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North Chicago, IL, United States

Coronary artery disease is the leading cause of death in both men and women worldwide. Little is known about gender-based differences in lipid goal attainment during secondary prevention of coronary artery disease. We conducted this study to analyze gender differences in low-density lipoprotein cholesterol target attainment in secondary prevention after acute myocardial infarction over a 5-year period. In this retrospective study, the electronic database of lipid clinic at a single center was used as the data source. Temporal trends and gender differences in demographics, lipid profile, and medication use were determined. Goal low-density lipoprotein (LDL) was defined per National Cholesterol Education Program ATP III guidelines.A total of 1365 patients (823 males, 542 females) constituted the study sample. Patients in 2007 were older than those in 2003 (females 68.6 ± 14 vs. 70.7 ± 11.7 years; males 63.6 ± 12 vs. 65.8 ± 11 years; P < 0.05) and had a higher body mass index (females 27.8 ± 1 vs. 28.6 ± 1 kg/m; males 27.6 ± 1 vs. 28.1 ± 1 kg/m, in 2003 and 2007 respectively, P < 0.05). Mean LDL decreased significantly overtime in both males and females. No gender difference in lipid-lowering therapy was observed. Females had a higher LDL than did males in 2003 (115.3 ± 12.3 vs. 99.7 ± 12.5 mg/dL; P < 0.05), and this difference persisted through 2007 (102.2 ± 11.7 vs. 91.3 ± 11.2 mg/dL; P < 0.05). Overall rate of achieving goal LDL improved from 76.5% (2003) to 83.02% (2007), P < 0.05, but remained lower for females than for males both in 2003 and 2007 [69.8% vs. 80.1% (2003), P < 0.05, and 77.9% vs. 85.6% (2007), P < 0.05].The trend over a recent 5-year period shows that females are less likely to achieve goal LDL than males are, and it indicates the need for more aggressive lipid-lowering strategies in females.

Prutkin J.M.,University of Washington | Reynolds M.R.,Lahey Clinic Medical Center | Bao H.,Yale University | Curtis J.P.,Yale University | And 3 more authors.
Circulation | Year: 2014

Background: The rate of implantable cardioverter-defibrillator (ICD) infections has been increasing faster than that of implantation. We sought to determine the rate and predictors of ICD infection in a large cohort of Medicare patients. Methods and Results: Cases submitted to the ICD Registry from 2006 to 2009 were matched to Medicare fee-for-service claims data using indirect patient identifiers. ICD infections occurring within 6 months of hospital discharge after implantation were identified by ICD-9 codes. Logistic regression was used to examine factors associated with risk of ICD infection. Of 200 909 implants, 3390 patients (1.7%) developed an ICD infection. The infection rate was 1.4%, 1.5%, and 2.0% for single, dual, and biventricular ICDs, respectively (P<0.001). Generator replacement had a higher rate compared with initial implant (1.9% versus 1.6%, P<0.001). The factors associated with infection were adverse event during implant requiring reintervention (odds ratio [OR], 2.692; 95% confidence interval [CI], 2.304-3.145), previous valvular surgery (OR, 1.525; 95% CI, 1.375-1.692), reimplantation for device upgrade, malfunction, or manufacturer advisory (OR, 1.354; 95% CI, 1.196-1.533), renal failure on dialysis (OR, 1.342; 95% CI, 1.123-1.604), chronic lung disease (OR, 1.215; 95% CI, 1.125-1.312), cerebrovascular disease (OR, 1.172; 95% CI, 1.076-1.276), and warfarin (OR, 1.155; 95% CI, 1.060-1.257). Conclusions-Patients who developed an ICD infection were more likely to have had peri-ICD implant complications requiring early reintervention, previous valve surgery, device replacement for reasons other than battery depletion, and increased comorbidity burden. Efforts should be made to carefully consider when to reenter the pocket at any time other than battery replacement. © 2014 American Heart Association, Inc.

Singh M.,Chicago Medical School | Bedi U.S.,Ochsner Clinic
Current Atherosclerosis Reports | Year: 2013

Atherosclerosis is a complex disease associated with aberrant lipoprotein metabolism and leukocyte infiltration into arterial tissue that leads to cardiovascular diseases. Statins have emerged as among the most effective means of reducing the risk of cardiovascular disease in both primary and secondary prevention settings. Statins are the only pharmacological agents that have been consistently shown to have antiatherosclerotic effects. Statins slow atherosclerosis progression and can even induce atherosclerosis regression. Technological advances in imaging modalities to assess atherosclerosis have made possible direct visualization of atherosclerotic plaques and estimation of plaque burden and permit the evaluation of the impact of medical therapies on the natural history of plaque progression. However, owing to several limiting factors as discussed in this review, presently atherosclerotic plaque progression cannot be used as a therapeutic goal for reduction of the risk of cardiovascular disease. In this review we discuss the evidence for the use of imaging modalities in the detection of atherosclerotic plaque regression, the effects of statins on the atherosclerotic process, and the clinical relevance of atherosclerosis regression. © 2012 Springer Science+Business Media New York.

Loomba R.S.,Chicago Medical School | Arora R.,Veterans Affairs Medical Center
American Journal of Therapeutics | Year: 2010

The association between hyperglycemia and increased mortality associated with acute coronary syndrome (ACS) has been studied and affirmed. Although more studies are needed to explore how managing this hyperglycemia can affect ACS mortality, the need to educate regarding current data is urgent so that it can be clinically applied. Reviews, randomized controlled trials, and other studies were obtained by means of electronic search strategies, such as Medline and Cochrane Library, as well as hand selection. Sources selected were limited to those that discussed ACS and hyperglycemia, and specific emphasis was placed on sources that focused on ACS and hyperglycemia in conjunction with one another. Selected studies were then assessed for quality and relevance. Clear correlations between mean and persistent glucose levels and ACS mortality are found. Persistent glucose levels offer a better model to predict ACS mortality than on-admission glucose levels. However, findings concerning the effect on ACS-related mortality of controlling glucose levels have been conflicting. Copyright © 2010 Lippincott Williams & Wilkins.

Barakat M.G.,Chicago Medical School | Arora R.R.,Chicago Medical School
American Journal of Therapeutics | Year: 2016

The development of efficient combined antiretroviral therapies has lengthened the mean life span of the population affected with human immunodeficiency virus (HIV) transforming this terminal infection to a chronic yet manageable disease. Nonetheless, patients with HIVtreatment naive or not exhibit larger risks for coronary artery disease than the noninfected population. Moreover, coronary atherosclerosis/arteriosclerosis may be the most prevalent condition in the HIV-infected population that is being accentuated by the effects of viral agents and the antiretroviral drugs, especially protease inhibitors. Nonetheless, generalized metabolic dysfunctions and premature senescence are often attributed to the viremia caused by the HIV infection directly and primarily. Therefore, a multifactorial approach is to be considered when attempting to explain the strong correlation between HIV and coronary artery disease, including co-opportunistic viremias and Vitamin D insufficiency/deficiency. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.

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