Reduction of ST-elevation myocardial infarction in Canton Ticino (Switzerland) after smoking bans in enclosed public places—No Smoke Pub Study

Background: Second-hand smoke increases the risk of acute myocardial infarction. Canton Ticino (CT) first introduced a smoking ban in public places in 2007. This offered the opportunity to assess the long-term impact of a smoking ban on the incidence of ST-elevation myocardial infarctions (STEMI) compared with a population where the law was not yet implemented. Methods: We assessed the incidence of STEMI hospitalizations per 100 000 inhabitants both during 3 years before and after the ban application in CT and in Canton Basel City (CBC), where this law was not yet applied. Data were obtained from the codified hospital registry (ICD-10 codes). Results: In CT, the mean incidence of STEMI admissions during the 3 pre-ban years (123.7) was significantly higher than the incidence of admissions in each of the 3 post-ban years (92.9, 101.6 and 89.6 respectively; P <.024). Analysing population subsets, a post-ban reduction was observed among ≥65-year-old people of both sexes in each of the 3 post-ban years and in the <65-year age group during the first post-ban year (P = 0.02). Conversely, the mean incidence of STEMI hospitalizations in CBC (92.4) didn't change significantly in each of the 3 post-ban years (83.9, 83.3 and 79.5, P = NS) during the same period. However, a significant long-term reduction in STEMI admissions was observed in CBC among the male group with ≥65 years (P < 0.01). Conclusion: Our work suggests a significant impact of the smoke-free policy on the number of annual STEMI. Specific population subsets (i.e. ≥65-year-old females) were particularly affected by the smoking ban, showing a significant reduction in STEMI hospitalization

Intractable coronary fibromuscular dysplasia leading to end‐stage heart failure and fatal heart transplantation

Coronary fibromuscular dysplasia is uncommon, and even rarer its unstable and recurrent course. We present the unique case of a 52-year-old woman who underwent in total 12 coronary angiographies and three percutaneous coronary intervention within 24 months because of repetitive acute coronary syndromes due to refractory spasm, dissection, restenosis all leading to end-stage heart failure, and heart transplantation. The patient died 12 days after the heart transplantation complicated by intraoperative acute thrombotic occlusion of left anterior descending artery of the graft despite normal pretransplant coronary angiography. Autopsy of the recipient heart confirmed coronary fibromuscular dysplasia with massive intimal hyperplasia and restenosis

An open-label, noncomparative phase II trial to evaluate the efficacy and safety of docetaxel in combination with gefitinib in patients with hormone-refractory metastatic prostate cancer

BACKGROUND: Prostate cancer is the most common type of cancer in men, however, therapeutic options are limited. 50-90% of hormone-refractory prostate cancer cells show an overexpression of epidermal growth factor receptor (EGFR), which may contribute to uncontrolled proliferation and resistance to chemotherapy. In vitro, gefitinib, an orally administered tyrosine kinase inhibitor, has shown a significant increase in antitumor activity when combined with chemotherapy. PATIENTS AND METHODS: In this phase II study, the safety and efficacy of gefitinib in combination with docetaxel, a chemotherapeutic agent commonly used for prostate cancer, was investigated in patients with hormone-refractory prostate cancer (HRPC). 37 patients with HRPC were treated continuously with gefitinib 250 mg once daily and docetaxel 35 mg/m2 i.v. for up to 6 cycles. PSA response, defined as a =50% decrease in serum PSA compared with trial entry, was the primary efficacy parameter. PSA levels were measured at prescribed intervals. RESULTS: The response rate and duration of response were consistent with those seen with docetaxel monotherapy. The combination of docetaxel and gefitinib was reasonably well tolerated in this study. CONCLUSION: Future studies should investigate whether patients with specific tumor characteristics, e.g. EGFR protein overexpression, respond better to gefitinib than patients without, leading to a more customized therapy option

Reduction of ST-elevation myocardial infarction in Canton Ticino (Switzerland) after smoking bans in enclosed public places-: No Smoke Pub Study

BACKGROUND Second-hand smoke increases the risk of acute myocardial infarction. Canton Ticino (CT) first introduced a smoking ban in public places in 2007. This offered the opportunity to assess the long-term impact of a smoking ban on the incidence of ST-elevation myocardial infarctions (STEMI) compared with a population where the law was not yet implemented. METHODS We assessed the incidence of STEMI hospitalizations per 100 000 inhabitants both during 3 years before and after the ban application in CT and in Canton Basel City (CBC), where this law was not yet applied. Data were obtained from the codified hospital registry (ICD-10 codes). RESULTS In CT, the mean incidence of STEMI admissions during the 3 pre-ban years (123.7) was significantly higher than the incidence of admissions in each of the 3 post-ban years (92.9, 101.6 and 89.6 respectively; P <.024). Analysing population subsets, a post-ban reduction was observed among ≥65-year-old people of both sexes in each of the 3 post-ban years and in the <65-year age group during the first post-ban year (P = 0.02). Conversely, the mean incidence of STEMI hospitalizations in CBC (92.4) didn't change significantly in each of the 3 post-ban years (83.9, 83.3 and 79.5, P = NS) during the same period. However, a significant long-term reduction in STEMI admissions was observed in CBC among the male group with ≥65 years (P < 0.01). CONCLUSION Our work suggests a significant impact of the smoke-free policy on the number of annual STEMI. Specific population subsets (i.e. ≥65-year-old females) were particularly affected by the smoking ban, showing a significant reduction in STEMI hospitalizations

Document de consensus sur la prise en charge du cholestérol LDL

L’hypothèse établissant un lien causal entre le cholestérol à lipoprotéines de basse densité (c-LDL pour low density lipoprotein en anglais) et les événements cliniques liés à l’athérosclérose, tels l’infarctus aigu du myocarde, l’accident cérébral vasculaire (AVC) ou l’artériopathie des membres inférieurs a abouti à l’un des concepts le mieux documenté scientifiquement et des plus abouti en médecine. Les recommandations émises en 2019 par l’ESC/EAS pour la prise en charge des dyslipidémies se basent sur les dernières avancées en recherche ainsi que l’accès à de nouveaux traitements médicamenteux. Elles résument l’état actuel des évidences scientifiques et émettent de nouvelles recommandations. Les taux plasmatiques de c-LDL sont particulièrement élevés chez l’homme adulte, contrairement à la plupart des espèces animalesL’athérosclérose est typiquement une maladie humaine, et elle est très fréquenteLes taux de c-LDL sont principalement liés à la qualité et quantité de l’alimentation, ainsi que la sédentarité et la tabagismeLes taux de c-LDL sont parfois déterminés génétiquement et augmentent avec l’âgeLe taux de c-LDL est directement associé au développement des plaques d’athéroscléroseLes plaques athérosclérose sont responsables de la majorité des infarctus du myocarde et des AVC, et ainsi d’une grande partie des décès cardiovasculairesLes mutations génétiques associées à des taux sanguins de c-LDL abaissé protègent contre la survenue d'infarctus du myocarde et de la mort subite, alors que celles associées à des taux élevés de c-LDL peuvent provoquer les pathologies liées à l’athérosclérose déjà mentionnéesDifférentes thérapies médicamenteuses permettent de réduire les taux plasmatiques de c-LDLLes principaux médicaments hypolipémiants sont les statines, l’ézétimibe et les inhibiteurs de la protéine PCSK9Ces traitements hypolipémiants réduisent considérablement le risque d’infarctus du myocarde, d’AVC et de morts subitesPlus le taux de c-LDL est bas, plus le risque de crise cardiaque, d'AVC et risque de mort subite est faible (le plus bas, le mieux «the lower, the better»)Le risque cardiovasculaire de développer un infarctus du myocarde, un AVC ou une mort subit détermine l'utilisation de traitements hypolipémiant ainsi que leurs posologie.Les patients qui ont présenté un événement clinique lié à des lésions d’athérosclérose, ou chez qui des lésions d’athérosclérose ont été mises en évidence (principalement par l’imagerie) sont à risque très élevé de récurrence d'événements cardiaquesPour les patients à haut et à très haut risque, la valeur cible du c-LDL doit être &lt;1,8 ou &lt;1,4 mmol/L, ainsi qu’un abaissement de 50% des valeurs mesurées sans traitement