Journal ArticleDOI
Eplerenone, a Selective Aldosterone Blocker, in Patients with Left Ventricular Dysfunction after Myocardial Infarction
Bertram Pitt,Willem J. Remme,Faiez Zannad,James D. Neaton,Felipe Martinez,Barbara Roniker,Richard Bittman,Steve Hurley,Jay H. Kleiman,Marjorie Gatlin +9 more
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TLDR
The addition of eplerenone to optimal medical therapy reduces morbidity and mortality among patients with acute myocardial infarction complicated by left ventricular dysfunction and heart failure.Abstract:
background Aldosterone blockade reduces mortality and morbidity among patients with severe heart failure. We conducted a double-blind, placebo-controlled study evaluating the effect of eplerenone, a selective aldosterone blocker, on morbidity and mortality among patients with acute myocardial infarction complicated by left ventricular dysfunction and heart failure. methods Patients were randomly assigned to eplerenone (25 mg per day initially, titrated to a maximum of 50 mg per day; 3313 patients) or placebo (3319 patients) in addition to optimal medical therapy. The study continued until 1012 deaths occurred. The primary end points were death from any cause and death from cardiovascular causes or hospitalization for heart failure, acute myocardial infarction, stroke, or ventricular arrhythmia. results During a mean follow-up of 16 months, there were 478 deaths in the eplerenone group and 554 deaths in the placebo group (relative risk, 0.85; 95 percent confidence interval, 0.75 to 0.96; P=0.008). Of these deaths, 407 in the eplerenone group and 483 in the placebo group were attributed to cardiovascular causes (relative risk, 0.83; 95 percent confidence interval, 0.72 to 0.94; P = 0.005). The rate of the other primary end point, death from cardiovascular causes or hospitalization for cardiovascular events, was reduced by eplerenone (relative risk, 0.87; 95 percent confidence interval, 0.79 to 0.95; P=0.002), as was the secondary end point of death from any cause or any hospitalization (relative risk, 0.92; 95 percent confidence interval, 0.86 to 0.98; P=0.02). There was also a reduction in the rate of sudden death from cardiac causes (relative risk, 0.79; 95 percent confidence interval, 0.64 to 0.97; P=0.03). The rate of serious hyperkalemia was 5.5 percent in the eplerenone group and 3.9 percent in the placebo group (P = 0.002), whereas the rate of hypokalemia was 8.4 percent in the eplerenone group and 13.1 percent in the placebo group (P<0.001). conclusions The addition of eplerenone to optimal medical therapy reduces morbidity and mortality among patients with acute myocardial infarction complicated by left ventricular dysfunction and heart failure.read more
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Clinical practice guidelines for multiple endocrine neoplasia type 1 (MEN1)
Rajesh V. Thakker,Paul J. Newey,Gerard V Walls,John P. Bilezikian,Henning Dralle,Peter R. Ebeling,Shlomo Melmed,Akihiro Sakurai,Francesco Tonelli,Maria Luisa Brandi +9 more
TL;DR: It is recommended that MEN1 patients and their families should be cared for by multidisciplinary teams comprising relevant specialists with experience in the diagnosis and treatment of patients with endocrine tumors.
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Diabetes and vascular disease: pathophysiology, clinical consequences, and medical therapy: part I
Joshua A. Beckman,Francesco Paneni,Francesco Paneni,Francesco Cosentino,Francesco Cosentino,Mark A. Creager +5 more
TL;DR: This review will focus on the most current advances in the pathophysiological mechanisms of vascular disease: emerging role of endothelium in obesity-induced insulin resistance, hyperglycemia-dependent microRNAs deregulation and impairment of vascular repair capacities, and alterations of coagulation, platelet reactivity, and microparticle release.
Journal ArticleDOI
2014 AHA/ACC Guideline for the Management of Patients With Non–ST-Elevation Acute Coronary Syndromes: Executive Summary
Ezra A. Amsterdam,Nanette K. Wenger,Ralph G. Brindis,Donald E. Casey,Theodore G. Ganiats,David R. Holmes,Allan S. Jaffe,Hani Jneid,Rosemary F. Kelly,Michael C. Kontos,Glenn N. Levine,Philip R. Liebson,Debabrata Mukherjee,Eric D. Peterson,Marc S. Sabatine,Richard W. Smalling,Susan J. Zieman +16 more
TL;DR: In this paper, early hospital care, hospital discharge, and post-hospital discharge care are recommended for Acs, based on myocardial revascularization and initial evaluation and management.
Journal ArticleDOI
2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines.
Paul A. Heidenreich,Biykem Bozkurt,David Aguilar,Larry A. Allen,Joni J. Byun,Monica Colvin,Anita Deswal,Mark H. Drazner,Shannon M. Dunlay,Linda R. Evers,James C. Fang,Savitri Fedson,Gregg C. Fonarow,Salim S. Hayek,Adrian F. Hernandez,Prateeti Khazanie,Michelle M. Kittleson,Christopher S. Lee,Mark S. Link,Carmelo A. Milano,Lorraine C. Nnacheta,Alexander T. Sandhu,Lynne W. Stevenson,Orly Vardeny,Amanda R. Vest,Clyde W. Yancy +25 more
TL;DR: The "2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure" as discussed by the authors provides patient-centric recommendations for clinicians to prevent, diagnose, and manage patients with heart failure.
Journal ArticleDOI
2011 ACCF/AHA Focused Update Incorporated Into the ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non–ST-Elevation Myocardial Infarction A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines
Jeffrey L. Anderson,Cynthia D. Adams,Elliott M. Antman,Charles R. Bridges,Robert M. Califf,Donald E. Casey,William E. Chavey,Francis M. Fesmire,Judith S. Hochman,Thomas N. Levin,A. Michael Lincoff,Eric D. Peterson,Pierre Theroux,Nanette K. Wenger,R. Scott Wright,Hani Jneid,Steven M. Ettinger,Theodore G. Ganiats,George J. Philippides,Alice K. Jacobs,Jonathan L. Halperin,Nancy M. Albert,Mark A. Creager,David L. DeMets,Robert A. Guyton,Frederick G. Kushner,E. Magnus Ohman,William G. Stevenson,Clyde W. Yancy +28 more
TL;DR: This poster presents a poster presented at the 2016 American Academy of Thoracic Surgeons conference on “Cardiovascular Angiography and Interventions: Foundations of Cardiovascular and Pulmonary Rehabilitation,” presented in Los Angeles, USA.
References
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Journal ArticleDOI
The Effect of Spironolactone on Morbidity and Mortality in Patients with Severe Heart Failure
Bertram Pitt,Faiez Zannad,Willem J. Remme,Robert J. Cody,Alain Castaigne,Alfonso Perez,Jolie Palensky,Janet Wittes +7 more
The effect of spironolactone on morbidity and mortality in patients with severe heart failure
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