Biomedical subjects

Anatoly Langer

Publications and source records attributed to Anatoly Langer.

42 records · Page 3Linked to original sources

PubMed2003

Skin tissue cholesterol (SkinTc) is related to angiographically-defined cardiovascular disease.

UNLABELLED: Parallel changes associated with aging found in the vasculature and skin at necropsy, have prompted small preliminary studies to assess the relation between skin tissue cholesterol (SkinTc) and cardiovascular disease. While these studies have been suggestive, no formal investigation is available to test this association. It would, therefore, be valuable to determine whether a relation between SkinTc and angiographic narrowing actually exists, the latter representing one accepted measurement of coronary atherosclerosis. METHODS: Patients at three hospitals undergoing coronary angiography and not on lipid altering agents (n = 649) were examined for skinTc using a non-invasive method. Vessels were evaluated manually (number with stenosis > or = 50%). Clinical characteristics, current medication use, and Framingham global risk score were recorded. RESULTS: SkinTc was significantly higher in patients with angiographic disease (124 +/- 30 vs. 118 +/- 30, P = 0.02). After adjustment for traditional coronary artery disease risk factors, SkinTc provided 7% additional risk (per 10 SkinTc units) for angiographic disease. CONCLUSION: SkinTc, measured with a non-invasive method, is associated with the presence of coronary artery disease as determined by catheterization. Such an assay may eventually help stratify patient risk and target prevention efforts.

Aged↗

PubMed2003

Statin therapy and the management of acute coronary syndromes.

The pathophysiology of acute coronary syndromes is related to erosion or rupture of vulnerable plaque leading to intracoronary thrombosis as a result of activation of the coagulation cascade and platelet aggregation. Potential benefit of hypolipidemic 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibition may be related to the pleiotropic effects such as endothelial function improvement, stabilization of the plaque in relation to reduced macrophage activity and smooth muscle cell proliferation, as well as other anti-inflammatory effects that have been demonstrated in animal models. With the publication of the Myocardial Ischemia Reduction with Aggressive Cholesterol Lowering (MIRACL) study, early initiation of statin therapy within 24 to 96 h has been recognized as an important addition to the therapeutic armamentarium in the management of patients with acute coronary syndromes.

Acute Disease↗

PubMed2002

Randomized comparison of T-type versus L-type calcium-channel blockade on exercise duration in stable angina: results of the Posicor Reduction of Ischemia During Exercise (PRIDE) trial.

BACKGROUND: Mibefradil is a T-type calcium-channel antagonist and arterial vasodilator with negative chronotropic effects. It is not known if T-type calcium-channel blockade is superior to L-type calcium-channel blockade in patients with stable angina pectoris. METHODS: A multicenter, randomized, double-blind trial was conducted in patients with documented coronary disease and stable angina to compare a 360 mg dose of diltiazem CD with 100 mg dose of mibefradil. The primary end point was change in time to symptom-limited exercise termination from baseline to 8 weeks. Secondary efficacy parameters included time to onset of persistent ST-segment depression, time to awareness of angina, and change in exercise duration from baseline to 2 and 4 weeks of treatment. RESULTS: A total of 121 patients were randomized to mibefradil and 113 to diltiazem CD. At 8 weeks, the increase in exercise duration was 24.5 seconds greater in the mibefradil group (P =.017; 95% CI 4.4-44.7 seconds). At 8 weeks, time to development of > or =1 mm ST-segment depression was greater by 45.3 seconds (P =.0025; 95% CI 16.2-74.5) with mibefradil, but time to development of angina was not significantly different. CONCLUSION: T-type calcium-channel antagonism with mibefradil improved treadmill exercise parameters compared with diltiazem in patients with chronic stable angina. Further investigation and development of antagonists of T-type calcium channels with fewer adverse drug interactions is warranted and may be promising in the management of ischemic heart disease.

Angina Pectoris↗

PubMed2002

Development and prognosis of non-Q-wave myocardial infarction in the thrombolytic era.

BACKGROUND: Data on non-Q myocardial infarctions (MI) are derived primarily from prethrombolytic era studies. Previous trials demonstrated different development rates and none reported on clinical outcomes. METHODS: Our goal was to determine the incidence and prognosis of non-Q-wave MI among patients with ST-segment elevation receiving thrombolysis. A retrospective analysis of 5 randomized controlled trials was made. The main outcome measures included rates of (1) transformation of ST-segment elevation to Q- and non-Q-wave MI and (2) inhospital and 1-year mortality and reinfarction among patients who subsequently develop a Q or non-Q MI postthrombolysis as compared to controls. RESULTS: Non-Q wave development was greater among patients receiving thrombolysis versus placebo/control (3.1% absolute difference, 95% CI 1.2%-5.0%). Among patients receiving thrombolysis, those who developed a non-Q MI experienced significantly lower inhospital and 1-year mortality (absolute differences -3.8% [95% CI -5.2% to -2.4%] and -6.4% [95% CI -9.9% to -3.0%], respectively) and reinfarction (absolute differences -2.9% [95% CI -4.3% to -1.6%] and -3.5% [95% CI -6.1% to -0.9%], respectively) rates, compared with those who evolved a Q MI. Inhospital and 1-year mortality was also significantly lower when compared to placebo/control patients who developed a non-Q MI (absolute differences 4.6% [95% CI -8.2% to -1.1%] and -7.5% [95% CI -12.5% to -2.5%], respectively). CONCLUSIONS: Patients receiving thrombolysis more often develop a non-Q-wave MI and have a better prognosis than either those who develop a Q MI postthrombolysis or a non-Q MI after standard medical therapy.

Electrocardiography↗

PubMed2002

Does chronic Chlamydia pneumoniae infection increase the risk of myocardial injury? Insights from patients with non-ST-elevation acute coronary syndromes.

BACKGROUND: Cumulative evidence suggests a positive association between Chlamydia pneumoniae (Cpn) infection and risk of future coronary events among patients with stable coronary artery disease. However, its prognostic role in unstable coronary syndromes is less well defined. Because Cpn immunoglobulin A (IgA) may be a more reliable indicator of chronic infection than immunoglobulin G (IgG), we speculated that in patients with non-ST-elevation acute coronary syndromes (ACS), this marker might serve as a more useful prognostic tool. Accordingly, we evaluated plasma samples acquired at presentation in 178 patients with ACS for a possible association between Cpn IgA titer and biochemical evidence of myocardial injury. METHODS: Cpn IgG (positive if > or =1:32), and IgA titers (positive if > or =1:16) were measured by use of the microimmunofluorescence technique in 70 patients with ACS in whom myocardial injury developed associated with their presenting events (elevated CK-MB and/or troponin I); and in 108 patients with ACS without such injury. The odds ratios (ORs) for myocardial injury associated with consecutive antibody titers were determined for each of Cpn IgG and IgA. Multiple logistic regression was applied to adjust for key baseline characteristics. RESULTS: Median age of subjects was 64 years; 63% were male and 33% were smokers. The median antibody titers among those with and without myocardial injury respectively were as follows: IgG (1:128 vs 1:128), IgA (1:32 vs <1:16, P =.2). The adjusted ORs for myocardial injury associated with consecutive IgA titers were as follows: IgA > or =1:16, adjusted OR 1.49 (P =.22); > or =1:32, OR 1.95 (P =.04); > or =1:64, OR 1.37 (P =.38); > or =1:128, OR 0.77 (P =.55). No significant trend was found for any IgG titer. CONCLUSIONS: Among patients with non-ST-elevation ACS, a Cpn IgA > or =1:32 at presentation was associated with a significantly higher risk of myocardial injury complicating the presenting event.

Aged↗

PubMed2002

Preventing thrombosis: update of first-line therapy in the management of non-ST segment elevation acute coronary syndromes.

Non-ST segment elevation acute coronary syndrome (NSTE ACS) has a high rate of recurrence. Both antithrombotic and antiplatelet agents in association with coronary revascularization play an important role in the prevention of an adverse outcome. Acetylsalicylic acid, heparin and low molecular weight heparin (especially enoxaparin), and the intravenous small-molecule glycoprotein IIb/IIIa inhibitors, are of proven value. Recently, clopidogrel has been shown to reduce recurrent ischemic events, both early and during the first year after the index ACS. Furthermore, two recent trials have shown that an early invasive strategy is preferable to a conservative approach in the higher risk patient. As yet, no study has shown either the efficacy or the safety of combining all these treatment modalities in the management of the NSTE ACS patient. The initial choice of antithrombotic and antiplatelet agents and a strategy for early revascularization is made after considering the risk of recurrent acute ischemic events. For patients destined to have an early invasive strategy, it is desirable to choose an anti-thrombotic/antiplatelet combination that will reduce events before revascularization, enhance the revascularization procedure and not be associated with excessive bleeding. A risk-determined algorithm is presented, which applies observations made at the time of presentation to decide the optimal management for the individual patient.

Acute Disease↗