A Non-classical Presentation of Tangier Disease with Three ABCA1 Mutations.

Tangier disease is a very rare autosomal recessive inherited disorder characterized by markedly reduced high-density lipoprotein (HDL) levels, characteristic large, yellow-orange tonsils, and enlarged liver, spleen and lymph nodes. It is caused by mutations in the ABCA1 gene. There is no specific treatment, and medications traditionally used to increase HDL are ineffective.

Intensive multifactorial intervention for stable coronary artery disease: optimal medical therapy in the COURAGE (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation) trial.

Objectives: This paper describes the medical therapy used in the COURAGE (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation) trial and its effect on risk factors.

Background: Most cardiovascular clinical trials test a single intervention. The COURAGE trial tested multiple lifestyle and pharmacologic interventions (optimal medical therapy) with or without percutaneous coronary intervention in patients with stable coronary disease.

Comparison of drug-eluting and bare-metal stents for stable coronary artery disease.

Objectives: The current study was designed to determine whether drug-eluting stents (DES) are superior to bare-metal stents (BMS) in patients with stable angina.

Background: Percutaneous coronary intervention has been shown to decrease symptoms of angina; its use for stable angina has not been shown to reduce myocardial infarction or mortality.

Methods: We conducted a retrospective, cross-sectional analysis of prospective data comparing the use of BMS versus DES in patients who met criteria used by the COURAGE (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation) study investigators.

Electrocardiographic intervals in the healthy geriatric population--what are the "normals"?

The authors compared the average electrocardiographic (ECG) intervals in a population of patients 80 years and older with published "normal" values. The medical records of patients who presented to the Mayo Clinic for health maintenance examinations and who had a routine ECG performed (N=702) were selected. Age; sex; rhythm; PR, QRS, and QTc intervals; incidence of cardiac disease; and presence of interval-prolonging medication were recorded.

Optimal medical therapy with or without PCI for stable coronary disease.

Background: In patients with stable coronary artery disease, it remains unclear whether an initial management strategy of percutaneous coronary intervention (PCI) with intensive pharmacologic therapy and lifestyle intervention (optimal medical therapy) is superior to optimal medical therapy alone in reducing the risk of cardiovascular events.

Methods: We conducted a randomized trial involving 2287 patients who had objective evidence of myocardial ischemia and significant coronary artery disease at 50 U.S.

The evolving pattern of symptomatic coronary artery disease in the United States and Canada: baseline characteristics of the Clinical Outcomes Utilizing Revascularization and Aggressive DruG Evaluation (COURAGE) trial.

Major improvements in medical therapy and percutaneous coronary intervention for coronary artery disease (CAD) have emerged during the previous 2 decades, but no randomized trial in patients with stable CAD has been powered to compare these 2 strategies for the hard clinical end points of death or myocardial infarction (MI), and previous studies have not evaluated the effect of coronary stents and intensive medical therapy on cardiac events during long-term follow-up. Between 1999 and 2004, 2,287 patients with documented myocardial ischemia and angiographically confirmed CAD were randomized to the Clinical Outcomes Utilizing Revascularization and Aggressive DruG Evaluation (COURAGE) trial, with a principal hypothesis that a strategy of percutaneous coronary intervention plus intensive, guideline-driven medical therapy would be superior to a strategy of intensive medical therapy alone. The primary end point was a composite of all-cause mortality or acute MI (time to first event) during a 2.

Pathophysiology, diagnosis, and management of dyslipidemia.

Atherosclerosis is a systemic diffuse disease that may manifest as an anglographically localized coronary, cerebral, mesenteric, renal, and/or peripheral arterial stenosis or as diffuse atherosclerosis. While relief of organ ischemia is frequently possible with percutaneous or surgical revascularization, this in itself does not alleviate the long-term risks of disease recurrence or modify the metabolic derangements that promote atherosclerosis. It is critically important to recognize the need for treatment of dyslipidemia and to institute necessary therapies.

Effects of beta-blocker therapy on ventilatory responses to exercise in patients with heart failure.

Background: Ventilatory efficiency is the increase in ventilation relative to carbon dioxide production during exercise. Congestive heart failure (CHF) is associated with decreased ventilatory efficiency. beta-blockers improve hemodynamics, prolong survival, and improve functional class in patients with CHF, though peak exercise performance may not improve.