RESUMEN
BACKGROUND: In inhibiting platelet function, aspirin seems to reduce the risk of cerebrovascular accidents, death, and acute coronary events in patients with nonrheumatic atrial fibrillation. Aspirin given on alternate days might have the advantage of not hindering prostacyclin synthesis. Thus a study was performed to evaluate whether aspirin used in this way might improve the results reported with daily treatment. METHODS: To test this hypothesis 285 patients (age range 40 to 82 years) with primary atrial fibrillation were randomly allocated in an open multicenter trial to 3 groups: (1) group A1, treated with 125 mg aspirin daily (n = 104); (2) group A2, treated with 125 mg aspirin on alternate days (n = 90), (3) group C (controls), who were not treated with anticoagulants or platelet inhibitors (n = 91). RESULTS: Inclusion took place from January 1990 to July 1994, and follow-up ended in May 1996 (range 1 to 62 months). Sudden cardiac death in association with heart failure or angina was the most common final event: 4.8%, 1.1%, and 6.6% in groups A1, A2, and C, respectively. Both cardiovascular mortality rate and the incidence of main events were reduced, in relative terms, by 80% (1. 1% in group A2 vs 6.6% in group C). The differences were smaller between group A1 and C but did not reach statistical significance. The reduction of main cardiovascular events between groups A1 and A2 was statistically significant (7.7% vs 2.2% = 5.5%; 95% confidence limits 1%, 11%; P <.05). The difference did not reach statistical significance when other end points were analyzed. CONCLUSION: In this trial low-dose aspirin given on alternate days seemed to be an efficient intervention in preventing major cardiovascular events. Regarding strokes, however, aspirin was less efficient. Mortality rate in the 3 groups as a whole was associated with heart failure and the development of ischemic heart disease.
Asunto(s)
Aspirina/administración & dosificación , Fibrilación Atrial/complicaciones , Fibrilación Atrial/tratamiento farmacológico , Trastornos Cerebrovasculares/prevención & control , Fibrinolíticos/administración & dosificación , Infarto del Miocardio/prevención & control , Inhibidores de Agregación Plaquetaria/administración & dosificación , Anciano , Anciano de 80 o más Años , Trastornos Cerebrovasculares/etiología , Esquema de Medicación , Femenino , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/etiología , Proyectos Piloto , Resultado del TratamientoRESUMEN
We report the cases of three young men, heavy smokers, without previous heart disease and who were resuscitated after cardiac arrest due to ventricular fibrillation attributed to coronary spasm. All of them complained of atypical chest pain and the exercise testing, echocardiogram and coronary angiography were normal. The first case was diagnosed by Holter monitoring and by provocative testing with intracoronary ergonovine; the second by provocative testing with intracoronary acetylcholine and the third by Holter monitoring. The patients were treated with a calcium antagonist and/or nitrates and in the follow up they remained asymptomatic.
Asunto(s)
Vasoespasmo Coronario/complicaciones , Paro Cardíaco/etiología , Fibrilación Ventricular/complicaciones , Adulto , Bloqueadores de los Canales de Calcio/uso terapéutico , Angiografía Coronaria , Vasoespasmo Coronario/diagnóstico , Vasoespasmo Coronario/tratamiento farmacológico , Electrocardiografía Ambulatoria , Estudios de Seguimiento , Paro Cardíaco/terapia , Humanos , Masculino , Persona de Mediana Edad , Nifedipino/uso terapéutico , Nitratos/uso terapéutico , Resucitación , Fumar/efectos adversos , Factores de Tiempo , Vasodilatadores/uso terapéutico , Fibrilación Ventricular/etiologíaRESUMEN
OBJECTIVE: To determine the predictive value of lipoproteins for early coronary heart disease in men less than 50 years old from southern Europe. METHODS AND RESULTS: One hundred and fifty-seven men less than 50 years old were consecutively evaluated for symptoms of coronary heart disease in a tertiary referral hospital. A group of 415 male miners with mean age of 41 +/- 8 years without clinical or electrocardiographic evidence of coronary disease served as controls. Blood samples were taken by venipuncture as soon as possible after admission to the hospital from cases and after 12 hours of fasting in controls. Plasma concentrations of total cholesterol (TChol), HDL-cholesterol (HDLChol), triglycerides (TG), apoproteins A1 and B and Lp(a) were determined. The odds ratios, as estimators of relative risk, were computed using the Mantel-Haenszel procedure. The odds ratios from highest to lowest were a TChol/HDLChol ratio equal to or greater than 5: 10.7 (95% confidence interval (CI) 6.1 to 18.8), TG > 2.25 mmol.l-1 and HDLChol < 0.9 mmol.l-1: 7.4 (95% CI 3.9 to 14.1), HDLChol < 0.9 mmol.l-1: 6.9 (95% CI 4.5 to 10.6), TG > 2.25 mmol.l-1: 3.3 (95% CI 2.0 to 5.3), Lp(a) > 30 mg.dl-1: 2.7 (95% CI 1.8 to 4.1), Apo B > 120 mg.dl-1: 2.4 (95% CI 1.3 to 4.2), non-HDLChol > 5.2 mmol.l-1: 2.2 (CI 1.4 to 3.3), TChol > 6.5 mmol.l-1: 1 (95% CI 0.6 to 1.6), TChol > 5.2 mmol.l-1: 0.9 (95% CI 0.6 to 1.3). CONCLUSIONS: This study indicates that in males less than 50 years a ratio TChol/HDLChol > or = 5 presents the greatest risk power for early coronary heart disease. Plasma concentrations of TChol alone did not demonstrate to have value as risk factor for cardiovascular disease.