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Marc A. Pfeffer

Other affiliations: Partners HealthCare, University of Miami, Mount Sinai Hospital  ...read more
Bio: Marc A. Pfeffer is an academic researcher from Brigham and Women's Hospital. The author has contributed to research in topics: Heart failure & Myocardial infarction. The author has an hindex of 166, co-authored 765 publications receiving 133043 citations. Previous affiliations of Marc A. Pfeffer include Partners HealthCare & University of Miami.


Papers
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Journal ArticleDOI
TL;DR: In this article , the authors examined the efficacy of sacubitril/valsartan in acute myocardial infarction (AMI) complicated by reduced left ventricular ejection fraction (LVEF), pulmonary congestion or both.
Abstract: BACKGROUND PARADISE-MI examined the efficacy of sacubitril/valsartan in acute myocardial infarction (AMI) complicated by reduced left ventricular ejection fraction (LVEF), pulmonary congestion or both. We sought to assess the trajectory of pulmonary congestion using lung ultrasound (LUS) and its association with cardiac structure and function in a prespecified substudy. METHODS Patients without prior heart failure (HF) underwent 8-zone LUS and echocardiography at baseline (±2 days of randomization) and after 8 months. B-lines were quantified offline, blinded to treatment, clinical findings, timepoint and outcomes. RESULTS Among 152 patients (median age 65, 32% women, mean LVEF 41%), B-lines were detectable in 87% at baseline (median B-line count: 4 [IQR 2-8]). Among 115 patients with LUS data at baseline and follow-up, B-lines decreased significantly from baseline (mean ± SD: -1.6 ± 7.3; p=0.018). The proportion of patients without pulmonary congestion at follow-up was significantly higher in those with fewer B-lines at baseline. Adjusted for baseline, B-lines at follow-up were on average 6 (95% CI: 3, 9) higher in patients who experienced an intercurrent HF event vs. those who did not (p=0.001). A greater number of B-lines at baseline was associated with larger left atrial size, higher E/e' and E/A ratios, greater degree of mitral regurgitation, worse right ventricular systolic function, and higher tricuspid regurgitation velocity (p trend <0.05 for all). CONCLUSIONS In this AMI cohort, B-lines, indicating pulmonary congestion, were common at baseline and, on average, decreased significantly from baseline to follow-up. Worse pulmonary congestion was associated with prognostically important echocardiographic markers.

2 citations

Journal ArticleDOI
TL;DR: The availability of HmG CoA reductase inhibitors changed the approach to cholesterol management, because these drugs were well tolerated and caused marked reductions in total cholesterol (TC) and LDL-C in the majority of individuals.
Abstract: Featured Article: Sacks FM, Pfeffer MA, Moye LA, Rouleau JL, Rutherford JD, Cole TG, et al. The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol levels. N Engl J Med 1996;335:1001–9.4 In 1984, a National Heart, Lung and Blood Institute trial demonstrated that reducing LDL cholesterol (LDL-C)5 with a combination of diet and large doses of the cholesterol-binding resin cholestyramine reduced coronary events (1) and slowed the progression of coronary artery obstruction (2) in men with increased cholesterol concentrations. Resins were not well tolerated, however, and patient compliance was poor. Subsequently, the availability of 3-hydroxy-3-methyl-glutaryl-coenzyme A (HmG CoA) reductase inhibitors changed the approach to cholesterol management, because these drugs were well tolerated and caused marked reductions in total cholesterol (TC) and LDL-C in the majority of individuals. Two important clinical-outcome trials were launched promptly for patients with hypercholesterolemia. The Scandinavian Simvastatin Survival Study (3) enrolled patients with coronary artery disease and hypercholesterolemia [average TC, 261 mg/dL (6.6 mmol/L); average LDL-C, 188 mg/dL (4.87 mmol/L)], and the West of Scotland Coronary Prevention Study (4) used pravastatin in men without clinical coronary disease [average TC, 272 mg/dL (7.0 mmol/L); average LDL-C, 192 mg/dL (5.0 mmol/L)]. On the basis of the earlier findings (1, 2), we assumed that these trials would show clinical benefit; however, patients with the …

2 citations

Journal ArticleDOI
TL;DR: The CHARM programme is designed to define the clinical benefits of the long-acting angiotensin II type 1 (AT 1 ) receptor blocker, candesartan cilexetil, in a wide variety of patients with symptomatic heart failure.
Abstract: Heart failure is a major cause of death, hospital admissions and poor quality of life. It affects some 1-2% of the general population, increasing to up to 8% in people over 75 years of age. Although treatment with angiotensin-converting enzyme (ACE) inhibitors reduces symptoms and mortality, 50-70% of patients with heart failure still die within 5 years of diagnosis. There is thus clear scope for improving the treatment of patients with this condition. The CHARM programme is designed to define the clinical benefits of the long-acting angiotensin II type 1 (AT 1 ) receptor blocker, candesartan cilexetil, in a wide variety of patients with symptomatic heart failure. Candesartan cilexetil will be evaluated in three double-blind, randomized studies involving patients grouped according to left ventricular function and ACE inhibitor tolerance/intolerance.

2 citations


Cited by
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Journal ArticleDOI
21 May 2003-JAMA
TL;DR: The most effective therapy prescribed by the most careful clinician will control hypertension only if patients are motivated, and empathy builds trust and is a potent motivator.
Abstract: "The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure" provides a new guideline for hypertension prevention and management. The following are the key messages(1) In persons older than 50 years, systolic blood pressure (BP) of more than 140 mm Hg is a much more important cardiovascular disease (CVD) risk factor than diastolic BP; (2) The risk of CVD, beginning at 115/75 mm Hg, doubles with each increment of 20/10 mm Hg; individuals who are normotensive at 55 years of age have a 90% lifetime risk for developing hypertension; (3) Individuals with a systolic BP of 120 to 139 mm Hg or a diastolic BP of 80 to 89 mm Hg should be considered as prehypertensive and require health-promoting lifestyle modifications to prevent CVD; (4) Thiazide-type diuretics should be used in drug treatment for most patients with uncomplicated hypertension, either alone or combined with drugs from other classes. Certain high-risk conditions are compelling indications for the initial use of other antihypertensive drug classes (angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, β-blockers, calcium channel blockers); (5) Most patients with hypertension will require 2 or more antihypertensive medications to achieve goal BP (<140/90 mm Hg, or <130/80 mm Hg for patients with diabetes or chronic kidney disease); (6) If BP is more than 20/10 mm Hg above goal BP, consideration should be given to initiating therapy with 2 agents, 1 of which usually should be a thiazide-type diuretic; and (7) The most effective therapy prescribed by the most careful clinician will control hypertension only if patients are motivated. Motivation improves when patients have positive experiences with and trust in the clinician. Empathy builds trust and is a potent motivator. Finally, in presenting these guidelines, the committee recognizes that the responsible physician's judgment remains paramount.

24,988 citations

Book
23 Sep 2019
TL;DR: The Cochrane Handbook for Systematic Reviews of Interventions is the official document that describes in detail the process of preparing and maintaining Cochrane systematic reviews on the effects of healthcare interventions.
Abstract: The Cochrane Handbook for Systematic Reviews of Interventions is the official document that describes in detail the process of preparing and maintaining Cochrane systematic reviews on the effects of healthcare interventions.

21,235 citations

28 Jul 2005
TL;DR: PfPMP1)与感染红细胞、树突状组胞以及胎盘的单个或多个受体作用,在黏附及免疫逃避中起关键的作�ly.
Abstract: 抗原变异可使得多种致病微生物易于逃避宿主免疫应答。表达在感染红细胞表面的恶性疟原虫红细胞表面蛋白1(PfPMP1)与感染红细胞、内皮细胞、树突状细胞以及胎盘的单个或多个受体作用,在黏附及免疫逃避中起关键的作用。每个单倍体基因组var基因家族编码约60种成员,通过启动转录不同的var基因变异体为抗原变异提供了分子基础。

18,940 citations

Journal ArticleDOI
TL;DR: The CKD-EPI creatinine equation is more accurate than the Modification of Diet in Renal Disease Study equation and could replace it for routine clinical use.
Abstract: The Modification of Diet in Renal Disease (MDRD) Study equation underestimates glomerular filtration rate (GFR) in patients with mild kidney disease. Levey and associates therefore developed and va...

18,691 citations

Journal ArticleDOI
TL;DR: Lifetime prevalence estimates are higher in recent cohorts than in earlier cohorts and have fairly stable intercohort differences across the life course that vary in substantively plausible ways among sociodemographic subgroups.
Abstract: Context Little is known about lifetime prevalence or age of onset of DSM-IV disorders. Objective To estimate lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the recently completed National Comorbidity Survey Replication. Design and Setting Nationally representative face-to-face household survey conducted between February 2001 and April 2003 using the fully structured World Health Organization World Mental Health Survey version of the Composite International Diagnostic Interview. Participants Nine thousand two hundred eighty-two English-speaking respondents aged 18 years and older. Main Outcome Measures Lifetime DSM-IV anxiety, mood, impulse-control, and substance use disorders. Results Lifetime prevalence estimates are as follows: anxiety disorders, 28.8%; mood disorders, 20.8%; impulse-control disorders, 24.8%; substance use disorders, 14.6%; any disorder, 46.4%. Median age of onset is much earlier for anxiety (11 years) and impulse-control (11 years) disorders than for substance use (20 years) and mood (30 years) disorders. Half of all lifetime cases start by age 14 years and three fourths by age 24 years. Later onsets are mostly of comorbid conditions, with estimated lifetime risk of any disorder at age 75 years (50.8%) only slightly higher than observed lifetime prevalence (46.4%). Lifetime prevalence estimates are higher in recent cohorts than in earlier cohorts and have fairly stable intercohort differences across the life course that vary in substantively plausible ways among sociodemographic subgroups. Conclusions About half of Americans will meet the criteria for a DSM-IV disorder sometime in their life, with first onset usually in childhood or adolescence. Interventions aimed at prevention or early treatment need to focus on youth.

17,213 citations