Secondary Prevention Of Vascular Events Research Articles

The role of screening blood tests in patients with arterial disease attending vascular outpatients

To evaluate the benefits of a policy of performing screening blood tests in new patients with arterial disease referred to the vascular outpatients department. Clinical audit over a 12-month period of all new referrals with arterial disease to the vascular outpatients department at the Leicester General Hospital. Two hundred and seventy-two patients had at least one blood test performed at their outpatient visit. All of these patients had a full blood count performed, of which 21 results (21%) were abnormal. Further investigation of patients with abnormal results revealed one case of bladder cancer, one case of leukaemia and one patient with polycythaemia. Urea and electrolytes were measured in 269 patients (99%). Of these, 26 (10%) were expectedly abnormal in patients with known renal impairment. A further 27 patients (10%) were identified to have some degree of unrecognised renal impairment. Serum non-fasting glucose was measured in 252 patients (93%). There were 11 unexpectedly raised results, but further investigation of these patients only diagnosed one of these patients as diabetic. Serum cholesterol was measured in 201 patients (74%). One hundred and thirty-two patients (66%) had an abnormally raised serum cholesterol level. Of these, only 12 patients (6%) were known to have hyperlipidaemia. Screening new patients with arterial disease in vascular outpatients does identify significant abnormalities, in particular renal impairment and hyperlipidaemia. Correction of these abnormalities may reduce the morbidity associated with contrast induced nephrotoxic acute renal failure, and also contribute to secondary prevention of vascular events associated with raised lipids.

Antiplatelet therapy in coronary artery disease: review and update of efficacy studies.

The mechanisms of action of currently available and newer antiplatelet agents and evidence of the efficacy of antiplatelet agents for primary and secondary prevention of coronary artery disease are reviewed. Available data do not support the widespread use of aspirin for primary prevention of cardiovascular disease. Patients over the age of 50 years with at least one additional risk factor for coronary artery disease may benefit, although possibly at an increased risk of hemorrhagic stroke. Aspirin is recommended for secondary prevention of vascular disease in patients with stable or unstable angina, clinical or laboratory evidence of coronary artery disease, history of myocardial infarction, or history of stroke or transient ischemic attack. There are no data supporting a role for dipyridamole for primary or secondary prevention of ischemic heart disease. Abciximab has been shown to reduce the risk of cardiovascular complications at 30 days after percutaneous transluminal coronary angioplasty in patients with refractory unstable angina. Studies with other glycoprotein IIb/IIIa-receptor antagonists, including eptifibatide, tirofiban, and lamifiban, have yielded promising results. Ticlopidine may be used for secondary prevention of cardiovascular disease in patients with unstable angina who are allergic to or intolerant of aspirin. Clopidogrel has been shown to be safe and effective for secondary prevention of vascular events. Aspirin has a role in secondary prevention of coronary artery disease; among patients who are allergic to or intolerant of aspirin, ticlopidine has a role in patients with unstable angina and clopidogrel has a potential role in patients with ischemic heart or vascular disease.

A Randomized, ASA-Controlled Trial of Mesoglycan in Secondary Prevention after Cerebral Ischemic Events

The aim of this randomized, open, parallel-group study was to compare the efficacy and tolerability of mesoglycan, a glycosaminoglycan preparation, and acetylsalicylic acid (ASA) in prevention of vascular events after cerebral ischemic events. In 48 collaborating centers we followed a total of 1,398 patients with recent episodes of reversible ischemic attacks or stroke of atherothrombotic origin, randomized to mesoglycan (701 patients) or ASA (697 patients). During the observation period patients'' new events were recorded: primary outcome events were considered reversible ischemic neurologic deficits, stroke, acute myocardial infarction or death from other vascular causes. At the end of the follow-up period (median duration 18 months) the number of primary outcome events observed in the two treatment groups was similar (68 in the ASA, 70 in the mesoglycan group). Major stroke was observed in 24 patients of the ASA group and in 26 of the mesoglycan group, while deaths from vascular causes were 37 and 32, respectively. Log-rank statistics failed to evidence significant differences between treatment groups. On the other hand, a significantly (p < 0.01, chi square test) higher incidence of side effects was reported in the ASA group (146 vs. 50). The findings of the present investigation are promising and suggest that further studies on mesoglycan as an antithrombotic agent in the secondary prevention of vascular events are warranted.

Long-term survival after first-ever stroke: the Oxfordshire Community Stroke Project.

There have been relatively few community-based studies of long-term prognosis after acute stroke. This study aimed to provide precise estimates of the absolute and relative risks of dying in an unselected cohort of patients with a first-ever stroke. Six hundred seventy-five patients were registered by a community-based stroke register (the Oxfordshire Community Stroke Project) and prospectively followed up for up to 6.5 years. Their relative risk of death was calculated using age- and sex-specific mortality rates for Oxfordshire. During the first 30 days, 129 (19%) patients died. Patients who survived at least 30 days after a first-ever stroke thereafter had an average annual risk of death of 9.1%, 2.3-fold the risk in people from the general population. Although the absolute (about 15%) and relative (about threefold) risks of death were highest in these 30-day survivors over the first year after the stroke, they were at increased risk of dying over the next few years (range of relative risk for individual years, 1.1-2.9). Predictably, older patients had a worse absolute survival but, relative to the general population, stroke also increased the relative risk of dying in younger patients. During the first 30 days stroke accounts for most deaths; after this time nonstroke cardiovascular disease becomes increasingly important and is the most common cause of death after the first year. These data highlight the importance of long-term secondary prevention of vascular events in stroke patients, targeted as much at the cardiovascular as at the cerebrovascular circulation.

Secondary prevention of vascular events by combination therapy with aspirin and dilazep in patients with cerebral infarction

Secondary prevention of vascular events by combination therapy with aspirin and dilazep in patients with cerebral infarction