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Daniel G Hackam

Publications and source records attributed to Daniel G Hackam.

29 records · Page 2Linked to original sources
PubMed2003

Emerging risk factors for atherosclerotic vascular disease: a critical review of the evidence.

CONTEXT: Atherosclerotic vascular disease is an enormous public health problem. A number of emerging risk factors for atherosclerosis have recently been proposed to help identify high-risk individuals. OBJECTIVE: To review the epidemiological, basic science, and clinical trial evidence concerning 4 emerging risk factors: C-reactive protein, lipoprotein(a), fibrinogen, and homocysteine. DATA SOURCES: Using the terms atherosclerosis, cardiovascular disease, risk factors, prevention, screening, C-reactive protein, lipoprotein(a), fibrinogen, and homocysteine, we searched the MEDLINE database from January 1990 to January 2003. Conference proceedings, abstract booklets, bibliographies of pertinent articles and books, and personal files were hand searched to identify additional articles. STUDY SELECTION: Original investigations and reviews of the epidemiology of atherosclerosis and the association of conventional and novel risk factors with vascular risk were selected. On the basis of the search strategy, 373 relevant studies were identified. DATA EXTRACTION: A diverse array of studies were examined, including randomized controlled trials, prospective cohort studies, systematic overviews, case-control, cross-sectional, and mechanistic studies. Data extraction was performed by one of the authors. DATA SYNTHESIS: The available epidemiological and basic science evidence supports, to varying degrees, independent associations between these 4 candidate risk factors and atherosclerotic vascular disease. However, there is relatively little data regarding the additive yield of screening for these factors over that of validated global risk assessment strategies currently in use. Furthermore, controlled intervention studies targeting individuals with these factors for proven risk-reduction therapies, or specifically treating these factors with available therapies, are few. The explanatory power of the major, established cardiovascular risk factors has been systematically underestimated. CONCLUSIONS: Although C-reactive protein, lipoprotein(a), fibrinogen, and homocysteine are associated with vascular disease risk, their optimal use in routine screening and risk stratification remains to be determined.

Arteriosclerosis↗
PubMed2003

Oral anticoagulant therapy in patients with coronary artery disease.

Oral anticoagulation (OA) has been used to treat patients with coronary artery disease (CAD) for more than 40 years and has been a subject of intense controversy since that time. Seven to 10% of patients with acute myocardial infarction (MI) develop recurrent MI, stroke, or death in the 6 weeks following the index event and approximately 20% after 4 years, despite optimal background therapy with aspirin. Recent large studies and systematic reviews have greatly clarified the role of OA in the modern era. On the weight of the evidence, which is reviewed in detail in this article, long-term, moderate-intensity OA (International Normalized Ratio 2.0 to 3.0) should be considered an option for the prevention of recurrent CAD, particularly in high-risk patients.

Administration, Oral↗
PubMed2002

Carotid plaque area: a tool for targeting and evaluating vascular preventive therapy.

BACKGROUND AND PURPOSE: Carotid plaque area measured by ultrasound (cross-sectional area of longitudinal views of all plaques seen) was studied as a way of identifying patients at increased risk of stroke, myocardial infarction, and vascular death. METHODS: Patients from an atherosclerosis prevention clinic were followed up annually for up to 5 years (mean, 2.5+/-1.3 years) with baseline and follow-up measurements recorded. Plaque area progression (or regression) was defined as an increase (or decrease) of >/=0.05 cm(2) from baseline. RESULTS: Carotid plaque areas from 1686 patients were categorized into 4 quartile ranges: 0.00 to 0.11 cm(2) (n=422), 0.12 to 0.45 cm(2) (n=424), 0.46 to 1.18 cm(2) (n=421), and 1.19 to 6.73 cm(2) (n=419). The combined 5-year risk of stroke, myocardial infarction, and vascular death increased by quartile of plaque area: 5.6%, 10.7%, 13.9%, and 19.5%, respectively (P<0.001) after adjustment for all baseline patient characteristics. A total of 1085 patients had >/=1 annual carotid plaque area measurements: 685 (63.1%) had carotid plaque progression, 306 (28.2%) had plaque regression, and 176 (16.2%) had no change in carotid plaque area over the period of follow-up. The 5-year adjusted risk of combined outcome was 9.4%, 7.6%, and 15.7% for patients with carotid plaque area regression, no change, and progression, respectively (P=0.003). CONCLUSIONS: Carotid plaque area and progression of plaque identified high-risk patients. Plaque measurement may be useful for targeting preventive therapy and evaluating new treatments and response to therapy and may improve cost-effectiveness of secondary preventive treatment.

Adult↗