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Biomedical subjects

Wilbert S Aronow

Publications and source records attributed to Wilbert S Aronow.

At least 19 recordsLinked to original sources
PubMed2007

Treatment of heart failure with abnormal left ventricular systolic function in the elderly.

This article summarizes the four stages of heart failure (HF) as defined by the American College of Cardiology and the American Heart Association and discusses the treatments for elderly patients with HF and abnormal left ventricular systolic function. The article explains the important role of diuretics, the first-line drugs in the treatment of older patients with HF and volume overload. Other treatments described include angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, beta-blockers, aldosterone antagonists, isosorbide dinitrate plus hydralazine, digoxin, and calcium channel blockers. The article explains the role each of these plays and reports on studies that have examined and compared various treatments.

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PubMed2007

Heart-failure-complicating acute myocardial infarction.

This article addresses issues related to acute myocardial infarction(MI) complicated by heart failure, particularly in elderly patients. Findings have shown that acute MI complicated by congestive heart failure (CHF) is associated with a high mortality, and that women with acute MI are more likely to be older and to develop CHF than men with acute MI. In general, management of CHF-complicating acute MI is similar in older and younger patients. Actions discussed include hemodynamic monitoring; the administration of oxygen; and the use of morphine, diuretics, nitroglycerin,angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, spironolactone, beta-blockers, calcium channel blockers, magnesium, digoxin, and positive inotropic drugs. The article also discusses measures for treating arrhythmias and for diagnosing mechanical complications.

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PubMed2007

Peripheral arterial disease.

Peripheral arterial disease (PAD) in the elderly can be: 1) asymptomatic, 2) associated with intermittent claudication, or 3) cause critical limb ischemia. Persons with PAD are at increased risk for all-cause mortality, cardiovascular mortality, and mortality from coronary artery disease (CAD). Hypertension, diabetes mellitus, dyslipidemia, and hypothyroidism should be treated, and smoking should be stopped. Statins reduce the incidence of intermittent claudication and increase exercise duration until the onset of intermittent claudication in persons with PAD and hypercholesterolemia. Antiplatelet drugs (eg, aspirin, clopidogrel, angiotensin-converting enzyme [ACE] inhibitors, statins) should be given to all persons with PAD. Beta blockers should be given if CAD is present. Exercise rehabilitation programs and cilostazol lengthen exercise time until leg pain develops. Chelation therapy has no scientific basis and should be avoided. Revascularization or amputation may be indicated in some cases.

Aging↗
PubMed2006

Incidence of new stroke or new myocardial infarction or death in patients with severe carotid arterial disease treated with and without statins.

We investigated in 449 patients with severe carotid arterial disease, who did not undergo revascularization, the incidence of new stroke or new myocardial infarction (MI) or death in patients treated with statins (66%) and in patients not treated with lipid-lowering therapy (34%). Hypercholesterolemia was present in all of the 298 patients (100%) treated with statins and in 145 of 151 patients (96%) not treated with statins (p = 0.001). Follow-up was 26 +/- 18 months in patients treated with statins and 21 +/- 17 months in patients not treated with statins (p <0.0001). New stroke or new MI or death occurred in 45 of 298 patients (15%) treated with statins and in 102 of 151 patients (68%) not treated with statins (p <0.0001). Stepwise Cox regression analysis showed that significant independent prognostic factors for time to development of new stroke or new MI or death were use of statins (risk ratio 0.13, p <0.0001), smoking (risk ratio 1.45, p = 0.0329), systemic hypertension (risk ratio 1.81, p = 0.0011), diabetes mellitus (risk ratio 2.87, p <0.0001), previous stroke (risk ratio 3.18, p <0.0001), and previous MI (risk ratio 2.15, p <0.0001). In conclusion, statins decrease the incidence of new stroke or MI or death in patients with severe carotid arterial disease who do not undergo revascularization.

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PubMed2006

Comparison of prevalence of unrecognized myocardial infarction and of silent myocardial ischemia detected by a treadmill exercise sestamibi stress test in patients with versus without diabetes mellitus.

We investigated, in 287 patients with diabetes (71% men; mean age 63 +/- 8 years) and 292 age- and gender-matched patients with diabetes, the prevalence of unrecognized myocardial infarction (MI) and silent myocardial ischemia (SMI) detected by a treadmill exercise sestamibi stress test. In the patients without a history of MI, MI was diagnosed by treadmill exercise sestamibi stress test in 40 of 217 patients (18%) with diabetes and 16 of 224 patients (7%) without diabetes (p <0.001). In patients with a history of angina, SMI was diagnosed in 35 of 98 patients (36%) with diabetes and 30 of 101 patients (30%) without diabetes (p = NS). In patients without a history of angina, SMI was diagnosed in 62 of 189 patients (33%) with diabetes and 35 of 191 patients (15%) without diabetes (p <0.001). In patients with 2 or 3 risk factors, SMI was diagnosed in 58 of 144 patients (40%) with diabetes and 41 of 142 patients (29%) without diabetes (p <0.005). In patients with 0 or 1 risk factor, SMI was diagnosed in 39 of 143 patients (27%) with diabetes and 24 of 150 patients (16%) without diabetes (p <0.02). In conclusion, patients with diabetes have a higher prevalence of unrecognized MI and a higher prevalence of SMI without a history of angina than patients without diabetes.

Angina Pectoris↗
PubMed2006

Differences of lateral and septal mitral annulus velocity by tissue Doppler imaging in the evaluation of left ventricular diastolic function.

Left ventricular diastolic dysfunction (LVDD) was investigated in 276 outpatients at a university cardiology practice by tissue Doppler imaging of mitral valve annular velocity. The well-investigated parameters of mitral inflow were used as the standard. Using septal E/Ea ratios, 62 patients (22%) had no LVDD, 44 patients (16%) had mild LVDD, 126 patients (46%) had moderate LVDD, 25 patients (9%) had severe LVDD, and 19 patients (7%) had indeterminate LVDD. Using lateral E/Ea ratios, 131 patients (48%) had no LVDD, 40 patients (14%) had mild LVDD, 62 patients (22%) had moderate LVDD, 9 patients (3%) had severe LVDD, and 12 patients (13%) had indeterminate LVDD. In conclusion, the use of septal tissue Doppler imaging tends to overestimate the severity of LVDD compared with the use of lateral tissue Doppler imaging.

Blood Flow Velocity↗
PubMed2006

Effects of digoxin on morbidity and mortality in diastolic heart failure: the ancillary digitalis investigation group trial.

BACKGROUND: About half of the 5 million heart failure patients in the United States have diastolic heart failure (clinical heart failure with normal or near-normal ejection fraction). Except for candesartan, no drugs have been tested in randomized clinical trials in these patients. Although digoxin was tested in an appreciable number of diastolic heart failure patients in the Digitalis Investigation Group ancillary trial, detailed findings from this important study have not previously been published. METHODS AND RESULTS: Ambulatory chronic heart failure patients (n = 988) with normal sinus rhythm and ejection fraction > 45% (median, 53%) from the United States and Canada (1991 to 1993) were randomly assigned to digoxin (n = 492) or placebo (n = 496). During follow-up with a mean length of 37 months, 102 patients (21%) in the digoxin group and 119 patients (24%) in the placebo group (hazard ratio [HR], 0.82; 95% confidence interval [CI], 0.63 to 1.07; P = 0.136) experienced the primary combined outcome of heart failure hospitalization or heart failure mortality. Digoxin had no effect on all-cause or cause-specific mortality or on all-cause or cardiovascular hospitalization. Use of digoxin was associated with a trend toward a reduction in hospitalizations resulting from worsening heart failure (HR, 0.79; 95% CI, 0.59 to 1.04; P = 0.094) but also a trend toward an increase in hospitalizations for unstable angina (HR, 1.37; 95% CI, 0.99 to 1.91; P = 0.061). CONCLUSIONS: In ambulatory patients with chronic mild to moderate diastolic heart failure and normal sinus rhythm receiving angiotensin-converting enzyme inhibitor and diuretics, digoxin had no effect on natural history end points such as mortality and all-cause or cardiovascular hospitalizations.

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PubMed2006

In-hospital mortality and time from onset of symptoms of acute myocardial infarction in 540 patients undergoing primary coronary angioplasty. Comparison between blacks, whites and patients of other races, and between men and women.

The time from the onset of symptoms of acute myocardial infarction to primary coronary angioplasty was 18 +/- 23 h in 386 men and 19 +/- 24 h in 154 women (p not significant) and 14 +/- 19 h in 27 blacks, 19 +/- 23 h in 493 whites, and 13 +/- 11 h in 20 patients of different races (p not significant). In-hospital mortality was 6% in 144 patients aged > or =70 years and 1% in 396 patients <70 years (p < 0.005). In-hospital mortality was 2% in 386 men and 4% in 154 women (p not significant). In-hospital mortality was 2% in 493 whites, 4% in 27 blacks, and 0% in 20 patients of other races (p not significant). In-hospital mortality was 6% in 143 patients with a left ventricular ejection fraction (LVEF) <40% and 1% in 397 patients with a LVEF > or =40% (p < 0.005). In-hospital mortality was 5% in 223 patients with a glomerular filtration rate (GFR) <90 ml/min and 1% in 317 patients with a GFR > or =90 ml/min (p < 0.005).

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PubMed2006

Relation of microalbuminuria and coronary artery disease in patients with and without diabetes mellitus.

Microalbuminuria (MA) is a well-known risk factor for coronary artery disease (CAD) in diabetics and nondiabetics. It is associated with higher cardiovascular mortality, especially in diabetics. However, there are few data linking angiographic severity of CAD to microalbuminuria. We examined coronary angiograms for extent of severe CAD (luminal narrowing > or = 50%) in patients with type 2 diabetes mellitus (DM) and MA (DM+MA+, n = 101), patients with DM and without MA (DM+MA-, n = 101), patients without DM and with MA (DM-MA+, n = 64), and patients without DM and MA (DM-MA-, n = 64). We also evaluated fasting glucose levels in all patients and glycosylated hemoglobin in diabetics. Patients' mean age in the DM+MA+, DM+MA-, DM-MA+, and DM-MA- groups was similar. Gender distribution across the 4 groups was also not significantly different. There were no significant differences in the prevalence of hypertension, hypercholesterolemia, and current smoking across the 4 groups. The presence of 2- or 3-vessel CAD showed a linear increase from group DM-MA- to group DM+MA+ (p < 0.001). Diabetics with MA had higher fasting glucose and glycosylated hemoglobin levels than diabetics without MA (p < 0.001). Thus, patients with MA have more severe angiographic CAD than those without MA. This relation is independent of other risk factors and is particularly evident in patients with DM.

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PubMed2006

Comparison of prevalence of atherosclerotic vascular disease in postmenopausal women with osteoporosis or osteopenia versus without osteoporosis or osteopenia.

Atherosclerotic vascular disease (AVD) and osteoporosis or osteopenia are common conditions among postmenopausal women and appear to be linked in a manner that is not fully understood. In a retrospective study that was conducted among 1,000 postmenopausal women who were seen in a general medicine clinic, AVD was more commonly seen among women with osteoporosis (92 of 154, 60%) than among those with osteopenia (63 of 179, 35%, p <0.001) or no osteoporosis or osteopenia (148 of 667, 22%, p <0.001). AVD was also more prevalent in women with osteopenia than in those with no osteoporosis or osteopenia (p <0.001). Modifiable risk factors for AVD were present to the same extent in women with osteoporosis, osteopenia, or no osteoporosis or osteopenia.

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PubMed2006

Association of hemoglobin A(1c) level with the severity of coronary artery disease in patients with diabetes mellitus.

Coronary angiography was performed in 152 men and 163 women with diabetes mellitus (mean age 55 +/- 8 years) because of chest pain. The mean hemoglobin A(1c) level was 6.66 +/- 0.58% in 132 patients with 0-vessel coronary artery disease (CAD), 8.00 +/- 0.84% in 40 patients with 1-vessel CAD, 8.83 +/- 1.45% in 76 patients with 2-vessel CAD, and 10.40 +/- 2.28% in 67 patients with 3- or 4-vessel CAD. There was a significant increasing trend of hemoglobin A(1c) levels over the increasing number of vessels with CAD (p <0.0001).

Angina Pectoris↗
PubMed2006

Atherosclerotic vascular disease may be associated with osteoporosis or osteopenia in postmenopausal women: a preliminary study.

The objective of this study was to determine if there is an association between osteoporosis or osteopenia and atherosclerotic vascular disease (AVD) (two conditions quite prevalent in nursing homes) in a sample of postmenopausal women. We conducted a retrospective chart review on 101 postmenopausal women in a university-affiliated nursing home to investigate if there is an association between osteoporosis or osteopenia and AVD. Bone mineral density (BMD) was measured by DEXA scan obtained from a computerized radiology database. Low BMD was defined as > or =1.5 standard deviations below the mean of a cohort of young women. AVD was diagnosed if documented coronary artery disease, cerebrovascular disease, or peripheral arterial disease was present. The mean age and prevalence of smoking, hypertension, diabetes mellitus, and hypercholesterolemia were not significantly different between 51 women with osteoporosis or osteopenia and 50 women with normal BMD. AVD was present in 31 of 51 women (51%) with osteoporosis or osteopenia and in 19 of 50 women (38%) with a normal BMD (p<0.025).

Absorptiometry, Photon↗
PubMed2006

Higher New York Heart Association classes and increased mortality and hospitalization in patients with heart failure and preserved left ventricular function.

BACKGROUND: The association between higher New York Heart Association (NYHA) class and outcomes in patients with heart failure and preserved systolic function is not well known. METHODS: We performed a retrospective follow-up study of 988 patients with heart failure with ejection fraction > 45% who participated in the DIG trial. Using Cox proportional hazard models, we estimated risks and all-cause mortality, heart failure mortality, all-cause hospitalization, and hospitalization due to worsening heart failure during a median follow-up of 38.5 months. RESULTS: Patients had a median age of 68 years; 41.2% were women and 13.9%, nonwhites. Overall, 23.4% of patients died, and 19.9% were hospitalized because of worsening heart failure. Proportion of patients with NYHA classes I, II, III, and IV were 19.9%, 58.0%, 20.9%, and 1.2%, respectively, and 14.7%, 21.1%, 35.9%, and 58.3%, respectively, died of all causes (P < .001 for trend). Respective rates for heart failure-related hospitalizations were 14.2%, 17.1%, 32.5%, and 33.3% (P < .001 for trend). Compared with NYHA class I patients, adjusted hazard ratios (HRs) for all-cause mortality for class II, III, and IV patients were 1.54 (95% CI 1.02-2.32, P = .042), 2.56 (95% CI 1.64-24.01, P < .001), and 8.46 (95% CI 3.57-20.03, P < .001), respectively. Respective adjusted HRs (95% CI) for hospitalization due to heart failure for class II, III, and IV patients were 1.16 (0.76-1.77) (P = .502), 2.27 (1.45-3.56) (P < .001), and 3.71 (1.25-11.02) (P = 018). New York Heart Association classes II through IV were also associated with higher risk of all-cause hospitalization. CONCLUSION: Higher NYHA classes were associated with poorer outcomes in patients with heart failure and preserved systolic function.

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PubMed2006

Heart disease and aging.

CAD is the most common cause of death in older persons and was present in 43% of 1,160 men and in 41% of 2,464 women, mean age 81 years. Hypertension was present in 60% of these older women and in 57% of these older men. The prevalence of valvular aortic stenosis, aortic regurgitation, mitral regurgitation, and MAC increases with age in older men and in older women. The prevalence and incidence of CHF increase with age. CHF is the most common cause of hospitalization in persons aged 65 years and older. The prevalence of normal LV ejection fraction associated with CHF increases with age and is higher in older women than in older men. The prevalence of chronic atrial fibrillation increases with age and was present in 16% of 1,160 older men and in 13% of 2,464 older women. Atrial fibrillation is an independent predictor of new coronary events and thromboembolic stroke in older persons. Older persons who have unexplained syncope should have 24-hour ambulatory electrocardiograms to determine whether pauses of longer than 3 seconds are present that require permanent pacemaker implantation.

Age Factors↗