Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0151744 (myocardial ischemia)
 31,282 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The Myocardial Ischemia Reduction with Aggressive Cholesterol Lowering (MIRACL) study was the first trial to assess whether statins might be of clinical benefit in those with recently unstable coronary disease. MIRACL found that high-dose atorvastatin was safe and reduced the incidence of the composite endpoint, death, non-fatal myocardial infarction, resuscitated sudden cardiac death or emergent rehospitalization for recurrent ischemia at 16 weeks when compared with placebo. Despite a number of important study limitations, MIRACL's findings and the prior observation that inpatient initiation of lipid-lowering therapy is associated with higher rates of subsequent utilization, suggest that it is prudent to begin statin therapy when patients present with an acute coronary syndrome.
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PMID:The Myocardial Ischemia Reduction with Acute Cholesterol Lowering trial: MIRACuLous or not, it's time to change current practice. 1198 77

Statins may act rapidly to reverse abnormalities of the arterial wall that may predispose to recurrent ischemic events after acute coronary syndromes. Such abnormalities are endothelial dysfunction, a local inflammatory response. and an exaggerated thrombogenic tendency. In one study almost 20,000 patients with first myocardial infarction were studied with regard to statin treatment (28%) or not. Baseline characteristics were adjusted using multivariate regression analysis including propensity analysis. One year mortality was 3.7/5.0% in statin/not statin groups, respectively, P = 0.001, relative risk 0.75. In another study of more than 20,000 patients, 18% were prescribed statin after an acute coronary syndrome and followed for six months. Propensity analysis was performed in this study as well. Deaths in statin/not statin groups were 1.7/3.5%, P<0.0001, relative risk 0.48. In the Myocardial Ischemia Reduction with Aggressive Cholesterol Lowering (MIRACL), a double-blind randomized, placebo-controlled intervention study, 3086 patient with acute non-Q-wave coronary syndromes were allocated immediately in hospital to receive atorvastatin 80 mg daily or placebo for four months. No lower limit for plasma LDL cholesterol was used. Primary endpoint was time to first occurrence of death, non-fatal myocardial infarction, cardiac arrest, and worsening angina with objective evidence of ischemia. This was significantly reduced compared to the placebo group by 2.4% (14.8 versus 17.2%, relative risk 0.84, P= 0.048). Atorvastatin also reduced significantly fatal or non-fatal strokes. Possible mechanisms behind these acute beneficial effects are discussed. The studies highlight the importance of treatment with a statin in the early management of acute coronary syndromes and the need to incorporate this therapeutic strategy in national guidelines and treatment recommendations.
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PMID:Early initiation of treatment with statins in acute coronary syndromes. 1201 32

Cardiologists have traditionally focused on coronary narrowing as seen on angiography and have orientated treatment towards bypassing these lesions or widening them with angioplasty. In patients with stable coronary artery disease, percutaneous coronary interventions reliably relieve angina and myocardial ischemia, but do not prevent myocardial infarction or reduce mortality. Cholesterol lowering therapy has been shown, in several large, randomized trials reported over the past decade, to reduce mortality and coronary events, including the need for revascularization in a broad spectrum of patients. Mechanical and metabolic treatments for coronary disease should be used synergistically.
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PMID:Mechanical or metabolic treatment for coronary disease: synergistic, not antagonistic, approaches. 1204 96

The use of statin agents in patients with acute coronary syndromes (ACSs) remains an area of intense clinical interest. Statin therapy has an established secondary preventive benefit in patients with coronary artery disease, and its extension to ACS seems logical. A number of observational studies have shown an association between initiation of statin therapy early in ACS and improved clinical outcome. Additionally, 4 randomized controlled trials have examined the use of statin therapy for ACS: the Myocardial Ischemia Reduction with Aggressive Cholesterol Lowering (MIRACL) study, the Pravastatin Turkish Trial, the Fluvastatin on Risk Diminishing After Acute Myocardial Infarction (FLORIDA) study, and the Lipid-Coronary Artery Disease (L-CAD) study. Three of these trials showed a benefit with early initiation of statin therapy, whereas 1 trial demonstrated neither benefit nor harm. All the available trials lacked the power and design to sufficiently evaluate whether early initiation of statin therapy reduces mortality and reinfarction in patients with ACS. Four ongoing trials have been designed and sufficiently powered to determine whether statin therapy reduces the risk of death and reinfarction when initiated early in ACS treatment. A body of evidence suggests that the pleiotropic actions of statin agents might modulate benefit in ACS. This article summarizes the available data and provides a rationale for early initiation of statin therapy for patients with ACS.
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PMID:Statin lipid-lowering therapy for acute myocardial infarction and unstable angina: efficacy and mechanism of benefit. 1263 May 93

Cholesterol lowering therapy markedly reduces the frequency of subsequent cardiovascular events and is associated with a modest degree of angiographic regression of atherosclerotic lesions. There is a strong association between lipids and fibrinogen, plasminogen activator-1, and activated factor VII levels. Low density lipoprotein may be thrombogenic whereas high density lipoprotein protects against thrombosis. Lipoprotein (a) may affect atherosclerosis and thrombosis mainly by binding to fibrin and attenuating the fibrin-enhanced plasminogen activation. Tissue factor-complex initiates coagulation by activating factor X and factor IX leading in the presence of calcium to the generation of thrombin. Lipid lowering treatment with statins stabilizes atheromatous plaque and has antithrombotic effects. Therefore there are links between lipids and the haemostatic mechanisms which affect atherosclerotic, vasomotor and thrombotic components of ischemic heart disease.
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PMID:Effects of lipids on thrombotic mechanisms in atherosclerosis. 1241 62

The morbidity and mortality of cardiovascular diseases is high in developed countries including Czech Republic. The lifestyle decreases it in 50%. The aim of this work was to ascertain if the short lasting stay without stress and with vegetarian diet (without eggs) and physical activity is able to decrease the main risk factors of cardiovascular diseases. In 106 volunteers, mean age 49.1 (+/- 14.1) years, 83 women and 23 men, the body weight, blood pressure, serum cholesterol and blood glucose (Accutrend GC, Boehringer, Mannheim, BRD) have been measured before and after the stay at the same conditions. Eighty persons were healthy, seven persons with essential hypertension, eight persons with ischemic heart disease, four persons with diabetes mellitus and seven persons with other than cardiovascular diseases. In some persons the lipid spectrum was measured. Cholesterol decreased in blood serum from 4.9 to 4.3 mmol/l (11%--p < 0.01), blood glucose decreased from 4.2 to 3.3 mmol/l (p < 0.05), blood pressure systolic from 121.5 to 117.4 mm Hg (p < 0.01) and diastolic from 76.5 to 73.8 mm Hg (p < 0.05), body weight was not significantly changed. Our results showed, that 10-days lasting stay containing vegetarian diet and physical activity decreased the risk factors of cardiovascular diseases in 50 years-old volunteers.
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PMID:[Effect of a 10-day animal fat-free diet on cholesterol and glucose serum levels, blood pressure and body weight in 50-year-old volunteers]. 1244 4

The aim of this review of the landmark HMG-CoA reductase inhibitors (statins) studies is to enable the clinician to draw practical lessons from these trials. The Scandinavian Simvastatin Survival Study (4S) established the importance of treating the hypercholesterolemic patient with established cardiovascular heart disease. The West of Scotland Coronary Prevention Study (WOSCOPS) showed the benefit of treating healthy hypercholesterolemic men who were nevertheless at high risk of developing cardiovascular heart disease in the future. The Cholesterol and Recurrent Events (CARE) study, a secondary prevention trial, proved the benefit of treating patients with myocardial ischemia and cholesterol levels within normal limits. This conclusion was confirmed by the Long-term Intervention With Pravastatin in Ischemic Disease (LIPID) study, another secondary prevention study that enrolled patients with a wide range of cholesterol levels (4-7 mmol/dL), into which the large majority of patients would belong. The importance of treating patients with established ischemic heart disease (IHD), and those at high risk of developing cardiovascular heart disease, regardless of cholesterol level, was being realized. The Air Force/Texas Coronary Artery Prevention Study (AFCAPS/TexCAPS) then showed that treatment can reduce adverse cardiovascular events even in the primary prevention of patients with normal cholesterol levels. The Myocardial Ischemia Reduction With Aggressive Cholesterol Lowering (MIRACL) trial showed that hypocholesterolemic therapy is useful in the setting of an acute coronary syndrome, while the Atorvastatin Versus Revascularisation Treatment (AVERT) study showed that aggressive statin therapy is as good as angioplasty in reducing ischemic cardiac events in patients with stable angina pectoris. Finally, the Heart Protection Study (HPS) randomized more than 20,000 patients, and the value of statins in reducing adverse cardiovascular events in the high-risk patient, including the elderly, women, and even in those with low cholesterol levels, is beyond doubt. The emphasis is now on the risk level for developing cardiovascular events, and treatment should target the high-risk group and not be dependent on the actual cholesterol level of the patient. It is interesting to compare the large amount of data on the value and safety of the statins with the much more limited and less convincing data on antioxidant vitamins.
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PMID:Protecting the heart: a practical review of the statin studies. 1281 99

Statin therapy significantly decreases the rate of clinical events in secondary prevention, however their use in patients with the acute phase of acute coronary syndromes remains controversial. Their pleiotropic effects on thrombosis, inflammation, and endothelial dysfunction, might improve vascular healing. Although numerous observational studies have shown a significant reduction in mortality, one trial suggested that the statins may have a potentially harmful effect in patients with low cholesterol. However, randomised controlled trials have not demonstrated harmful effects. Of these trials, the Myocardial Ischemia Reduction with Aggressive Cholesterol Lowering (MIRACL) study is the only trial with adequate statistical power to show a significant reduction in ischemic events at 16 weeks with a high dose of once daily atorvastatin 80 mg.
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PMID:[The place of statins in acute coronary accidents]. 1282 1

The pathophysiology of acute coronary syndromes is related to erosion or rupture of vulnerable plaque leading to intracoronary thrombosis as a result of activation of the coagulation cascade and platelet aggregation. Potential benefit of hypolipidemic 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibition may be related to the pleiotropic effects such as endothelial function improvement, stabilization of the plaque in relation to reduced macrophage activity and smooth muscle cell proliferation, as well as other anti-inflammatory effects that have been demonstrated in animal models. With the publication of the Myocardial Ischemia Reduction with Aggressive Cholesterol Lowering (MIRACL) study, early initiation of statin therapy within 24 to 96 h has been recognized as an important addition to the therapeutic armamentarium in the management of patients with acute coronary syndromes.
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PMID:Statin therapy and the management of acute coronary syndromes. 1287 13

My grandmother used to caution me. "An ounce of prevention is worth a pound of cure." That saying is certainly applicable to coronary heart disease (CHD). CHD remains a major cause of death in the United States today despite modern medical technology. The primary results of CHD, myocardial ischemia and myocardial infarct, when not deadly, often mean a seriously impaired lifestyle. However, since the 1960s, we have known that there were identifiable risk factors related to CHD. One of the major modifiable risk factors is an elevated lipoprotein level (e.g., hyperlipidemia), and today, we have an armament of lipid-lowering medications that are one means of preventing CHD for many individuals. In this article, the major classes of medications with lipid lowering effects are examined. Some of these medications are not new, but with the knowledge that the earlier they are used the more effective they may be, increasing numbers of people are now using nicotinic acid, bile acid-binding resins, fibric acid derivatives, or reductase inhibitors. As a result of the increased focus on lipid-lowering medications, nurses caring for middle-age and older adults are seeing and will continue to see larger numbers of their patients with prescriptions for these drugs. Nurses who are knowledgeable about the many antilipidemics on the market today will be more prepared to answer patient's questions and educate patients about reducing risk of CHD. A brief overview of the physiology of lipid metabolism, the pathophysiology of atherosclerosis, and risk factors for CHD make the rational for using these medications more understandable. Recommendations for early identification of individuals at risk for CHD are identified. In this Part 1 of a two-part series, two of the four major classes of lipid-lowering drugs are examined by looking at the mechanism of action and possible side effects of selected drugs in these classes. In Part 2 (May/June 2004), the other two classes of antilipidemic drugs will be examined and the recommendations of the National Cholesterol Education Program for clinical management of high blood cholesterol will be reviewed.
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PMID:An ounce of prevention. Drugs used to treat hyperlipidemia (Part 1). 1499 54


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