Ezetimibe plus moderate-dose simvastatin after acute coronary syndrome: what are we IMPROVEing on?

The recent IMProved Reduction of Outcomes: Vytorin Efficacy International Trial (IMPROVE-IT) is the first study to demonstrate a significant benefit of another medication (ezetimibe) on top of statin therapy in patients who have recently experienced an acute coronary syndrome. Despite the fact that ezetimibe led to positive results on the primary endpoint, the clinical benefit translated to real-life practice is only modest at best. However, this is the first major trial to demonstrate a significant benefit of a lipid medication in addition to statins.

Health care 2020: reengineering health care delivery to combat chronic disease.

Chronic disease has become the great epidemic of our times, responsible for 75% of total health care costs and the majority of deaths in the US. Our current delivery model is poorly constructed to manage chronic disease, as evidenced by low adherence to quality indicators and poor control of treatable conditions. New technologies have emerged that can engage patients and offer additional modalities in the treatment of chronic disease.

Changing the endpoints for determining effective obesity management.

Health authorities worldwide recommend weight loss as a primary endpoint for effective obesity management. Despite a growing public awareness of the importance of weight loss and the spending of billions of dollars by Americans in attempts to lose weight, obesity prevalence continues to rise. In this report we argue that effective obesity management in today's environment will require a shift in focus from weight loss as the primary endpoint, to improvements in the causal behaviors; diet and exercise/physical activity (PA).

The association between resistance exercise and cardiovascular disease risk in women.

Objectives: The objective of this study was to examine the association between resistance exercise and cardiovascular disease risk, independent of body composition, physical activity and aerobic capacity, in healthy women.

Design: A cross-sectional analysis including 7321 women with no history of heart disease, hypertension or diabetes was performed.

Methods: Participation in resistance exercise was self-reported and body weight and height was measured.

Impact of echocardiographic left ventricular geometry on clinical prognosis.

Abnormal left ventricular (LV) geometry, including LV hypertrophy (LVH), is associated with increased risk of major cardiovascular (CV) events and all-cause mortality and may be an independent predictor of morbid CV events. Patients with LVH have increased risk of congestive heart failure, coronary heart disease, sudden cardiac death and stroke. We review the risk factors for LVH and its consequences, as well as the risk imposed by concentric remodeling (CR).

Obesity and prognosis in chronic diseases--impact of cardiorespiratory fitness in the obesity paradox.

The effects of overweight and obesity on chronic diseases, particularly on cardiovascular disease (CVD), and its impact on increasing CVD risk factors and total CVD are reviewed. However despite the adverse effects of obesity on CVD risk factors and CVD, obesity has a surprising association with prognosis in patients with established diseases, often showing an "obesity paradox," [corrected] where overweight (body mass index (BMI), 25 to 29.9 kg·m(-2)) and obese patients (BMI, ≥30 kg·m(-2)) with established CVD frequently have a better prognosis than that of their leaner counterparts (BMI, <25 kg·m(-2)) with the same diseases.

Obesity and cardiovascular diseases: implications regarding fitness, fatness, and severity in the obesity paradox.

Obesity has been increasing in epidemic proportions, with a disproportionately higher increase in morbid or class III obesity, and obesity adversely affects cardiovascular (CV) hemodynamics, structure, and function, as well as increases the prevalence of most CV diseases. Progressive declines in physical activity over 5 decades have occurred and have primarily caused the obesity epidemic. Despite the potential adverse impact of overweight and obesity, recent epidemiological data have demonstrated an association of mild obesity and, particularly, overweight on improved survival.

The impact of obesity on risk factors and prevalence and prognosis of coronary heart disease-the obesity paradox.

Obesity is associated with a host of cardiovascular risk factors and its prevalence is rising rapidly. Despite strong evidence that obesity predisposes to the development and progression of coronary heart disease (CHD), numerous studies have shown an inverse relationship between various measures of obesity (most commonly body mass index) and outcomes in established CHD. In this article we review the evidence surrounding the ≪obesity paradox≫ in the secondary care of CHD patients and the CHD presentations where a paradox has been found.