February 26th 2024
At 3 months following ischemic stroke, lower mean oxygen saturation but not apnea-hypopnea index was associated with functional deficits, according to a French research team.
Examining the Link Between Obesity and Mental Illness
February 7th 2009When medical professionals think of the health consequences of obesity, we usually think of increased prevalence of coronary artery disease, stroke, some cancers, diabetes, and hypertension. If we think a bit more, osteoarthritis, gallstones, asthma, and sleep disorders come to mind.1 How many of us are aware of the connection between obesity and the increased risk of various mental illnesses and conditions?
High School Athlete With Family History of Sudden Cardiac Death
February 2nd 2009I have a healthy 16-year-old patient who needs a preparticipation physical examination. The family history is significant for the father’s sudden death from a thoracic aortic aneurysm at 42 years of age. How far should I pursue the workup?
Coronary Artery Disease Costs $156.4 Billion Annually
December 1st 2008Coronary artery disease (CAD), the most common form of cardiovascular disease in the United States, is the most costly type of cardiovascular condition to manage, according to the American Heart Association. Of the estimated $448.5 billion in total costs for cardiovascular diseases and stroke in 2008, CAD accounted for $156.4 billion, more than twice the cost of hypertension ($69.4 billion) and stroke ($65.5 billion) (Figure 1). Direct costs associated with CAD were $87.6 billion in 2008, of which prescription drug costs alone were $9.7 billion (Figure 2). Of the $68.8 billion in indirect costs for CAD in 2008, $58.6 billion were associated with lost productivity caused by increased mortality.
Ischemic Stroke: Update on Prevention Part 2, The Role of Statins and Antiplatelet Agents
July 2nd 2008Selecting the most effective stroke prevention strategy for patients with cerebrovascular disease is an acknowledged challenge. In addition to decisions about the appropriateness of carotid surgery or angioplasty and stenting, there is the often tricky matter of designing the most effective medical regimen.
Screening for Vascular Disease in a Former Smoker
May 2nd 2008As part of his preparation for retirement, a 66-year-old executive undergoes a complete physical examination. He is in good health and has no symptoms to report. Along with other age-appropriate screening studies, you discuss testing for vascular disease with him.
Stroke Prevention: Update on Antiplatelet Therapy
March 2nd 2008Each year about 700,000 Americans sustain a stroke, and about 29% of those patients who are aged 65 years or older die within 1 year. Worldwide, stroke is the third leading cause of death and the leading cause of severe disability in adults.
Systolic Hypertension: A Guide to Optimal Therapy
March 2nd 2008Systolic hypertension is an independent risk factor for coronary artery disease, stroke, and end-stage renal disease. Nonpharmacological interventions for systolic hypertension include limitation of dietary sodium and alcohol intake along with weight reduction and aerobic exercise.
Early Antidepressant Treatment Is Effective for Post-Stroke Depression
March 1st 2008Major depression is twice as likely to develop in post-stroke patients (approximately 20%) than in nonstroke patients of the same age.1 Other psychiatric symptoms that are also more common in post-stroke patients include minor depression, anxiety, anger, and inappropriate or excessive laughing or crying (emotional incontinence).2
A Middle-Aged Woman With MI, Stroke, and DVT
February 1st 2008A 57-year-old woman presents for follow-up several months after a series of thrombotic episodes. Four days after she underwent ankle fusion to relieve pain and edema associated with a leg fracture that had occurred 40 years earlier, she sustained a massive myocardial infarction (MI).
Mortality Rates for Heart Disease, Stroke Decline
February 1st 2008Mortality data released by the CDC in January show that between 1999 and 2005, the age-adjusted death rate for coronary heart disease decreased by 25.8%, from 195 to 144 deaths per 100,000 persons per year. The new data also indicate that since 1999, the death rate for stroke has decreased by 24.4%, from 61 to 47 deaths per 100,000 persons per year. The reduction in mortality rates in 2005 resulted in approximately 160,000 fewer deaths from coronary heart disease and stroke, 2 of the 3 leading causes of death in the United States.
The Future of Inhaled Insulin Therapy
February 1st 2008Diabetes is a destructive disease that kills thousands eachyear in the United States and disables thousands more, and its incidence hasbeen rising dramatically. Glycemic control is imperative to forestallcomplications; however, it can be difficult for patients to achieve glycemicgoals.
Defining Preventive Care Under CDHPs
February 1st 2008Consumer-directed health plans (CDHPs) are attracting new interest as a result of a ruling by the Internal Revenue Service (IRS) over what constitutes preventive services. CDHP benefit designs take various forms, but in general, these are low-premium, high-deductible plans that provide full or close to full coverage for enrollees once the deductible is met and are typically tied to a health savings account (HSA).
Ruptured Abdominal Aortic Aneurysm
February 1st 2008An obese 61-year-old man with a history of heroin abuse was brought to the hospital after he had fallen onto his buttocks on a sidewalk. He was able to stand initially, but weakness and numb-ness in his legs rendered him suddenly unable to walk or prevent himself from voiding. He denied abdominal or back pain. His medical history included asthma, chronic obstructive pulmonary disease, and hypertension.
Using Passive Measures to Improve Patient Medication Adherence
January 1st 2008Adherence is a complex behavioral process strongly influenced by environmental factors. Six posters designed to improve medication adherence were displayed in a medical clinic, with each poster displayed for 1 month. These posters were seen by clinic patients but, as passive measures, required no additional time on the part of clinicians. Medication adherence to antidepressant therapy was assessed for two 18-month periods. Days of therapy and median gap (the number of days a patient goes without medication before filling the next prescription) were similar between the periods. Medication possession ratio (MPR) was increased in the intervention period (0.974 vs 0.994 days). During the 6-month period that the adherence posters were displayed, persistence decreased by only 10% (versus 22% for the nonintervention period). Use of passive measures may improve patient medication adherence. In this prospective study, both the MPR and persistence were improved. (Drug Benefit Trends. 2008:20:17-24)
Hospitalist Care Offers Modest Advantages
January 1st 2008Although the hospitalist model is rapidly altering inpatient care-an estimated 29% of American hospitals have hospitalists on staff and more than 12,000 hospitalists practice in the United States-little information about the clinical and economic outcomes of care by hospitalists is available.
Echocardiographic Spectrum of Interatrial Septal Aneurysms
October 1st 2007Interatrial septal aneurysm (IASA) and patent foramen ovale (PFO)-either alone or coexisting-are a frequent cause of cryptogenic cerebral and/or peripheral thromboemboli. The IASA plus PFO combination has been shown to confer higher risk, particularly in adults aged 45 years or younger. Therefore, recognition and documentation of these 2 abnormalities during an echocardiographic (transthoracic or transesophageal) study, when performed for other indications, is essential.
EASD: Retrospective Review Suggests Cardioprotective Benefit with Pioglitazone (Actos)
September 19th 2007AMSTERDAM -- Treatment regimens for type 2 diabetes that include pioglitazone (Actos) were associated with lower risk of stroke and myocardial infarction, claimed investigators for the drug's maker.
Anticoagulation: Should It Remain Standard Therapy After Cardioembolic Stroke?
September 15th 2007Ischemic infarcts of the brain are usually caused by vascular disease, but 1 in 5 results from emboli that arise in the heart. The largest contributor to cardioembolic stroke is non-valvular atrial fibrillation, which is associated with a 5-fold increased risk of cerebral infarction.
Marginal Benefit for Investigational Venous Thromboembolism Drug
September 12th 2007AMSTERDAM -- Mixed results from trials investigating the clinical efficacy of idraparinux, an investigational long-acting factor X inhibitor, suggest the drug is not as effective as standard therapy for treatment of pulmonary embolism.