Showing papers by "Sanjay Kaul published in 2008"

ACCF/ACG/AHA 2008 Expert Consensus Document on Reducing the Gastrointestinal Risks of Antiplatelet Therapy and NSAID Use: A Report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents

Abstract: This document has been developed by the American College of Cardiology Foundation (ACCF) Task Force on Clinical Expert Consensus Documents, the American College of Gastroenterology (ACG), and the American Heart Association (AHA). Expert consensus documents (ECDs) are intended to inform practitioners, payers, and other interested parties of the opinion of the ACCF and document cosponsors concerning evolving areas of clinical practice and/or technologies that are widely available or new to the practice community. Topics chosen for coverage by ECDs are so designed because the evidence base, the experience with technology, and/or the clinical practice are not considered sufficiently well developed to be evaluated by the formal American College of Cardiology/American Heart Association (ACC/AHA) practice guidelines process. Often the topic is the subject of ongoing investigation. Thus, the reader should view ECDs as the best attempt of the ACCF and other cosponsors to inform and guide clinical practice in areas where rigorous evidence may not be available or the evidence to date is not widely accepted. When feasible, ECDs include indications or contraindications. Topics covered by ECDs may be addressed subsequently by the ACC/AHA Practice Guidelines Committee as new evidence evolves and is evaluated. The Task Force on ECDs makes every …

Rosiglitazone and cardiovascular risk.

Abstract: A meta-analysis of 42 clinical trials suggested that rosiglitazone, a widely used thiazolidinedione, was associated with a 43% greater risk of myocardial infarction (P = 003) and a 64% greater risk of cardiovascular death (P = 006) However, a number of criticisms have been raised that potentially undermine the conclusions of this analysis In this article, we point out some of these limitations, summarize the currently available evidence concerning rosiglitazone and cardiovascular risk, share implications for drug safety evaluation, and offer practical recommendations to health care providers We conclude that the data showing the increased risk for myocardial infarction and death from cardiovascular disease for diabetic patients taking rosiglitazone are inconclusive

The disconnect between practice guidelines and clinical practice--stressed out.

Abstract: DESPITE INCREASING EVIDENCE SUPPORTING plaque instability as the proximate cause of atherosclerotic events, treatment strategies continue to focus on the anatomic stenosis. This preoccupation with coronary luminology causes clinicians to perform stress tests and angiograms to identify flow-limiting lesions, even among asymptomatic patients, and to mitigate the effects of these lesions by direct mechanical or surgical intervention. As a result, clinical practice guidelines currently recommend revascularization when stress testing reveals demonstrable myocardial ischemia despite optimal medical management. Unfortunately, the guidelines are not as clear as they might be on this matter. For example, one guideline reads as follows:

Have the risks of rosiglitazone been exaggerated

Abstract: Nissen and Wolski recently reported a meta-analysis of 42 clinical trials of 27,847 subjectsthat ignited a firestorm of controversy by claim-ing that treatment with rosiglitazone (Avandia,GlaxoSmithKline [GSK]), a widely prescribedPPAR-γ agonist, was associated with a “…worri-some…” 43% greater risk of myocardial infarc-tion (MI; p = 0.03) and a 64% greater risk ofcardiovascular death (CVD; p = 0.06)

Is homocysteine a relevant cardiovascular risk factor

Abstract: Scientific research is searching constantly for new markers to help stage the progress and prognosis of cardiovascular disease. Over the past few decades, homocysteine has been suggested as a risk factor involved in the promotion of atherosclerosis and thrombotic vascular events. Several large observational studies have indicated a relationship between homocysteine and cardiovascular illness. However, more robust prospective trials reveal a weaker association between the two than do case-control and cross-sectional data. Recently, many randomized controlled trials have evaluated the impact of homocysteine-lowering therapy on vascular risk. The overall evidence suggests a null effect, thereby failing to validate the hypothesis that a reduction in homocysteine levels would result in clinical benefit. This review outlines the latest relevant data and illustrates why the use of homocysteine as a screening tool or a target of cardiovascular treatment cannot be recommended.