David T. Nash, MD

September 01, 2005

For years, cardiologists and primary care physicians have engaged in a spirited debate about the appropriate target for low-density lipoprotein cholesterol (LDL-C) lowering in patients with coronary artery disease.

April 01, 2005

Now that the role of inflammation in the pathogenesis of cardiovascular disease has been recognized, biomarkers of inflammation have become the subject of intense research interest. Once considered a novel cardiovascular risk factor, the inflammatory biomarker C-reactive protein (CRP) is currently believed to improve global risk prediction in patients not previously deemed at high risk.

January 01, 2005

ABSTRACT: A host of evidence supports the treatment of high levels of low-density lipoprotein (LDL) cholesterol with HMG-CoA reductase inhibitors (statins), which are effective in both primary and secondary prevention of coronary heart disease (CHD). Studies have shown that statins prevent first cardiac events in otherwise healthy persons with elevated LDL cholesterol and low high-density lipoprotein cholesterol levels. Statins are also associated with a reduction in cardiac death, stroke, hospitalization, and the need for revascularization in patients with established CHD and hyperlipidemia. Secondary prevention trials of statin therapy that included persons aged 65 to 75 years found significant risk reduction in this age group. Among the concerns associated with statin treatment are lack of proper titration, failure to achieve LDL target goals, and underuse in patients with established CHD.

September 02, 2004

Despite the manydouble-blind,placebo-controlledtrials thathave demonstratedthe efficacy of statins inreducing the risk of cardiovascularevents, a largenumber of patients who aretreated with these drugsstill experience suchevents. This may be becausepatients who requireintensive lipid lowering arenot receiving adequatedosages of statins.

December 01, 2003

ABSTRACT: Diuretics remain a mainstay of heart failure therapy. Angiotensin-converting enzyme (ACE) inhibitors and ß-blockers inhibit activation of neurohormonal systems; these agents are recommended for most patients with symptomatic systolic heart failure. Angiotensin II receptor blockers (ARBs) are alternatives for patients who are unable to tolerate ACE inhibitors. Recent trials suggest that ARBs are also useful when added to the regimen of patients with a low ejection fraction. Although digoxin can provide long-term inotropic support in men, it significantly increases the risk of mortality in women; because of the risk of toxicity, use digoxin with caution in older persons and patients with renal dysfunction. Consider an aldosterone antagonist in patients who remain symptomatic at rest despite the use of a diuretic, digoxin, an ACE inhibitor or an ARB, and a ß-blocker. Lifestyle modifications such as dietary restriction and exercise are helpful in all patients.

April 01, 2003

ABSTRACT: Results of the Heart Protection Study (HPS)-the largest prospective statin trial to date-have confirmed that the cardioprotective effects of statin therapy extend to high-risk patients regardless of age, sex, or baseline serum cholesterol levels. Yet despite compelling efficacy data, statins are not prescribed as often or as aggressively as they should be, even among patients at high risk for coronary heart disease (CHD). Recent studies have shown a significant reduction in the risk of CHD among patients 65 years and older with statin treatment. These agents are also recommended as first-line therapy for prevention of CHD in postmenopausal women. Statins appear to be cardioprotective even in patients with average baseline serum total cholesterol levels.

October 01, 2002

More than1.8 millioncardiaccatheterizationsandat least 600,000 percutaneoustransluminal coronaryangioplasty (PTCA)procedures are performedin the United States annually.1 The use of these diagnosticand interventionalmodalities continues togrow even as financial constraintsincrease. Yet formany patients with coronaryartery disease (CAD),medical therapy may be anappropriate option.

September 01, 2002

Heart failure(HF), the mostcommon Medicarediagnosisrelatedgroup,has a significant and growingimpact on health careresources. The incidenceof HF has tripled during thelast decade. Almost 5 millionAmericans have HF, and anestimated 500,000 new casesare diagnosed yearly. Thelifetime risk of HF is about20%.1 Drug therapy has improvedconsiderably in recentyears, but the magnitudeand severity of theproblem has created a needfor newer therapies--particularlysince HF is associatedwith an increased risk ofsudden death and a diminishedquality of life.2

January 01, 2002

Although the cardiovascular death ratehas declined in the United States, thenumber of hospitalizations for cardiacdisease has not. The improvement incare has been offset by an increase inthe number of older Americans. By2050, more than 100 million Americanswill be 60 years of age or older,and about 30 million will be older than80 years.