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Objective To ascertain the risk of acute myocardial infarction, invasive cardiac procedures, and mortality among patients with newly diagnosed angina over five years. Design Incident cohort study of patients with primary care data linked to secondary care and mortality data. Setting 40 primary care practices in Scotland. Participants 1785 patients with a diagnosis of angina as their first manifestation of ischaemic heart disease, 1 January 1998 to 31 December 2001. Main outcome measures Adjusted hazard ratios for acute myocardial infarction, coronary artery bypass grafting, percutaneous transluminal coronary angioplasty, death from ischaemic heart disease, and all cause mortality, adjusted for demographics, lifestyle risk factors, and comorbidity at cohort entry. Results Mean age was 62.3 (SD 11.3). Male sex was associated with an increased risk of acute myocardial infarction (hazard ratio 2.01, 95% confidence interval 1.35 to 2.97), death from ischaemic heart disease (2.80, 1.73 to 4.53), and all cause mortality (1.82, 1.33 to 2.49). Increasing age was associated with acute myocardial infarction (1.04, 1.02 to 1.06, per year of age increase), death from ischaemic heart disease (1.09, 1.06 to 1.11, per year of age increase), and all cause mortality (1.09, 1.07 to 1.11, per year of age increase). Smoking was associated with subsequent acute myocardial infarction (1.94, 1.31 to 2.89), death from ischaemic heart disease (2.12, 1.32 to 3.39), and all cause mortality (2.11, 1.52 to 2.95). Obesity was associated with death from ischaemic heart disease (2.01, 1.17 to 3.45) and all cause mortality (2.20, 1.52 to 3.19). Previous stroke was associated with all cause mortality (1.78, 1.13 to 2.80) and chronic kidney disease with death from ischaemic heart disease (5.72, 1.74 to 18.79). Men were more likely than women to have coronary artery bypass grafting or percutaneous transluminal coronary angioplasty after a diagnosis of angina; older people were less likely to receive percutaneous transluminal coronary angioplasty. Acute myocardial infarction after a diagnosis of angina was associated with an increased risk of death from ischaemic heart disease and all cause mortality (8.84 (5.31 to 14.71) and 4.23 (2.78 to 6.43), respectively). Neither of the invasive cardiac procedures significantly reduced the subsequent risk of all cause mortality. Conclusions In this sample of people with incident angina from primary care, there were sex differences in survival and age and sex differences in the provision of revascularisation after a diagnosis. Acute myocardial infarction after a diagnosis of angina was strongly predictive of mortality. To minimise adverse outcomes, optimal preventive treatments should be used in patients with angina. [ABSTRACT FROM AUTHOR]

Objective To evaluate resting heart rate as an independent predictor of cardiovascular risk in women. Design Prospective cohort study. ' Setting The Women's Health Initiative was undertaken at 40 research clinics' in the United States. Participants 129135 postmenopausal women. Main outcome measure Clinical cardiovascular events. Results During a mean of 7.8 (SD 1.6) years of follow up, 2281 women were identified with myocardial infarction or coronary death and 1877 with stroke. We evaluated associations between resting heart rate and cardiovascular events in Cox regression models adjusted for multiple covariates. Higher resting heart rate was independently associated with coronary events (hazard ratio 1.26, 95% confidence interval 1.11 to 1.42 for highest [>76 beats per minute] i/lowest quintile [562 beats per minute]; P=0.001), but not with stroke. The relation between heart rate and coronary events did not differ between white women and women from other ethnic groups (P for interaction^.45) or between women with and without diabetes (P for interactions.31), but it was stronger in women aged 50-64 at baseline than in those aged 65-79 (P for interaction=0.009). Conclusion Resting heart rate, a low tech and inexpensive measure of autonomie tone, independently predicts myocardial infarction or coronary death, but not stroke, in women. ' [ABSTRACT FROM AUTHOR]

Objective To examine trends in long term survival in patients alive 28 days after myocardial infarction and the impact of evidence based medical treatments and coronary revascularisation during or near the event. Design Population based cohort with 12 year follow-up. Setting Perth, Australia. Participants 4451 consecutive patients with a definite acute myocardial infarction according to the World Health Organization MONICA (monitoring trends and determinants in cardiovascular disease) criteria admitted to hospital during 1984-7, 1988-90, and 1991-3. Main outcome measures All cause mortality identified from official mortality records and the hospital morbidity data, with death from cardiovascular disease as a secondary end point. Results In the 1991-3 cohort, 28 day survivors of acute myocardial infarction had a 7.6% absolute event reduction (95% confidence interval 4% to 11%) or a 28% lower relative risk reduction (16% to 38%), unadjusted for risk of death, over 12 years after the incident admission compared with the 1984-7 cohort, similar to the survival of the 1988-90 cohort. The improved survival for the 1991-3 cohort persisted after adjustment for demographic factors, coronary risk factors, severity of disease, and event complications with an adjusted relative risk reduction of 26% (14% to 37%), but this was not apparent after further adjustment for medical treatments in hospital and coronary revascularisation procedures within 12 months of the incident myocardial infarction. Conclusion The improving trends in 12 year survival after a definite acute myocardial infarction are associated with progressive use of evidence based treatments during the initial admission to hospital and in the 12 months after the event. These changes in the management of acute myocardial infarction are probably contributing to the continuing decline in mortality from coronary heart disease in Australia. [ABSTRACT FROM AUTHOR]

Objective: To determine the efficacy of statin treatment on risk of coronary heart disease in patients with familial hypercholesterolaemia. Design: Cohort study with a mean follow-up of 8.5 years. Setting: 27 outpatient lipid clinics. Subjects: 2146 patients with familial hypercholesterolaemia without prevalent coronary heart disease before 1 January 1990. Main outcome measures: Risk of coronary heart disease in treated and "untreated" (delay in starting statin treatment) patients compared with a Cox regression model in which statin use was a time dependent variable. Results: In January 1990, 413 (21%) of the patients had started statin treatment, and during follow-up another 1294 patients (66%) started after a mean delay of 4.3 years. Most patients received simvastatin (n=1167, 33 mg daily) oratorvastatin (n=211,49 mg daily). We observed an overall risk reduction of 76% (hazard ratio 0.24 (95% confidence interval 0.18 to 0.30), P<0.001). In fact, the risk of myocardial infarction in these statin treated patients was not significantly greater than that in an age matched sample from the general population (hazard ratio 1.44 (0.80 to 2.60), P=0.23). Conclusion: Lower statin doses than those currently advised reduced the risk of coronary heart disease to a greater extent than anticipated in patients with familial hypercholesterolaemia. With statin treatment, such patients no longer have a risk of myocardial infarction significantly different from that of the general population. [ABSTRACT FROM AUTHOR]

Several letters to the editor are presented in response to articles in previous issues including the editorial "Calcium Supplements in people with osteoporosis," by J. G. Cleland and colleagues in the July 29, 2010 issue, and "Effect of calcium supplements on risk of myocardial infarction and cardiovascular events: meta-analysis," by M. J. Bolland and colleagues in the July 29, 2010 issue, along with the response of the editors and the authors of the study.

The article summarizes the recommendations stated in the National Institute for Health and Clinical Excellence (NICE) guideline for the management of unstable angina and non-ST elevation myocardial infarction. Suggested components in a formal risk assessment are a full clinical history, a physical examination and blood tests, among others. The antiplatelet treatment recommendations are reportedly based on a high quality systematic review and cost effectiveness evidence and on moderate to high quality evidence from randomized controlled trials and cost effectiveness evidence. Other topics discussed include drug treatment, invasive management, cardiac rehabilitation and planning of discharge.

The article focuses on various medical research studies. It mentions the study on chronic kidney disease in adults which are improbable to obtain the expected cardiovascular benefits of antiplatelet drugs such as clopidogel and aspirin. The study on aspirin that helps to prevent cancer and on tissue plasminogen activator alteplase which is the standard thrombolytic for eligible patients diagnosed with acute ischaemic stroke. Furthermore, study on intracoronary abciximab on adults after percutaneous coronary intervention (PCI) were also been discussed.

The article offers news briefs related to medical researches in the U.S. A research has revealed that adults in the U.S. have poor cardiovascular health and body mass index (BMI). A research related to the closing of patent foramen ovale after a cryptogenic stroke revealed that the closure does not prevent further cerebral ischemia. A research found that prostate specific antigen (PSA) screening reduced mortality caused due to prostate cancer.

The article discusses various medical researches published in various medical journals. According to a study published in the "Journal of the American Medical Association," chronic kidney disease is linked with deficiency of vitamin D. It has been stated that the study suggests that paricalcitol, an active vitamin D compound, should not be given to patients with kidney diseases as it deteriorates function of kidney. According to another study published in the "Journal of the American Medical Association," lack of physical activity and sedentary behaviour are contributing factor in developing cardiovascular disease and cardiometabolic risk factors like blood pressure, insulin and blood lipids.

The article offers research news briefs on issues related to medical care. One research states that women having in vitro fertilisation (IVF) need no more than two implanted embryos for the best chance of a live baby. Another research indicates that more than two thirds of U.S. men and women were overweight or obese in national surveys done during 2009 and 2010. A meta-analysis study also reveals that one in 100 adults having knee replacement surgery and one in 200 having hip replacement surgery develop symptomatic venous thromboembolism (VTE) before leaving hospital.

The article offers health related news briefs. It includes that very few countries would be able to achieve the target of reduced maternal and child mortality rate. Another topic includes the use of the extract of palmetto tree for the formulation of medicine for urinary symptoms. Besides this, another one informs that the delay in the reperfusion after myocardial infarction can be fatal for he life of a man and a graph is also presented to demonstrate the incidents of heart failure and system delay. Besides this, it also includes that zoledronic acid is harmful for the woman in early stage of breast cancer.

The article offers updates related to medical issues and innovations worldwide. Researchers have combined eight medical groups that have classified four unique phases of the rapid increase in systolic blood pressure during puberty in Great Britain. Rotavirus vaccines associated with the rare cases of intussusception was withdrawn from the market after it was found cases of introversion in vaccinated infants in Brazil and Mexico. Conducted surveys have showed the growing rate of diabetic kidney diseases in the U.S.

The article focuses on various medical research articles published in various periodicals. It includes information on randomized clinical trials probing the efficacy of asthma treatments compared with real world trials, osteoporosis related fracture preventive effects of bisphosphonates in older women and a clinical trial of radical prostatectomy for men with early prostate cancer. It mentions a study which reveals that structured and supervised exercise programmes help reducing glycated hemoglobin concentration in the blood thus enabling control of type 2 diabetes. Information on animal experimentation of erythropoietin as treatment for myocardial infarction is also presented.

The authors discuss a meta-analysis of randomized controlled trials (RCTs) on the use of aspirin to reduce the risk of non-fatal myocardial infarction, by Rothwell and colleagues, published in the 2010 issue of "Lancet." The meta-analysis found that cancer patients who took aspirin for almost six years have 21 percent lower mortality rates than those who did not. The authors comment on the methods used by Rothwell and colleagues in their meta-analysis. They argue that data on aspirin use is not yet sufficient to recommend it for the general population.

The author comments on the study "Patterns of alcohol consumption and ischaemic heart disease in culturally divergent countries: the Prospective Epidemiological Study of Myocardial Infarction (PRIME)," by J.-B. Ruidavets and colleagues, published within the issue. The current study compared the drinking cultures and rates of heart disease in groups of middle aged men in France and Northern Ireland. The limitations of the study are highlighted.

The authors consider the findings of randomized controlled trials on the benefits of dabigatran etexilate, an oral prodrug, in patients with atrial fibrillation. The prevalence of atrial fibrillation in Great Britain is briefly cited. Particular reference is given to the 2009 Randomized Evaluation of Long Term Anticoagulation Therapy (RE-LY) trial. Identified side effects of dabigatran etexilate at increased dosage included gastrointestinal bleeding and myocardial infarction. The authors argue that the question of safety and efficacy is still unanswered.

The article presents an overview of several studies related to healthcare and medicine published in other general journals. They include a study that investigated the association between sibutramine and extra heart attacks in adults with cardiovascular disease. Another study found a limited analgesic effect of oral sucrose in neonates. A research study discovered that people with atherosclerosis or multiple risk factors for atherosclerosis have higher risks of heart attack, stroke, or death from cardiovascular disease.

The authors comment on the study "Short Term Effects of Temperature on Risk of Myocardial Infarction in England and Wales: Time Series Regression on Analysis of the Myocardial Ischaemia National Audit Project (MINAP) registry," by K. Bhaskaran and colleagues, published within the issue. The authors contend that the research findings correlate with findings from a similar study in Paris, France during the 2003 heat wave. The authors point out that the strength of the study is that myocardial infarction was supported by clinical data.

The author believes that oxygen should be given to patients suffering from myocardial infarction. He criticizes a systemic review which claimed that inhaled oxygen does not improve pain and survival in patients with acute myocardial infarction. He also notes the importance of oxygen for people suffering from stable angina pectoris because the disease is caused by a lack of oxygen supply to the myocardium.

The article presents the findings of several medical studies as of June 19, 2010. A study published in the "New England Journal of Medicine" observed a steady decline in the incidence of myocardial infarction (MI) in northern California. The link between exposure to valproic acid in the first trimester of pregnancy and spina bifida is reported in the "New England Journal of Medicine." A study reported in the "Archives of Internal Medicine" examined the association between eating white rice and diabetes.

The article offers clinical information on takotsubo cardiomyopathy, a condition characterized by acute, reversible left ventricular dysfunction that does not correlate with epicardial coronary artery blood supply. Takotsubo cardiomyopathy commonly affects postmenopausal women and is usually triggered by psychological and physical stress. The differential diagnosis for takotsubo cardiomyopathy is myocardial infarction. Treatment approaches for takotsubo cardiomyopathy include Β receptor blockers and angiotensin converting enzyme inhibitors. Patients with takotsubo cardiomyopathy have good prognosis because the left ventricular dysfunction resolves spontaneously.

A letter to the editor is presented in response to guidance from the British National Institute for Health and Clinical Excellence (NICE) on unstable angina and non-ST segment elevation myocardial infarction.

Quizzes about medical topics are presented, including myocardial infarction, breast masses, and HIV infection.

A letter to the editor is presented in response to the article "Myocardial Infarction and Stroke Associated With Diuretic Based Two Drug Antihypertensive Regimens: Population Based Case-Control Study," by I. Boger-Megiddo and colleagues in the January 25, 2010 issue.

The authors comment on a study by D. A. Mulrooney and colleagues on cardiac outcomes in adult survivors of childhood and adolescent cancer. The linked retrospective cohort study enrolled more than 14,000 adult survivors of childhood and adolescent cancers. It was found that those patients treated between 1970 and 1986 are more likely than their siblings to report cardiac sequelae such as congestive heart failure and myocardial infarction. However, the authors suggest that risks may have been underestimated or overestimated in the study.

The author ponders on the link between migraine aura and cardiovascular disease. She discusses a study by Schürks and colleagues, which examined the association between migraine and stroke, myocardial infarction and death. She claims that the findings of the study noted the need for doctors to closely monitor and aggressively treat cardiovascular risk factors in patients with migraine. The author argues that since women with aura are at high risk of having ischaemic stroke, doctors should address the factors that might trigger an attack.

This section discusses various health-related studies published in different journals. A study published in the "New England Journal of Medicine" estimated the cumulative doses of radiation received by patients in the U.S. during imaging procedures. Another study published in the same journal determined the cardiac troponin concentrations in 718 consecutive patients with suspected myocardial infarction. Meanwhile, a research published in the "Journal of the American Medical Association" discovered that clopidogrel is not the best antiplatelet drug for patients with cytochrome P450 (CYP) 2C19*2 variant.

The article discusses research on the safety of thiazolidinediones, rosiglitazone and pioglitazone, in type 2 diabetes. It references the study "Adverse cardiovascular events during treatment with pioglitazone and rosiglitazone: population based cohort study," by D. N. Juurlink and colleagues, published in a 2009 issue of the journal. The study compared the risk of acute myocardial infarction, heart failure and death in type 2 diabetic patients who were treated with rosiglitazone and pioglitazone. Study authors found a reduced risk of heart failure in patients who took pioglitazone. They noted that thizolidinediones should be avoided in patients with heart failure.

The article presents news items related to medicine. Research reported in the "Archives of Internal Medicine" suggests that heart attack patients with a normal or near normal blood sugar level have better medical outcomes than patients with hyperglycemia. Research in the "Archives of Internal Medicine" found that high doses of vitamin C may help prevent gout in men. Research from "Lancet" indicates that percutaneous coronary interventions with bare metal or drug eluting stents in patients with chronic coronary artery disease did not save lives or prevent heart attacks when compared with other medical treatments.

The article reports on several researches. According to a research the decision making tool called DECISION+2 doesn't have any significant effects on patient outcomes as compared with standard methods. Another study reports that 80 years old have a higher risk of poor outcome after intra-arterial treatment for stroke than younger patients. According to a Dutch study, out-of-hospital cardiac arrests resulting from ventricular fibrillation have decreased gradually in 2005-08.

The article offers research briefs. Research of students from publicly funded U.S. schools in the greater Birmingham (Alabama), Houston, and Los Angeles areas has revealed that school and socioeconomic factors explain ethnic disparities in health of preadolescent children. A study has revealed that bariatric surgery helps prevent diabetes among obese Swedes. New generation of drug eluting stents are better than for people with myocardial infarction with elevation of the ST segment (STEMI).

The article discusses a study that evaluated if shift work was associated with major vascular outcomes. The systematic review and meta-analysis found that shift work is associated with myocardial infarction, coronary events, and ischaemic stroke. Though relative risks are modest, population attributable risks are important.

The article reports on research which was conducted to determine whether pharmacokinetic interaction between proton pump inhibitors and clopidogrel lead to harmful vascular events. A comparison between cohort and within person study designs was carried out as part of the research. The results reveal that the addition of a proton pump inhibitor to clopidogrel and aspirin does not seem to cause clinical harm.

The author discusses the third case in a matter of weeks of a man in his 50s having a myocardial infarction while at a wedding, and on inquiring being told that a common factor in each was when they got up to dance at a wedding on the song "Dancing Queen" being played by the band.

The article reports a new meta-analysis, which concluded that the long term safety of drug eluting stents for acute myocardial infarction (MI) remains in doubt, thus highlighting care to be taken when recommending drug eluding stents.

A letter to the editor is presented regarding the decision when to move patient in cardiorespiratory arrest from the field of play.

The author discusses a systematic review on the safety outcomes and efficacy between unfractionated heparin and enoxapirin during percutaneous coronary intervention. The author mentions the use of randomised and non-randomised studies for the review. He reveals the superiority of enoxaparin against heparin on the randomized studies, and the 34% reduction in mortality during the meta-analysis of enoxaparin and heparin.

The article presents abstracts on topics related to medicine which include the impacts of skin preparation solutions on the visibility of surgical site markings, reduction of postoperative pain by one perioperative injection of ketorolac, and postnatal mental health problems are more common in lower income countries than in higher income countries.

The article presents a research study on the incidence of acute myocardial infarction in Denmark from 1984 until 2008. It examines how comorbity and sex have affected the prognosis of the disease. It says that first time hospitalisation rate for subsequent short-term mortality and myocardial infarction both declined by almost half between 1984 and 2008.

The article reports on medical studies published in various journals. A "CMAJ" 2011 issue article shows that combined selective serotonin reuptake inhibitors (SSRI) and antiplatelet treatment increases bleeding risk. An "Anaesthesia" 2011 issue article shows that central venous catheter adjacent to haemodiafiltration catheter causes drug underdosing. 'Hypertension" 2011 issue article shows that systolic pressures are increased among hypertension patients due to the Great East Japan Earthquake.

A letter to the editor is presented in response to the article "Does the Evidence Support the Use of Mild Hypothermia After Cardiac Arrest?" by J. P. Nolan and J. Soar in the September 23, 2011 issue.

The article presents several study related to medical issues. It states about a study of 64 patients to analyze whether objective sensory assessment supports the initial diagnosis of carpal tunnel syndrome or not. It informs about other studies including one related with exercise can control stress, whether diabetes a cause or a consequence of pancreatic cancer and thrombophilia is linked to complications in pregnancy and miscarriage.

The article offers information on a nationwide retrospective cohort study in Denmark concerning the cardiovascular risk of using proton pump inhibitors and aspirin in treating patients with first time myocardial infarction. It says that the study included a total of 19,925 aspirin treated patients. Moreover, 1.46 (1.33 to 1.61) was the hazard ratio for the combined end point in Danish patients getting proton pump inhibitors based on the time dependent Cox proportional hazard model.

A letter to the editor is presented in response to the article "Implantable Cardioverter Defibrillators After Acute Myocardial Infarction," by R. Liew, published in the November 19, 2010 issue.

This section discusses medical-related research. A study published in the "Annals of Internal Medicine" showed that statins do not prevent myocardial infarction. The "New England Journal of Medicine" published a study which described the efficacy of a primary care based intervention in treating depression, diabetes and heart disease. Another study, which appeared in "New England Journal of Medicine," reported two cases of parapoxvirus infections in deer hunters.

The article focuses on a study which investigated the efficacy of vitamin B or omega 3 fatty acid supplementation in preventing cardiovascular events in patients with a history of ischaemic heart disease or stroke. The study included 2,501 men and women, aged 45 to 80 years, with a history of myocardial infarction, unstable angina or ischaemic stroke. Study authors found no benefit from daily consumption of vitamin B or omega 3 fatty acid.

The article reports that 63% of eligible heart attack patients in England were treated with primary angioplasty from 2009 to 2010, according the figures from the ninth annual myocardial ischaemia national audit project (MINAP).

The article provides information on a study which investigated whether ambient outdoor temperature affect the short term risk of myocardial infarction. Data analyzed were from hospital admissions for myocardial infarction recorded in the Myocardial Ischaemia National Audit Project (MINAP) database in England and Wales. The findings of the study are presented. It observes that each one°Celcius reduction in daily mean temperature was linked with a two percent increased risk of myocardial infarction.