Systematic review on evidence of the effectiveness of cholesterol-lowering drugs.

INTRODUCTION: Coronary heart disease (CHD) is the leading cause of mortality worldwide. With increasingly urbanized lifestyles in developing countries and the aging populations, the major risk factors for CHD such as obesity, diabetes mellitus, and hypercholesterolemia are likely to increase in the future. In the current report, we reviewed the evidence on the effect of cholesterol lowering using pharmacological agents. METHODS: A PubMed/Medline systematic search was performed over the past 12 years (1998-2009 inclusive) and relevant papers written in the English language were selected. We used key phrases including, "risk factors for hypercholesterolemia," "management of hypercholesterolemia," "guidelines for management of hypercholesterolemia," and "pharmacological management of hypercholesterolemia." RESULTS: There were a total of over 3500 reports. We selected key publications on the effect of cholesterol lowering using different pharmacological agents. CONCLUSION: Several options exist with regards to pharmacological management of hypercholesterolemia. There is a substantial body of evidence to support the effect of a population shift towards a favorable risk profile, which has huge potential in reducing the burden of CHD globally.

Glucose blood levels as a therapeutic target in acute ischaemic stroke setting.

Ischaemic stroke is extremely common in western societies contributing to 70-85% of strokes, one of the leading causes of mortality and long-term disability. Despite advancement in preventive measures, the total number of strokes is set to rise in the future due to increasing numbers of aging populations across the world. Diabetes as a risk factor for stroke has been well established. There are also emerging evidence to suggest glucose level management in acute stroke phase as a therapeutic target may be beneficial, albeit remains controversial. One of the issues in difficulty in interpreting study findings is their heterogeneity. In this article, we provide epidemiological, basic science, clinical observational and trial evidence leading to the current practice of regarding blood glucose as the therapeutic target in acute ischaemic stroke setting.

Optimum control of blood glucose for prevention and treatment of ischemic and hemorrhagic stroke.

Stroke is the most common cause of disability and a major cause of mortality. Each year, more than 500,000 Americans sustain a stroke. Reperfusion and antithrombotic therapies are still of limited benefit, hence increasing interest has been focused on therapeutic approaches that prevent and/or modulate infarct evolution. Hyperglycemia in acute stroke has a poor prognosis and is associated with significant morbidity and mortality. However, it remains unclear whether intensive lowering of blood glucose levels in the hyperacute and acute phases of stroke improves clinical outcomes. Experimental data suggest that elevated blood glucose may contribute to infarct expansion directly through a number of maladaptive metabolic pathways and that treatment with insulin may attenuate these adverse effects. Despite some controversy surrounding the optimal level of blood glucose control, much of the evidence to date supports rigorous blood glucose control and comprehensive cardiovascular risk factor management to prevent stroke in patients with diabetes. The current recommendation is to aim for strict control of blood pressure, glucose, and lipids along with lifestyle modification to improve cardiovascular health. However, there remains a distinct paucity of information concerning secondary stroke prevention. To date, the overwhelming evidence suggests that aggressive glucose management should be the standard of care in all patients with stroke and hyperglycemia. This article presents an overview of the recommendations for the optimum control of blood glucose for prevention and treatment of ischemic and hemorrhagic stroke.

Effect of dysphasia and dysphagia on inpatient mortality and hospital length of stay: a database study.

OBJECTIVES: To examine the effect of dysphasia and dysphagia on stroke outcome. DESIGN: Retrospective database study. SETTING: Norfolk, United Kingdom. PARTICIPANTS: Two thousand nine hundred eighty-three men and women with stroke admitted to the hospital between 1997 and 2001. MEASUREMENTS: Inpatient mortality and likelihood of longer length of hospital stay, defined as longer than median length of stay (LOS). Dysphagia was defined as difficulty swallowing any liquid (including saliva) or solid material. Dysphasia was defined as speech disorders in which there was impairment of the power of expression by speech, writing, or signs or impairment of the power of comprehension of spoken or written language. An experienced team assessed dysphagia and dysphasia using explicit criteria. RESULTS: Two thousand nine hundred eighty-three patients (1,330 (44.6%) male), median age 78 (range 17-105), were included, of whom 77.7% had ischemic, 10.5% had hemorrhagic, and 11.8% had undetermined stroke types. Dysphasia was present in 41.2% (1,230) and dysphagia in 50.5% (1,506), and 27.7% (827) had both conditions. Having either or both conditions was associated with greater mortality and longer LOS (P<.001 for all). Using multiple logistic regression models controlling for age, sex, premorbid Rankin score, previous disabling stroke, and stroke type, corresponding odds ratios for death and longer LOS were 2.2 (95% confidence interval (CI)=1.8-2.7) and 1.4 (95% CI=1.2-1.6) for dysphasia; 12.5 (95% CI=8.9-17.3) and 3.9 (95% CI=3.3-4.6) for dysphagia, 5.5 (95% CI=3.7-8.2), 1.9 (95% CI=1.6-2.3) for either, and 13.8 (95% CI=9.4-20.4) and 3.7 (95% CI=3.1-4.6) if they had both, versus having no dysphasia, no dysphagia, or none of these conditions, respectively. CONCLUSION: Patients with dysphagia have worse outcome in terms of inpatient mortality and length of hospital stay than those with dysphasia. When both conditions are present, the presence of dysphagia appears to determine the likelihood of poor outcome. Whether this effect is related just to stroke severity or results from problems related directly to dysphagia is unclear.

Systematic review of studies of patients' satisfaction with breast reconstruction after mastectomy.

Systematic review of studies of patients' satisfaction with breast reconstruction published in English (1994-2006) using Medline, Embase, Cochrane databases. Twenty-eight studies related to cosmesis and two related to pain management were identified. Study designs were mostly randomised surveys but half of samples were small. Five studies compared surgical techniques and satisfaction, twelve analysed surgical techniques; two studies looked at the effect of radiation therapy. Nine studies assessed satisfaction determinants. All studies reported good levels of satisfaction. Methodological deficiencies (small sample sizes, context and study designs, satisfaction assessment, basic statistical analysis) limit the generalisability of the findings. Overall, studies suggested that patients were satisfied with breast reconstruction whatever the technique used, whereas age or procedure timing did not affect general satisfaction. Breast symmetry, size, shape and scars were reported as influencing the patients' score. Nipple reconstruction positively influenced satisfaction; radiation before/after reconstruction achieved satisfactory cosmesis, and complications predicted dissatisfaction.