Prevention Of Infarction Research Articles

Complex Atheromatosis of the Aortic Arch: An Emerging Diagnosis in Cerebral Ischemia of Unknown Cause

Complex atheromatosis of the aortic arch has been increasignly recognized as a cause of cerebral infarction in patients with stroke of uncertain etiology. The incorporation of transesophageal echocardiographic studies in routine clinical practice allows direct visualization of cardiac and vascular structures previously innaccessible, including atherosclerotic plaques in the aortic arch. Large atheromatous plaques, which protrude strikingly into the aortic arch lumen and have obvious mobile components are associated with a high probability of being the etiology of embolism. Aortic arch atheromatosis should be considered a dynamic process entailing a non-negligible risk of recurrent cardiovascular events. Therefore, adequate diagnosis and optimal treatment is mandatory for secondary prevention of cerebral ischemic infarction and progression of aortic arch atheromas.

Abstract W P369: International Variability in Stroke Preventive Care

Introduction: Research protocols for stroke prevention trials commonly specify goals for preventive care. We report variability in goal achievement between 3 countries participating in an on-going stroke secondary prevention trial. Methods: The Insulin Resistance Intervention after Stroke (IRIS) trial is testing pioglitazone, compared with placebo, for prevention of stroke and myocardial infarction among non-diabetic patients with a recent ischemic stroke/TIA. Preventive care is provided by personal physicians, although achievement of prevention goals is monitored and reported to participants and their physicians annually. Goals are from the American Heart Association guidelines: blood pressure (BP) <140/90 mmHg, statin therapy, and anti-platelet or anticoagulation depending on clinical indications. At baseline and year 1, we compared the proportions of participants meeting these goals in the largest enrolling countries: Canada (CA), United Kingdom (UK) and United States (US). Results: Participant characteristics were similar across countries, except the proportions of women and blacks were lower in the UK and CA than the US, and self-reported hypertension was more common in US than CA or UK. At baseline, achievement of BP goal was lower in the UK (53%) compared with the US (66%) and CA (75%) (Chi 2 p<0.0001). Statin therapy was used more commonly in the UK (91%) and CA (88%) compared with the US (80%) (Chi 2 p<0.0001). Differences persisted at year 1. At baseline, use of antithrombotic therapy was high (99%) in all countries. However, at year 1, use fell in US (96%) compared to CA and UK (p=0.02). Conclusions: Secondary preventive care for stroke varied among 3 countries for BP, statin therapy and antithrombotic therapies despite the IRIS protocol specifying uniform goals. These findings may be the result of disagreement among practitioners in the 3 countries for secondary prevention goals, variability in care delivery, or variability in research implementation. Understanding and resolving variability may lead to more efficient research and improved care for patients.

Expert Survey on the Prevention and Treatment Situation of Traditional Chinese Medicine for Coronary Artery Disease

Objective: To grasp the current situation of Traditional Chinese Medicine (TCM) on prevention and treatment for coronary artery disease (CAD) and the possible advantages and disadvantages. Method: Using a survey in the form of questionnaire among 60 cardiovascular disease experts, to grasp current situation of TCM on prevention and treatment of CAD and the possible advantages and disadvantages. Results: In most areas of China, CAD is common, and angina is the most common clinical type. More than 91% experts choose to integrate traditional and western medicine for treatment and prevention of CAD. TCM proprietary medicine, traditional herbal decoction and intravenous TCM are widely used in the clinical work. Clinical advantages of TCM in the prevention of CAD that are listed in the questionnaire include improving symptoms, enhancing quality of life, increasing exercise tolerance, improving cardiac function, relieving angina, secondary prevention of myocardial infarction, etc. The shortcomings include troublesome brewing of herbal medicine, unpleasant taste of decoction, minimal clinical evidence, slow onset of effects and non-standardized prescription of medicine, etc. Conclusion: The survey reflects the present situation of clinical diagnosis and treatment of TCM on prevention and treatment of CAD to a certain extent; more accurate conclusions need the broader, deeper and large-scale clinical survey.

Abstract 18304: Clinical Impact of Initial Reduction of Low-density Lipoprotein Cholesterol Level on Long-term Outcome of Acute Myocardial Infarction in the Statin Era

Background: In terms of secondary prevention of acute myocardial infarction (AMI), optimal period for achievement of target percent reduction of LDL-C level has not yet been well established. Methods: The Assessment of Lipophilic vs. Hydrophilic Statin Therapy in AMI (ALPS-AMI) study enrolled a total of 508 patients (mean age, 66.0±11.6 years, 80.6% male) hospitalized for AMI. Of these patients, 248 patients achieved percent reduction of LDL-C ≧ 30% until 8 week after randomization, 204 patients achieved at 4 week (early reduction group), 44 patients achieved at 8week (late reduction group). The two groups were identified prospectively and analyzed with regard to the composite end point (MACE: all-cause death, myocardial infarction, stroke). We evaluated long term clinical outcomes of AMI patients after PCI in terms of the period for achievement of target percent reductions in LDL-C. Results: MACE were significantly higher in the late reduction group compared to early reduction group (20.5% vs. 3.9 %, P<0.0001). The incidence of cardiac death were[[Unable to Display Character:  ]]significantly higher in the late reduction group than early reduction group (6.8% vs. 0.5%, P=0.003). In multivariate Cox proportional hazards analysis, percent reduction level of LDL-C during initial 4 week (HR, 0.93; 95% CI: 0.89-0.96, P<0.0001) and baseline LDL-C level (HR, 0.98; 95% CI: 0.96-0.99, P=0.038) predicted adverse events after adjustment for age. Conclusions: The earlier reduction of LDL-C level is important for the patients with AMI in terms of reduction of ischemic events. We should reduce LDL-C level to target percent reductions for at least moderate-intensity statin therapy as early as 4 weeks after primary PCI in patients with AMI.

Abstract 226: Adherence to Aspirin Therapy for Primary Prevention of Coronary Artery Disease and Cerebrovascular Accidents

Cardiovascular disease is the leading cause of death in the United States. One simple, overlooked, and easily available therapy can reduce this risk: aspirin. Low dose aspirin reduces the risk of first time myocardial infarction (MI) in men and ischemic stroke (CVA) in women. The American Heart Association recommends anti-platelet therapy for those with an ASCVD (atherosclerotic cardiovascular disease) risk score> 7.5%. The aim of our study was to determine adherence to guidelines regarding aspirin therapy for primary prevention of myocardial infarction and stroke in our resident clinic. A retrospective chart review of randomized patients with risk factors for CAD and CVA seen at Ambulatory Center in Newark, NJ, between 5/1/12 and 10/29/13 was conducted. Those with contraindications to aspirin therapy were excluded. Over 400 charts were reviewed; 281 met inclusion criteria. Per chart review, only 30% (84/281) of all at-risk patients were taking aspirin. When assessing various risk factors, 44.9% (35/78) of males ages 45-79; 24% (28/116) of females ages 55-79 (95% Confidence Interval [CI] = +-5.9%); 35.7% (51/143) of those with 10-year ASCVD risk score greater than 7.5% (95% CI = +-7.9%); 36.1% (39/108) of diabetic patients (95% CI 95% = +-9.2%); 32.8% (66/201) of those on anti-hypertensive medication (95% CI = +- 6.5%) and 29.3% (36/123) of those with a smoking history were taking aspirin (95% CI = +-8.2%). Of note, the number of women taking aspirin was statistically low as compared to men across all risk factors except for ASCVD score (p<0.01). This study revealed poor adherence to guidelines with regards to use of aspirin for primary prevention of cardiovascular disease and stroke in our resident clinic. In particular, adherence to aspirin therapy for women was strikingly low. However, our estimate may be somewhat low due to improper documentation of over the counter medications. We are implementing interventions to increase awareness of aspirin use such as educational campaigns for patients, mini-lectures for ambulatory resident cohorts, automated EMR reminders and adding aspirin therapy to health maintenance smart texts to achieve our goal of 100% compliance.

Myocardial infarction and gastro-intestinal bleeding risks associated with aspirin use among elderly individuals with type 2 diabetes

Introduction. The benefit of aspirin in primary prevention of myocardial infarction and the associated gastro-intestinal bleeding risks have not been well established in the elderly population with diabetes.Methods. Using Quebec administrative databases, we conducted two nested case-control analyses within a cohort of individuals aged ≥ 66 years newly treated with an oral antidiabetes drug between 1998 and 2003. The 28,067 individuals had no cardiovascular disease recorded in the database in the year prior cohort entry. They had not used prescribed aspirin, antiplatelet, or anticoagulant drugs, and were not hospitalized for gastro-intestinal bleeding in the year prior cohort entry. The odds of myocardial infarction and gastro-intestinal bleedings were compared between individuals who were current, past, or non-users of aspirin.Results. There were 1101 (3.9%) cases of myocardial infarction. Compared to non-users, neither aspirin users (OR 0.89; 95% CI 0.71–1.13) nor aspirin past users (0.81; 0.62–1.06) showed a statistically significant lower risk of myocardial infarction. There were 373 (1.3%) cases of gastro-intestinal bleeding. Current users of aspirin had about a 2-fold greater risk of gastro-intestinal bleeding compared to non-users (2.19; 1.53–3.13).Conclusions. Our results suggest that individual assessment of bleeding risk and cardiovascular risk is mandatory among elderly people with diabetes before introducing aspirin therapy.

Caractéristiques pharmacologiques et cliniques des inhibiteurs directs du facteur Xa : rivaroxaban, apixaban, edoxaban et betrixaban

Heparins and vitamin K antagonists (VKA) used commonly are the standard treatment of venous and arterial thromboses. They are very efficient and safe, but have some limitations: iatrogenicity, laboratory monitoring, parenteral use for heparins and fondaparinux. Nowadays, four new inhibitors of factor Xa are used orally (rivaroxaban, apixaban, edoxaban, betrixaban), and they are at least as efficient as heparins and vitamin K antagonists. The objective is to substitute these indirect inhibitors of factor Xa (heparins, low molecular weight heparins and fondaparinux) in the prevention of venous and arterial thromboembolic episodes. The new direct inhibitors do not require routine laboratory monitoring of blood coagulation. They inhibit the extrinsic and the intrinsic pathways of blood coagulation. Rivaroxaban and apixaban are efficacious and safe in the prevention of cerebral infarcts in patients with non-valvular fibrillation. Apixaban is another direct inhibitor of factor Xa used orally which is developed in the same indications as rivaroxaban. Edoxaban and betrixaban are also in development. The objective of this work is to study the pharmacodynamic, pharmacokinetic, the efficacy and safety of these four oral direct factor Xa inhibitors.

Practical Challenges of Current Video Rate OCT Elastography: Accounting for Dynamic and Static Tissue Properties.

Optical coherence tomography (OCT) elastography (OCTE) has the potential to be an important diagnostic tool for pathologies including coronary artery disease, osteoarthritis, malignancies, and even dental caries. Many groups have performed OCTE, including our own, using a wide range of approaches. However, we will demonstrate current OCTE approaches are not scalable to real-time, in vivo imaging. As will be discussed, among the most important reasons is current designs focus on the system and not the target. Specifically, tissue dynamic responses are not accounted, with examples being the tissue strain response time, preload variability, and conditioning variability. Tissue dynamic responses, and to a lesser degree static tissue properties, prevent accurate video rate modulus assessments for current embodiments. Accounting for them is the focus of this paper. A top-down approach will be presented to overcome these challenges to real time in vivo tissue characterization. Discussed first is an example clinical scenario where OTCE would be of substantial relevance, the prevention of acute myocardial infarction or heart attacks. Then the principles behind OCTE are examined. Next, constrains on in vivo application of current OCTE are evaluated, focusing on dynamic tissue responses. An example is the tissue strain response, where it takes about 20 msec after a stress is applied to reach plateau. This response delay is not an issue at slow acquisition rates, as most current OCTE approaches are preformed, but it is for video rate OCTE. Since at video rate each frame is only 30 msec, for essentially all current approaches this means the strain for a given stress is changing constantly during the B-scan. Therefore the modulus can’t be accurately assessed. This serious issue is an even greater problem for pulsed techniques as it means the strain/modulus for a given stress (at a location) is unpredictably changing over a B-scan. The paper concludes by introducing a novel video rate approach to overcome these challenges.

5．脳梗塞再発予防―日本人にとって最適な抗血栓療法とは

5．脳梗塞再発予防―日本人にとって最適な抗血栓療法とは

111th Scientific Meeting of the Japanese Society of Internal Medicine: Educational Lecture: 5. Secondary prevention of cerebral infarction--Most useful antithrombotic therapy for Japanese patients

111th Scientific Meeting of the Japanese Society of Internal Medicine: Educational Lecture: 5. Secondary prevention of cerebral infarction--Most useful antithrombotic therapy for Japanese patients

THE APPLICATION OF STATINS IN THE PREVENTION OF PRIMARY AND SECONDARY CEREBRAL INFARCTION AND TRANSIENT ISCHEMIC ATTACKS (literature review)

The application of statins in cardiology aimed at reduction of the risk of cardiovascular problems has noticeably increased over the last years. In this regard, it has been assumed that statins can be effective in the primary and secondary prevention of cerebral infarction and transient ischemic attack. The recent studies have provided contradictory data on the issue, which reduces the assignability of this group of drugs by neurologists. This review covers the characteristic features of statins in angioneurology.

Exercise training and post-operative prognosis after coronary intervention

Aging is worldwide recognized as a dominant risk factor for most forms of cardiovascular disease [1-3]. However, mechanisms by which it exerts its role and determines poor outcome have been only partially clarified. Numerous evidence indicate that aging is associated with alteration of several mechanisms whose integrity confers protective action on the heart and vasculature [5-9]. Autonomic status derangement, diminished efficacy of ischemic preconditioning, impaired angiogenic responses after ischemic injury, increased oxidative stress, and abnormal left ventricular remodelling after myocardial infarction are all putative mechanisms potentially involved in the vulnerability of cardiovascular system occurring with aging. Interestingly, many of the alterations that take place in the aged heart and vasculature are very similar to those observed in pathologic conditions, such as heart failure (HF), and, most importantly, are at least in part revertible. Exercise training plays a pivotal role in primary and secondary prevention of cardiovascular disease, in counteracting the age-related deterioration of some mechanisms that are crucially involved in the homeostasis of cardiovascular system and that may condition the outcome of cardiovascular disease in the elderly. Moreover, it is associated to reduction of the post-operative atrial fibrillation with reduction of the number of prescribed drugs [10]. Preconditioning represent the strongest form of in vivo protection against myocardial ischemic injury, consisting in brief episodes of myocardial ischemia able to reduce cellular damage subsequent to a more prolonged ischemic injury. Remote preconditioning is the phenomenon by which ischemia in one region of the heart causes protection in a remote region of the heart itself or of another organ, thus suggesting that circulating factors or a neural reflex triggers protection in the remote region. Aging is associated with higher rates of morbidity after coronary intervention and a progressive loss in efficacy of ischemic preconditioning with age has been indicated as a potential mechanism explaining the worse prognosis in the elderly. A diminished norepinephrine release in response to transient ischemic stress has been indicated having role in the loss of preconditioning protection occurring with age. Preinfarction angina is considered one of the strongest clinical equivalent of ischemic preconditioning being associated with both reduction in infarct size and prevention of left ventricular dysfunction. Evidences demonstrate the loss of the protective effect of preinfarction angina with age, resulting in a no more protective effect on both early and late mortality in the elderly after acute cardiac events. In adult and elderly humans, high levels of physical activity preserve the protective role of preinfarction angina against in-hospital mortality and cardiogenic shock after myocardial infarction. More recent data indicate that higher levels of physical activity performed before primary coronary angioplasty may independently predict the reduction of early and late cardiac mortality in older infarcted patients [11]. Accordingly, it has been reported a robust association between physical activity habits of elderly participants prior to coronary artery bypass grafting and survival free from both all-cause and cardiac death, [12]. Interestingly, in these studies, the greatest benefits of exercise on survival were observed in the more sedentary patient groups, thus strongly supporting the importance of implementation of physical activity levels in the elderly also as secondary prevention strategy.

Effect of NSAIDs on Na+/H+ exchanger activity in rat colonic crypts

Nonsteroidal anti-inflammatory drugs (NSAIDs; 1) are widely recommended for several acute and chronic conditions. For example, both indomethacin and aspirin are taken for pain relief. Aspirin is also used for prevention of myocardial infarction, and indomethacin can be administered orally or as a suppository for patients with rheumatoid disease and other chronic inflammatory states. However, use of NSAIDs can cause damage to the mucosal barrier surrounding the gastrointestinal (GI) tract, increasing the risk of ulcer formation. While microencapsulation of NSAIDs has been shown to reduce upper GI injury, sustained release in the lower GI tract and colon may cause epithelial erosion due to increased acidification. The use of suppositories has also been linked to rectal and lower GI bleeding. In this study, we investigated the role of NSAIDs aspirin and indomethacin on Na⁺/H⁺ exchanger (NHE) activity in rat colonic crypts. By comparing average rates of pH recovery between control and NSAID perfusion runs, we were able to determine that both aspirin and indomethacin increase hydrogen extrusion into the colonic lumen. Through treatment with 5-ethylisopropyl amiloride (EIPA), amiloride, and zoniporide dihydrochloride, we further demonstrated that indomethacin specifically enhances proton excretion through regulation of apical NHE-3 and NHE-2 and to a lesser extent on basolateral NHE-1 and NHE-4. Our results suggest that clinical exposure to NSAIDs may affect colonic tissue at the site of selected NHE isoforms, resulting in modulation of transport and barrier function.

Posterior Circulation Hyperperfusion Syndrome after Superficial Temporal Artery–Superior Cerebellar Artery Bypass for Vertebral Artery Dissection

A 68-year-old man was diagnosed with infarction of the cerebellum and medulla oblongata caused by vertebral artery dissection manifesting as severe stenosis with poor collateral flow. He underwent superficial temporal artery (STA)-superior cerebellar artery (SCA) bypass for the prevention of fatal brain stem infarction. He had consciousness disturbance 2 days postoperatively. Single-photon emission computed tomography revealed hyperperfusion in the posterior circulation. His consciousness improved as hyperperfusion improved. We report the first case of posterior circulation hyperperfusion syndrome after STA-SCA bypass and provide a review of the relevant literature.

Clinical analysis of effects of statins in adjuvant treatment of 108 patients with cerebral infarction

Objective To explore the effect of statin in treatment of hypertensive atherosclerotic patients with cerebral infarction and the its effect in prevention cerebral infarction recurrence.Methods 108 hypertension patients with atherosclerotic cerebral infarction were randomly divided into two groups,each group had 54 cases.The control group received conventional treatment;the observation group was given combination therapy with statin and the conventional treatment.The efficacy was evaluated after 2 months.The blood pressure,blood lipid and cerebral function,cerebral infarction recurrence within 1 year after treatment in the two groups were observed.The clinical efficacy of the two groups was compared.Results After treatment,blood pressure,blood lipid indexes and brain function of the observation group were better than those of the control group(all P ＜ 0.05).The total effective rate of the observation group was 100％,which was higher than 76％ in the control group(x2 =9.488,P ＜ 0.05).The control group had 12 cases of recurrence(recurrence rate 22％),1 case recurrence in the observation group(recurrence rate 2％),with no significant difference between two groups (x2 =13.277,P ＜ 0.05).Conclusion The clinical efficacy of statins in the treatment and prevention of hypertension atherosclerotic cerebral infarction is safe and significant,which is worth to use in clinical practice. Key words: Statins; Brain infarction; Hypertension

Abstract 150: Resource Utilization Patterns and Outcomes Among Acute Coronary Syndrome Patients: Findings From a Multi-Payer Analysis

Background: Antiplatelet agents are a mainstay for the prevention of subsequent myocardial infarction (MI) or stroke among patients with acute coronary syndrome (ACS). This study analyzed recent pharmacy and medical claims from Medicare, Medicaid, and commercial insurance databases to assess health resource utilization patterns for ACS patients and identify potential gaps in care. Methods: Retrospective data analyses were performed using the Antithrombotic Quality Analyzer (AQuA), a software tool that analyzes health plan data to evaluate quality of care for various cardiovascular conditions. Five databases were analyzed: 1) IMS LifeLink (IMS), 7/2008-6/2010; 2) OptumInsight (Optum), 4/2010-3/2012; 3) MarketScan Commercial (MarketScanComm), 7/2009-6/2011; 4) MarketScan Medicare Supplemental (MarketScanMedicare), 7/2009-6/2011; and 5) Florida Medicaid (Medicaid)- 7/2008-6/2010. Given large sample sizes, a 10% random sample was selected from all databases except Medicaid for which the full sample was used. Included patients were ≥ 18 years old with a primary or secondary diagnosis of ACS during an inpatient and/or emergency room encounter. The first observed ACS diagnosis constituted the index date, with patient outcomes assessed over a maximum of two years. Study measures included guideline-recommended outpatient therapies, ACS complications, and re-hospitalization rates. Results: Total samples (mean age) included 8,791 (64) from IMS, 2,725 (58) from Optum, 8,917 (54) from MarketScanComm, 6,641 (77) from MarketScanMedicare, and 1,978 (57) from Medicaid. Among ACS patients, 41% (IMS), 48% (Optum), 39% (MarketScanComm), 35% (MarketScanMedicare), and 39% (Medicaid) received beta-blockers, while 35% (IMS), 45% (Optum), 36% (MarketScanComm), 30% (MarketScanMedicare), and 31% (Medicaid) received antiplatelets (not including aspirin). A total of 35% (IMS), 43% (Optum), 33% (MarketScanComm), 28% (MarketScanMedicare), and 43% (Medicaid) of ACS patients with diabetes, congestive heart failure, and/or hypertension received an ACE inhibitor. The majority of ACS patients with hyperlipidemia received a cholesterol lowering medication (67% IMS, 77% Optum, 69% MarketScanComm, 51% MarketScanMedicare, 64% Medicaid). Re-hospitalization rates within 30 days were 28% (IMS), 21% (Optum), 22% (MarketScanComm), 29% (MarketScanMedicare), and 25% (Medicaid), with 4%-6% of patients re-hospitalized for MI. Patients experiencing 1-2 re-hospitalizations and ≥ 3 re-hospitalizations during follow-up ranged from 28 - 35% and 8 - 24%, respectively. Conclusion: These findings suggest that many patients with ACS do not receive appropriate recommended antithrombotic prophylaxis, and opportunities exist to improve therapy. Increased use of software tools such as AQuA may support enhanced education efforts aimed at improving adherence to guidelines and quality of care.

Appropriateness of cardiovascular care in elderly adult cancer survivors

Research suggests that the quality of non-cancer-related care among cancer survivors (CS) is suboptimal. Secondary disease prevention is an important component of survivorship care that has not been previously evaluated. Our aims were (1) to assess the utilization of and adherence to medications and treatments for the secondary prevention of myocardial infarction (MI) in CS versus non-cancer patients (NCP) and (2) to compare temporal trends in cardiovascular care between these two patient cohorts. Linking data from Medicare, pharmacy assistance programs, and cancer registries, we calculated the percentage of individuals receiving preventive medications (statins, β-blockers, angiotensin-converting enzyme inhibitors) and revascularization interventions (angioplasty, stent, bypass surgery) within 90 days after acute MI in CS and propensity score-matched NCP. We assessed trends over time and determined predictors of appropriate preventive care using modified Poisson regression. We identified 1,119 CS and 7,886 NCP. Compared to NCP, more survivors received statins (38 vs. 31 %) and β-blockers (67 vs. 59 %), but fewer underwent bypass surgery (1.5 vs. 2.8 %) after MI. From 1997 to 2004, both survivors and NCP were increasingly prescribed medications to prevent future coronary events. Over the same time period, receipt of bypass surgery was significantly lower among survivors. Co-morbidities, such as depression and lung disease, and demographic factors, such as advanced age and female, were associated with underuse of preventive care among survivors when compared to NCP. Use of preventive medications and procedures has generally improved, but uptake of bypass surgery among CS still lags behind NCP.

Plaquettes, athérothrombose, antiplaquettaires et ischémie cérébrale

Platelets play a much more important role in myocardial ischemia than in cerebral ischemia, because atherothrombosis - the underlying cause of the vast majority of myocardial infarcts - is responsible for only 25-30% of cerebral infarcts. Aspirin is the only effective antiplatelet drug for primary prevention of ischemic events, especially those affecting the heart. For secondary prevention of cerebral infarction, clopidogrel and the combination of aspirin with extended-release dipyridamole are both marginally better than aspirin alone, but aspirin remains the gold standard worldwide because of its remarkable cost/benefit/tolerability ratio. The clopidogrel-aspirin combination is to be avoided because of the risk of hemorrhage, particularly in the brain and gastrointestinal tract. Revascularization strategies and the choice of antiplatelet drugs for the acute phase of myocardial and cerebral ischemia are very different, consisting of endovascular treatment and aggressive platelet inhibition for coronary infarcts, versus intravenous thrombolysis and / or aspirin for cerebral infarcts. None of the new antiplatelet drugs used in acute coronary syndromes has so far been studied in acute cerebral ischemia.

Complementary/Alternative Medicine in Cardiovascular Diseases 2013

Cardiovascular diseases (CVDs) are the leading cause of death worldwide, and the mortality is likely to further accelerate in many developing countries. In 2008, almost one in three deaths all over the world was attributed to CVDs. It is also estimated that by 2030 over 23 million deaths from CVDs will occur each year. Despite advances in modern management of CVDs, either revascularization or medical therapy, complications related to these procedures and recurrent acute cardiovascular events still afflict patients. Meanwhile, patients with CVDs often suffer from unfavorable quality of life. In recent decades, the potential benefit of complementary/alternative medicine (CAM) therapy in improving CVDs prognosis has drawn more and more attention, and the use of CAM by physicians and patients has also increased markedly. However, the evidence of CAM for CVDs patients and the research on mechanism of actions are still insufficient. Last year, the published special issue named “The potential benefit of complementary/alternative medicine in cardiovascular diseases” got a great success, which facilitates the compilation of this special issue 2013. We believe that such a series can have a long-term impact, and in time gather a community around it in much the same way a successful annual conference does. In this issue, original research papers and reviews from different parts of the world including China, Republic of Korea, USA, Germany, and Malaysia are presented. These papers are focused on the mechanism of action and the clinical application of CAM in treating CVDs. In the clinical trials, the benefits of Chinese medicine and some other CAM therapies for CVDs patients were demonstrated. A multicenter prospective cohort study showed that heart failure, age ≥65 years old, and myocardial infarction were associated with an increase in one-year follow-up incidence of major adverse cardiac events (MACEs) in hospitalized coronary heart disease patients, and integrative medicine showed a tendency for reducing the incidence of MACEs. The similar benefit of integrative medicine therapy for patients with acute coronary syndrome after PCI was showed in a multicenter randomized controlled trial (RCT), 5C trial. Another RCT compared the effectiveness of Qi-shen-yi-qi dripping pills (QSYQ) with that of aspirin in the secondary prevention of myocardial infarction. This trial did not show significant difference of primary and secondary outcomes between aspirin and QSYQ, which suggest QSYQ might be an alternative medication for patients' intolerance of aspirin in patients who have had an MI. Specifically, a new potential biomarker of “toxin syndrome” in coronary heart disease patients was proposed in a paper containing two clinical trials. The authors concluded that the new biomarker “inter-alpha-trypsin inhibitor heavy chain H4” might have a potential role in early identifying high-risk coronary heart disease patients in stable period. Most of the experiment researches in this issue were focused on Chinese medicine and Korean medicine. Two researches explored the role and mechanism of Qiliqiangxin capsule (QL), an oral Chinese proprietary medicine, for arrhythmia and heart failure, respectively. A pharmacological research showed that blocking androgen receptor could abolish the ability of Panax ginseng to protect the heart from myocardial ischemia reperfusion injury. The benefit of Doinseunggitang, a Korean traditional prescription, on the treatment and prevention of diabetic vascular complications was also described in a study. A systematic review suggested that oral Panax notoginseng preparation could relieve angina pectoris related symptoms. Meanwhile, the potential benefit of Qiju Dihuang Wan, a Chinese herbal prescription, on the treatment of essential hypertension was also reviewed. Additionally, yoga was recommended as an effective intervention for reducing blood pressure in a systematic review. Due to indefinite mechanism of actions and lacking of high quality evidence, traditional Chinese medicine and other traditional medicine worldwide are considered as CAM in Western countries. In this case, original researches on mechanism of actions play an important role in the modernization and internationalization of CAM and should be further strengthened in future researches. In the hierarchy of evidence-based medicine, high quality RCT is still considered as the golden standard for evaluating interventional treatment. Currently, multicenter RCTs and a prospective cohort study have been conducted to evaluate the benefit of CAM for CVDs, and most of these researches showed positive findings. Nevertheless, the effectiveness of CAM on the treatment of CVDs in the real world is still unclear which limits the application of CAM. The reason is that efficacy of intervention in RCT is not equal to its effectiveness in the real world. In the future, in addition to high quality RCTs, more evidence from real world researches is warranted to support the use of CAM including traditional Chinese medicine for CVDs patients. Ke-ji Chen Ka Kit Hui Myeong Soo Lee Hao Xu

The Effect of Face-to-Face Education and Educational Booklet on Heart Health Indexes of the Hospitalized Patients with Myocardial Infarction

Management of risk factors and heart health indexes in the patients who have been diagnosed with myocardial infarction will result in prevention of secondary myocardial infarction, reduction of postimprovement mortality, increase of life span and improvement of life quality. Patient education has been found to be one of the most fundamental and essential care programs on the basis of identification and control of the patients' health criteria. The study is a quasi-experimental research consisting of two groups. In this study, 112 patients with myocardial infarction who were below the age of 70 were selected randomly and divided into two groups (case group and control group) after being matched based on age and sex. The researcher first measured the health indexes including smoking, cholesterol level, body mass, level of anxiety, and amount of systolic and diastolic blood pressure in patients who have been diagnosed with myocardial infarction for the first time. He performed education program in case group and analyzed the said variables after four months. He also compared the behaviors in the two groups after being educated. The data was analyzed by SPSS software, version 15 (This product is licensed to FeFDBi, ABiComputer, 1337), and the two groups were compared by using appropriate statistical tests. According to the results, after education period, systolic blood pressure of the case group improves compared with control group (P < 0.05/P = 0.022), case group tends to quit smoking more than control group does (P = 0.013), cholesterol level of case group improves compared with control group (P < 0.0001), changes of body mass are more positive in case group compared with control group (P = 0.012), and anxiety of case group reduces compared with control group (P < 0.0001).