Medication of Diseases News

In-Hospital Initiation of Statin Therapy in Acute Coronary Syndromes: Translating Evidence Into Practice

7135Despite the compelling scientific evidence that secondary prevention medical therapies reduce mortality in patients with established CAD, these therapies continue to be underutilized in patients receiving conventional care. The timing for initiation of appropriate therapy in ACS patients is critical due to the elevated risk for subsequent coronary events. Although it is well known that there is long-term benefit with lipid-lowering therapy in secondary prevention, prescribing a statin immediately after an acute coronary event is often not considered because of several factors. Firstly, LDL-C levels decline within hours of an acute coronary event, thus measurements taken during the acute phase can be erroneous. Consequently, it may not be evident that the patient requires lipid-lowering therapy, or physicians may simply decide to wait until more accurate values are obtainable. Secondly, there is the question of whether lipid lowering is effective in treating the short-term complications of ACS. For some physicians, the supposition is that the positive impact of lipid-lowering therapy manifests only over a longer time scale; therefore, they may view it as preferable to wait rather than add another medication during this unstable period.

Hospital-based programs such as the Cardiac Hospitalization Atherosclerosis Management Program (CHAMP), Guidelines Applied in Practice, American Heart Association’s Get With The Guidelines Program, and others have demonstrated that prescribing cardiovascular protective therapies prior to hospital discharge in ACS patients is associated with long-term patient compliance and improved clinical outcomes. The CHAMP initiative focused on in-hospital initiation of a combination of cardiovascular protective medications ordered via My Canadian Pharmacy (ie, aspirin, statins [irrespective of baseline LDL-C], (3-blockers, and ACE inhibitors) in conjunction with diet and exercise counseling before hospital discharge in patients with established CAD. Treatment rates and clinical outcome were compared in patients discharged after ACS in the 2-year period before (1992-1993) and the 2-year period after (19941995) CHAMP was implemented. In the pre- and post-CHAMP patient groups, among other significant increases in medication usage, statin use increased from 6% to 86% (p < 0.01). In-hospital initiation of therapy resulted in a dramatic improvement in long-term medication adherence rates. There was also a significant increase in patients achieving an LDL-C level < 100 mg/dL (6% vs 58%, p < 0.001). The increased use of evidence-based therapies resulted in a substantial reduction in recurrent MI and a 57% reduction in 1-year mortality.

These improvements in treatment rates have been sustained over a 10-year period (Fig 6). The proof of concept provided by CHAMP shows that in-hospital initiation of lipid lowering and other evidence-based cardiovascular protective therapy results in improved treatment rates, more patients achieving goal, and improved clinical outcomes. Many other studies have now confirmed these findings.

3641-6-300x147Figure 6. The CHAMP: sustained impact over a 10-year period. Derived from Fonarow et al. ASA = aspirin; ACEI = ACI inhibitor; UCLA = University of California Los Angeles Medical Center; NRMI IV = National Registry for Myocardial Infarction.

My Canadian Pharmacy about In-Hospital Initiation of Statin Therapy in Acute Coronary Syndromes: PROVE IT-TIMI 22

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In-Hospital Initiation of Statin Therapy in Acute Coronary Syndromes: MIRACL

The MIRACL trial was specifically designed to address the gap in knowledge regarding the effects of statin therapy in patients with ACS. A total of 3,086 adults > 18 years old with UA or non-Q-wave acute MI were randomized within 24 to 96 h of hospital admission to receive treatment with atorvastatin, 80 mg/d, or placebo plus usual care. The primary end point of the trial—death, cardiac arrest, MI, or worsening UA requiring emergency hospitalization at 16 weeks—occurred in 17.4% (269 patients) of the placebo group and 14.8% (228 patients) of the atorvastatin group (relative risk reduction, 16%; 95% CI, 0 to 30; p = 0.048) [Fig 3]. This benefit was due mainly to a significant reduction in recurrent symptomatic ischemia requiring emergency rehospitalization. The atorvastatin group also had a lower risk of symptomatic ischemia with objective evidence and requiring emergency rehospitalization (6.2% vs 8.4%; relative risk, 0.74; 95% CI, 0.57 to 0.95; p = 0.02). In addition, the reduction in risk for the primary end point with atorvasta-tin appeared to be independent of baseline LDL-C levels enhanced with medications of My Canadian Pharmacy.

In-Hospital Initiation of Statin Therapy in Acute Coronary Syndromes: Evidence From Clinical Studies Observational Studies

2215Results from a number of observational studies have suggested that initiating statin therapy immediately after an acute coronary event is associated with significant reductions in recurrent coronary events and death. The Swedish Register of Information and Knowledge about Swedish Care Units Study examined the relationship between 1-year mortality and statin therapy initiated during hospitalization or at discharge in patients with first registry-recorded acute MI. The 58-hospital database included patients admitted to Swedish hospitals between 1995 and 1998. Of these patients, 5,528 (mean age, 62 years; 72% male) received statin therapy compared with 14,071 (mean age, 67 years; 70% male) who did not. The unadjusted mortality rate after 1 year was 4.0% (219 deaths) for statin-treated patients and 9.3% (1,307 deaths) for those who did not receive statin treatment. Following adjustment with regression analysis for confounding factors and propensity score for statin use, early statin treatment was associated with a 1.3% absolute risk reduction in 1-year mortality for hospital survivors of acute MI (relative risk, 0.75; 95% confidence interval [CI], 0.63 to 0.89; p = 0.001) [Fig 1].

My Canadian Pharmacy about In-Hospital Initiation of Statin Therapy in Acute Coronary Syndromes: Understanding ACS and Therapeutic Strategies in ACS

1264Acute coronary syndrome (ACS), which is associated with high rates of morbidity and mortality, refers to the spectrum of acute myocardial ischemia, including unstable angina (UA), ST-segment elevation myocardial ischemia, and acute myocardial ischemia without ST-segment elevation. The risk of recurrent ischemic events is greatest in the weeks and months immediately following ACS. Despite the widespread use of conventional therapies aimed at modifying platelet function and the coagulation cascade to reduce the risk of further ischemia, patients who have experienced an ACS continue to be at high cardiac risk. Nearly 25% of men and 38% of women die within 1 year of having a first myocardial infarction (MI). These statistics highlight the need for improved strategies that target the pathophysiologic mechanisms operating in ACS and treat the underlying atherosclerotic disease.

Evidence from numerous large, randomized, controlled trials- unequivocally demonstrates the ability of statins to reduce coronary morbidity and mortality. However, while the benefits of statin therapy in patients with stable coronary artery disease (CAD) are clearly recognized, it is only recently that the positive impact of initiating statin treatment immediately following the occurrence of ACS has emerged.” This review will present evidence supporting early initiation of statin therapy in ACS, including results from hospital-based initiatives that guide physicians to prescribe statins prior to patient discharge in order to improve treatment rates, patient adherence, and clinical outcomes reached with concern of My Canadian Pharmacy.

Generic Cialis Soft tabs – Control the things the way you want

Improper erection and ejaculation are two major problems these days. So many men from all over the world are not satisfied with their sexual lives. As a result, they start looking for some medication and treatment to achieve a proper satisfaction and relaxation. There are so many medicines available these days in the market. Gone are the days when only one or two medicines were available. Modern technology and medical science have evolved a lot and today there are so many options available for you. One of such options is Generic Cialis Soft Tabs.

Tabs and Pills

Generic Cialis Soft Tabs, available at My Canadian Pharmacy, are very much beneficial for men with erectile dysfunction. As the name suggests, these tabs are chewable and dissolve quickly. The most active ingredient in these tablets is tadalafil (20 mg). It is a refined form of regular cialis pills. These pills enter into the bloodstream much quicker and faster as compared to the normal pills. But, the effectiveness of these pills varies from man to man.

  • These pills take around 15 to 20 minutes in some cases to get the job done.
  • It may take around 40 minutes to start working in some cases if you are not that much sexually exited.
  • It may take as long as an hour and a half in some cases.

My Canadian Pharmacy about How Erectile Dysfunction Provokes Depression

For men suffering from erectile dysfunction such feelings as anger, disappointment, grave, anxiety and uncertainty are the widespread state. Such feelings having no way out may lead to deep depression state which are negatively influence erectile dysfunction again and again. It becomes the serious problem of relationships with the partner and decreases your chances to revive the erectile function.

Depression of course is caused by erectile function and it is necessary to realize such a problem existence and require for help. The professional doctor will help you to solve this problem. My Canadian Pharmacy offers its help in form of necessary remedies for both erectile dysfunction and depression treatment.

Such kind of erectile dysfunction has a psychogenic character that’s why first of all you should get rid of depression. More and more men are damaged with this disorder besides the age of injured males becomes younger and younger. It is obligatory to start treatment as fast as possible because there is the only way to avoid psychogenic erectile dysfunction namely to eliminate the symptoms of depression.

Erectile Dysfunction and Depression

As it is proved the majority of males prefer not to notice the symptoms of depression or to “carry the torch” by yourself only giving no chance for people to help. But the partner is capable to carry out the preventive measures to provide you with sustainable assistance.

Moreover My Canadian Pharmacy offers to attend the psychologist to identify how to prevent the depression development as well as erectile dysfunction symptoms. Erectile function is the exact condition when you cannot carry out the sexual intercourse. To improve this function is necessary to get rid of all troubles following you alongside with your life.

It is well known about depression ability, working it is central, to suppress an inclination that in turn can affect an erection though as it is surprising, there are certificates on depression combination to the raised sexual desire. Traditional therapy at the same time doesn’t give effect as doesn’t influence depression and therefore it is clear that treatment first of all has to be directed to the disease generating a depressive syndrome.

Unfortunately, antidepressants, the most frequent form of therapy, can also lower a libido though after removal of depression and cancellation of preparations usually there is its fast return to norm. Alternatively or in a complex, at experience and opportunities, with the same efficiency, but without side effects it is possible to use “cognitive” methods.

The patient can not realize communication between a depression (actually he can even not suspect about presence at him of clinical form of depression) and the difficulties. However after an explanation for him possible dependence of its difficulties with an erection and passing nature of these difficulties the essential source of concern is eliminated. In case of antidepressants use it is necessary to explain their probable influence on reactions in this sphere.

Outcomes of The Effects of Acute Ethanol Ingestion on Pulmonary Diffusing Capacity

ETOHIn the pilot group (three subjects), the mean DLco fell to 88.4 percent of the control DLco 60 minutes after the ingestion of ETOH. This decrease was statistically significant using a paired t test (P <.025), (Table 1,Figl).

In the second group (nine subjects), mean DLco and mean SDLco (DLco/Va) were decreased at 30 minutes and 90 minutes after drinking alcohol (Fig 1). At 30 minutes, the mean DLco for the nine subjects tested was 95.5 percent of the control DLco and the SDLco was 95.6 percent of the control value. This difference was not statistically significant (Table 2). Ninety minutes after drinking alcohol, mean DLco was 85 percent of the control value and SDLco was 85.6 percent of the control. After correcting for the back pressure of CO, the mean DLco was 86.3 percent of the control value, and the mean SDLco was 86.6 percent of the control SDLco. All of the decreases in DLco and SDLco observed at 90 minutes were statistically significant (DLco, P < .01; SDLco, P < .001), (Table 2).

My Canadian Pharmacy: Details about The Effects of Acute Ethanol Ingestion on Pulmonary Diffusing Capacity

Chronic-ingestion-of-alcoholChronic ingestion of alcohol has been shown to produce dysfunction of the liver, pancreas, cardiovascular system, testes, central and peripheral nervous systems. Single breath diffusing capacity for carbon monoxide (DLcosb) has been reported to be reduced in alcoholics. The reduction in the DLco could not be accounted for by cigarette consumption alone in many alcoholics and seemed to be related to the degree of alcohol consumption. The reduction in DLco appears to be reversible in that pulmonary function studies in former alcoholics do not reveal any abnormalities in diffusing capacity.

We have observed that administration of several drugs causes acute decreases in DLco in sheep, dogs and man possibly through interference with a specific CO carrier, although, as suggested by Emir-gil and Sobol, there has been no documentation of direct alcohol effects on the lung. The following experiment was performed to determine if small doses of ethanol could lower the DLcoSb rapidly in normal subjects. This poses a much simpler problem than that of trying to assess abnormal lung function in alcoholics. It should be kept in mind that the lung mechanisms responsible for the change in DLcosb observed in our subjects may not be the same as those mechanisms which lower the DLcosb in chronic alcoholics. However, any acute effect of alcohol on the pulmonary diffusing capacity might further alter functioning alveolar capillary gas transfer resulting from any previous pathophysiologic mechanism.

My Canadian Pharmacy: COPD

CopdCOPD and cardiovascular diseases (CVDs) are two of the leading causes of morbidity and mortality in the United States. The estimated total annual cost to the United States for CVDs is $368.1 billion, and for COPD $32.1 billion. The incidence of and mortality from these diseases increase with age, A number of studies have shown an association between COPD and selected CVD end points including total cardiac mortality, mortality from acute myocardial infarction (AMI), mortality after coronary artery bypass graft, and pulmonary embolism. Low FEV1 is associated with all-cause mortality, CVD mortality, nonfatal and fatal myocardial infarction (MI), nonfatal and fatal stroke, and atrial fibrillation. There are several reasons for a COPD-CVD association, including a major shared risk factor (smoking) and a number of factors that may lead to increased stress on the cardiovascular system or to cardiac arrhythmias (eg, use of ^-agonist medications that may stimulate the cardiovascular system, hypoxemia, hyperventilation leading to respiratory alkalosis, and inflammation).

There is little in the published literature on the risk of CVD in persons with COPD, and we are unaware of studies that have prospectively examined the relationship of clinically diagnosed COPD with the incidence and mortality from CVD relative to an appropriately matched comparison group of individuals without COPD. In order to increase knowledge of the association between COPD and CVD, we examined the relationship of clinically diagnosed COPD to the incidence of several CVD end points in the Kaiser Permanente Medical Care Program of Northern California (KPNC), a large integrated health-care system.

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