High-dose B vitamin supplementation and progression of subclinical atherosclerosis: a randomized controlled trial.

Background And Purpose: Although plasma total homocysteine (tHcy) levels are associated with cardiovascular disease, it remains unclear whether homocysteine is a cause or a marker of atherosclerotic vascular disease. We determined whether reduction of tHcy levels with B vitamin supplementation reduces subclinical atherosclerosis progression.

Methods: In this double-blind clinical trial, 506 participants 40 to 89 years of age with an initial tHcy >8.

Relation of progression of coronary artery atherosclerosis to risk of cardiovascular events (from the Monitored Atherosclerosis Regression Study).

We investigated whether change in coronary artery atherosclerosis as measured by quantitative coronary angiography is related to cardiovascular event risk. Although many studies have demonstrated the effectiveness of statins in decreasing atherosclerotic progression and cardiovascular event risk, a relation between coronary atherosclerotic progression and event risk has not been documented in clinical trials that have evaluated statin therapy. The Monitored Atherosclerosis Regression Study (MARS) was a randomized, double-blind, placebo-controlled trial designed to test whether lovastatin would decrease coronary atherosclerotic progression as measured by quantitative coronary angiography.

Hormone therapy and the progression of coronary-artery atherosclerosis in postmenopausal women.

Background: In postmenopausal women with coronary artery disease, conjugated equine estrogen with or without continuous administration of medroxyprogesterone acetate has failed to slow the progression of atherosclerosis. Whether 17beta-estradiol (the endogenous estrogen molecule) alone or administered sequentially with medroxyprogesterone acetate can slow the progression of atherosclerosis is unknown.

Methods: We conducted a double-blind, placebo-controlled trial in 226 postmenopausal women (mean age, 63.

Effect of short-term treatment with azithromycin on recurrent ischaemic events in patients with acute coronary syndrome in the Azithromycin in Acute Coronary Syndrome (AZACS) trial: a randomised controlled trial.

Background: There is serological and epidemiological evidence of an association between Chlamydia pneumoniae infection and coronary artery disease. Results of previous smaller studies have indicated a reduction of recurrent ischaemic events in patients with acute coronary syndrome when given macrolide antibiotics. We aimed to assess whether short-term treatment with the macrolide antibiotic azithromycin reduces recurrent ischaemic events in patients admitted for unstable angina or myocardial infarction.

Alpha-tocopherol supplementation in healthy individuals reduces low-density lipoprotein oxidation but not atherosclerosis: the Vitamin E Atherosclerosis Prevention Study (VEAPS).

Background: Epidemiological studies have demonstrated an inverse relationship between vitamin E intake and cardiovascular disease (CVD) risk. In contrast, randomized controlled trials have reported conflicting results as to whether vitamin E supplementation reduces atherosclerosis progression and CVD events.

Methods And Results: The study population consisted of men and women > or =40 years old with an LDL cholesterol level > or =3.

Recognition memory for tactile sequences.

In three experiments participants were required to compare the similarity in item order for two temporally separated sequences of tactile stimuli presented to the fingers of the hand. Between-sequence articulatory suppression but not tactile interference impaired recognition accuracy (Experiment 1), and the null effect of tactile interference was not due to the second tactile sequence overwriting the sensory record of the first sequence (Experiment 2). Experiment 3 showed that compared to a condition where the second sequence was presented in the tactile modality only, recognition was enhanced when the second sequence was seen presented either to the hand or on a diagrammatic representation of a hand.

Estrogen in the prevention of atherosclerosis. A randomized, double-blind, placebo-controlled trial.

Background: Although observational studies suggest that estrogen replacement therapy (ERT) reduces cardiovascular morbidity and mortality in postmenopausal women, use of unopposed ERT for prevention of coronary heart disease in healthy postmenopausal women remains untested.

Objective: To determine the effects of unopposed ERT on the progression of subclinical atherosclerosis in healthy postmenopausal women without preexisting cardiovascular disease.

Design: Randomized, double-blind, placebo-controlled trial.

Prevalence of subclavian artery stenosis in patients with peripheral vascular disease.

Internal mammary arteries (IMA) as conduits in coronary artery bypass grafting are superior to saphenous vein grafts. If there is subclavian artery stenosis (SAS) proximal to the IMA graft, impairment of flow to the IMA may occur. If the stenosis is severe, retrograde flow from the grafted coronary artery to the brachial artery may lead to angina.

Intensity of antianginal therapy in patients referred for coronary angiography: a comparison of fee-for-service and health maintenance organization therapeutic strategies.

Background: No formal criteria have been developed to guide medical therapy for angina prior to revascularization, and no comparisons have been made between health maintenance organization (HMO) and fee-for-service (FFS) hospitals with respect to angina treatment.

Hypothesis: Using a literature-based measure of medical intensity, we tested the hypothesis that there is no difference in anginal medical therapeutic intensity between HMO and FFS systems.

Methods: For each antianginal drug, we developed a model from which an intensity score between 0 and 100 could be calculated.

Time related quality of life after elective cardiac operation.

Background: Due to improved operative techniques, myocardial preservation, and perioperative care, open heart procedures are now being performed in older and sicker patients. As a result, the quality of life has become an important issue in the decision making process.

Methods: Between January 1993 and October 1994, 604 patients above 65 years of age who underwent non-emergent open heart operations were followed prospectively over a 2-year period.

Underuse and overuse of diagnostic testing for coronary artery disease in patients presenting with new-onset chest pain.

Purpose: To determine the extent of overuse and underuse of diagnostic testing for coronary artery disease and whether the socioeconomic status, health insurance, gender, and race/ethnicity of a patient influences the use of diagnostic tests.

Subjects And Methods: We identified patients who presented with new-onset chest pain not due to myocardial infarction at one of five Los Angeles-area hospital emergency departments between October 1994 and April 1996. Explicit criteria for diagnostic testing were developed using the RAND/University of California, Los Angeles, expert panel method.

Community practice of primary angioplasty for myocardial infarction.

Results obtained with primary angioplasty at the community level do not duplicate the results of the published trials. Major changes in current community practice patterns are needed to achieve the success rates of the published trials.

Nonselective angiography of the internal mammary artery: a fast, reliable, and safe technique.

Selective cannulation of the mammary artery can be time consuming and carries a risk of arterial injury. The nonselective technique described here is faster, safer, and as reliable as the standard selective technique. A consecutive series of patients with previous coronary artery bypass graft surgery (CABG) were randomized to undergo either selective or nonselective mammary artery angiography.

Spontaneous regression of restenosis: an angiographic study.

Objectives: This study was designed to examine the possibility that spontaneous regression in stenosis severity occurs over time in patients with restenosis after percutaneous transluminal coronary angioplasty.

Background: The underlying mechanisms of restenosis are intimal hyperplasia and smooth muscle cell proliferation in response to vascular injury. We hypothesized that the initial hyperplastic response is followed by dynamic remodeling and eventual spontaneous regression, leading to stabilization or a reduction in stenosis severity.

Spontaneous coronary dissection: a cluster of cases with this rare finding.

Spontaneous coronary dissection is a rare entity. It has been reported to be usually fatal, with greater than an 80% mortality rate. From April 1990 through March 1993, 10 patients had spontaneous coronary dissection.

Coronary angiographic changes with lovastatin therapy. The Monitored Atherosclerosis Regression Study (MARS).

Objective: To assess the effects of lipid-lowering therapy with lovastatin on coronary angiographic findings in patients with coronary artery disease and to compare the findings with those of two lipid-lowering angiographic trials using similar end points.

Design: Randomized, double-blind, placebo-controlled, multicenter coronary angiographic trial.

Setting: Community- and university-based cardiac catheterization laboratories.

Percutaneous closure of a secundum atrial septal defect and double balloon valvotomies of a severe mitral and aortic valve stenosis in a patient with Lutembacher's syndrome and severe pulmonary hypertension.

This is a 43-yr-old female presenting with recurrent atrial septal defect, closed surgically, 10 years prior, severe aortic and mitral stenosis, and severe tricuspid regurgitation. She was considered inoperable because of the severe pulmonary hypertension and the complexity of the disease. A percutaneous umbrella closure of the atrial septal defect in conjunction with mitral and aortic balloon valvotomies could be safely and successfully performed.

A new technique for right heart catheterization with a Swan-Ganz balloon catheter via femoral vein in the patient with dilated right heart chambers, utilizing a modified transseptal-type sheath.

Right heart catheterization with a Swan-Ganz balloon catheter via femoral vein in the patient with dilated right atrium and ventricle is frequently difficult due to excessive catheter coiling in the dilated atrium. A new technique is described in this situation. By using a modified transseptal-type sheath positioned counterclockwise in right atrium as an introducing sheath, a balloon catheter can be easily advanced to the distal pulmonary artery by smooth counterclockwise direction and secure support from this sheath.

Impaired fibrinolysis in coronary artery disease.

We assessed endogenous endothelial-dependent fibrinolysis in 99 subjects with coronary artery disease (CAD) documented by angiography and in 28 control subjects with normal coronary arteries on angiography. We used specific, sensitive assays for plasma tissue-type plasminogen activator (t-PA) antigen, t-PA activity, plasminogen activator inhibitor (PAI) activity, plasminogen, and alpha-2 plasmin inhibitor (alpha-2 PI). Mean PAI activity was significantly higher, and mean t-PA activity after venous occlusion of the upper arm (a standard test of the capacity of vascular endothelium to release t-PA) was significantly lower in subjects with CAD than in subjects with normal coronary arteries.

Transfer of acutely ill cardiac patients for definitive care. Demonstrated safety in 755 cases.

The safety of transporting acutely ill cardiac patients for cardiac catheterization has not been established. We describe 755 consecutive patients sent by ambulance from community hospitals to a tertiary center during an 18-month period. Eighty-seven percent of the patients were class III or IV New York Heart Association classification for angina.

Efficacy and safety of outpatient cardiac catheterization.

Outpatient cardiac catheterization has become the standard in our laboratory. The only exclusion for outpatient study is current hospitalization for cardiac symptoms. Thus, any patient well enough to be at home is studied on an outpatient basis.