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.

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.

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.