James H O'Keefe

..Increased attention should be paid to absolute concentrations of LDL subfraction cholesterol, which may be a more sensitive indicator of coronary heart disease risk than total LDL or an LDL pattern...

..Validity and reliability of the ESSI, however, has not been formally tested in patients undergoing percutaneous coronary intervention (PCI)...

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..In a sedentary individual, this type of daily physical activity should help confer the robust vigorous health that enabled our ancestors to survive and thrive as hunter-gatherers in the wild...

..Simvastatin, at the 80-mg daily dose, is more toxic to muscles and liver than other statins at their highest dose, and thus should be used with caution...

..This review outlines the essence of our hunter-gatherer genetic legacy and suggests practical steps to re-align our modern milieu with our ancient genome in an effort to improve cardiovascular health...

..This anti-inflammatory diet should be considered for the primary and secondary prevention of coronary artery disease and diabetes...

..No major safety concerns have surfaced in studies that lowered LDL to this range of 50 to 70 mg/dl. The current guidelines setting the target LDL at 100 to 115 mg/dl may lead to substantial undertreatment in high-risk individuals...

..Suggestions for exercise mode, duration, intensity, and frequency are outlined with a focus on realigning our daily physical activities with the archetype that is encoded within our genome...

..Specific CV risk factors and optimal therapies for primary and secondary prevention are discussed...

..Diet, exercise, and various pharmacologic agents can improve postprandial dysmetabolism. Using these strategies may help improve the prognosis for patients with diabetes mellitus and/or coronary heart disease...

..Alcohol should not be universally prescribed for health enhancement to nondrinking individuals owing to the lack of randomized outcome data and the potential for problem drinking...

..We retrospectively evaluated the effect of eplerenone vs. placebo in a subset of 1483 diabetic patients with LVSD and signs of CHF following AMI...

..Aldosterone receptor blockers appear to provide additive benefit when used in conjunction with either an ACE inhibitor or an angiotensin receptor blocker...

..In a typical inactive person, this type of daily physical activity will optimize gene expression and help to confer the robust health that was enjoyed by hunter-gatherers in the wild...

..004; 100% vs 32%, p <0.001, and 95% vs 36%, p <0.001 respectively). In conclusion, cardiometabolic syndrome and its individual components were noted in current NFL players, particularly linemen...

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..Coronary artery calcium (CAC) scoring is increasingly being used after myocardial perfusion imaging (MPI) to detect preclinical coronary artery disease (CAD). However, there are few data to support this approach...

..In conclusion, these data suggest that there are no adverse effects for moderate drinkers to continue consuming alcohol and that they may have better physical functioning compared to those who quit drinking after an AMI...

..The purpose of this study is to explore the correlation between dobutamine-induced chest pain and evidence of ischemia on myocardial perfusion imaging (MPI)...

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..In conclusion, eplerenone is a medication that offers the cardiovascular therapeutic and prognostic benefits of aldosterone antagonism but with fewer side effects compared to spironolactone...

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..We conducted a systematic review of English articles using MEDLINE and the Cochrane Controlled Trials Register (1970-2010) using the following search terms: cardiovascular disease, randomized trials, hypoglycemia, and insulin resistance...

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..Recent studies have demonstrated that statins may possess antiarrhythmic properties in addition to their lipid-lowering effects...

..We sought to investigate the role of angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) in preventing the new onset of type 2 diabetes mellitus...

..2 vs 29.0 kg/m(2), p = 0.025) were also observed in 25(OH)D-deficient subjects. In conclusion, vitamin D deficiency is present in almost all patients with acute myocardial infarction in a multicenter United States cohort...

..Sustainable sources of omega-3 fatty acids will need to be identified if long-term cardiovascular risk reduction is to be achieved at the population level...

..In the meanwhile, monitoring serum 25-hydroxyvitamin D levels and correction of vitamin D deficiency is indicated for optimization of musculoskeletal and general health...

..One advantage of MPI with a hybrid CT device is the ability to obtain same-setting measurement of the coronary artery calcium score (CACS)...

..abstract:..

..Blood DHA and EPA levels could one day be used to identify patients with deficient levels and to individualize therapeutic recommendations...

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..For Agatston scores <10, the interscan variability of such a protocol was significantly lower than that for a sequential acquisition protocol. At higher Agatston scores, the 2 protocols had similar variability characteristics...

..Recent studies have demonstrated that statins may possess anti-arrhythmic properties in addition to their lipid-lowering effects...

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..40 (0.18 to 0.88, p = 0.02). In conclusion, this meta-analysis provides evidence that DPP4 inhibitors are safe from a CV standpoint and may possibly decrease risk of adverse CV events...

..The frequency with which physicians assess diabetic patients' glycemic control during an ACS hospitalization is not known and may represent an opportunity for quality improvement...

..However, caution should be used in the interpretation of increased cardiovascular disease risk, as it does not necessarily translate into early increased mortality...

..In conclusion, even in the digital age, the physical examination remains uniquely relevant to patient care, particularly when focused on the physiologic status of the cardiac patent...

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..In conclusion, a meta-analysis of randomized controlled trials suggests that longer duration of varenicline therapy improves long-term abstinence rates...

..A total of 57% of patients who had acute coronary syndrome had abnormal glucose metabolism; approximately 66% of those who met criteria for new diabetes were not diagnosed or treated as such by the physicians who managed them...

..These clinical variables included atrial fibrillation, left ventricular hypertrophy, severe mitral regurgitation and paced rhythm...

..89; 95% CI 0.8 0.98; p = 0.017). Despite the changing risk profile, the short-term mortality continues to improve for patients undergoing AMI PCI...

..Both pathogenic and non-pathogenic bacteria commonly colonize neckties and avoiding neckties is a simple measure that may prove helpful in our fight against nosocomial infections...

..Therefore, intensive LDL cholesterol reduction to levels of 30 to 70 mg/dl should be pursued in subjects with or at high risk for coronary artery disease...

..Also reviewed are the therapies that are available for the treatment of diabetic HF and whether intensifying the use of these therapies might improve the worsened clinical outcomes for the patient who has diabetes...

..The use of carvedilol compared with metoprolol did not effect glycemic control...

..To investigate the association of postprandial dysmetabolism, ie, hyperglycemia, and hyperlipidemia with myocardial disease in diabetic, glucose-intolerant, and glucose-tolerant patients...

..However, some trial results indicate that carvedilol, which blocks beta1-, beta2-, and alpha1-receptors and is a potent antioxidant, may produce at least comparable effects in both patient groups...

..The effects of the 2 beta-blockers on clinical outcomes need to be compared in long-term clinical trials...

..Furthermore, early use of an insulin-sensitizing agent either alone or incombination is expected to improve both acute and long-term outcomes in patients with type 2 diabetes...

..However, carvedilol, a nonselective beta-blocker with vasodilating and insulin-sensitizing properties, can largely circumvent these problems and is the ideal beta-blocker for the patient with diabetes...

..Overall, the changes in lipoprotein profile induced by rosiglitazone therapy seem to have less atherogenic potential than those resulting from the use of troglitazone...

..Antidiabetic agents that target insulin resistance may be more cardioprotective than those that primarily augment insulin secretion...

..These differences cannot be explained by effects on blood pressure or alpha1-antagonism but may relate to antioxidant properties of carvedilol...

..There is evidence that glycemic control is also important in improving clinical outcomes. The adverse effects of beta-blockade on carbohydrate and lipid metabolism and vasoconstriction may be circumvented by the use of carvedilol...

..Despite this benefit of beta-blockers, physicians have been reluctant to use them in patients with diabetes, in whom they are even more effective, because of the negative effects on carbohydrate and lipid metabolism...

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..TZDs can be used safely in renally impaired patients with diabetes, and hepatotoxicity has not been a problem with second-generation TZDs, making these agents both safe and effective in the treatment of type 2 diabetes...

..Notably, decreasing insulin resistance also may reduce the incidence of adverse atherosclerotic consequences...

..Prophylactic utilization of ACE inhibitors and beta-blockers to avoid, rather than await, the need to treat HF should be considered in high-risk diabetic patients...

..This improvement was independent of the correction of glucotoxicity...

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..To review the relationship between insulin resistance and thrombogenesis, especially in the context of obesity, diabetes, and cardiovascular disease, and to discuss therapeutic implications...

..To investigate the association of diabetes and hepatobiliary disease...

..Voluntary weight loss, by lowering insulin resistance, accelerates the time to clinical presentation of an asymptomatic insulinoma...

..Promptly diagnosing and treating anemia in patients with diabetes may result in an improved quality of life and decreased morbidity and mortality...

..The GEMINI trial, therefore, is the first large randomized trial to assess whether utilizing a third-generation beta-blocker yields a favorable metabolic profile in the patient with Type 2 diabetes and hypertension...

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..In addition, maximisation of glycaemic control will result in prevention, delay of onset or amelioration of both the microvascular and perhaps the macrovascular complications of diabetes...