. Am Heart J1991;121:951–7.3. Kannel WB, Ho K, Thom T. Changing epidemiological features ofcardiac failure. Br Heart J 1994;72 Suppl 2:S3–S9.4. Batista RJV, Santos JLV, Takeshita N, Bocchino L, Lima PN, CunhaMA. Partial left ventriculectomy to improve left ventricular function inend-stage heart disease. J Card Surg 1996;11:96–7.5. Dickstein ML, Spotnitz HM, Rose EA, Burkhoff D. Heart reductionsurgery: an analysis of the impact on cardiac function. J ThoracCardiovasc Surg 1997;113:1032–40.6. McCarthy PM. Ventricular remodeling: hype or hope? Nat Med1996;2:859–60.7. Angelini GD, Pryn S, Mehta D, et al. Left-ventricular-volumereduction for end-stage heart failure. Lancet 1997;350:489.8. Batista RJ, Verde J, Nery P, et al. Partial left ventriculectomy to treatend-stage heart disease. Ann Thorac Surg 1997;64:634–9.9. Bocchi EA, Bellotti G, Vilella de Moraes A, et al. Clinical outcomeafter left ventricular surgical remodeling in patients with idiopathicdilated cardiomyopathy referred for heart transplantation: short-termresults. Circulation 1997;96 Suppl II:II-165–72.10. McCarthy PM, Starling RC, Wong J, et al. Early results with partialleft ventriculectomy. J Thorac Cardiovasc Surg 1997;114:755–65.11. McCarthy JF, McCarthy PM, Starling RC, et al. Partial left ventri-culectomy and mitral valve repair for end-stage congestive heartfailure. Eur J Cardiothorac Surg 1998;13:337–43.12. Costanzo MR, Augustine S, Bourge R, et al. Selection and treatmentof candidates for heart transplantation. A Statement for healthprofessionals from the Committee on Heart Failure and CardiacTransplantation of the Council on Clinical Cardiology, AmericanHeart Association. Circulation 1995;92:3593–612.13. Torre-Amione G, Kapadia S, Benedict C, Oral H, Young JB, MannDL. Proinflammatory cytokine levels in patients with depressed leftventricular ejection fraction: a report from the Studies Of LeftVentricular Dysfunction (SOLVD). J Am Coll Cardiol 1996;27:1201–6.14. Diggle DJ, Liang KY, Zeger SL. Analysis of Longitudinal Data. NewYork: Oxford Science Publications, 1994.15. Starling RC, McCarthy PM. Partial left ventriculectomy: sunrise orsunset? Eur J Heart Failure 1999;1:313–7.16. Franco-Cereceda A, McCarthy PM, Blackstone EH, et al. Part leftventriculectomy is not an alternative to transplantation in end-stagecardiac failure patients with idiopathic dilated cardiomyopathy. J Tho-rac Cardiovasc Surg. In Press.17. Fonarow GC, Stevenson LW, Walden JA, et al. Impact of acomprehensive heart failure management program on hospital read-mission and functional status of patients with advanced heart failure.J Am Coll Cardiol 1997;30:725–32.18. Leier CV. Cardiomyoplasty: is it time to wrap it up? J Am CollCardiol 1996;28:1181–2.19. Gorcsan J 3rd, Feldman AM, Kormos RL, Mandarino WA, DemetrisAJ, Batista RJ. Heterogeneous immediate effects of partial left ventri-culectomy on cardiac performance. Circulation 1998;97:839–42.20. Popovic Z, Miric M, Gradinac S, et al. Effects of partial leftventriculectomy on left ventricular performance in patients withnonischemic dilated cardiomyopathy. J Am Coll Cardiol 1999;32:1801–8.21. Bolling SF, Pagani FD, Deeb GM, Bach DS. Intermediate-termoutcome of mitral reconstruction in cardiomyopathy. J Thorac Car-diovasc Surg 1998;115:381–8.22. Doughty RN, Whalley GA, Gamble G, MacMahon S, Sharpe N. Leftventricular remodeling with carvedilol in patients with congestive heartfailure due to ischemic heart disease. Australia–New Zealand HeartFailure Research Collaborative Group. J Am Coll Cardiol 1997;29:1060–6.23. Massie BM, Fisher SG, Deedwania PC, Singh BN, Fletcher RD,Singh SN. Effect of amiodarone on clinical status and left ventricularfunction in patients with congestive heart failure. Circulation 1996;93:2128–34.