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Biomedical subjects

R Gorlin

Publications and source records attributed to R Gorlin.

At least 19 recordsLinked to original sources
PubMed1992

Treatment of chronic stable angina pectoris.

Patients with angina pectoris may be stratified into low- or high-risk categories on the basis of clinical findings and a careful workup, possibly including nuclear imaging of stress-induced abnormal perfusion or contractile patterns and coronary angiography. High-risk patients may require revascularization by angioplasty or bypass surgery, whereas low-risk patients can be managed medically. It is important to consider the impact of various anti-ischemic drugs on the myocardial demand-supply equation. A recent study indicated that the combination of a beta blocker plus isosorbide mononitrate is more effective in increasing exercise duration than is either the combination of a beta blocker and a calcium antagonist or triple therapy. In patients with single-vessel disease, angioplasty has been shown to be more effective than medical therapy in relieving symptoms, but the incidence of restenosis and the associated costs are high. Surgery favorably affects mortality in patients with left main coronary artery disease or 3-vessel disease with left ventricular impairment. New evidence suggests that endothelial dysfunction may play a more important role in chronic stable angina pectoris than has been appreciated and that such dysfunction may be treated with nitrates.

Angina Pectoris↗
PubMed1992

Need for a large randomized trial to evaluate the effects of digitalis on morbidity and mortality in congestive heart failure.

Despite major advances in the prevention and treatment of cardiovascular diseases, the incidence and prevalence of congestive heart failure (CHF) have been increasing in recent years. As the average age of the population increases, the prevalence of CHF is expected to continue to increase. The number of deaths in which CHF was considered the underlying or contributing cause increased from 51,000 in 1955 to 274,000 by 1988 in the United States. Even accounting for population growth and an increase in the number of elderly, this represents a 2-fold increase. Additionally, CHF was responsible for about 643,000 hospitalizations in 1988. Digitalis is one of the drugs most commonly prescribed for CHF and has been used for greater than 200 years. In 1990, digoxin was one of the most commonly prescribed drugs in the United States, accounting for greater than 21 million prescriptions. There has been little decline in the drug's use over the last 5 years, indicating that newer treatments for CHF have not replaced the widespread use of digitalis. Despite these findings, considerable controversy surrounds the appropriateness of its role and value in treating CHF patients who are in sinus rhythm. A number of recent, uncontrolled studies have arrived at apparently contradictory conclusions concerning the effects of digitalis on mortality in postmyocardial infarction and heart failure patients. A large, double-blind, randomized, controlled clinical trial to evaluate the effects of digitalis on mortality, morbidity and quality of life is being sponsored by the National Heart, Lung, and Blood Institute in conjunction with the Department of Veterans Affairs Cooperative Studies Program.(ABSTRACT TRUNCATED AT 250 WORDS)

Digitalis Glycosides↗
PubMed1992

Fish oils in the prevention of atherosclerosis.

The hypothesis that oils derived from the flesh of fish and marine mammals inhibit the atherosclerotic process is critically reviewed. Populations consuming a diet rich in fish have low rates of coronary heart disease. Dietary fish oil is associated with changes in serum lipids, prostaglandin and leukotriene metabolism, enhanced endothelial function and effects on growth factors released from platelets, leukocytes and endothelial cells. Dietary fish oil supplementation has been associated with inhibition of atherosclerosis experimentally induced by dietary hyperlipidemia and balloon injury. Results of studies of the use of fish oil to inhibit postangioplasty restenosis in human subjects have been inconclusive.

Animals↗
PubMed1992

Russek Lecture. Must cardiology lose its heart?

Regulations and restrictions imposed by external agencies are forcing cardiologists into an unnatural self-protective and defensive posture against their patients. The key to breaking the pattern of mutual skepticism and mistrust lies in returning the focus to its rightful place: the patients' needs. Thus, payment systems must be devised that reward cognitive skills, time spent with patients and continuity of care as they reward technologic interventions and procedures. In advocating necessary changes in the system, only physicians themselves can provide a convincing voice in the political arena. They must look beyond their own self-interest to recapture the moral and ethical high ground where the best care of their patients and their own professional satisfaction stand side by side.

Cardiology↗
PubMed1992

Polycystic ovary syndrome: lack of hypertension despite profound insulin resistance.

It has been hypothesized that insulin resistance and hyperinsulinemia contribute to the development of arterial hypertension. To further investigate this relationship, we compared arterial blood pressure in controls and women with polycystic ovary syndrome (PCO), an insulin-resistant state. Fourteen PCO women and 18 normal control women of similar age, body mass index, and race were studied. Plasma glucose and insulin levels were determined in an oral glucose tolerance test. The insulin sensitivity (SI) index was determined by the minimal model method. Systolic and diastolic blood pressure were measured by 24-h ambulatory monitoring. Left ventricular mass was assessed by echocardiography. The two groups had comparable fasting glucose levels, but the 2-h postload glucose was higher in PCO (8.0 +/- 0.5 vs. 5.6 +/- 0.3 mmol/L; P less than 0.001). Compared to controls, PCO women were significantly more insulin resistant by fasting insulin, 2-h insulin concentrations, and SI (28.3 +/- 6.7 vs. 68.3 +/- 10.0 min-1/nmol.mL; P less than 0.01). Average ambulatory systolic (121 +/- 2 vs. 118 +/- 2 mm Hg) and diastolic (76 +/- 2 vs. 73 +/- 2 mm Hg) blood pressures were similar for PCO and control women. No difference was found in left ventricular mass. Therefore, despite profound insulin resistance and hyperinsulinemia, women with PCO do not have increased arterial pressure or left ventricular mass.

Adult↗
PubMed1991

Thrombosis-related markers in unstable angina pectoris.

While thrombus formation has been implicated in the pathogenesis of unstable angina, the value of thrombus-related markers for distinguishing unstable from stable angina is not well defined. Fibrin D-dimer and plasminogen activator inhibitor were prospectively analyzed in the peripheral blood of 46 patients (26 with unstable angina and 20 with stable angina or normal coronary arteries). Baseline blood samples were drawn within 24 h after rest pain in patients with unstable angina and in 19 of these 26 patients in less than 6 h. In patients with unstable angina, mean +/- SD (median) values for fibrin D-dimer and plasminogen activator inhibitor values measured 0.09 +/- 0.06 (0.07) microgram/ml and 9.1 +/- 9.6 (5.9) IU, respectively, compared to 0.11 +/- 0.10 (0.05) microgram/ml and 5.5 +/- 1.9 (5.0) IU/ml, in patients in the control group (p = NS for all comparisons between the two groups). Recurrent in-hospital pain, coronary anatomy and need for intervention showed no relation to the levels of these markers. In 19 additional patients (9 with unstable angina and 10 control patients) samples from the coronary sinus and the peripheral blood were also analyzed. Again, in patients with unstable angina all samples were drawn less than 24 h after rest pain; in six of nine patients samples were drawn in less than 6 h. A coronary sinus to peripheral blood gradient for either of these markers could not be demonstrated. The differences between peripheral and coronary sinus D-dimer and plasminogen activator inhibitor concentrations were also similar in patients with unstable angina and control patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1991

Hypertension and vascular disease in the 1990s.

Many pharmacologic agents are effective in normalizing blood pressure in the hypertensive patient. The major issues in antihypertensive therapy today transcend control of blood pressure and focus, instead, on safety considerations, patient acceptance, and additional benefits to target organs. With the drugs currently available, 10-15% of patients withdraw from therapy because of undesirable clinical side effects. Nonclinical side effects such as hyperlipidemia, hypokalemia, and hyperglycemia can limit the clinician's choice of drugs, especially for elderly patients. Antihypertensive agents should also limit target organ damage. The prevalence of stroke can be reduced solely by controlling blood pressure, but inhibition of cardiac ischemic events requires use of specific classes of agents. Beta blockers reduce mortality and reinfarction postmyocardial infarction, whereas angiotensin-converting enzyme (ACE) inhibitors affect several factors leading to heart failure, including cardiac and vascular hypertrophy, remodeling and dilatation postmyocardial infarction, and arrhythmias. Specific actions on intrarenal and other vascular dynamics may make these drugs appropriate for use in patients with diabetes and perhaps hypertensive kidney disease and systemic arterial disease. The range of options available in antihypertensive therapy in the 1990s affords the physician the opportunity to meet additional goals of therapy, specific for each patient.

Antihypertensive Agents↗
PubMed1991

Digitalis and beta-blocking agents: effects on depression following myocardial infarction.

Depression is frequently seen in patients following myocardial infarction (MI), many of whom are receiving digitalis glycosides, beta-blockers, or other agents that may exert central nervous system (CNS) effects. In a prospective study of the clinical significance of post-MI depression, 335 patients were assessed using a standardized diagnostic interview for depression at 8 to 10 days, and 190 were reinterviewed at 3 to 4 months. Patients prescribed digitalis, beta-blockers, or other cardioactive medications at hospital discharge were identified. Logistic regression analyses were performed to determine the contribution of these agents to depression at 3 to 4 months, controlling for medical and sociodemographic factors as well as for baseline depression. Treatment with digitalis predicted depression at 3 to 4 months (p less than 0.05); no other medications, including beta-blockers, predicted depression (p greater than 0.10). Digitalis may have CNS effects that contribute to depression post-MI and this finding should be considered in the differential diagnosis of depression in cardiac patients.

Adrenergic beta-Antagonists↗
PubMed1991

Do we need another antihypertensive agent?

The factors to be considered in selecting antihypertensive agents have traditionally centered around balancing efficacy against adverse side effects. The former can be achieved by a variety of agents alone or in combination. The latter not only involves safety but is also concerned with whether an otherwise safe agent is tolerated by the patient so compliance with the treatment regimen can be achieved. A relatively new consideration is how antihypertensive agents affect other disease states that may or may not be associated with hypertension. For example, how a drug may affect diabetes, gout, myocardial hypertrophy, atherosclerosis, and coronary events must be evaluated. These concerns taken together answer the question of why yet another antihypertensive agent may be needed in the pharmacologic armamentarium.

Adrenergic beta-Antagonists↗
PubMed1990

Angiographic patterns of balloon inflation during percutaneous transluminal coronary angioplasty: role of pressure-diameter curves in studying distensibility and elasticity of the stenotic lesion and the mechanism of dilation.

There are few in vivo data concerning the mechanisms of balloon inflation during coronary angioplasty. To characterize how lesions dilate, videodensitometry was used to measure the diameter of the inflated balloon across 29 coronary lesions in 27 patients. Pressure-diameter curves for each lesion were derived with use of a standardized incremental inflation protocol in which pressures between 2 and 6 atm in 3 mm low profile balloons approximated normal vessel diameter. The diameter of coronary stenosis before and after angioplasty was also measured. Pressure-diameter curves showed that the most improvement in luminal caliber occurred at low inflation pressure. A distensibility factor was defined as the ratio of the amount of balloon inflation at 2 atm compared with the balloon diameter at 6 atm. Eccentric irregular lesions (n = 11) had a greater distensibility factor (0.49 +/- 0.17) than did lesions (n = 18) without this configuration (0.33 +/- 0.14) (p less than 0.02). The former were soft, presumably because of thrombus in these lesions. In addition, there were no differences in patterns of balloon inflation for lesions requiring additional inflation or for dilations resulting in an intimal crack or dissection after angioplasty. There was often a loss of luminal caliber when balloon diameter at 6 atm was compared with the diameter after angioplasty. This was defined as elasticity or recoil. There was a significant direct correlation between the amount of elasticity and the extent of balloon inflation at 6 atm (that is, lesions more fully dilated at 6 atm showed more elasticity).(ABSTRACT TRUNCATED AT 250 WORDS)

Angiography↗