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This Week in JAMA
December 1, 1999

This Week in JAMA

JAMA. 1999;282(21):1987. doi:10.1001/jama.282.21.1987
CARDIOVASCULAR DISEASE

Hemodynamic shear stress decreases in regions of low flow velocity, shown in blue on this flow velocity map of the carotid bifurcation at end-systole. Reduced shear stress stimulates endothelial function that predisposes to atherogenesis.

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Thrombolytic Therapy for Acute Ischemic Stroke

Treatment of acute ischemic stroke has been limited by the need to intervene within 3 hours of symptom onset. In a trial of intra-arterial recombinant prourokinase (r-proUK) administered with low-dose heparin within 6 hours of stroke onset to patients with acute ischemic stroke and angiographically proven occlusion of the middle cerebral artery, Furlan and colleagues found that significantly more patients who received r-proUK had good neurologic recovery at 90 days than patients who received heparin alone. Early intracranial hemorrhage was increased in the r-proUK group compared with the control group, but rates of intracranial hemorrhage at day 10 and 90-day mortality were similar. In a placebo-controlled trial of intravenous recombinant tissue-type plasminogen activator (rt-PA) administered between 3 and 5 hours after symptom onset, Clark and colleagues found no significant difference in neurologic recovery 90 days after treatment. The rate of symptomatic intracerebral hemorrhage within the first 10 days of treatment, however, was significantly higher in the rt-PA group.

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Low Coronary Risk Profile Increases Life Expectancy

In this analysis of data from a subcohort of 366,559 individuals aged 18 to 59 years with a low risk-factor profile for cardiovascular disease (serum cholesterol level less than 5.17 mmol/L [<200 mg/dL], blood pressure less than or equal to 120/80 mm Hg, and no current cigarette smoking) who had been enrolled in 2 long-term prospective studies, Stamler and colleagues found that the risk of coronary heart disease mortality was 0.08 to 0.23 and of cardiovascular death, 0.15 to 0.28, in the low-risk group compared with all others. The estimated greater life expectancy associated with a favorable risk profile ranged from 5.8 years to 9.5 years.

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Dietary Sodium, Weight, and Cardiovascular Health

Individuals who are overweight may be more sensitive to adverse effects of dietary sodium on cardiovascular health than normal weight individuals. In an analysis of data from the first National Health and Nutrition Examination Survey Epidemiologic Follow-up Study (mean follow-up, 19 years), He and colleagues report that among overweight persons, a 100-mmol increase in dietary sodium intake was associated with a significantly increased risk of stroke and of cardiovascular and all-cause mortality. No significant association was found between dietary sodium intake and cardiovascular disease risk among individuals who were not overweight.

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Evidence-Based Assessment of NCEP Guidelines

Based on a review of data from 37 clinical trials on the effects of cholesterol lowering on coronary events and mortality, stroke, and total mortality published since 1993, Ansell and colleagues assessed the recommendations of the Second Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel II). The authors conclude that despite some important differences, the selected lipid intervention trials generally support the NCEP guidelines and present an evidence-based algorithm for lipid-lowering therapy.

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Oral Anticoagulant Therapy and Outcomes of CAD

In this meta-analysis of data from more than 20,000 patients with coronary artery disease (CAD) enrolled in 31 trials of oral anticoagulant (OA) therapy, Anand and colleagues found that compared with control, high-intensity (international normalized ratio [INR], 2.8-4.8) OA therapy reduced risk of mortality by 22%, myocardial infarction by 42%, and thromboembolic events by 63%, and moderate-intensity (INR, 2-3) OA therapy reduced risk of mortality by 18%, myocardial infarction by 52%, and stroke by 53%, but risk of major bleeding increased 6.0- to 7.7-fold. Moderate- to high-intensity (INR ≥2) OA therapy did not improve outcomes compared with aspirin and was associated with a 2.4-fold increased risk of major bleeding.

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50 Years of Studying CAD Risk

Steinberg and Gotto review the research that validated the relationship between lipid disorders and coronary artery disease (CAD) since the founding of the National Heart Institute in 1948.

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Progress in Improving Cardiovascular Health

Lenfant reflects on changes in cardiovascular health, recent progress in cardiovascular disease research, and questions still unanswered.

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Contempo 1999

Several lines of evidence suggest an association between Chlamydia pneumoniae and atherosclerosis.

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JAMA Patient Page

For your patients: How to stay healthy.

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