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Background: The risk of coronary heart disease (CHD) in users of antidiabetic agents must be quantified to permit reasoned therapeutic choices., Objectives: To assess the risk of myocardial infarction (MI) and coronary revascularization (CR), in diabetic patients who began rosiglitazone, pioglitazone, metformin, or sulfonylureas., Methods: We conducted a retrospective cohort study of MI and CR in the PharMetrics database. We performed head-to-head comparisons using propensity-score-stratified Cox proportional hazards models, examining risks both on-treatment and during total follow-up before regimen switches., Results: For the combined outcome (MI and CR), the crude rates per 1000 person years were 9 on monotherapy, 13 on dual therapy, and 21 on therapies combined with insulin. In the absence of insulin, regimens containing thiazolidinediones (TZDs) tended toward lower risk than comparable regimens containing sulfonylureas and higher risk than those containing metformin. The summary hazard ratio for rosiglitazone versus pioglitazone was 1.04 (95%CI: 0.94-1.14) for total follow-up and 1.05 (0.92-1.19) for on-treatment time. For MI, the hazard ratios were 1.07 (0.89-1.27) for total follow-up and 1.21 (0.95-1.54) for on-treatment time., Conclusions: The present data indicate that the risk of CHD in patients using TZDs appears to lie between the risks associated with sulfonylureas and metformin. Neither the risk of MI and CR together nor the risk of MI alone was significantly different between rosiglitazone and pioglitazone. A nonsignificant observed excess risk of 21% for MI during on-treatment time will require combination with the results of other studies to provide a reliable assessment.

Purpose: The purpose of this study was to estimate rates of acute coronary syndrome (ACS), and sudden cardiac death in relation to use of rofecoxib, celecoxib, naproxen, diclofenac, and ibuprofen., Methods: We conducted a retrospective cohort study among 424,584 health plan enrollees ages 40-64 who used non-aspirin non-steroidal anti-inflammatory drugs (NANSAIDs) by prescription from 1999 to 2001. We used automated medical and pharmacy claims data to compute person-time exposed to study drugs, and to identify hospitalizations for ACS. The primary endpoint was ACS, inclusive of myocardial infarction (MI), unstable angina, and sudden cardiac death as identified through claims data and confirmed through hospital medical records, or through the National Death Index., Results: Compared with ibuprofen or diclofenac use, the relative risk (RR) of ACS during periods of current rofecoxib use was 1.35 (95%CI 1.09-1.68). For current use of celecoxib, the RR was 1.03 (95%CI 0.83-1.27). Risks in the first 30 days of rofecoxib and celecoxib use were modestly elevated. Rofecoxib use at the 25 mg/day (modal) dose was associated with an elevated risk of ACS (RR 1.54, 95%CI 1.15-2.04), while use at 26-50 mg/day (>modal) was not (RR 0.81, 95%CI 0.41-1.60). There were no increased risks with modal or greater than modal doses of celecoxib or naproxen compared with all doses of ibuprofen or diclofenac combined., Conclusions: The incidence of ACS was 1.35 times greater during rofecoxib use than use of ibuprofen or diclofenac. No statistically significant elevation in risk was observed with celecoxib use. Naproxen use was not associated with risk of ACS.

In many Sub-Saharan African populations, in particular urban dwellers, there have been marked rises in the prevalences of obesity in women, hypertension, diabetes, and cerebral vascular disease. Yet there have been only slight rises in coronary heart disease. To learn more of the roles of the various influencing factors in the puzzling situations described, some aspects of the past and present occurrences of these diseases are described and discussed, with comparisons being made with corresponding situations in African Americans, as well as in certain white populations. Despite increases in the knowledge of influencing factors, such fail to explain fully the epidemiologic situations described. As to the future, judging from the experiences of other populations, despite continuing indigence, within the next generation significant rises in coronary heart disease in certain African populations seem to be inevitable. However, in many of those populations, in particular those in the South, the extent of changes, apart from those linked with level of socioeconomic state, will be strongly affected by the rising epidemic of human immunodeficiency virus and acquired immunodeficiency syndrome.

BACKGROUND: To identify predictors of colon ischemia, we examined demographic and clinical characteristics of patients, as well as their prior health care utilization.METHODS: Using insurance data, we identified 700 persons at least 20-yr old with presumed colon ischemia between 1995 and 1999, and 6,440 controls. Case identification was based on diagnosis and procedure codes in insurance claims for which we used a previously reported, validated algorithm. We ascertained preceding medical diagnoses and the use of drugs and health services from the insurance claims files.RESULTS: Patients with colon ischemia were nearly three times as likely to have IBS than controls. A history of nonspecific colitis, lower gastrointestinal tract hemorrhage, systemic rheumatologic disorders, and ischemic heart disease in the preceding 6 months, and abdominal surgery in the past month were also much more common in colon ischemia cases than controls. Use of a drug to treat diarrhea was strongly associated with risk. The most prevalent risk factor for colon ischemia was the use of drugs with a side effect of constipation, found in one-third of cases and one in nine controls. Cases had seen physicians, particularly gastroenterologists, much more commonly in the preceding 6 months than had controls.CONCLUSIONS: Clinically evident colon ischemia arises preferentially in persons with prior abdominal complaints, many of whom carry a diagnosis of IBS. Drugs that reduce bowel motility may constitute a widespread and potentially avoidable risk factor. The frequency of preceding doctor visits, without a specific diagnosis, suggests that colon ischemia may have a prolonged subacute presentation. [ABSTRACT FROM AUTHOR]

There has been much controversy concerning the value of efforts to reduce blood cholesterol levels. In this contribution, the risks and benefits of interventions are discussed. Lowering cholesterol level by drugs is not recommended except in a small minority of subjects at very high risk of coronary heart disease (CHD), since it causes an excess of non-CHD deaths. Dietary intervention, by contrast, is safe. However, for it to be effective it must be sufficiently vigorous to achieve a drop in blood cholesterol of at least 6%, though considerably more is preferable. This action should be part of a more general effort aimed at the prevention of all Western diseases based on changes in lifestyle. [ABSTRACT FROM AUTHOR]

Discusses the dietary iron overload in populations in southern Africa and its association with low frequency of severe atherosclerosis and/or a low occurrence of ischemic heart disease (IHD). Iron accumulation as important risk factors for atherosclerosis and IHD; Cofactors absent in the African setting that are present in western countries.

The article focuses on the condition of public health in various countries. In the United States there is now 99% survival of infants, with life expectancy of 70-00 years and more, a far cry from the figure of 50 years in 1900. Funds for health have reached a high of 16% in the United States. The chief "killers", coronary heart disease (CHD) and stroke, have had their mortality rates almost halved, yet CHD incidence rate has not changed. Total mortality rate from cancer is stationary, or falling only slightly. The prevalence of obesity in women, and of hypertension and diabetes, already exceeds that in the white population. In most countries there is a tremendous health burden from infections, not only from malaria, but also from tuberculosis, and, more recently, from HIV infection. Rates of HIV infection in South Africa are the highest in the world; in parts, nearly 50% of antenatal African women are infected. In Spain, although mean serum cholesterol is rising, CHD mortality is falling. In Japan, although some risk factors are rising, inexplicably, mortality rates for breast and colon cancers are falling.