Search

Background: Warfarin sodium is a highly efficacious drug, but proper levels of anticoagulation are difficult to maintain. Conflicting data exist on the influence of patient adherence on anticoagulation control., Methods: We performed a prospective cohort study at 3 anticoagulation clinics to determine the effect of adherence on anticoagulation control. Patients treated with warfarin with a target international normalized ratio of 2.0 to 3.0 were monitored with electronic Medication Event Monitoring System (MEMS) medication bottle caps. Detailed information was collected on other factors that might alter warfarin response., Results: Among 136 participants observed for a mean of 32 weeks, 92% had at least 1 missed or extra bottle opening; 36% missed more than 20% of their bottle openings; and 4% had more than 10% extra bottle openings. In multivariable analyses, there was a significant association between underadherence and underanticoagulation. For each 10% increase in missed pill bottle openings, there was a 14% increase in the odds of underanticoagulation (P<.001); participants with more than 20% missed bottle openings (1-2 missed days each week) had more than a 2-fold increase in the odds of underanticoagulation (adjusted odds ratio, 2.10; 95% confidence interval, 1.48-2.96). Participants who had extra pill bottle openings on more than 10% of days had a statistically significant increase in overanticoagulation (adjusted odds ratio, 1.73; 95% confidence interval, 1.09-2.74)., Conclusion: Patients have substantial difficulties maintaining adequate adherence with warfarin regimens, and this poor adherence has a significant effect on anticoagulation control.

Background: Pulmonary fibrosis and atherosclerosis have many similarities at the histopathologic level. Moreover, fibrotic lung diseases exhibit systemic effects and have the potential to affect the vasculature beyond the lung. The existence of a relationship between the two, however, has not been studied., Methods: To investigate whether fibrotic lung disorders may predispose to atherosclerosis, we conducted a cross-sectional study of 630 patients referred for lung transplantation evaluation at a university hospital. We compared the prevalence of angiographic coronary artery disease (CAD) in patients with fibrotic vs nonfibrotic lung diseases., Results: Fibrotic lung diseases were associated with an increased prevalence of CAD compared with nonfibrotic diseases after adjustment for traditional risk factors (odds ratio, 2.18; 95% confidence interval, 1.17-4.06). The magnitude and significance of this association were maintained when only nongranulomatous fibrotic disease or its subset, idiopathic pulmonary fibrosis, was examined. The strength of the relationship between fibrotic disorders and CAD increased when multivessel disease was analyzed (odds ratio, 4.16; 95% confidence interval, 1.46-11.9). No significant association was detected for granulomatous fibrotic disorders (odds ratio, 1.56; 95% confidence interval, 0.47-5.16; P =.47), although this subgroup had fewer cases of CAD for analysis., Conclusions: These findings support an association between fibrotic lung disorders and CAD. Further research is necessary to confirm this relationship and to explore the pathologic processes underlying, and potentially linking, these 2 conditions.

Background: Although cigarette smoking is a major risk factor for acute myocardial infarction (MI), cigarette tar yield has not been clearly demonstrated to affect MI risk., Methods: A case-control study of first MI in smokers aged 30 through 65 years was conducted among 68 hospitals in an 8-county area during a 28-month period. Case subjects were smokers hospitalized at any of the area hospitals with a first MI. Approximately 4 community control smokers per case subject were randomly selected from the same geographic area using random digit dialing. Detailed data on smoking history and cigarette brand were collected., Results: We identified 587 case subjects and 2685 controls who smoked cigarettes with known tar yields. After adjustment using multivariable logistic regression, the odds ratios (ORs) for subjects smoking medium- and high compared with low-tar-yield cigarettes were 1.86 (95% confidence interval [CI], 1.21-2.87) and 2.21 (95% CI, 1.47-3.34), respectively. The adjusted OR increased as tar per day intake increased (P<.001 for the trend); compared with the lowest category of tar per day, the ORs (95% CIs) for increasing tar per day were 1.16 (0.83-1.62), 1.85 (1.35-2.52), 2.42 (1.54-3.78), and 2.50 (1.78-3.52). There was a similar trend of increasing ORs as tar per day increased in smokers of lower-yield cigarettes (P<.001 for the trend) and when low-yield cigarette smokers were excluded (P<.001 for the trend)., Conclusions: Smoking higher-yield cigarettes is associated with an increased risk of MI, and there is a dose-response relationship between total tar consumption per day and MI.