Effects of Proton Pump Inhibitors on Cardiovascular Events and Inflammatory Factors in Patients With Upper Gastrointestinal Bleeding Undergoing Dual Antiplatelet Therapy.

INTRODUCTION: Dual antiplatelet therapy (DAPT), vital post-percutaneous coronary intervention (PCI) to prevent cardiovascular events (CVEs) via aspirin and P2Y12 receptor antagonists, faces controversy when combined with proton pump inhibitors (PPIs) due to potential impacts on bleeding risk and antiplatelet efficacy, prompting the need for further research to determine optimal co-administration practices. This work evaluated the effects of PPIs on CVEs and inflammatory factors in patients with upper gastrointestinal bleeding (UGIB) undergoing DAPT after PCI. MATERIALS AND METHODS: The data of 166 patients who underwent PCI and developed UGIB while on DAPT from April 2021 to April 2023 were retrospectively analyzed. The patients were rolled into two groups: those who received PPI treatment and those who did not, namely, the PPI and non-PPI group, respectively. Clinical data from these patients was analyzed, intending to provide relevant theoretical evidence for clinical practice. Furthermore, the occurrence of CVEs and the levels of inflammatory factors of patients in all groups were statistically analyzed. RESULTS: Melena was the most common clinical symptom observed in all UGIB patients. The incidence of CVEs in the PPI group was not greatly different from that in the non-PPI group (P>0.05). The distribution of CVEs occurrence among different PPI drugs also exhibited no obvious difference (P>0.05). The PPI group exhibited greatly lower C-reactive protein (CRP) and tumor necrosis factor α (TNF-α) based on the non-PPI group (P<0.05). CONCLUSION: Melena was the most frequent clinical manifestation in UGIB patients. The use of PPIs did not increase the risk of CVEs, and different PPI drugs did not affect the occurrence of CVEs. Furthermore, PPIs lowered CRP and TNF-α levels in serum of these patients.

A Comparison of the Effects of Empagliflozin and Sitagliptin, When Combined With Metformin, on Lipid Levels in Patients with Type 2 Diabetes: A Clinical Investigation.

Introduction Type 2 diabetes (T2D) is emerging as a major global health concern. An associated condition, dyslipidemia, which acts as a significant modifiable risk factor for T2D, exhibits variations across different ethnicities and socioeconomic backgrounds. While many patients rely on metformin as their primary treatment, it does not always effectively control hyperglycemia. As a result, there is a growing need for adjunctive treatments, including sodium-glucose cotransporter-2 (SGLT2) and dipeptidyl peptidase-4 (DPP-4) inhibitors. This study evaluated the comparative effects of empagliflozin (an SGLT2 inhibitor) and sitagliptin (a DPP-4 inhibitor), both combined with metformin, on the lipid profiles of individuals with T2D. Methods Over six months at the Federal Government Polyclinic Hospital in Islamabad, we enrolled 126 participants diagnosed with T2D. Using a nonprobability consecutive sampling technique, we divided them into two groups. Group A received metformin and empagliflozin, while Group B was administered metformin and sitagliptin. We assessed their fasting lipid profiles three months into the treatment. Results Both groups consisted of 63 patients each. We observed that those in Group B, treated with sitagliptin and metformin, demonstrated a more significant reduction in total cholesterol and low-density lipoprotein-C levels than those in Group A, treated with empagliflozin and metformin. This difference proved to be statistically meaningful. Conclusion The combination of sitagliptin and metformin showed enhanced benefits in lipid profile management compared to the combination of empagliflozin and metformin in patients with T2D. This discovery underscores the need for holistic treatment modalities that factor in blood glucose levels and cardiovascular health.

Indirect effects of COVID-19 pandemic on reproductive, maternal, newborn and child health services in Pakistan.

Background: COVID-19 is having many impacts on health, economy and social life; some due to the indirect effects of closure of health facilities to curb the spread. Closures were implemented in Pakistan from March 2020, affecting provision of reproductive, maternal, newborn and child health (RMNCH) services. Aims: To appraise the effects of containment and lockdown policies on RMNCH service utilization in order to develop an early response to avoid the catastrophic impact of COVID-19 on RMNCH in Pakistan. Methods: Routine monitoring data were analysed for indicators utilization of RMNCH care. The analysis was based on Period 1 (January-May 2020, first wave of COVID-19); Period 2 (June-September 2020, declining number of cases of COVID-19); and Period 3 (October-December 2020, second wave of COVID-19). We also compared data from May and December 2020 with corresponding months in 2019, to ascertain whether changes were due to COVID-19. Results: Reduced utilization was noted for all RMNCH indicators during Periods 1 and 3. There was a greater decline in service utilization during the first wave, and the highest reduction (~82%) was among children aged < 5 years, who were treated for pneumonia. The number of caesarean sections dropped by 57%, followed by institutional deliveries and first postnatal visit (37% each). Service utilization increased from June to September, but the second wave of COVID-19 led to another decrease. Conclusion: To reinstate routine services, priority actions and key areas include continued provision of family planning services along with uninterrupted immunization campaigns and routine maternal and child services.

COVID-19 Infection in Vaccinated Healthcare Professionals.

BACKGROUND: There are different types of Coronavirus disease (COVID-19) vaccines available presently, and their emergency use has been approved by WHO worldwide on a mass scale. COVID-19 vaccine breakthrough infections have been reported worldwide. In Pakistan, there are limited data on COVID-19 vaccine breakthrough infections and their clinical course, especially in healthcare professionals (HCPs). Our study aims to investigate COVID-19 infections among vaccinated HCPs. METHODS: A prospective study was conducted on 425 healthcare professionals. Data collected from healthcare professionals included names, age, gender, number of vaccination doses, COVID-19 infection pre and post-vaccination, the severity of COVID-19 infection (if positive), and co-morbid conditions. Ethical board approval was taken. Statistical Package for Social Sciences (SPSS) version 23 (IBM Corp., Armonk, NY) was used to analyze the data. RESULTS: After complete vaccination, 17.27% acquired COVID-19 infection; 2.47% had COVID-19 infection both pre and post-vaccination. The mean age was 32.46 years (n=71) with a standard deviation of ±9.376. The male to female ratio was 1.53. COVID-19 PCR was positive in 95.77%. During the course of the disease, 4.2% were asymptomatic, 92.95% had mild symptoms, 1.4% were hospitalized, and 1.4% had to be managed in the intensive care unit. None of the HCPs who had received booster doses acquired a COVID-19 infection. CONCLUSION: It was found that prior COVID-19 infection and vaccination do not confer immunity from infection. However, proper vaccination limits the severity, morbidity, and mortality of COVID-19 infection.

Lycopene as a Natural Antioxidant Used to Prevent Human Health Disorders.

Lycopene, belonging to the carotenoids, is a tetraterpene compound abundantly found in tomato and tomato-based products. It is fundamentally recognized as a potent antioxidant and a non-pro-vitamin A carotenoid. Lycopene has been found to be efficient in ameliorating cancer insurgences, diabetes mellitus, cardiac complications, oxidative stress-mediated malfunctions, inflammatory events, skin and bone diseases, hepatic, neural and reproductive disorders. This review summarizes information regarding its sources and uses amongst different societies, its biochemistry aspects, and the potential utilization of lycopene and possible mechanisms involved in alleviating the abovementioned disorders. Furthermore, future directions with the possible use of this nutraceutical against lifestyle-related disorders are emphasized. Its protective effects against recommended doses of toxic agents and toxicity and safety are also discussed.

Effects of galacto-oligosaccharide prebiotics in blood profile of severely acute malnourished children.

This study assessed the effects of galacto-oligosaccharides (Oligomate) on hematocrit, serum enzymes, total bilirubin levels, and serum electrolytes in controls and severely malnourished infants, with emphasis on gastrointestinal symptoms. Oligomate doses and phases did not affect stools frequency per day, indicating that prebiotic effect on stool may be due to the prebiotic type. The number of vomits per day during phases 2 and 3 were significantly reduced (p<0.05) in response to prebiotics, despite the prebiotic dose effect was not significant (p>0.05). Moreover, prebiotics administration during phases 2 and 3 markedly improved hemoglobin levels (p<0.05), but not the dose. Similarly, hematocrit levels and white blood cells were significantly improved during the last 2 phases, but dose have no effects on blood hematocrit levels. Erythrocyte sedimentation rate significantly decreased (p<0.05) in phases 2 and 3 compared to phase 1. No dose-related effect was stated on erythrocytes sedimentation rate. Regarding the serum enzymes, SGPT significantly decreased (p<0.05) in phases 2 and 3 compared to phase 1, whereas SGOT significantly decreased only in phase 3. Total bilirubin levels increased significantly (p<0.05) in phase 3 when compared to phases 1 or 2. Prebiotics significantly decreased (p<0.05) sodium levels in the treated group, while potassium levels did not change in all groups, excepting during phase 2, where it increased significantly. Thus, our results confirm the hypothesis that prebiotic supplementation improves blood parameters and health status, consequently decreasing the infection risk and number of vomit per day in infants.

Bio-therapeutics effects of probiotic strain on the gastrointestinal health of severely acute malnourished children.

The core objective was to evaluate the effect of probiotic fortification at three phases of formula milk administration in malnourished children. A dose related effect was determined in 30 severely acute malnourished children (6-59 months) in a double-blind, randomized design. According to the results, serum albumin levels, treatment T2 (6 billion cfu) has significantly increased albumin levels (3.7g/dL) and the effect of phase-III (Plumpy'nut) was found to be better. Results regarding sodium levels showing probiotic-dose have significant effect (P≤0.05) in phases as well. Moreover, the effect of T1 i.e. 3 billion cfu of probiotics has significantly reduced sodium levels (141.8mmol/L) vs. others and the effect of phase-II was better on reducing sodium levels. which is further confirmed in terms of reduced erythrocyte sedimentation rate levels at phase-III (29.566 vs. phase-II, 41.3 and phase-I, 46.533 mm/h). Conclusively, the effect of 6 billion cfu at phase-III was more effective on blood parameters.

Antibiotics, Acid and Heat Tolerance of Honey adapted Escherichia coli, Salmonella Typhi and Klebsiella pneumoniae.

The medicinal importance of honey has been known for many decades due to its antimicrobial properties against life-threatening bacteria. However, previous studies revealed that microorganisms are able to develop adaptations after continuous exposure to antimicrobial compounds. The present study was conducted to explore the impact of subinhibitory concentrations of branded honey (Marhaba) and unbranded honey (extracted from Ziziphus mauritiana plant) locally available in Pakistan on Escherichia coli ATCC 10536, Salmonella Typhi and Klebsiella pneumoniae by investigating the development of self- or cross-resistance to antibiotics (gentamicin, kanamycin and imipenem). Minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of autoclaved honeys were determined. The bacterial cells of E. coli ATCC 10536, S. Typhi and K. pneumoniae were subjected to honey adaptation by exposing to » × MIC (4 passages) and ½ × MIC (4 passages) of both honeys. Moreover, tolerance to low pH and high temperature was also studied in adapted and unadapted cells. The decreasing trend in growth pattern (OD600nm) of E. coli ATCC 10536, S. Typhi and K. pneumoniae was observed with increases in the concentration of honeys (6.25-50% v/v) respectively. Our results showed that continuous exposure of both honeys did not lead to the development of any self- or cross-resistance in tested bacteria. However, percent survival to low pH was found to be significantly higher in adapted cells as compared to unadapted cells. The results indicate that both branded honey (Marhaba) and unbranded honey (extracted from Ziziphus mauritiana plant) were effective in controlling the growth of tested pathogenic bacteria. However, the emergence of tolerance to adverse conditions (pH 2.5, temperature 60 °C) deserves further investigation before proposing honey as a better antibacterial agent in food fabrication/processing, where low pH and high temperatures are usually implemented.

White Sesame Seed Oil Mitigates Blood Glucose Level, Reduces Oxidative Stress, and Improves Biomarkers of Hepatic and Renal Function in Participants with Type 2 Diabetes Mellitus.

OBJECTIVES: The study was designed to investigate the impact of white sesame seed oil (WSSO) consumption on fasting blood glucose (GLU), insulin (INS), glycosylated hemoglobin (HbA1c), and hepatic antioxidant enzymes. A secondary aim was to check the influence on serum biochemistry, hepatic, cardiac, and renal functions. METHODS: Forty-six participants with type 2 diabetes were recruited and randomly divided into two equal groups: diabetic control (DCON) and diabetic sesame oil (DSO). At baseline and 30, 60, and 90 days, blood samples were drawn and analyzed. Two-way repeated-measures analysis of variance was used to evaluate the difference between groups and across time. RESULTS: In both groups, GLU, INS, and HbA1c were not significantly different at baseline (mean 187.07 ± 5.63 mg/dl, mean 12.12 ± 1.03 µU/ml, and mean 7.55 ± 0.37%, respectively). At 90 days, GLU was significantly (p < 0.05) decreased in DSO (137.83 ± 3.16 mg/dl) when compared with DCON (218.13 ± 5.92 mg/dl), while INS was significantly increased in DSO (23.13 ± 1.15 µU/ml) as compared to DCON (7.93 ± 0.38 µU/ml). At 90 days, HbA1c was significantly lower (p < 0.05) in DSO as compared to DCON. Thiobarbituric acid reactive substances were significantly lower (p < 0.05) in DSO (1.08 ± 0.05 [MDA] nmol/ml) as compared to DCON (2.26 ± 0.07 [MDA] nmol/ml). In DSO, activities of hepatic antioxidant enzymes (superoxide dismutase, catalase, and glutathione peroxidase) increased while in DCON these activities decreased significantly (p < 0.05) across the time period. Biomarkers of liver, cardiac, and renal functions improved significantly in DSO as compared to DCON. CONCLUSION: WSSO as a functional food may play an important role in GLU regulation and against deleterious effects of diabetes in humans with type 2 diabetes.

Evaluation of White Sesame Seed Oil on Glucose Control and Biomarkers of Hepatic, Cardiac, and Renal Functions in Male Sprague-Dawley Rats with Chemically Induced Diabetes.

White sesame seed oil (WSSO) has been used in cooking and food preparations for centuries. It has many purported health benefits and may be a promising nutraceutical. The primary purpose of this study was to examine the effects of WSSO on fasting blood glucose (GLU) and insulin (INS) in male Sprague-Dawley rats with chemically induced diabetes. A secondary aim was to explore other hematological biomarkers of hepatic, cardiac, and renal function. Sixty-three male Sprague-Dawley rats were randomized into standard diet groups, normal control (NCON) (n = 21) and diabetic control (DCON) (n = 21), and a diabetic sesame oil (DSO) (n = 21) group, which were fed a diet containing 12% WSSO. Blood samples were analyzed at 0, 30, and 60 days. Differences between groups and across days were assessed with two-way repeated measures analysis of variance. At baseline, GLU and INS were similar in both diabetic groups, mean 248.4 ± 2.8 mg/dL and mean 23.4 ± 0.4 µU/mL, respectively. At 60 days, GLU was significantly (P < .05) higher in DCON (298.0 ± 2.3 mg/dL) compared with DSO (202.1 ± 1.0 mg/dL). INS showed similar favorable trends after WSSO supplementation. Consumption of WSSO significantly improved glucose control and other biomarkers of hepatic stress, as well as cardiac and renal health. WSSO may be a viable functional food to help reduce the detrimental effects of diabetes.

Doppler Systolic Signal Void in Hypertrophic Cardiomyopathy: Apical Aneurysm and Severe Obstruction without Elevated Intraventricular Velocities.

BACKGROUND: In patients with hypertrophic cardiomyopathy (HCM), akinetic apical aneurysms are associated with ventricular tachycardia, heart failure, apical thrombus, and mortality. The cause of apical aneurysms remains unresolved, and there is controversy about prevalence and significance of mid-left ventricular (LV) obstruction, often present in these patients. The aim of this study was to test the hypothesis that low velocities in patients with aneurysms are due to near complete cessation of mid-LV flow, characteristically marked by a Doppler signal void. METHODS: This was a retrospective analysis of 39 patients with HCM with segmental hypertrophy of the mid left ventricle and complete systolic emptying at the mid-LV level. The severity of dynamic obstruction was evaluated by measuring the time during which cross-sectional mid-LV cavity area was <1 cm(2). Presence or absence of an LV Doppler midsystolic signal void was determined. RESULTS: Akinetic apical aneurysms were present in 21 patients. The duration of two-dimensional mid-LV short-axis complete emptying was longer in patients with akinetic apical aneurysms (194 ± 45 vs 148 ± 63 msec, P = .013), nearly 50% of systole. Midsystolic signal voids were seen only in patients with akinetic apical aneurysms (P < .001), present in 86%. In patients with akinetic aneurysms, there was a strong correlation between the duration of the systolic signal void and the proportion of systole with complete emptying < 1 cm(2) (r = 0.704; P = .001). Complete emptying < 1 cm(2) for ≥ 38% of systole was associated with akinetic aneurysm (odds ratio, 9.35; P < .004). CONCLUSION: Patients with akinetic apical aneurysm HCM have near complete cessation of flow across severe dynamic mid-LV obstruction for nearly 50% of systole. This explains how the adverse effects of obstruction may occur without high velocities on echocardiography.

Prevalence and long-term prognosis of patients with complete bundle branch block (right or left bundle branch) with normal left ventricular ejection fraction referred for stress echocardiography.

BACKGROUND: The prognostic value of stress echocardiography (SE) in patients with complete bundle branch blocks (BBB) with normal left ventricular ejection fraction (LVEF) has not been well described. We sought to determine the prognostic value of SE in patients with BBB and normal LVEF. METHODS: We analyzed 7214 patients (58 ± 14 years; 57% female) with a mean follow-up time of 9 ± 4 years. Dobutamine SE was performed in 51% of patients and exercise SE was performed in 49%. All-cause mortality data were obtained from the Social Security Death Index. RESULTS: There were 222 (3%) patients with right bundle branch block (RBBB) and 50 (0.7%) patients with left bundle branch block (LBBB). Patients with LBBB were 3 times more likely to have an abnormal stress test after adjusting for age, gender, mode of stress test, and coronary artery disease risk factors (OR = 3.3; 95% CI: 1.86-5.92; P < 0.001). The mortality rates were 4.5%/year for patients with LBBB, 2.5%/year for patients with RBBB, and 1.9%/year for patients without BBB (P < 0.001). Among patients with a normal SE, those with LBBB had similar mortality to those without LBBB (HR = 0.9; 95% CI: 0.4-2.2; P = 0.8). Patients with LBBB and abnormal SE had more than 2 times greater risk of all-cause mortality (HR = 2.4; 95% CI: 1.4-4.2; P = 0.002). CONCLUSION: A normal stress echocardiogram in LBBB is associated with benign prognosis while those with LBBB and abnormal SE have the worst outcomes.

Incidence, prognosis, and factors associated with cardiac arrest in patients hospitalized with acute coronary syndromes (the Global Registry of Acute Coronary Events Registry).

OBJECTIVES: Contemporary data are lacking with respect to the incidence rates of, factors associated with, and impact of cardiac arrest from ventricular fibrillation or tachycardia (VF-CA) on hospital survival in patients admitted with an acute coronary syndrome (ACS). The objectives of this multinational study were to characterize trends in the magnitude of in-hospital VF-CA complicating an ACS and to describe its impact over time on hospital prognosis. METHODS: In 59 161 patients enrolled in the Global Registry of Acute Coronary Events Study between 2000 and 2007, we determined the incidence, prognosis, and factors associated with VF-CA. RESULTS: Overall, 3618 patients (6.2%) developed VF-CA during their hospitalization for an ACS. Incidence rates of VF-CA declined over time. Patients who experienced VF-CA were on average older and had a greater burden of cardiovascular disease, yet were less likely to receive evidence-based cardiac therapies than patients in whom VF-CA did not occur. Hospital death rates were 55.3% and 1.5% in patients with and without VF-CA, respectively. There was a greater than 50% decline in the hospital death rates associated with VF-CA during the years under study. Patients with a VF-CA occurring after 48 h were at especially high risk for dying during hospitalization (82.8%). CONCLUSION: Despite reductions in the magnitude of, and short-term mortality from, VF-CA, VF-CA continues to exert an adverse effect on survival among patients hospitalized with an ACS. Opportunities exist to improve the identification and treatment of ACS patients at risk for VF-CA to reduce the incidence of, and mortality from, this serious arrhythmic disturbance.

Geographic variance of cardiovascular risk factors among community women: the national Sister to Sister campaign.

BACKGROUND: There are substantial variations in cardiovascular disease (CVD) risk and outcomes among women. We sought to determine geographic variation in risk factor prevalence in a contemporary sample of U.S. women. METHODS: Using 2008-2009 Sister to Sister (STS) free heart screening data from 17 U.S. cities, we compared rates of obesity (body mass index [BMI] ≥30 kg/m(2)), hypertension (HTN ≥140/90 mm Hg), low high-density lipoprotein cholesterol (HDL-C <40 mg/dL), and hyperglycemia (≥126 mg/dL) with national rates. RESULTS: In 18,892 women (mean age 49.8 ± 14.3 years, 37% black, 32% white, 14% Hispanic), compared to overall STS rates, significantly higher rates were observed for obesity in Baltimore (42.4%), Atlanta (40.0%), Dallas (37.9%), and Jacksonville (36.0%); for HTN in Atlanta (43.9%), Baltimore (42.5%), and New York (39.1%); for hyperglycemia in Jacksonville (20.3%), Philadelphia (18.1%), and Tampa (17.8%); and for HDL-C <40 mg/dL in Phoenix (37.4%), Dallas (26.5%), and Jacksonville (18.1%). Compared to national American Heart Association (AHA) 2010 update rates, most STS cities had higher rates of hyperglycemia and low HDL-C. CONCLUSIONS: In a large, community-based sample of women nationwide, this comprehensive analysis shows remarkable geographic variation in risk factors, which provides opportunities to improve and reduce a woman's CVD risk. Further investigation is required to understand the reasons behind such variation, which will provide insight toward tailoring preventive interventions to narrow gaps in CVD risk reduction in women.

Heart failure in subjects with chronic kidney disease: Best management practices.

Renal dysfunction is common in patients with heart failure (HF) and can complicate HF therapy. Treating patients with HF and kidney disease is difficult and requires careful assessment, monitoring and balancing of risk between potential benefits of treatment and adverse impact on renal function. In this review, we address the pathophysiological contexts and management options in this adversarial relation between the heart and the kidney, which exists in a substantial proportion of HF patients. Angiotensin converting enzyme inhibitors and ß-blockers are associated with similar reductions in mortality in patients with and without renal insufficiency but usually are less often prescribed in patients with renal insufficiency. Careful monitoring of side effects and renal function should be done in all patients with renal insufficiency and prompt measures should be adopted to prevent further complications.

The frequency and functional impact of overlapping hypertension on hypertrophic cardiomyopathy: a single-center experience.

Between 1995 and 2005, 196 adults with hypertrophic cardiomyopathy (HCM) were evaluated. Among these, 122 (62%, group 1) patients also had systemic hypertension. The clinical presentation, management, outcome, and echocardiographic findings of these patients were compared with 74 (38%, group 2) patients without systemic hypertension. Patients in group 1 were older at the time of HCM diagnosis and had a higher prevalence of diabetes (28% vs 9%; P=.02) and coronary artery disease (40% vs 25%; P=.03). In addition, echocardiography showed a significantly higher prevalence of systolic anterior motion of the anterior mitral valve in association with dynamic left ventricular outflow obstruction (52% vs 19%; P=.02) and mitral annular calcification (27% vs 13%; P=.03) in group 1 patients. Left ventricular wall thickness (17 mm vs 19 mm), end-diastolic diameter (42 mm vs 42 mm), resting outflow tract gradient >30 mm Hg (17% vs 16%), and ejection fraction (65% vs 64%) were similar in the two groups. HCM frequently coexists with systemic hypertension in the adult population. Presence of systemic hypertension in HCM patients is associated with older age and higher risk of diabetes, coronary artery disease, and noncardiac death.

Hypertension prevalence and prescribing trends in older US adults: 1999-2004.

To describe hypertension trends in US adults aged 65 years and older using Medicare Current Beneficiary Survey (MCBS) data, a cross-sectional, nationally representative health examination survey from MCBS files between 1999 and 2004 was investigated. Overall, 62% of beneficiaries, or an estimated 20 million US adults aged 65 years and older, were hypertensive as extrapolated from MCBS data. From 1999 to 2004, the prevalence rate of hypertension increased from 59% to 65% (P<.001). Nonwhite persons and women had a higher prevalence of hypertension than whites and men. A history of diabetes mellitus, prior myocardial infarction, coronary artery disease, or stroke was significantly associated with hypertension treatment. In addition, significant geographic variation in treatment was noted. There was a significant increase in hypertension prevalence in older Medicare beneficiaries from 1999 to 2004. Women, patients 85 years and older, and nonwhite patients were less likely to be treated with antihypertensive medications, and significant geographic variation existed in treatment.

Hyperlipidemia in older adults.

Older adults carry the highest risk for coronary artery disease and the highest burden of atherosclerosis. Although most clinical trials of cholesterol-lowering therapy have not specifically targeted older persons, growing evidence supports treatment of elevated low-density lipoprotein cholesterol levels in older patients, especially those at high risk for coronary events. The decision to treat a high or high-normal cholesterol level in an elderly individual must be individualized based on chronologic and physiologic age. This article summarizes current data on lipid-lowering therapy in older adults and the management of hyperlipidemia in elderly patients.

Patient adherence and preference considerations in managing cardiovascular risk: focus on single pill and amlodipine/atorvastatin fixed combination.

Cardiovascular disease (CVD) accounts for in excess of 930,000 deaths in the United States each year. Risk factors for CVD often co-exist. Studies estimate that over half of the hypertensive population also has dyslipidemia. Observational data suggest that fewer than 10% of patients attain recommended therapeutic targets for both conditions. A variety of patient, regimen and system characteristics have been associated with the risk for non-adherence. Poly-pharmacy and complex drug regimens are associated with poor patient adherence and thus the use of fixed-dose combination therapies, may improve adherence by reducing the pill burden. The fixed-dose combination of amlodipine/atorvastatin offers a convenient and effective approach to manage two important CVD risk factors. The combination of amlodipine/atorvastatin has a synergistic effect. The half-life of both agents facilitates once-daily dosing and both can be administered at any time of the day with or without food. Amlodipine/atorvastatin combined pill can be used to initiate both agents or patients can be switched directly from single-agent therapy with one or both agents. The convenience of single-pill amlodipine/atorvastatin has the potential to improve patient adherence and the management of cardiovascular risk in selected patients, thereby improving clinical outcomes.

Peripheral arterial disease: current perspectives and new trends in management.

Peripheral arterial disease (PAD) is defined as an arterial brachial index (ABI) of < or =0.90 in the lower extremities and results from a narrowing of the arteries as a result of progressive atherosclerosis. PAD affects 12-20% of Americans aged 65 years or older; however, most are asymptomatic and many do not seek treatment. Improved awareness and education in both the general population and among health care providers about these modifiable risk factors has the potential to improve general health and decrease morbidity and mortality secondary to atherosclerotic vascular disease.