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Biomedical subjects

Michael J Bloch

Publications and source records attributed to Michael J Bloch.

At least 19 recordsLinked to original sources
PubMed2006

Venous thrombosis and conjugated equine estrogen in women without a uterus.

BACKGROUND: Postmenopausal hormone therapy has been associated with a 2- to 3-fold increased risk of venous thromboembolism (VT) (including deep vein thrombosis and pulmonary embolism) in observational studies and secondary prevention clinical trials. Clinical trial data on the effects of estrogen alone on VT are limited. METHODS: The Women's Health Initiative estrogen trial enrolled 10 739 women aged 50 to 79 years without a uterus. Participants were randomly assigned to receive conjugated equine estrogen (0.625 mg/d) or placebo. RESULTS: During a mean of 7.1 years, VT occurred in 111 women randomly assigned to receive estrogen (3.0 per 1000 person-years) and 86 randomly assigned to receive placebo (2.2 per 1000 person-years; hazard ratio, 1.32; 95% confidence interval, 0.99-1.75). Deep venous thrombosis was reported in 85 women randomly assigned to receive estrogen (2.3 per 1000 person-years) and 59 randomly assigned to receive placebo (1.5 per 1000 person-years; hazard ratio, 1.47; 95% confidence interval, 1.06-2.06). The VT risk was highest in the first 2 years. There were no significant interactions between estrogen use and age, body mass index, or most other VT risk factors. Comparison of Women's Health Initiative VT findings for estrogen and previous Women's Health Initiative findings for estrogen plus progestin showed that the hazard ratios for estrogen plus progestin were significantly higher than those for estrogen alone (P = .03), even after adjusting for VT risk factors. CONCLUSION: An early increased VT risk is associated with use of estrogen, especially within the first 2 years, but this risk increase is less than that for estrogen plus progestin.

Aged↗
PubMed2006

Clinical insights into the diagnosis and management of atherosclerotic renal artery disease.

Atherosclerotic renovascular disease (ARVD) is an increasingly common contributor to hypertension and renal failure. However, not all patients with an identified obstructive atherosclerotic renal artery stenosis will have clinical improvement, even after successful percutaneous intervention. As such, there remains extensive controversy regarding optimal diagnostic and treatment strategies. Part of this controversy is the result of a paucity of well-designed prospective, randomized clinical trials, but the complex nature of the disorder and the heterogeneity of patients presenting with possible ARVD make simple diagnostic and treatment paradigms difficult to develop. This narrative review describes the latest observations concerning the prevalence, pathogenesis, natural history, diagnostic studies, and treatment options for suspected ARVD. Hopefully, this knowledge will improve the ability of clinicians to weigh risks and benefits and determine the best strategy in individual patients.

Angiography↗
PubMed2006

Partners in lowering cholesterol: comparison of a multidisciplinary educational program, monetary incentives, or usual care in the treatment of dyslipidemia identified among employees.

OBJECTIVE: We sought to assess whether either a low-cost educational intervention or small monetary incentive is more effective than usual care in lowering low-density lipoprotein (LDL) cholesterol among employees. METHODS: Employees with an LDL-C >130 mg/dL were eligible. After receiving on-line educational materials, subjects were assigned to three groups: group 1 received dollar 100 if they reduced their LDL-C by 15% within 6 months, group 2 participated in a multi-disciplinary educational program, and group 3 received no further intervention. RESULTS: In total, 171 employees participated. Baseline mean LDL-C was 156 mg/dL. Approximately 6 months after randomization, mean LDL-C was reduced 17.9 mg/dL (11.3%) in group 1, 17.9 mg/dL (11.5%) in group 2, and 5.5 mg/dL (3.5%) in group 3. Reductions in groups 1 and 2 were statistically superior to group 3 (P = 0.02). CONCLUSIONS: Both an employer directed low-cost educational program and small monetary incentives similarly lowered LDL-C compared with usual care.

Cholesterol, LDL↗