N Hook | PubMed Health

PubMed1995

Outcome monitoring of fluvastatin in a Department of Veterans Affairs lipid clinic.

The aggressive lipid-lowering goals recommended by the second Adult Treatment Panel (ATP II) have created an increasing demand for treatment with 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors. Fluvastatin is the first completely synthetic agent in this class and offers a considerable price advantage over the other HMG-CoA therapies. In May 1994, the Buffalo Veterans Affairs Medical Center Lipid Clinic adopted a fluvastatin-preferred program in which all patients who were recommended for an HMG-CoA reductase inhibitor would be treated with fluvastatin as a first-line agent. Fluvastatin was started at 20 mg daily and titrated to goal. Patients who were stable with other HMG-CoA reductase inhibitors were converted to fluvastatin as just described. Preliminary analysis shows that, for new patients, 20 mg of fluvastatin daily at bedtime reduced low density lipoprotein cholesterol (LDL-C) by an average of 22% (range, 5-32%). Preliminary results for patients converted from another HMG-CoA reductase inhibitor showed that fluvastatin produced an additional LDL-C reduction of 18% (range, 5-30%). With a daily dose of 20 mg fluvastatin, patients with no heart disease (primary prevention) achieved ATP II goals in 60% of cases. For patients with established heart disease (secondary prevention), the goals of ATP II are lower but, despite this, 30% of patients taking fluvastatin at 20 mg daily achieved these goals. The patients in both groups who failed to achieve ATP II goals were titrated to a 40 mg daily dose, but the results of this titration are not yet available. Pharmacoeconomic outcomes were favorable.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1984

Effect of left ventricular aneurysmectomy on exercise performance.

We performed pre- and post-operative exercise testing on 12 patients with coronary artery bypass surgery and ventricular aneurysmectomy and 2 patients with ventricular aneurysmectomy alone. Most patients showed better exercise performance, higher double product, better work capacity and were able to exercise longer. Two patients who had ventricular aneurysmectomy alone showed similar changes. Most patients showed improved New York Heart Association functional classification and exercise performance after surgery.

Adult↗

PubMed1977

Assessment of cardiac risk in surgical patients.

Fifty patients admitted to the hospital for elective noncardiac surgery were carefully assessed for cardiac risk by exercise stress testing. Twenty-five of 38 (66%) patients with adequate testing had abnormal stress test results. Patients with symptoms of angina had a high incidence of abnormal stress test results (15 of 20). In the majority of these patients, the exercise stress test was true-positive, so that on angiography, severe coronary artery disease was present. In patients with no cardiac symptoms, 33% (ten of 30) had abnormal stress test results and seven patients had significant coronary artery disease. Our preliminary data indicate that exercise stress testing is a good noninvasive screening test to detect asymptomatic coronary artery disease. Those patients who have an abnormal stress test or an abnormal ECG or angina should undergo coronary angiography to determine extent of coronary disease.

Aged↗