ABSTRACT
INTRODUCTION: Use of systemic hormone therapy has been positively associated with development of dementia. Little is known about the dose-dependent effect of vaginal estradiol on dementia risk. METHODS: We assessed associations between cumulative dose of vaginal estradiol tablets and dementia in a case-control study nested in a nationwide Danish cohort of women aged 50 to 60 years at study initiation, who did not use systemic hormone therapy. Each case was age-matched to 10 female controls. RESULTS: A total of 4574 dementia cases were matched to 45,740 controls. Cumulative use of vaginal estradiol tablets was not associated with all-cause dementia; adjusted hazard ratio 1.02 (95% confidence interval [CI] 0.89-1.18) for low dose (< 750 mcg), 1.07 (0.94-1.21) for medium dose (750-2000 mcg), and 0.93 (0.84-1.03) for high dose (> 2000 mcg). Similarly, Alzheimer's disease (AD) only was not associated with vaginal estradiol. DISCUSSION: Exposure to vaginal estradiol tablets was not associated with all-cause dementia or AD only.
Subject(s)
Alzheimer Disease , Estradiol , Estrogens , Administration, Intravaginal , Alzheimer Disease/drug therapy , Alzheimer Disease/epidemiology , Case-Control Studies , Cohort Studies , Estradiol/administration & dosage , Estradiol/adverse effects , Estrogens/administration & dosage , Estrogens/adverse effects , Female , Humans , Middle AgedABSTRACT
BACKGROUND: The role of antiarrhythmic drugs for atrial fibrillation/atrial flutter (AF/AFL) after catheter ablation is not well established. HYPOTHESIS: We hypothesized that changing the myocardial substrate by ablation may alter the responsiveness to dronedarone. METHODS: We assessed the efficacy and safety of dronedarone in the treatment of paroxysmal/persistent atrial fibrillation/atrial flutter (AF/AFL) post-ablation, based on a post hoc analysis of the ATHENA study. A total of 196 patients (dronedarone 90, placebo 106) had an ablation for AF/AFL before study entry. In these patients, the effect of treatment on the first hospitalization because of cardiovascular (CV) events/all-cause death was assessed, as was AF/AFL recurrence in individuals with sinus rhythm at baseline. The safety of dronedarone vs placebo was also determined. RESULTS: In patients with prior ablation, dronedarone reduced the risk of AF/AFL recurrence (hazard ratio [HR]: 0.65 [95% confidence interval [CI]: 0.42, 1.00]; P < .05) as well as the median time to first AF/AFL recurrence (561 vs 180 days) compared with placebo. The HR for first CV hospitalization/all-cause death with dronedarone vs placebo was 0.98 (95% CI: 0.62, 1.53; P = .91). Rates of treatment-emergent adverse events were 83.1% vs 75.5% and rates of serious TEAEs were 27.0% vs 18.9% in the dronedarone and placebo groups, respectively. One death occurred with dronedarone (not treatment-emergent) and five occurred with placebo. CONCLUSION: In patients with prior ablation for AF/AFL, dronedarone reduced the risk of AF/AFL recurrence compared with placebo, but not the risk of first CV hospitalization/all-cause death. Safety outcomes were consistent with those of the overall ATHENA study.
Subject(s)
Anti-Arrhythmia Agents/therapeutic use , Atrial Fibrillation/therapy , Atrial Flutter/therapy , Catheter Ablation , Dronedarone/therapeutic use , Heart Rate/drug effects , Aged , Aged, 80 and over , Anti-Arrhythmia Agents/adverse effects , Atrial Fibrillation/diagnosis , Atrial Fibrillation/mortality , Atrial Fibrillation/physiopathology , Atrial Flutter/diagnosis , Atrial Flutter/mortality , Atrial Flutter/physiopathology , Catheter Ablation/adverse effects , Catheter Ablation/mortality , Double-Blind Method , Dronedarone/adverse effects , Female , Hospitalization , Humans , Male , Middle Aged , Recurrence , Risk Assessment , Risk Factors , Time Factors , Treatment OutcomeABSTRACT
The new ERC guidelines on resuscitation emphasize the importance of quality CPR. BLS should be started as early as possible. Lay rescuers should not check for a pulse, they should call for help and start chest compressions immediately. Compression depth should be 4-5 cm at a rate of 100 compressions per minute. Chest compressions and ventilation should be performed in a ratio of 30:2. Lay rescuers should continue until professional help arrives. Lay rescuers may use the same procedure for children as recommended for adults. Professionals should, however, initiate CPR in children with 5 ventilations followed by a compression-ventilation ratio of 15:2. Automatic External Defibrillation should be used as early as possible.
Subject(s)
Cardiopulmonary Resuscitation/methods , Electric Countershock/methods , Adult , Cardiopulmonary Resuscitation/instrumentation , Cardiopulmonary Resuscitation/standards , Child , Defibrillators , Heart Arrest/diagnosis , Heart Arrest/physiopathology , Heart Arrest/therapy , Humans , Practice Guidelines as TopicABSTRACT
Patients with diabetes have an unfavourable prognosis after an acute myocardial infarction. The DIGAMI 2 study investigated the effect of various metabolic treatment strategies in type 2 diabetic patients with acute myocardial infarction: acutely introduced, long-term insulin treatment did not improve survival when compared with conventional management at similar levels of glucose control. However, good glucose control seems important since the glucose level was found to be a strong predictor of long-term mortality in this patient category.
