Search

Background: Both hyper - and hypokalemia increase cardiovascular risk. Modest hyperkalemia is common with angiotensin-converting enzyme inhibition. We studied post-hoc the association of an initial, on-treatment serum potassium measurement with subsequent cardiovascular outcomes over 4.5 years in 9,297 individuals at high cardiovascular risk, randomized to an ACE inhibitor or to placebo. Methods: Post-hoc analysis of cardiovascular outcomes, as related to serum potassium levels, in the HOPE (Heart Outcomes and Prevention Evaluation) study which compared ramipril to placebo, and included 692 patients with a serum potassium level >5.0 mM and 137 with a serum potassium level < 3.5 mM, defined as hyper-and hypokalemia, respectively. Serum potassium was measured 1 month after start of randomized treatment. Results: With hyperkalemia, the primary event rate was unchanged compared to normokalemia (15.5 vs 15.7%, p > 0.4, respectively), with hypokalemia, the primary event rate was higher (22.6% vs 15.5%, respectively, p = 0.023). The hazard ratio for the primary outcome associated with this initial hypokalemia was 1.44 (1.00 - 2.06) on multivariate analysis. The combined primary outcome (myocardial infarction, cardiovascular death, stroke) was not different throughout deciles of serum potassium but the lowest and highest deciles included many with normokalemia. Randomized treatment was with-held because of hyperkalemia in 8 and 6 people allocated to ramipril and placebo, respectively. The benefit of ramipril on cardiovascular outcomes was independent of serum potassium, but ramipril reduced hypokalemia in the entire cohort (1.15 vs 1.86% with placebo, p = 0.005), particularly in those participants on diuretics (3.8% vs 6.5%, p = 0.07). Conclusions: In patients at high cardiovascular risk, modest hypokalemia predicts a less favorable outcome while modest hyperkalemia does not. Ramipril reduces hypokalemia and decreases risk. [ABSTRACT FROM AUTHOR]

Presents several studies on renal disease and failure. Effectiveness of trimethoprim-sulfamethoxazole for the treatment of uncomplicated urinary tract infections; Effects of acute renal failure on in-hospital mortality in patients with cardiogenic shock; Clinical significance of creatine kinase-MB elevation after percutaneous coronary intervention in patients with renal insufficiency; Relationship between mild renal insufficiency and atherosclerotic coronary heart disease in women.

Background: The cardiovascular risk associated with early renal insufficiency is unknown. Clinicians are often reluctant to use angiotensin-converting enzyme inhibitors in patients with renal insufficiency.Objective: To determine whether mild renal insufficiency increases cardiovascular risk and whether ramipril decreases that risk.Design: Post hoc analysis.Setting: The Heart Outcomes and Prevention Evaluation (HOPE) study, a randomized, double-blind, multinational trial involving 267 study centers.Patients: 980 patients with mild renal insufficiency (serum creatinine concentration >/= 124 micromol/L [>/=1.4 mg/dL]) and 8307 patients with normal renal function (serum creatinine concentration < 124 micromol/L [<1.4 mg/dL]) Patients with a baseline serum creatinine concentration greater than 200 micromol/L (2.3 mg/dL) were excluded.Measurements: The primary outcome measure was incidence of cardiovascular death, myocardial infarction, or stroke.Results: Cumulative incidence of the primary outcome was higher in patients with renal insufficiency than in those without (22.2% vs. 15.1%; P < 0.001) and increased with serum creatinine concentration. Patients with renal insufficiency had a substantially increased risk for cardiovascular death (11.4% vs. 6.6%) and total mortality (17.8% vs. 10.6%) (P < 0.001 for both comparisons). The effect of renal insufficiency on the primary outcome (adjusted hazard ratio, 1.40 [95% CI, 1.16 to 1.69]) was independent of known cardiovascular risks and treatment. Ramipril reduced the incidence of the primary outcome in patients with and those without renal insufficiency (hazard ratio, 0.80 vs. 0.79; P > 0.2 for the difference).Conclusions: In patients who had preexisting vascular disease or diabetes combined with an additional cardiovascular risk factor, mild renal insufficiency significantly increased the risk for subsequent cardiovascular events. Ramipril reduced cardiovascular risk without increasing adverse effects. [ABSTRACT FROM AUTHOR]

Objective: To assess the incidence of postpartum thyroid dysfunction in women with type I diabetes.Design: Cohort study of consecutive patients with clinical and biochemical assessments of thyroid dysfunction and glycemic control done during the first postpartum week and 3 and 6 months after delivery.Setting: University medical center providing obstetric care for more than 90% of the pregnant women in the region with type I diabetes.Patients: Fifty-one patients with type I diabetes who resided in the Hamilton, Ontario, catchment area and who delivered babies between May 1989 and June 1991, were not taking thyroid medication or thyroactive or immunosuppressive medications. Forty patients completed follow-up.Main Outcome Measures: Postpartum thyroid dysfunction was defined on the basis of thyroid function test results.Results: Postpartum thyroid dysfunction occurred in 10 of 40 patients (25%; 95% CI, 12.7% to 41.2%); postpartum thyroiditis developed in 9 patients and postpartum Graves disease developed in 1 patient during the first 6 months after delivery. The incidence could have varied between 19.6% and 41.2% , depending on whether none or all of the 11 nonparticipating eligible patients developed thyroid dysfunction. Glycemic control was not affected by thyroid dysfunction.Conclusions: Women with type I diabetes are at a high risk for symptomatic postpartum thyroid dysfunction and therefore may benefit from routine thyroid function screening at postpartum visits. [ABSTRACT FROM AUTHOR]