What are effective medication combinations for dyslipidemia?

Many combination drug therapies are effective in treating dyslipidemia. Compared with statin monotherapy, combinations that include ezetimibe (Zetia), a bile acid sequestrant, or niacin further lower low- density lipoprotein (LDL) cholesterol (strength of recommendation [SOR]: A), and increase the likelihood of attaining National Cholesterol Education Program (NCEP) LDL cholesterol goals (SOR: B). Adding ezetimibe to a bile acid sequestrant reduces LDL cholesterol (SOR: B). Fibrate or niacin added to statin monotherapy provide mixed lipid-modifying effects for combined dyslipidemia (SOR: A)

What is the best regimen for newly diagnosed hypertension?

Low-dose thiazide diuretics (eg, hydrochlorothiazide 12.5 to 25 mg/d) are the best first-line pharmacotherapy for treating uncomplicated hypertension(strength of recommendation [SOR]: A, based on randomized trials [RCTs] and 1 meta-analysis). Alternate first-line agents include angiotensinconverting enzyme (ACE) inhibitors, beta blockers, and calcium channel blockers (SOR: A, based on RCTs)

Evaluation of fracture risk and potential drug holidays for postmenopausal women on long-term bisphosphonate therapy

This is the publisher's version, also available electronically from http://www.dovepress.com/evaluation-of-fracture-risk-and-potential-drug-holidays-for-postmenopa-peer-reviewed-article-IJWHStudy objective: To describe characteristics of postmenopausal women on long-term bisphosphonate therapy who fall into one of four fracture risk categories (low, mild, moderate, high), and to determine the prevalence of women eligible for a drug holiday. Design: Retrospective electronic health record review. Setting: Eight primary care clinics within a university-based health care system. Patients: A total of 201 postmenopausal women of ages 55–89 years, with osteopenia or osteoporosis, prescribed bisphosphonate therapy for >4 years, between October 10, 2002 and September 9, 2012. Main results: The patients' mean age was 71.4 (±8.2) years; their mean body mass index was 25.3 (±5.6) kg/m2; and 73.1% were white. Seventy-four out of 201 patients (36.8%) were low-risk; 10/201 (5.0%) were mild-risk; 72/201 (35.8%) were moderate-risk; and 45/201 (22.4%) were high-risk. Eighty-one women (40.3%) were eligible for a drug holiday or discontinuation. The estimated drug cost avoided per eligible patient was $574.80. Calcium and/or vitamin D supplementation was documented in 52.7% of women. Conclusion: More than one-third of postmenopausal women taking long-term bisphosphonate therapy had low fracture risk, and over 40% of our patients were eligble for a drug holiday or discontinuation. These data emphasize the need to accurately assess risk and benefit in patients treated with bisphosphonate therapy

Transatlantic lipid guideline divergence: same data but different interpretations

Despite consensus that excessive circulating concentrations of apoB-lipoproteins is a key driver for the atherosclerotic process and that treatments that low-density lipoprotein cholesterol lowering by up-regulation of low-density lipoprotein cholesterol receptor expression reduces that risk, divergent viewpoints on interpretation of study data have resulted in substantial differences in European and American lipid guideline recommendations. This article explores those differences and highlights the importance of understanding guideline-based lipid management to improve patient care and reduce the risk of clinical atherosclerotic cardiovascular disease

Methane-derived authigenic carbonates from the northern Gulf of Mexico and their relation to gas hydrates

Author Posting. © The Author(s), 2007. This is the author's version of the work. It is posted here by permission of Elsevier B.V. for personal use, not for redistribution. The definitive version was published in Journal of Geochemical Exploration 95 (2007): 1-15, doi:10.1016/j.gexplo.2007.05.011.Authigenic carbonates were sampled in piston cores collected from both the Tunica Mound and the Mississippi Canyon area on the continental slope of the northern Gulf of Mexico during a Marion Dufresne cruise in July 2002. The carbonates are present as hardgrounds, porous crusts, concretions or nodules and shell fragments with or without carbonate cements. Carbonates occurred at gas venting sites which are likely to overlie gas hydrates bearing sediments. Electron microprobe, X-ray diffraction (XRD) and thinsection investigations show that these carbonates are high-Mg calcite (6 - 21 mol % MgCO3), with significant presence of framboidal pyrite. All carbonates are depleted in 13C (δ13C = -61.9 to -31.5 ‰ PDB) indicating that the carbon is derived mainly from anaerobic methane oxidation (AMO). Age estimates based on 14C dating of shell fragments and on regional sedimentation rates indicate that these authigenic carbonates formed within the last 1,000 yr in the Mississippi Canyon and within 5,500 yr at the Tunica Mound. The oxygen isotopic composition of carbonates ranges from +3.4 to +5.9 ‰ PDB. Oxygen isotopic compositions and Mg2+ contents of carbonates, and present in-situ temperatures of bottom seawater/sediments, show that some of these carbonates, especially from a core associated with underlying massive gas hydrates precipitated in or near equilibrium with bottom-water. On the other hand, those carbonates more enriched in 18O are interpreted to have precipitated from 18O-rich fluids which are thought to have been derived from the dissociation of gas hydrates. The dissociation of gas hydrates in the northern Gulf of Mexico within the last 5,500 yr may be caused by nearby salt movement and related brines.Financial support for this work was provided by the Grant-in-Aid from the Ministry of Education and Science and the Research Grant from JAPEX

Neighborhood socioeconomic status, Medicaid coverage and medical management of myocardial infarction: Atherosclerosis risk in communities (ARIC) community surveillance

<p>Abstract</p> <p>Background</p> <p>Pharmacologic treatments are efficacious in reducing post-myocardial infarction (MI) morbidity and mortality. The potential influence of socioeconomic factors on the receipt of pharmacologic therapy has not been systematically examined, even though healthcare utilization likely influences morbidity and mortality post-MI. This study aims to investigate the association between socioeconomic factors and receipt of evidence-based treatments post-MI in a community surveillance setting.</p> <p>Methods</p> <p>We evaluated the association of census tract-level neighborhood household income (nINC) and Medicaid coverage with pharmacologic treatments (aspirin, beta [β]-blockers and angiotensin converting enzyme [ACE] inhibitors; optimal therapy, defined as receipt of two or more treatments) received during hospitalization or at discharge among 9,608 MI events in the ARIC community surveillance study (1993-2002). Prevalence ratios (PR, 95% CI), adjusted for the clustering of hospitalized MI events within census tracts and within patients, were estimated using Poisson regression.</p> <p>Results</p> <p>Seventy-eight percent of patients received optimal therapy. Low nINC was associated with a lower likelihood of receiving β-blockers (0.93, 0.87-0.98) and a higher likelihood of receiving ACE inhibitors (1.13, 1.04-1.22), compared to high nINC. Patients with Medicaid coverage were less likely to receive aspirin (0.92, 0.87-0.98), compared to patients without Medicaid coverage. These findings were independent of other key covariates.</p> <p>Conclusions</p> <p>nINC and Medicaid coverage may be two of several socioeconomic factors influencing the complexities of medical care practice patterns.</p