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Archive 1

 

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30 NOV 2001

Combination drug therapy : Simvastatin + Niacin: reduces the risk of myocardial infarction or hospitalization for chest pain by 70% in patients with coronary disease and low HDL cholesterol.

La Simvastatine associee a la Niacine diminue l'hospitalisation pour douleur thoracique et la survenue d'infarctus de 70% chez les patients au HDL bas.

Source = N Engl J Med 2001; 345(22):1583-92.


Folic acid (1 mg), Vitamin B12 (400 µg), and Pyridoxine (10 mg) significantly reduce homocysteine and restenosis after angioplasty.

L'acide folique associe au complexe vitaminique B diminue significativement l'homocysteinemie et la restenose post angioplastie.

Source = Engl J Med 2001; 345(22):1593-9


Lower your blood pressure by reducing your alcohol consumption

La diminution de la consommation d'alcool contribue a la diminution de la pression arterielle.

Source = Hypertension 2001;38:1112-1117


In some patients, ACE inhibitor therapy could increase the rate of in-stent restenosis

L'inhibiteur de l'enzyme de conversion peut etre a l'origine de la restenose apres stent.

Source = J Am Coll Cardiol 2001;38:1434-1439


After coronary artery bypass graft surgery (CABG) , aggressive lipid lowering therapy is much more beneficial .

Le traitement antilipemiant a forte dose est tres benefique apres pontage aortocoronaire pour eviter l'atherosclerose.

Source = Circulation 2001;104:2635-2637,2660-2665

29 NOV 2001

New Statin benefits :it inhibits the cardiac hypertrophic response, and also prevents cardiac dilatation in rats. These properties are not lipid related.

Les Statines ont de nouvelles proprietes: inhibition de l'hypertrophie cardiaque mais aussi prevention de la dilatation, chez le rat, et ceci independamment du chiffre des lipides.

Source = J Clin Invest 2001;108:1429-1437

28 NOV 2001

Atrial Fibrillation: Poor Compliance with international practice guidelines. Many cardiologists do not prescribe anticoagulation therapy by antivitamin K for chronic AF without contraindications.

La fibrillation auriculaire chronique est insuffisamment traitee par les anticoagulants oraux, contrairement aux directives internationales.

Source = Eur Heart J 2001;22:1954-1959.


Periodontal disease and Atherosclerosis : A significant relation makes periodontal disease a moderate but new cardiovascular risk factor.

Les infections dentaires sont un nouveau facteur de risque cardiovasculaire quoique modere, de par la relation entre infection dentaire et atherosclerose.

Source = Arterioscler Thromb Vasc Biol 2001;21:1816-1822


Women who had both pre-eclampsia and preterm delivery are at higher risk of death from cardiovascular disease.

Pre-eclampsie et accouchement premature sont associes a un plus grand risque de mortalite due a des maladies cardiovasculaires.

Source = BMJ 2001;323:1213-1217


Infants exposed to cocaine during pregnancy have decreased heart rate variability during the first days of life.

Les nourrissons nes de meres se droguant a la cocaine ont une frequence cardiaque peu variable durant leurs premioers jours.

Source = Am Heart J 2001;142:828-832

27 NOV 2001

Hospitalized patients suffer 100 times more venous thromboembolism than community residents.If they all receive thromboembolic prophylaxis, a 50% reduction of venous thromboembolism disease should be observed.

La maladie thromboembolique veineuse est 100 fois plus frequente chez les patients hospitalises. Une reduction de 50% pourrait etre obtenue par l'anticoagulation preventive generalisee a l'hopital.

Source = Mayo Clinic Proceedings 2001;76:1102-1110

17 NOV 2001

In Patients With Multivessel Disease, 7 year follow up show same benefit after PTCA (=angioplasty) or CABG (=open heart surgery).

L'angioplastie et le pontage aorto coronaire procure le meme benefice chez les cardiaques pluritronculaires, meme 7 ans apres

Source = J Am Coll Cardiol 2001;38:1440-1449.

Mortality rates and Length of stay is the same with or without Propafenone after CABG.The risk of atrial fibrillation (AF) after CABG is about 40%, it could be cut to about 20% with the use of beta-blockers. plus moderate-dose propafenone further to 12%. Length of stay was the same in all three groups, at about 7 days. Mortality rates were similar in all three groups as well. The safety of propafenone prophylaxis is confirmed.

Le risque de Fibrillation Auriculaire apres un pontage aortocoronarien est de 40%. Ceci peut etre diminue a 20% avec des betabloqueurs et jusqu'a 12% avec 675mg/24h de Propafenone, qui ne presente pas d'effets secondaires majeures. Par contre, mortalite et duree du sejour hospitalier restent inchanges.

Source = American Heart Association's 2001 Scientific Sessions.


Electrocardiogram in Acute Myocardial Infarction :A non-concave elevation of the ST segment appears indicative

L'elevation non-concave du segment ST serait quasi specifique d'un infarctus aigu du myocarde.

Source = Acad Emerg Med 2001;8:961-967.

15 NOV 2001

Risk of Mortality During Bacteremic Infection is reduced only by Statins. The reduced inflammation may be the explanation

Seules les statines peuvent diminuer le risque de mortalite des infections bacteriemiques, probablement par diminution de l'inflammation.

Source = Clin Infect Dis 2001;33:1352-1357.


All-cause mortality, cardiovascular mortality, major cardiac events, stroke and revascularization were reduced by one-third in all high-risk groups, with statins even in high-risk patients with "normal" cholesterol levels .

Toutes les causes de mortalite sont reduites du tiers chez les patients a haut risque cardiovasculaire recevant des statines, meme si leur cholesterol est dans les limites de la normale.

Source = British Heart Protection Study

12 NOV 2001

In Postmenopausal Women, Hormone replacement Therapy has no effect on Stroke Risk, after Acute Myocardial Infarction.

Le risque d'accident vasculaire cerebral reste inchange chez les femmes menopausees, qu'elles soient sous hormonotherapie ou non.

Source = J Am Coll Cardiol 2001;38:1297-1301.


Marital problems: avoiding relationship discussion is harmful for both hearts: blood pressure and heart rate reactivity increase compared to couples who talk about relationship problems.

Problemes conjugaux: en parler est benefique pour la tension arterielle et la frequence cardiaque des 2 epoux. L'epoux/se qui evite d'en parler subit une hta et une frequence cardiaque acceleree.

Source = J Behav Med 2001;24:401-421.


Cisapride significantly increases the QT interval, even at low doses.

Le cisapride allonge l'espace QT meme a faible dose.

Source = Int J Cardiol 2001;80:179-183.


New Classification of Heart Failure :
A= asymptomatic patient with no heart damage, but with risk factors for heart failure.
B= asymptomatic, but with signs of structural heart damage.
C= symptomatic with heart damage.
D= endstage disease.

Insuffisance cardiaque: Nouvelle classification.
A= Asymptomatique, sans retentissement cardiaque mais presence de facteur de risque d'insuffisance cardiaque.
B= Asymptomatique, mais avec retentissement cardiaque.
C= Symptomatique avec retentissement cardiaque.
D= Phase terminale.

Source = http://www.acc.org or http://www.americanheart.org


Beta-blockers plus ACE inhibitors in HF confers benefit.adding angiotensin II receptor blockers (ARBs) on top of an ACE inhibitor/beta-blocker cocktail confers no further improvement.

L'addition d'un betabloqueur a un inhibiteur de l'enzyme de conversion procure un benefice therapeutique supplementaire, par contre l'addition en plus d'un inhibiteur du recepteur de l'angiotensine est sans effet.

Source = Campbell DJ, Aggarwal A, Esler M, and Kaye D. Beta-blockers, angiotensin II, and ACE inhibitors in patients with heart failure. Lancet 2001;358:1609-10.

10 NOV 2001

Lactose contained in milk products may prevent colon cancer by 63%, except cheese and butter.
Le cancer du colon peut etre evite a 63% par le lactose contenu dans les produits laitiers a l'exception du fromage et du beurre.

Source = European Journal of Clinical Nutrition 2001;55:1000-1007

08 NOV 2001


Hypertension and heart failure (HF) improve when treated with continuous positive airway pressure (CPAP)in patients having obstructive sleep apnea (OSA).
Central sleep apnea (CSA, also called Cheynes-Stokes respiration) too.

Hta et Insufisance cardiaque sont ameliorees par la pression continue positive chez les patients souffrant d'apnee du sommeil obstructive ou de Cheynes-Stokes.

Source = Canadian Cardiovascular Congress 2001, Drs John Floras, John D Parker, Alexander (Sandy) Logan, and T Douglas Bradley (Mount Sinai Hospital, Toronto, ON)


Do not measure your blood presssure upon waking !
Sleep is normally a state of cardiovascular quiescence. Blood Pressure and heart rate decrease about 25%, and then BP rises abruptly upon waking.

Le sommeil procure un repos cardiaque avec diminution de 25% de la tension arterielle et de la frequence cardiaque. Ne prenez jamais votre tension arterielle au lever puisqu'elle subit un rebond considerable physiologique au lever apres un long repos.



Interleukin-6 (IL-6) , a cytokine, is a strong independent marker of increased mortality in unstable coronary aretery disease.

Interleukin-6 (IL-6) , une cytokine, est un marqueur independant puissant de mortalite dans l'insuffisance coronaire instable.

Source = Vorchheimer DA, Fuster V. Inflammatory markers in coronary artery disease. JAMA 2001; 286(17):2154-6.

07 NOV 2001


Naproxen is different than other NSAIDs (anti inflammatory agents other than cortisone) since it has a complete inhibition of platelets (aggregation and thrombosis) and is associated with a decreased risk of CV events relative to rofecoxib.

Naproxen presente des proprietes antiaggregantes qui didminuent les risques d'evenements cardiovasculaires compare aux autres anti inflammatoires non steroidiens et au rofecoxib.


Source = Konstam MA, Weir MR, Reicin A et al. Cardiovascular thrombotic events in controlled, clinical trials of rofecoxib. Circulation 2001;104:2280-8.& Mukherjee D, Nissen SE, Topol EJ. Risk of cardiovascular events associated with selective COX-2 inhibitors. JAMA 2001 Aug 22-29; 286(8):954-9.

06 NOV 2001

The UK plans new hypertension management after having the worst in the developped countries.
Ideal management includes :screening policy; initial evaluation and investigation; estimation of cardiovascular risk; non-pharmacological measures; use of antihypertensive drugs, aspirin, and statins; treatment targets; followup strategy; and methods for identifying and recalling patients who drop out of followup.

Le Royaume Uni travaille pour rattrapper son retard par rapport aux autres pays developpes dans la lutte contre l'hypertension arterielle.


Source = Hypertension 2001;38:827-832.

Statins useful also for valve disease (and ischemic disease.) after only 21 months.
Lipostat, Pravachol, Lipitor,etc... are beneficial not only to slow the progression of coronary atherosclerosis, but also to slow the progression of calcific aortic stenosis.
Note than there is no other known treatment to slow the progression of calcific aortic stenosis except surgery!

Les Statines ont un effet benefique sur les calicifications des valves aortiques.


Source = Circulation 2001;104:2205-2209.

In Midlife, take care of Hypertension
, it significantly increases the risk of stroke into old age, not only over 5 years, but up to 30 years!

L'hypertension de la soixantaine favorise l'accident vasculaire cerebral meme apres trente ans!


Source = Arch Intern Med 2001;161:2343-2350.

Two common genetic variants increase 3 to 4 times the risk of nonfatal hemorrhagic stroke in young white women.
They are Phe204 and Leu564 polymorphisms.

Les 2 variantes genetiques Phe204 et Leu564 augmentent la survenue d'accident vasculaire cerebral d'origine hemorragique chez les jeunes femmes de race blanche.


Source = Stroke 2001;32:2580-2585.

06 NOV 2001

72% of women with diabetes experience hypertension, heart disease, or a history of myocardial infarction, angina, or stroke. Women with diabetes are hospitalized for cardiovascular disease (CVD) four times more than women without diabetes.
75% of people with diabetes die of CVD-related causes.

72 % des femmes diabétiques souffrent de maladies cardiovasculaires ( HTA, infarctus, angor ou avc ). Elles sont hospitalisées pour maladies cardiovasculaires 4 fois plus que les femmes non diabétiques. 75% des diabetiques meurent du coeur.

Source = MMWR Morb Mortal Wkly Rep 2001;50:948-954. NOUVEAU : Version Française en Bleu.

03 NOV 2001

Eating one or two eggs a day has little or no effect on blood cholesterol and cardiovascular disease (CVD) risk, despite the high cholesterol content of eggs, because egg phospholipid lowers cholesterol absorption.

Un oeuf ou deux par jour n'augmentent pas les maladies cardiovasculaires ni le cholesterol.
Source : Jiang Y, Noh SK, Koo SI. Egg phosphatidylcholine decreases the lymphatic absorption of cholesterol in rats. J Nutr 2001 Sep; 131(9):2358-63.

High Levels of Physical Activity in Elderly Patients restore the cardioprotective effect of preinfarction angina (a protective effect of an episode of heart ischemic pain just prior to a myocardial infarction) .This beneficial effect is preserved in elderly patients who are characterized by a high level of physical activity. The ability of the heart to release norepinephrine during stress is restored.

L'activité physique chez les personnes agées favorise l'effet cardioprotecteur de l'angor pré-infarctus

Source : Abete P, Ferrara N, Cacciatore F et al. High level of physical activity preserves the cardioprotective effect of preinfaction angina in elderly patients. J Am Coll Cardiol 2001;38:1357-65. & Kloner RA. Preinfarct angina and exercise: yet another reason to stay physically active. J Am Coll Cardiol JACC 2001;38:1366-7.

PTCA (percutaneous transluminal coronary angioplasty) is better performed in high volume hospitals and/or physicians.

L'Angioplastie a de meilleures chances de succès dans les hôpitaux ou chez les cardiologues àgrande expérience.

Source : Circulation 2001;104:2155-2157,2171-2176.

Carvedilol has received FDA approval for the treatment of severe heart failure. It is now the first beta-blocker approved for severe HF.
The study COPERNICUS showed a 35% reduction in mortality risk with carvedilol versus placebo in severe heart failure patients.

Carvedilol a reçu l'autorisation de la FDA pour le traitement de l'insuffisance cardiaque sévère

Do not take Capecitabine and Coumarin-derivative anticoagulant therapies including warfarin and phenprocoumon, since danger of bleeding may be fatal unless check your INR very frequently.It is an FDA WARNING

Capecitabine et antivitamines K ( anticoagulants oraux ) peuvent causer des hémorragies fatales si le dosage de l'INR n'est pas fréquent.

Prayer therapy in stenting.Therapies that might reduce anxiety, pain and distress, are beneficial for angioplasty and stenting. There was an absolute reduction with any prayer therapy compared with standard therapy in short-term outcomes.

La prière favorise les résultats de l'angioplastie et du stent.

Source : Krucoff MW, Crater SW, Green CL et al. Integrative noetic therapies as adjucts to percutaneous intervention during unstable coronary syndromes: Monitoring and Actualization of Noetic Training (MANTRA) feasibility pilot. Am Heart J 2001;142:760-7.

Human cord blood cells stimulate the brain's endogenous recovery mechanisms and they are widely available. They could be used in treating early stroke from hours to days after onset.

Les cellules sanguines du cordon ombilical sont un traitement potentiel futur de l'ischémie cérébrale (= hémiplégie)

Source : Chen J, Sanberg P, Li Y, et al. Intravenous administration of human umbilical cord blood reduces behavioral deficits after stroke in rats. Stroke 2001;32:2682-2688.

Fluoxetine (=Prozac) and Citalopram (=Cipram, Cipramil, Celexa), two serotonin transport inhibitors, may treat primary pulmonary hypertension by inhibition of pulmonary artery smooth muscle cells generation.

Le traitement antidépresseur par Fluoxetine ou Citalopram pourrait bénéficier aux patients atteints d' hypertension pulmonaire primaire.


Source : J Clin Invest 2001;108:1141-1150.

02 NOV 2001

The association between high-normal BP (= a systolic BP of 130 to 139 mm Hg, diastolic BP of 85 to 89 mm Hg, or both ) and increased risk of CVD is particularly strong in elderly patients aged over 65.
The observed precursors of cardiovascular events are increased thickness of the carotid intima and media, altered cardiac morphologic features, and diastolic ventricular dysfunction.
High-normal blood pressure should be treated first by changing lifestyle : healthy eating , losing extra weight , exercising.

Source = Vasan RS, Larson MG, Leip EP, et al. Impact of high-normal blood pressure on the risk of cardiovascular disease. N Engl J Med 2001; 345(18):1291-7. & Panza JA. High-normal blood pressure - more "high" than "normal". N Engl J Med 2001; 345(18):1337-9.


The new synthetic pentasaccharide fondaparinux is more effective as anticoagulant prevention after hip and knee surgery (venous thromboembolism) than enoxaparin.

Source : Eriksson BI, Bauer KA, Lassen MR, et al. Fondarparinux compared with enoxaparin for the prevention of venous thromboembolism after hip-fracture surgery. N Engl J Med 2001; 345(18):1298-1304


Evaluation of Asymptomatic Aortic StenosisThe indications for aortic valve replacement are based on the development of symptoms = EKG, symptom, or blood pressure findings during exercise testing.

Source = Heart 2001;86:381-386.

01 NOV 2001

Exercise can actually improve diabetic status and even prevent the development of diabetes.

Do not measure your Blood Pressure by Doctors or Nurses at the office: "White-coat" blood pressure syndromes are very frequent (elevated office BP reading in a normotensive patient). Instead, at home, electronic machines take BP measurements more "appropriately" than do doctors and nurses.

Source : Matangi M, Angus D, Brouillard D. White coat systolic hypertension: definition and prevalence by 24-hour ambulatory blood pressure monitoring. Can J Cardiol 2001; 17(suppl C):119C.


Bad Future for Obese Children Arteries. Obese children are at greater risk to go on to develop cardiovascular disease (CVD) . The risk of CVD associated with childhood obesity is independent of adult weight so artery damage may be caused very early in obese children. Childhood obesity is linked with cardiovascular morbidity and mortality.

Source : Tounian P, Aggoun Y, Dubem B, et al. Presence of increased stiffness of the common carotid arter and endothelial dysfunction in severely obese children: a prospective study. Lancet 2001; 358(9291):1400-4.

Homocysteine and other new cardiovascular risk factors like fibrinogen PAI-1, lipoprotein-a may explain why severe stenosis in all major coronary arteries are more frequent in Canadians of South Asian origin than other Canadians. Studies show that exercise can actually improve diabetic status and even prevent the development of diabetes.

Source : Gupta M, Singh N, Warsi M, Reiter M, Ali K. Canadian South Asians have more severe angiographic coronary disease than European Canadians despite having fewer risk factors & Canadian women of South Asian origin are twice as likely to have left main or triple-vessel coronary disease as women of European origin. Can J Cardiol 2001; 17(suppl C):226C & 239C.


People with high blood pressure (BP), particularly sensitive to salt intake, should check their thyroid function (hypohyroidism may appear).


Source : Marcisz C, Jonderko G, Kucharz EJ. Influence of short-time application of a low sodium diet on blood pressure in patients with hyperthyroidism or hypothyroidism during therapy. Am J Hypertens 2001;14(10):995-1002.


Exercise is beneficial for Congestive Heart Failure by lowering levels of TNF-alpha.
At least 3 days a week, 10-minute warm-up, 25 minutes of low-impact endurance training--including walking--and 10 minutes of cooling down and stretching.

Source : The American Journal of Cardiology 2001;88:805-808.


Green tea prevents stroke brain damage. 100 times more effective than antioxidants!

Source : Proceedings of the National Academy of Sciences 2001;98:12227-12232.

31 OCT 2001

NEW : Vitamin C has a positive effect on Heart Failure. Besides benefits over atherosclerosis progression and plaque unstability, its antioxydant properties protect endothelial cells from death in Congestive Heart Failure Patients.
Sources : Rassig L, Hoffmann J, Hugel B et al. Vitamin C Inhibits Endothelial Cell Apoptosis in Congestive Heart Failure. Circulation 2001; 104:2182-87.

30 OCT 2001

Dietary Protein and Fiber Intake Improve Blood Pressure, particularly with fruits and vegetables as sources of soluble fiber.
Hypertension 2001;38:821-826.

A substantial number of lives may be saved by transfusions in Elderly Patients with anemia and acute myocardial infarction.
N Engl J Med 2001;345:1230-1236,1272-1274.

Appetite suppressants and valvular abnormalities :
Withdrawal of these drugs can stop the valvular disease.
JAMA 2001;286:2011-2014.

A New Complication of Type 2 Diabetes : Orthostatic Hypertension and consequently sustained hypertension and early-stage neuropathy.
Diabetes Care 2001;24:1783-1786.

AIDS : Among asymptomatic HIV-infected patients, the pericardial effusion (inflammation of the heart enveloppe ) is often present, also pulmonary hypertension and dilated cardiomyopathy may be present. More, highly active antiretroviral therapy may be harmful for the heart. Some heart drugs such as ACE inhibitors and Statins may not be well tolerated or toxic.
Heart 2001;86:365-367.

29 OCT 2001
New Great Evidence:
Cholesterol lowering therapy not only reduces bad cholesterol in blood but also greatly reduces the lipid plaque.
Less lipid in plaque means more stability and fewer ischemic events.
Arterioscler Thromb Vasc Biol 2001;21:1623-1629,1563-1564.

20 OCT 2001
Prevention ! Prevention ! Prevention !
The cardio-vascular disease are at a turnpoint: Already we see much less open heart surgeries for aorto-coronary bypass. We should witness in the near future less angioplasties. Finally, all invasive therapies should be in regression because prevention is in great progress via diet, exercise, antioxydants, statins, ace inhibitors etc...
Invasive Therapies ( angioplasty, surgery ) act on one point of the large network of the coronary arteries, while prevention benefits not only ALL the coronary network but also all the body arteries especially in the brain ( against stroke ), the kidneys, limbs etc...

19 OCT 2001

Marathon runners should take aspirin because there is an increase in the risk of acute ischemic events due to elevation of C-reactive protein, von Willebrand factor, D-dimer, WBC counts, and fibrinolytic activity probably by subclinical thrombosis. Healthy people with high blood pressure, diabetes, hypercholesterolemia, early family history of heart disease should avoid this competition.
Am J Cardiol 2001;88:35-40.

Myocardial infarction in smokers is reduced by selective serotonin reuptake inhibitors (SSRIs) treatment.
Circulation 2001;104:1894-1898.

New Anticoagulants more effective than standard therapy for prevention of venous thromboembolism after trauma.
low-molecular-weight heparin provides thromboprophylaxis superior to that achieved with low-dose heparin and is cost effective.
Crit Care Med 2001;29:1659-1665.

If you are a healthy adult, check your C-reactive protein. An elevation increases your cardiac risk. Statins and Aspirin will reduce it and prevent plaque unstability and sudden important cardiac event.

Nocturnal dialysis ( six nights per week) is more physiological than conventional dialysis (three times per week) and reduces heart hypertrophy.

A better predictor of coronary artery disease in non-insulin-dependent diabetes mellitus (type 2 diabetics) : Low levels of HDL2 cholesterol .
J Diabetes Complications 2001;15:265-269.

In elderly men, cardiovascular death risk and stroke risk are increased if a low ankle blood pressure is measured compared to brachial pressure, confirming the importance of ankle pressure measurement in elderly patients.
J Clin Epidemiol 2001;54:973-978,971-972.

For burning calories, losing weight and improving aerobic fitness, multiple short exercise sessions are as efficient as long exercise sessions.
J Am Coll Nutr 2001;20:494-501.


Blacks have more stoke and cardiac risk if their white blood count is high.
Am J Epidemiol 2001;154:758-864.


ACE inhibitor (Ramipril) treatment (Blood pressure treatment) reduces the risk of developing diabetes.
JAMA 2001;286:1882-1885.