18 results on '"Fleg, Jerome L."'
Search Results
2. Long-term prognostic significance of ambulatory electrocardiographic findings in apparently healthy subjects greater than or equal to 60 years of age
- Author
-
Fleg, Jerome L. and Kennedy, Harold L.
- Subjects
Ambulatory electrocardiography ,Supraventricular tachycardia -- Prognosis ,Health - Abstract
To determine the long-term prognostic significance of frequent or complex ectopic beats and ST-segment changes on 24-hour ambulatory electrocardiogram (ECG) in apparently healthy older subjects, 98 volunteers were followed up from the Baltimore Longitudinal Study of Aging who were 60 to 85 years old and free of cardiac disease by history, physical examination and maximal treadmill testing at the time of ambulatory ECG between 1978 and 1980. Over a mean follow-up period of 10 years, coronary events developed in 14 subjects: angina pectoris in 7, nonfatal myocardial infarction in 3 and sudden cardiac death in 4. The incidence of coronary events did not differ significantly between subjects who developed the following arrhythmias and those who did not, respectively: [is greater than or equal to] 30 supraventricular ectopic beats in any hour, 18 vs 13%; [is greater than or equal to] 100 supraventricular ectopic beats in 24 hours, 20 vs 12%; paroxysmal atrial tachycardia, 15 vs 14%; [is greater than or equal to] 30 ventricular ectopic complexes (VECs) in any hour, 17 vs 14%; [is greater than or to] 100 VECs in 24 hours, 18 vs 14%; or repetitive VECs, 20 vs 13%. The mean 24-hour heart rate (75 [+ or -] 8 vs 72 [+ or -] 9 beats/min) as well as the maximal (116 [+ or -] 20 vs 111 [+ or -] 18 beats/min) and minimal (51 [+ or -] 6 vs 53 [+ or -] 7 beats/min) heart rate also did not differ between the coronary event and non-event groups. Although flat or downsloping ST-segment depression [is greater than or equal to] 1.0 mm was seen in only 5 subjects, coronary events occurred in 2 of these 5 (40%) vs only 12 (13%) of 93 subjects without such ST-segment changes. When 11 additional persons with lesser degrees of ST-segment depression were included, events occurred in 6 of 16 (38%) compared with 8 of 82 (10%) subjects without any ST-segment changes, p
- Published
- 1992
3. Age-associated changes in left ventricular diastolic performance during isometric exercise in normal subjects
- Author
-
Swinne, Christian J., Shapiro, Edward P., Lima, Sandra D., and Fleg, Jerome L.
- Subjects
Age factors in disease -- Physiological aspects ,Heart ventricle, Left -- Physiological aspects ,Isometric exercise -- Physiological aspects ,Diastole (Cardiac cycle) -- Physiological aspects ,Health - Published
- 1992
4. Prevalence and prognostic significance of exercise-induced silent myocardial ischemia in apparently healthy subjects
- Author
-
Fleg, Jerome L.
- Subjects
Silent myocardial ischemia -- Prognosis ,Coronary heart disease -- Risk factors ,Exercise -- Health aspects ,Health - Abstract
The addition of thallium-201 ([.sup.201.Tl]) scintigraphy to traditional exercise electrocardiograhy (ECG) was assessed to determine whether the combination was a more accurate predictor of future coronary events than exercise ECG alone in an apparently healthy population. There were 407 participants enrolled in the Baltimore Longitudinal Study of Aging. The participants, who had no clinical or resting ECG evidence of coronary artery disease, underwent [.sup.201.Tl] scintigraphy immediately following maximal treadmill exercise. Four subsets of subjects were derived: (1) negative ECG and negative[.sup.201.Tl]; (2) positive ECG and negative [.sup.201.Tl]; (3) negative ECG and positive [.sup.201.Tl]; (4) positive ECG and positive [.sup.201.Tl]. A total of 66 individuals (16%) had positive ECGs and 55(14%) had positive [.sup.201.Tl] scans. Concordant positive results in both tests were seen in 23 subjects (6%), with a 7-fold increase in prevalence from age 40-59 years to >80 years. Over a mean follow-up of 4.6 years, cardiac events (angina pectoris, myocardial infarction, or cardiac death) occurred in 40 of 407 volunteers (9.8%). Analysis revealed a 48% incidence of cardiac events in the subset with concordant abnormal ECG and [.sup.201.Tl] test results versus an event rate of 3-12% for the other 3 groups (p
- Published
- 1992
5. Effect of light-to-moderate alcohol consumption on age-associated arterial stiffening
- Author
-
Hougaku, Hidetaka, Fleg, Jerome L., Lakatta, Edward G., Scuteri, Angelo, Earley, Christopher J., Najjar, Samer, Deb, Saswata, and Metter, E. Jeffrey
- Subjects
- *
CARDIOVASCULAR diseases , *ALCOHOLISM , *ALCOHOL drinking , *AGING - Abstract
Increased thickness and stiffness of large arteries may contribute to why aging is the most important risk for cardiovascular diseases. Arterial stiffness, intimal medial thickness, and alcohol intake were measured in 563 subjects. A U-shaped relation was found between alcohol intake and a stiffness index, with the lowest index in moderate drinkers, which may partially explain the relation between alcohol and cardiovascular disease. [Copyright &y& Elsevier]
- Published
- 2005
- Full Text
- View/download PDF
6. Left ventricular remodeling with age in normal men versus women: Novel insights using three-dimensional magnetic resonance imaging
- Author
-
Hees, Paul S., Fleg, Jerome L., Lakatta, Edward G., and Shapiro, Edward P.
- Subjects
- *
LEFT heart ventricle , *ECHOCARDIOGRAPHY , *MAGNETIC resonance imaging , *AGING , *COMPARATIVE studies , *ELECTROCARDIOGRAPHY , *HEART ventricles , *RESEARCH methodology , *MEDICAL cooperation , *REFERENCE values , *REGRESSION analysis , *RESEARCH , *SEX distribution , *THREE-dimensional imaging , *EVALUATION research , *VENTRICULAR remodeling , *BODY surface area - Abstract
Echocardiographic left ventricular (LV) wall thickness increases with age, suggesting LV hypertrophy. However, autopsy studies have shown no change, or even a decrease, in LV mass with age. With many pathologies, LV remodeling results in changes in ventricular shape. Age-associated LV shape change might explain this discrepancy, although this has not been studied. Magnetic resonance imaging (MRI) was used in 336 healthy, normotensive adults (mean age 56 ± 18 years; 200 women, 136 men) to measure LV mass, end-diastolic LV wall thickness, length, diameter, and shape. Echocardiographic LV mass was measured in a subset of 86 subjects by a standard algorithm. In women, LV wall thickness increased by 14% (r = 0.19, p <0.02), whereas LV length decreased by 9% (r = −0.26, p = 0.0006); LV diameter was unchanged. Thus, LV mass did not vary with age (r −0.04, p = 0.06) and the sphericity index decreased (r = −0.165, p <0.05). In men, LV wall thickness and diameter were unrelated to age, but there was an 11% decrease in LV length (r = −0.29, p = 0.003); therefore, there was an 11% decrease in LV mass (r = −0.20, p = 0.019) and a decrease in the sphericity index (r = −0.218, p <0.04). No change occurred in echocardiographic LV mass with age in either gender, although echocardiographic LV wall thickness increased in both. The left ventricle becomes more spherical with age in normal adults due to reduced LV length. In women, increased LV wall thickness offsets the decreasing LV length, whereas in men, LV wall thickness fails to compensate, resulting in decreased LV mass with age. [Copyright &y& Elsevier]
- Published
- 2002
- Full Text
- View/download PDF
7. Physician management of patients with heart failure and normal versus decreased left ventricular...
- Author
-
Fleg, Jerome L., Kitzman, Dalane W., Aronow, Wilbert S., Rich, Michael W., Gardin, Julius M., and Slone, Stacey A.
- Subjects
- *
HEART failure patients - Abstract
Discusses the management of heart failure patients with normal systolic function in the United States. Determination of patterns of laboratory utilization and therapeutic interventions; Comparison of patient management among family practitioners, general internists, geriatricians and cardiologists.
- Published
- 1998
- Full Text
- View/download PDF
8. Exercise-induced silent myocardial ischemia in master athletes.
- Author
-
Katzel, Leslie I., Fleg, Jerome L., Busby-Whitehead, M. Janette, Sorkin, John D., Becker, Lewis C., Lakatta, Edward G., and Goldberg, Andrew P.
- Subjects
- *
SILENT myocardial ischemia , *ATHLETES , *HEALTH - Abstract
Studies the prevalence of exercise-induced silent myocardial ischemia in athletes. Conduction of surveys on the family history of premature coronary artery disease; Risk factors for silent ischemia in men; Comparison of exercise tests in athletes and untrained men.
- Published
- 1998
- Full Text
- View/download PDF
9. Use of Coronary Computed Tomographic Angiography Findings to Modify Statin and Aspirin Prescription in Patients With Acute Chest Pain.
- Author
-
Pursnani, Amit, Celeng, Csilla, Schlett, Christopher L, Mayrhofer, Thomas, Zakroysky, Pearl, Lee, Hang, Ferencik, Maros, Fleg, Jerome L, Bamberg, Fabian, Wiviott, Stephen D, Truong, Quynh A, Udelson, James E, Nagurney, John T, and Hoffmann, Udo
- Abstract
Coronary CT angiography (CCTA) is used in patients with low-intermediate chest pain presenting to the emergency department for its reliability in excluding acute coronary syndrome (ACS). However, its influence on medication modification in this setting is unclear. We sought to determine whether knowledge of CCTA-based coronary artery disease (CAD) was associated with change in statin and aspirin prescription. We used the CCTA arm of the Rule Out Myocardial Infarction using Computed Angiographic Tomography II multicenter, randomized control trial (R-II) and comparison cohort from the observational Rule Out Myocardial Infarction using Computed Angiographic Tomography I cohort (R-I). In R-II, subjects were randomly assigned to CCTA to guide decision making, whereas in R-I patients underwent CCTA with results blinded to caregivers and managed according to standard care. Our final cohort consisted of 277 subjects from R-I and 370 from R-II. ACS rate was similar (6.9% vs 6.2% respectively, p = 0.75). For subjects with CCTA-detected obstructive CAD without ACS, initiation of statin was significantly greater after disclosure of CCTA results (0% in R-I vs 20% in R-II, p = 0.009). Conversely, for subjects without CCTA-detected CAD, aspirin prescription was lower with disclosure of CCTA results (16% in R-I vs 4.8% in R-II, p = 0.001). However, only 68% of subjects in R-II with obstructive CAD were discharged on statin and 65% on aspirin. In conclusion, physician knowledge of CCTA results leads to improved alignment of aspirin and statin with the presence and severity of CAD although still many patients with CCTA-detected CAD are not discharged on aspirin or statin. Our findings suggest opportunity for practice improvement when CCTA is performed in the emergency department. [ABSTRACT FROM AUTHOR]
- Published
- 2016
- Full Text
- View/download PDF
10. Usefulness of Doppler echocardiographic left ventricular diastolic function and peak exercise oxygen consumption to predict cardiovascular outcomes in patients with systolic heart failure (from HF-ACTION).
- Author
-
Gardin JM, Leifer ES, Kitzman DW, Cohen G, Landzberg JS, Cotts W, Wolfel EE, Safford RE, Bess RL, Fleg JL, Gardin, Julius M, Leifer, Eric S, Kitzman, Dalane W, Cohen, Gerald, Landzberg, Joel S, Cotts, William, Wolfel, Eugene E, Safford, Robert E, Bess, Renee L, and Fleg, Jerome L
- Abstract
Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training (HF-ACTION) was a multicenter, randomized controlled trial designed to examine the safety and efficacy of aerobic exercise training versus usual care in 2,331 patients with systolic heart failure (HF). In HF-ACTION patients with rest transthoracic echocardiographic measurements, the predictive value of 8 Doppler echocardiographic measurements-left ventricular (LV) diastolic dimension, mass, systolic (ejection fraction) and diastolic (mitral valve peak early diastolic/peak late diastolic [E/A] ratio, peak mitral valve early diastolic velocity/tissue Doppler peak early diastolic myocardial velocity [E/E'] ratio, and deceleration time) function, left atrial dimension, and mitral regurgitation severity-was examined for a primary end point of all-cause death or hospitalization and a secondary end point of cardiovascular disease death or HF hospitalization. Also compared was the prognostic value of echocardiographic variables versus peak oxygen consumption (Vo(2)). Mitral valve E/A and E/E' ratios were more powerful independent predictors of clinical end points than the LV ejection fraction but less powerful than peak Vo(2). In multivariate analyses for predicting the primary end point, adding E/A ratio to a basic demographic and clinical model increased the C-index from 0.61 to 0.62, compared with 0.64 after adding peak Vo(2). For the secondary end point, 6 echocardiographic variables, but not the LV ejection fraction or left atrial dimension, provided independent predictive power over the basic model. The addition of E/E' or E/A to the basic model increased the C-index from 0.70 to 0.72 and 0.73, respectively (all p values <0.0001). Simultaneously adding E/A ratio and peak Vo(2) to the basic model increased the C-index to 0.75 (p <0.0005). No echocardiographic variable was significantly related to the change from baseline to 3 months in exercise peak Vo(2). In conclusion, the addition of echocardiographic LV diastolic function variables improves the prognostic value of a basic demographic and clinical model for cardiovascular disease outcomes. [ABSTRACT FROM AUTHOR]
- Published
- 2012
- Full Text
- View/download PDF
11. Left Ventricular Diastolic Function and Exercise Capacity in Community-Dwelling Adults ≥65 Years of Age Without Heart Failure
- Author
-
Perry, Gilbert J., Ahmed, Mustafa I., Desai, Ravi V., Mujib, Marjan, Zile, Michael, Sui, Xuemei, Aban, Inmaculada B., Zhang, Yan, Tallaj, Jose, Allman, Richard M., Aronow, Wilbert S., Fleg, Jerome L., and Ahmed, Ali
- Subjects
- *
LEFT heart ventricle , *DIASTOLE (Cardiac cycle) , *BLOOD pressure , *CARDIOVASCULAR diseases in old age , *HEART failure , *AGE factors in disease , *EXERCISE physiology , *OLDER people , *DOPPLER echocardiography , *BODY mass index - Abstract
Left ventricular diastolic dysfunction (LVDD) has been reported to have strong correlation with exercise capacity. However, this relationship has not been studied extensively in community-dwelling older adults. Data on pulse and tissue Doppler echocardiographic estimates of resting early (E) and atrial (A) transmitral peak inflow and early (Em) mitral annular velocities, and six-minute walk test were obtained from 89 community-dwelling older adults (mean age, 74; range, 65-93 years; 54% women), without a history of heart failure. Overall, 47% had cardiovascular morbidity and 60% had normal diastolic function (E/A 0.75-1.5 and E:Em <10). Among the 36 individuals with LVDD, 83%, 14% and 3% had grade I (E/A <0.75, regardless of E/Em), II (E/A 0.75-1.5 and E/Em ≥10) and III (E/A>1.5 and E/Em ≥10) LVDD, respectively. Those with LVDD were older (77 versus 73 years; p = 0.001) and had a trend for higher prevalence of cardiovascular morbidity (58% versus 40%; p = 0.083). LVDD negatively correlated with six-minute walk distance (1013 versus 1128 feet; R = −0.25; p = 0.017). This association remained significant despite adjustment for cardiovascular morbidity (R = −0.35; p = 0.048), but lost significance when adjusted for age (R = −0.32; p = 0.105), age and cardiovascular morbidity (R = −0.38; p = 0.161), and additional adjustment for sex, race, body mass index, and systolic blood pressure (R = −0.44; p = 0.365). In conclusion, most community-dwelling older adults without heart failure had normal left ventricular diastolic function or grade-I LVDD. Although LVDD was associated with decreased performance on a six-minute walk test, that association was no longer evident after adjustment for age, body mass index and cardiovascular morbidity. [ABSTRACT FROM AUTHOR]
- Published
- 2011
- Full Text
- View/download PDF
12. Reproducibility of Peak Oxygen Uptake and Other Cardiopulmonary Exercise Testing Parameters in Patients With Heart Failure (from the Heart Failure and A Controlled Trial Investigating Outcomes of exercise traiNing)
- Author
-
Bensimhon, Daniel R., Leifer, Eric S., Ellis, Stephen J., Fleg, Jerome L., Keteyian, Steven J., Piña, Ileana L., Kitzman, Dalane W., McKelvie, Robert S., Kraus, William E., Forman, Daniel E., Kao, Andrew J., Whellan, David J., O'Connor, Christopher M., and Russell, Stuart D.
- Subjects
- *
HEART disease prognosis , *EXERCISE tests , *HEART failure patients , *CARDIAC arrest , *THERAPEUTICS , *LEFT heart ventricle diseases , *CLINICAL trials - Abstract
Peak oxygen uptake (pVo 2) is an important parameter in assessing the functional capacity and prognosis of patients with heart failure. In heart failure trials, change in pVo 2 was often used to assess the effectiveness of an intervention. However, the within-subject variability of pVo 2 on serial testing may limit its usefulness. This study was designed to evaluate the within-subject variability of pVo 2 over 2 baseline cardiopulmonary exercise tests. As a substudy of the HF-ACTION trial, 398 subjects (73% men, 27% women; mean age 59 years) with heart failure and left ventricular ejection fraction ≤35% underwent 2 baseline cardiopulmonary exercise tests within 14 days. Mean pVo 2 was unchanged from test 1 to test 2 (15.16 ± 4.97 vs 15.18 ± 4.97 ml/kg/min; p = 0.78). However, mean within-subject absolute change was 1.3 ml/kg/min (10th, 90th percentiles 0.1, 3.0), with 46% of subjects increasing and 48% decreasing on the second test. Other parameters, including the ventilation-to-carbon-dioxide production slope and Vo 2 at ventilatory threshold, also showed significant within-subject variation with minimal mean differences between tests. In conclusion, pVo 2 showed substantial within-subject variability in patients with heart failure and should be taken into account in clinical applications. However, on repeated baseline cardiopulmonary exercise tests, there appears to be no familiarization effect for Vo 2 in patients with HF. Therefore, in multicenter trials, there is no need to perform >1 baseline cardiopulmonary exercise test. [Copyright &y& Elsevier]
- Published
- 2008
- Full Text
- View/download PDF
13. Hospitalizations Due to Unstable Angina Pectoris in Diastolic and Systolic Heart Failure
- Author
-
Ahmed, Ali, Zile, Michael R., Rich, Michael W., Fleg, Jerome L., Adams, Kirkwood F., Love, Thomas E., Young, James B., Aronow, Wilbert S., Kitzman, Dalane W., Gheorghiade, Mihai, and Dell’Italia, Louis J.
- Subjects
- *
HEART failure , *ANGINA pectoris , *CORONARY disease , *HOSPITAL care - Abstract
Patients with diastolic heart failure (HF), i.e., clinical HF with normal or near normal left ventricular ejection fraction (LVEF), may develop unstable angina pectoris (UAP) due to epicardial atherosclerotic coronary artery disease and/or to subendocardial ischemia, even in the absence of coronary artery disease. However, the risk of UAP in ambulatory patients with diastolic HF has not been well studied. We examined incident hospitalizations due to UAP in 916 patients with diastolic HF (LVEF >45%) without significant valvular heart disease and 6,800 patients with systolic HF (LVEF ≤45%) in the Digitalis Investigation Group trial. During a 38-month median follow-up, 12% of patients (797 of 6,800) with systolic HF (incidence rate 435 per 10,000 person-years) and 15% of patients (138 of 916) with diastolic HF (incidence rate 536 per 10,000 person-years) were hospitalized for UAP (adjusted hazard ratio for diastolic HF 1.22, 95% confidence interval [CI] 1.02 to 1.47, p = 0.032). There was a graded increase in incident hospital admissions for UAP with increasing LVEF. Hospitalizations for UAP occurred in 11% (520 of 4,808, incidence rate 407 per 10,000 person-years), 14% (355 of 2,556, incidence rate 496 per 10,000 person-years), and 17% (60 of 352, incidence rate 613 per 10,000 person-years) of patients with HF, respectively, with LVEF values <35%, 35% to 55%, and >55%. Compared with patients with HF and an LVEF <35%, the adjusted hazard ratios for UAP hospitalization in those with LVEF values 35% to 55% and >55% were, respectively, 1.17 (95% CI 1.02 to 1.34, p = 0.028) and 1.57 (95% CI 1.20 to 2.07, p = 0.026). In conclusion, in ambulatory patients with chronic HF, a higher LVEF was associated with increased risk of hospitalizations due to UAP. As in patients with systolic HF, those with diastolic HF should be routinely evaluated for myocardial ischemia and managed accordingly. [Copyright &y& Elsevier]
- Published
- 2007
- Full Text
- View/download PDF
14. Comparison of cardiorespiratory fitness versus leisure time physical activity as predictors of coronary events in men aged < or = 65 years and > 65 years.
- Author
-
Talbot LA, Morrell CH, Metter EJ, Fleg JL, Talbot, Laura A, Morrell, Christopher H, Metter, E Jeffrey, and Fleg, Jerome L
- Abstract
Both high peak oxygen consumption (VO(2)) and high levels of leisure time physical activity (LTPA) are associated with a reduced risk of cardiovascular morbidity and mortality. We examined the contributions of LTPA and peak VO(2) to the risk of coronary events (CEs) in healthy younger (< or = 65 years, n = 522) and older (>65 years, n = 167) men from the Baltimore Longitudinal Study of Aging. LTPA derived from self reports of time spent in 97 activities were converted into METs-minutes/24 hours and grouped into high (> or = 6 METs), moderate- (4 to 5.9 METs), and low-intensity LTPA (<4 METs). Cardiorespiratory fitness was determined by measuring peak VO(2) during a maximal treadmill exercise test. Over a mean follow-up of 13.4 +/- 6.3 years, CEs occurred in 63 men. After accounting for coronary risk factors, proportional-hazards analyses showed a relative CE risk of 0.53 (p <0.0001) for a SD increase in peak VO(2) in younger men and 0.61 (p = 0.024) in older men, whereas total LTPA was unrelated to coronary risk in either age group. When the 3 LTPA intensity levels were substituted for total LTPA in the model, peak VO(2) remained the only predictor of events in younger men, whereas high-intensity LTPA (RR = 0.39 for tertile 3 vs tertiles 1 and 2, p = 0.016) and peak VO(2) (RR = 0.61/SD increase, p = 0.024) were of similar importance in older men. Thus, in healthy younger men, higher cardiorespiratory fitness but not LTPA predicts a reduced risk of coronary heart disease, independent of conventional risk factors. For older men, high-intensity LTPA and fitness appear to be of similar importance in reducing coronary risk. [ABSTRACT FROM AUTHOR]
- Published
- 2002
- Full Text
- View/download PDF
15. Effect of normative aging on midwall left ventricular systolic performance.
- Author
-
Ahmed, Sujood, Shapiro, Edward P., O'Connor, Frances E., Fleg, Jerome L., Ahmed, S, Shapiro, E P, O'Connor, F E, and Fleg, J L
- Subjects
- *
AGING , *LEFT heart ventricle , *CARDIOLOGY , *CARDIAC contraction , *HEART physiology , *LONGITUDINAL method , *REFERENCE values - Abstract
Studies the effect of normative aging on midwall left ventricular systolic performance. Key issues of interest; Analysis of pertinent topics and relevant issues; Implications on cardiology.
- Published
- 2001
- Full Text
- View/download PDF
16. Evolution of the Lipid Trial Protocol of the Action to Control Cardiovascular Risk in Diabetes (ACCORD) Trial
- Author
-
Ginsberg, Henry N., Bonds, Denise E., Lovato, Laura C., Crouse, John R., Elam, Marshall B., Linz, Peter E., O’Connor, Patrick J., Leiter, Lawrence A., Weiss, Daniel, Lipkin, Edward, and Fleg, Jerome L.
- Subjects
- *
ENDOCRINE diseases , *STATINS (Cardiovascular agents) , *ISOPENTENOIDS , *STEROLS - Abstract
The Action to Control Cardiovascular Risk in Diabetes (ACCORD) lipid trial aims to test whether a 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitor (statin) plus a fibrate is more efficacious in reducing cardiovascular events than a statin plus placebo in patients with type 2 diabetes mellitus with defined glycemic control. This is a blinded component in a 5,518-patient subset of the ACCORD cohort. These participants were randomized to either be (1) treated with simvastatin (titrated to 40 mg/day if necessary to achieve a goal low-density lipoprotein [LDL] cholesterol level of <2.59 mmol/L [100 mg/dL]) plus placebo or (2) treated to the same goal LDL cholesterol level with the statin plus active fenofibrate 160 mg/day or its bioequivalent (or 54 mg/day if the estimated glomerular filtration rate ranges from 30 to <50 mL/min per 1.73 m2). Setting an upper limit of LDL cholesterol qualifying for randomization excluded patients who would not likely achieve the LDL cholesterol goal. Recruitment for ACCORD began in January 2001, and follow-up is scheduled to end in June 2009. Since recruitment began, several clinical trials and consensus statements have been published that led to changes in the details of the lipid treatment algorithm and protocol. This report describes the design of the lipid protocol and modifications to the protocol during the course of the study in response to and in anticipation of these developments. The current protocol is designed to provide an ethically justifiable test of combined statin plus fibrate treatment consistent with the highest level of safety and lipid treatment standards of care. [Copyright &y& Elsevier]
- Published
- 2007
- Full Text
- View/download PDF
17. Comparison of Outcomes in Patients With Diabetes Mellitus Treated With Versus Without Insulin + Heart Failure With Preserved Left Ventricular Ejection Fraction (from the TOPCAT Study).
- Author
-
Huynh T, Harty BJ, Claggett B, Fleg JL, McKinlay SM, Anand IS, Lewis EF, Joseph J, Desai AS, Sweitzer NK, EileenO'Meara, Pitt B, Pfeffer MA, and Rouleau JL
- Subjects
- Aged, Case-Control Studies, Diabetes Mellitus, Type 1 drug therapy, Diabetes Mellitus, Type 1 mortality, Diabetes Mellitus, Type 2 drug therapy, Diabetes Mellitus, Type 2 mortality, Female, Heart Failure mortality, Hospitalization, Humans, Male, Middle Aged, Mineralocorticoid Receptor Antagonists therapeutic use, Spironolactone therapeutic use, Stroke Volume, Survival Rate, Treatment Outcome, Diabetes Mellitus, Type 1 complications, Diabetes Mellitus, Type 2 complications, Heart Failure complications, Heart Failure therapy, Hypoglycemic Agents therapeutic use, Insulin therapeutic use
- Abstract
We aimed to evaluate the impact of diabetes mellitus (DM) and insulin treatment on clinical outcomes in patients with heart failure and preserved left ventricular ejection fraction enrolled in the TOPCAT study. We investigated the influence of DM status (insulin-treated [ITDM], non-insulin treated [NITDM], and no diabetes [non-DM]) at baseline on time to development of the primary end point, a composite of cardiovascular (CV) mortality, heart failure hospitalization, and aborted cardiac arrest. Secondary end points included the individual components of the primary end point, myocardial infarction, stroke, all-cause mortality, hyperkalemia, and worsened renal function. Due to marked regional differences in characteristics and outcomes of the TOPCAT patients, with much lower events in patients enrolled in Russia/Georgia, we restricted our analyses on findings from patients enrolled from the Americas. Compared to patients without DM, patients with ITDM had approximately 2-fold increased risk for the primary end point, heart failure hospitalization, and myocardial infarction (hazard ratios: 1.80, 1.97, and 2.27, respectively) and approximately 50% increases in all-cause and CV mortality. The risks for these outcomes were also increased in patients with ITDM in comparison to patients with NITDM as well (hazard ratios: 1.63, 1.65, and 2.73, respectively, and approximately 40% increases in all-cause and CV mortality). Patients with NITDM had similar risks for the primary end point and all secondary end points as patients without DM. In conclusion, the apparent increased risk of adverse outcomes in patients with heart failure and preserved left ventricular ejection fraction and ITDM merits future research to improve the prognosis of these high-risk patients., (Copyright © 2018 Elsevier Inc. All rights reserved.)
- Published
- 2019
- Full Text
- View/download PDF
18. Relation of Angina Pectoris to Outcomes, Quality of Life, and Response to Exercise Training in Patients With Chronic Heart Failure (from HF-ACTION).
- Author
-
Parikh KS, Coles A, Schulte PJ, Kraus WE, Fleg JL, Keteyian SJ, Piña IL, Fiuzat M, Whellan DJ, O'Connor CM, and Mentz RJ
- Subjects
- Aged, Cause of Death, Chronic Disease, Female, Heart Failure complications, Hospitalization statistics & numerical data, Humans, Kaplan-Meier Estimate, Male, Middle Aged, Mortality, Prognosis, Proportional Hazards Models, Treatment Outcome, Angina Pectoris complications, Exercise Therapy, Exercise Tolerance, Heart Failure rehabilitation, Oxygen Consumption, Quality of Life
- Abstract
Angina pectoris (AP) is associated with worse outcomes in heart failure (HF). We investigated the association of AP with health-related quality of life (HRQoL), exercise capacity, and clinical outcomes and its interaction with exercise training in an HF population. We grouped 2,331 patients with HF with reduced ejection fraction in the Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training (HF-ACTION) trial of usual care ± exercise training according to whether they had self-reported AP by Canadian classification score. HRQoL and clinical outcomes were assessed by AP status. In HF-ACTION, 406 patients (17%) had AP at baseline (44% with Canadian classification score ≥II) with HF severity similar to those without AP. Patients with AP had similar baseline exercise capacity but worse depressive symptoms and HRQoL. AP was associated with 22% greater adjusted risk for all-cause mortality/hospitalizations, driven by hospitalizations. There was significant interaction between baseline AP and exercise training peak VO
2 change (p = 0.019) but not other end points. Exercise training was associated with greater peak VO2 improvement after 3 months in patients with AP (treatment effect = 1.25 ml/kg/min, 95% CI 0.6 to 1.9). In conclusion, AP was associated with worse HRQoL and depressive symptoms. Despite greater peak VO2 improvement with exercise training, patients with AP experienced more adverse outcomes., (Copyright © 2016 Elsevier Inc. All rights reserved.)- Published
- 2016
- Full Text
- View/download PDF
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.