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OBJECTIVE: The FDA has not approved the use of testosterone in women. However, parenteral testosterone is being used off-label in free standing clinics throughout America. The recent multi-ethnic study of atherosclerosis (MESA) population study showed that postmenopausal women with a higher testosterone/estradiol ratio had a higher incident of cardiovascular disease. This is a case of a postmenopausal woman who dissected her thoracic aorta after 8 months of parenteral testosterone. METHODS: The clinical examination, radiographic, and laboratory findings of a patient are presented along with a review of the literature. RESULTS: A heathy postmenopausal women, whose only risk factor was parenteral testosterone, developed a dissection of her entire thoracic aorta. CONCLUSION: The MESA study and other conflicting publications on cardiovascular events in transgender patients receiving exogenous androgens indicates the need for further investigation to determine the safety of testosterone therapy for women and its possible role in contributing to aortic disease.
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To determine whether a correlation exists between sugar-sweetened beverage consumption (SSB) and school free and reduced lunch (FRL) eligibility as a measure of socioeconomic status (SES). In January 2016, a modified version of the Bev 15 survey was anonymously administered to 5th and 6th grade students in 14 Chicago suburban public elementary schools. Students were asked to recall and record their beverage intake over the last 24 h for five predefined beverage groups [SSB, real fruit juice (RFJ), diet or sugar free beverages, milk, and water]. Concurrently, data regarding FRL eligibility for each of the 14 schools was obtained from the Illinois State Board of Education website. Mean student consumption of the five beverage categories in each school was correlated with the school's respective FRL status. A total of 1389 student surveys were used for analysis. FRL eligibility ranged from 16 to 64% in the 14 schools. There was a significant correlation between school FRL eligibility and consumption of SSB (p = 0.001), RFJ (p = 0.004) and diet or sugar-free beverage (p = 0.04). There was no significant correlation between FRL eligibility and consumption of water (p = 0.5), and milk (p = 0.2). This study shows that consumption of SSB highly correlates with school FRL eligibility, which can be a measure of SES. These findings reinforce the idea that there is a link between lower SES and unhealthy behaviors pertaining to dietary choices. Knowing this relationship between SSB consumption and FRL eligibility, specific schools can be targeted to reduce SSB consumption and its negative health consequences.
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Dieta , Instituciones Académicas , Estudiantes/estadística & datos numéricos , Bebidas Azucaradas/estadística & datos numéricos , Chicago , Niño , Dieta/economía , Dieta/estadística & datos numéricos , Humanos , Almuerzo , Clase SocialRESUMEN
Introduction: Given the known association between sugar-sweetened beverage (SSB) intake and poorer health, we instituted an educational curriculum to reduce student consumption of SSBs. Methods: The program included third- to fifth-grade students. A simple demonstration using teaspoons of sugar or small candies showed students the quantity of added sugar in common beverages. This amount of sugar was compared to the daily limit recommended by the American Heart Association. Key principles were reinforced over a 4-month period. Anonymous beverage recall surveys were distributed to 213 students at baseline and 211 students 6 months after exposure to the curriculum. Primary endpoints included evaluation of SSB, real fruit juice (RFJ), diet soda, and water servings in the last 24 hours. Results: The proportion of children consuming 2 or more beverages daily decreased from 8.9% to 4.3% (P = .0546) for diet soda, from 70.0% to 58.3% (P = .0123) for SSB + RFJ, and from 60.1% to 47.4% (P = .0087) for SSB. At baseline, students reported an average consumption of 3.5 SSB, 4.5 SSB + RFJ, 0.4 diet soda, and 3.3 water servings per day. At 6 months after exposure, the average daily beverage consumption decreased to 2.7 servings per day for SSB (P = .014), 3.8 for SSB + RFJ (P = .039), and 0.2 for diet soda (P = .027). Water consumption increased from 3.3 to 3.6 servings per day (P = .075). Discussion: Our data suggest grade school students are receptive to information about the adverse effects of SSBs on health. Adding similar educational programs to elementary school curriculum may help reduce long-term SSB consumption.
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OBJECTIVES: This study aimed to characterize the etiologies of patients presenting with myocardial infarction (MI) and found to have non-obstructive coronary artery disease (NOCAD) and compare risk factors and in-hospital mortality to those with obstructive coronary artery disease (CAD). BACKGROUND: Patients presenting with an MI are often found to have NOCAD defined as less than 50% luminal diameter reduction by visual estimation on coronary angiography. METHODS: This study is a retrospective analysis of a total of 2,038 patients that presented to NorthShore University HealthSystem with MI and underwent coronary angiography from 2010 to 2013. RESULTS: 1,822 patients (89%) had CAD and 216 (11%) had NOCAD. Of the NOCAD patients, the most common etiologies were Takotsubo cardiomyopathy (28%), no alternative explanation (26%), demand ischemia (21%), myopericarditis (7%), coronary artery vasospasm (5%), and coronary artery dissection (3%). NOCAD patients were more likely to be younger and female. There was no significant difference between NOCAD and CAD patients in terms of in-hospital mortality (3.7% vs. 4.0% respectively, OR = 1.1, 95% CI 0.5-2.3, P = 0.83 by univariate logistic regression, OR = 1.2, 95% CI 0.5-3.1, P = 0.74 by multivariable analysis). CONCLUSIONS: CAD patients were more likely to have traditional risk factors of diabetes, hypertension, hypercholesterolemia, previous MI, previous revascularization with percutaneous coronary intervention or coronary artery bypass graft surgery. Patients presenting with MI and NOCAD were found to have several different etiologies on coronary angiography with the most common being Takotsubo cardiomyopathy.
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Enfermedad de la Arteria Coronaria/complicaciones , Infarto del Miocardio/epidemiología , Medición de Riesgo/métodos , Anciano , Angiografía Coronaria , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Enfermedad de la Arteria Coronaria/mortalidad , Electrocardiografía , Femenino , Humanos , Incidencia , Masculino , Infarto del Miocardio/complicaciones , Infarto del Miocardio/diagnóstico por imagen , Estudios Retrospectivos , Factores de Riesgo , Tasa de Supervivencia/tendencias , Estados Unidos/epidemiologíaRESUMEN
OBJECTIVE: To assess the relationship of femoral vascular closure device (VCD) use to bleeding and ischemic events in patients undergoing primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) via different anticoagulation strategies. BACKGROUND: It is unknown whether femoral VCD reduce major bleeding after primary PCI for STEMI using bivalirudin anticoagulation. METHODS: We compared VCD-treated patients with propensity-matched controls in the HORIZONS-AMI trial with respect to net adverse clinical events (NACE), defined as the composite of major bleeding unrelated to coronary artery bypass graft surgery (CABG) and major adverse cardiac events (comprised of death, reinfarction, ischemia-driven target vessel revascularization, and stroke), at 30 days and 1 year. RESULTS: Among 3,602 patients enrolled in HORIZONS-AMI, 2,948 underwent primary PCI via femoral arterial access and 896 (30%) received VCDs, of whom 642 were included in our model along with 642 propensity-matched controls. At 30 days, VCD-treated patients had significantly less NACE (6.7% vs. 10.8%, HR: 0.61, 95% CI: 0.42-0.89, P = 0.009), driven by a lower rate of non-CABG related major bleeding (5.0% vs. 8.1%, HR: 0.61, 95% CI: 0.39-0.94, P = 0.02). Bleeding reduction was maintained at one year and consistent in magnitude regardless of randomization to bivalirudin or unfractionated heparin plus a glycoprotein IIb/IIIa inhibitor (P for interaction = 0.84). CONCLUSION: In patients undergoing transfemoral primary PCI for STEMI, VCD use was associated with significantly lower non-CABG major bleeding irrespective of anticoagulation strategy.
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Angioplastia Coronaria con Balón/efectos adversos , Anticoagulantes/uso terapéutico , Arteria Femoral , Hemorragia/prevención & control , Infarto del Miocardio/terapia , Fragmentos de Péptidos/uso terapéutico , Dispositivos de Cierre Vascular , Anciano , Angioplastia Coronaria con Balón/métodos , Angioplastia Coronaria con Balón/mortalidad , Anticoagulantes/efectos adversos , Distribución de Chi-Cuadrado , Femenino , Hemorragia/etiología , Hemorragia/mortalidad , Heparina/uso terapéutico , Hirudinas/efectos adversos , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Infarto del Miocardio/diagnóstico , Infarto del Miocardio/mortalidad , Fragmentos de Péptidos/efectos adversos , Inhibidores de Agregación Plaquetaria/uso terapéutico , Puntaje de Propensión , Punciones , Proteínas Recombinantes/efectos adversos , Proteínas Recombinantes/uso terapéutico , Recurrencia , Factores de Riesgo , Factores de Tiempo , Resultado del TratamientoAsunto(s)
Comités Consultivos/normas , American Heart Association , Cardiología/normas , Competencia Clínica/normas , Intervención Coronaria Percutánea/normas , Médicos/normas , Cardiología/métodos , Enfermedad de la Arteria Coronaria/diagnóstico , Enfermedad de la Arteria Coronaria/terapia , Fundaciones/normas , Humanos , Intervención Coronaria Percutánea/métodos , Informe de Investigación/normas , Estados UnidosAsunto(s)
Angioplastia Coronaria con Balón/normas , Cateterismo Cardíaco/normas , Competencia Clínica/normas , Enfermedad de la Arteria Coronaria/terapia , Educación de Postgrado en Medicina/normas , Intervención Coronaria Percutánea/normas , Angioplastia Coronaria con Balón/efectos adversos , Angioplastia Coronaria con Balón/educación , Cateterismo Cardíaco/efectos adversos , Consenso , Enfermedad de la Arteria Coronaria/diagnóstico , Humanos , Intervención Coronaria Percutánea/efectos adversos , Intervención Coronaria Percutánea/educación , Mejoramiento de la Calidad/normas , Indicadores de Calidad de la Atención de Salud/normas , Factores de Riesgo , Resultado del TratamientoAsunto(s)
Infarto del Miocardio , Angina de Pecho/terapia , Arritmias Cardíacas/etiología , Mortalidad Hospitalaria , Humanos , Infarto del Miocardio/complicaciones , Infarto del Miocardio/diagnóstico , Infarto del Miocardio/epidemiología , Infarto del Miocardio/fisiopatología , Infarto del Miocardio/terapia , Reperfusión Miocárdica , Inhibidores de Agregación Plaquetaria/administración & dosificación , Prevención Primaria , Factores de Riesgo , Sensibilidad y Especificidad , Terapia TrombolíticaRESUMEN
Cardiogenic shock remains associated with unacceptably high mortality, but recent improvements with early revascularization, continued support with pharmacologic agents, and use of an intra-aortic balloon pump have led to improvements in the rate of mortality. Timely intervention with cardiac surgery in patients with mechanical complications, 3-vessel disease, and left main disease is beneficial. Continued research and ever-improving understanding of this once deadly condition have helped further in improving prognosis. Cutting-edge technologies, such as myocyte cell implantation and the use of a cooling system, will help in pushing the boundaries farther.
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Vascular closure devices (VCDs) were initially developed to improve access site hemostasis and allow for earlier ambulation in patients undergoing diagnostic catheterization and percutaneous coronary intervention (PCI). Though initially thought to be beneficial, large meta-analysis has shown conflicting data regarding whether VCDs alter access site bleeding in a variety of clinical settings. One area of particular interest for the adoption of VCDs has been in the setting of acute coronary syndromes (ACS) in which multiple antiplatelet strategies are often employed leading to a high risk of bleeding. Bleeding in ACS has been shown to be a powerful independent predictor of 30-day mortality. Recently, investigators have reported that VCDs reduce access site bleeding in the setting of ACS. In our review, we use several selected representative clinical trials to provide a historical account for the use of VCDs. We also provide for a review of data as it relates to access site bleeding in ACS along with analysis showing that VCDs may potentially provide for reductions in bleeding and vascular complications in patients with ACS undergoing PCI.
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Síndrome Coronario Agudo/diagnóstico por imagen , Síndrome Coronario Agudo/terapia , Angioplastia Coronaria con Balón , Cateterismo Cardíaco , Angiografía Coronaria , Hemorragia/prevención & control , Técnicas Hemostáticas/instrumentación , Lesiones del Sistema Vascular/terapia , Angioplastia Coronaria con Balón/efectos adversos , Cateterismo Cardíaco/efectos adversos , Angiografía Coronaria/efectos adversos , Diseño de Equipo , Medicina Basada en la Evidencia , Hemorragia/etiología , Humanos , Punciones , Medición de Riesgo , Factores de Riesgo , Resultado del Tratamiento , Lesiones del Sistema Vascular/etiologíaRESUMEN
A number of bifurcation lesion classification schemes exist in which capital letters or Roman numerals categorize various types of bifurcation lesions. Unfortunately, these classification schemes are confusing and difficult to remember because of the lack of association between the numbers or letters and various anatomic abnormalities of bifurcation lesions. Recently, the Medina classification was proposed as a simpler, easier-to-remember scheme that labels bifurcation lesions by plaque involvement in 3 anatomic segments (proximal main segment, distal segment of main branch, and side branch). However, this classification also has limitations because it doesn't include important descriptive features of bifurcation lesions that could be important in determining optimum stent treatment strategy. The Movahed classification overcomes these limitations by including bifurcation angle and proximal vessel size in its scheme. The impact of these various classification schemes on stent treatment strategies and more recent clinical trial results is discussed.
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Angioplastia Coronaria con Balón , Enfermedad de la Arteria Coronaria/clasificación , Terminología como Asunto , Angioplastia Coronaria con Balón/efectos adversos , Angioplastia Coronaria con Balón/instrumentación , Angiografía Coronaria , Enfermedad de la Arteria Coronaria/diagnóstico , Enfermedad de la Arteria Coronaria/terapia , Medicina Basada en la Evidencia , Humanos , Selección de Paciente , Valor Predictivo de las Pruebas , Diseño de Prótesis , Ensayos Clínicos Controlados Aleatorios como Asunto , Medición de Riesgo , Stents , Resultado del TratamientoRESUMEN
The field of myocardial regeneration (angiogenesis and myogenesis) might prove to play an important role in the future management of cardiovascular disease. Stem cells are currently undergoing testing in Phase I and Phase II clinical trials. Methods of delivery will affect the outcome of such therapies, perhaps significantly. This document provides suggested guidance in 4 methods of delivery: endocardial, intracoronary, coronary sinus, and epicardial.
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Cateterismo Cardíaco/normas , Educación Médica Continua/normas , Cardiopatías/terapia , Regeneración , Medicina Regenerativa/educación , Trasplante de Células Madre/normas , Animales , Cateterismo Cardíaco/instrumentación , Certificación , Competencia Clínica/normas , Curriculum , Diseño de Equipo , Cardiopatías/fisiopatología , Humanos , Modelos Animales , Desarrollo de Músculos , Neovascularización Fisiológica , Desarrollo de Programa , Medicina Regenerativa/instrumentación , Medicina Regenerativa/normas , Trasplante de Células Madre/instrumentación , Resultado del TratamientoRESUMEN
BACKGROUND: The Acute Catheterization and Urgent Intervention Triage Strategy (ACUITY) trial demonstrated that bivalirudin monotherapy significantly reduces major bleeding compared with heparin (unfractionated or enoxaparin) or bivalirudin plus a glycoprotein IIb/IIIa inhibitor in acute coronary syndromes. Whether vascular closure devices (VCD) impact these results is unknown. Therefore, this study sought to determine whether VCD impact major access site bleeding (ASB) in patients with acute coronary syndromes undergoing early invasive management by the femoral approach. METHODS AND RESULTS: Major ASB in ACUITY was defined as ASB requiring interventional or surgical correction, hematoma > or =5 cm at the access site, retroperitoneal bleeding, or hemoglobin drop > or =3 g/dL with ecchymosis or hematoma <5 cm, oozing blood, or prolonged bleeding (>30 minutes) at the access site. Stepwise logistical regression was performed to identify the independent determinants of ASB. Of 11 621 patients undergoing angiography with or without percutaneous coronary intervention by the femoral approach, 4307 (37.1%) received a VCD and 7314 (62.9%) did not. Rates of major ASB were lower with VCD compared with no VCD (2.5% versus 3.3%, relative risk, 0.76; 95% CI, 0.61 to 0.94; P=0.01) and were lowest in patients treated with bivalirudin monotherapy and a VCD (0.7%). Stepwise logistic regression revealed that a VCD (odds ratio, 0.78; 95% CI, 0.61 to 0.99; P=0.04) and bivalirudin monotherapy (odds ratio, 0.35; 95% CI, 0.25 to 0.49; P<0.0001) were both independent determinates of freedom from major ASB. CONCLUSIONS: In patients with acute coronary syndromes undergoing an early invasive management strategy by the femoral approach, the use of a VCD, bivalirudin monotherapy, or both minimizes rates of major ASB. Clinical Trial Registration- URL: http://www.clinicaltrials.gov. Unique Identifier: NCT00093158.