No abstract available.
Pulmonary Embolism* ; Thrombosis*

No abstract available.
Apolipoproteins*

BACKGROUND: Many reports have shown that hormone replacement therapy(HRT) in postmenopausal women decreases lipoprotein(a)[Lp(a)]. However these had small numbers of subjects, short duration of therapy, or comparisons of only a few regimens. The influences of progesterone on Lp(a) and lipids, administered with estrogen, are controversial. METHODS: Five hundred and fifty-one postmenopausal women were divided into 4 groups : group A ; 0.625mg conjugated equine estrogen(CEE)(m=140), group B ; 0.625mg CEE plus 5mg medroxyprogesterone acetate(MPA)(m=97), group C ; 0.625mg CEE plus 10mg MPA(n=109), and group D ; 2mg estradiol valerate(E2) plus 0.5mg norgestrel(N)(n=134) and group E ; control(n=71). Lp(a) and lipids levels were measured before and 12 months after HRT. RESULTS: Estrogen replacement therapy(ERT) for 12 months lowered Lp(a) level by 37.1%. The addition of progesterone attenuated the Lp(a)-lowering effect of estrogen and decreased by 27.7%, 29.6%, and 30.3% in groups B(p<0.05), C(p<0.05), and D(p<0.0001) respectively. High density lipoprotein cholesterol(HDL-C) was increased markedly in group A(16.5%), increased moderately in groups B(10.8%) and C(11.3%), and not changed in group D. Low density lipoprotein cholesterol was decreased by 10.9%, 13.7%, 11.3%, and 17.6% in groups A, B, C, and D respectively. CONCLUSIONS: Reduction of Lp(a) with estrogen replacement therapy may be one of mechanisms for cardioprotective effect in postmenopausal women. The combined therapy of estrogen and progesterone may reveal different effects on heart due to adverse actions of progesterone on Lp(a) and HDL-C. The variations in the androgenic potency of progesterone may explaine inconsistent results on HDL-C in previous studies.
Cholesterol, LDL ; Estradiol ; Estrogen Replacement Therapy ; Estrogens ; Female ; Heart ; Hormone Replacement Therapy* ; Humans ; Lipoprotein(a)* ; Lipoproteins ; Medroxyprogesterone ; Progesterone*

The efficacy of 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors (statins) for reducing cardiovascular events has been established in large-scaled randomized controlled trials (RCT), and these trials have encompassed both primary and secondary prevention. Also, the safety of statins has been confirmed. Therefore, the market for statins is growing quite rapidly. Despite their proven benefits, a large number of patients who meet the guideline criteria for statin therapy are not receiving these drugs. Various strategies have been used to increase statin therapy in the target populations. However, the number of eligible patients taking statins has remained disappointing. It has been suggested that over-the-counter availability of statins would allow more consumers to use statins and achieve cardiovascular risk reduction. In contrast, those clinical trials have applied selection criteria to protect the internal validity at the expense of reducing the applicability of the trial's findings to the wider population of patients seen in routine clinical practice. Consequently, patients who are prescribed statins in routine clinical practice may systematically differ from those people who received statins in the clinical trials and may have different outcomes from those reported in the trials. This paper will review the efficacy of statins for preventing cardiovascular diseases, and suggest the pitfalls of the randomized controlled trails and the problems in the prescription of statins in the real clinical practice.
Cardiovascular Diseases ; Health Services Needs and Demand ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Oxidoreductases ; Patient Selection ; Prescriptions ; Primary Prevention ; Risk Reduction Behavior ; Secondary Prevention

Cardioprotective effect and the safety of 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors (statins) has been established in many large-scaled randomized controlled trials encompassing both primary and secondary prevention. Therefore, the market of statins is growing rapidly. In new millennium, several studies have shown the benefit from further reducing already low concentration of low density lipoprotein-cholesterol in high-risk patients. However, these clinical trials have applied selection criteria to protect the internal validity at the expense of reducing the applicability of the trial's findings to the wider population of patients seen in routine clinical practice. Treatment guideline for Korean hypercholesterolemic patients followed that of American. However, the death rate by coronary artery diseases is much lower in Korean population than in American population. The efficacy of statins in preventing cardiovascular diseases and the pitfalls in recent randomized controlled trails will be reviewed and the personal opinion for the management of Korean hypercholesterolemic patients will be suggested.
Cardiovascular Diseases ; Coronary Artery Disease ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Hypercholesterolemia* ; Mortality ; Oxidoreductases ; Patient Selection ; Primary Prevention ; Secondary Prevention

No abstract available.
Bone Density* ; Estrogens* ; Female ; Humans

No abstract available.
Coronary Artery Disease* ; Dyslipidemias* ; Female ; Humans

Massive pulmonary embolism is a major cause of morbidity and death in hospital. Most episodes of acute pulmonary embolism occurred from multiple emboli. When pulmonary embolism is suspected, the definitive diagnosis is pulmonary arteriography, but high degree of certainty can also be achieved with ventilation-perfusion scanning. The therapeutic modalities available for patients with acute pulmonary embolism are prophylatic and definitive therapy. Prophylatic therapy including anticoagulant with heparin is used to prevent further emboli episodes that might be fatal. Definitive therapy for pulmonary embolism including thrombolytic agents and pulmonary embolectomy attempts to dissolve and remove the resolution of the pathophysiologic sequelae of pulmonary embolism. We experienced a case of acute massive pulmonary embolism which occupied the pulmonary arteries bilaterally. Patient with orthopedic surgery one month before developedd dyspnea and chest tightness. Eventhough continuing enough amount of anticoagulant therapy, rapid hemodynamic deterioration and severe hypoxia occurred progressively. Urgent pulmonary embolectomy was succeeded and he has been followed up at out patient department.
Angiography ; Anoxia ; Diagnosis ; Dyspnea ; Embolectomy ; Fibrinolytic Agents ; Hemodynamics ; Heparin ; Humans ; Orthopedics ; Pulmonary Artery* ; Pulmonary Embolism* ; Thorax

OBJECTIVE: Effects of life style modifications on lipid profiles have been well established. However, data is scarce in Korean patients. We tried to quantify the effect of life style modifications on lipid profiles in relatively large number of Korean hyperlipidemic patients. METHODS: This study enrolled 1037 consecutive hyperlipidemic patients (total cholesterol or triglyceride levels ≥200 mg/dL) from 2003 to 2013. They were consisted of patients with hypercholesterolemia (n=308), borderline hypercholesterolemia (n=302), mixed hyperlipidemia (n=107), borderline mixed hyperlipidemia (n=156), and hypertriglyceridemia (n=164). Blood lipid levels were measured before and after life style modification for 2-4 months. RESULTS: Life style modification showed a small but significant reduction of body weight in all groups. It reduced low density lipoprotein (LDL) cholesterol by 9.1% (p=0.000), 5.9% (p=0.000), and 4.8% (p=0.003) in patients with hypercholesterolemia, borderline hypercholesterolemia, and mixed hyperlipidemia, respectively. LDL cholesterol was elevated in hypertriglyceridemic patients by 35% (p=0.000). Triglyceride levels decreased in patients with hypertriglyceridemia by 22% (p=0.000) and increased in hypercholesterolemic patients. There were no different effects of life style modification between men and women. CONCLUSION: Life style modification made significant improvement in lipid profiles in Korean patients. The degree of improvement from this study may provide useful data for the management of Korean hyperlipidemic patients.
Body Weight ; Cholesterol ; Cholesterol, LDL ; Diet Therapy ; Female ; Humans ; Hypercholesterolemia ; Hyperlipidemias* ; Hypertriglyceridemia ; Life Style* ; Lipoproteins ; Male ; Triglycerides

Percuaneous mitral valvuloplasty(PMV) is an alternative to surgical mitral commissurotomy for patients with mitral stenosis. To assess the immediate and follow-up results of PMV and to identify factors in fluencing the outcome and coplications of PMV, we analyzed the clinical, echocardiographic and hemodynamic data of 108 patients who underwent PMV. 1) Good hemodynamic results were obtained in 86 patients(79.6%). The factors predicting immediate outcome of PMV were mitral valve mobility, total echoscore, and EBDA/BSA. 2) Predictors of the increase in mitral valve area by PMV were age, sex, rhythm, and NYHA functional class before PMV. The independant predictors were rhythm(p=0.008) and functional class(p=0.002). 3) The degree of mitral regurgitation increased in 26 patients(24%), did not changed in 79 patients(73%) and decreased in 3 patients(3%). The increase of MR could not predicted from any features of the clinical, echocardiographic or hemodynamic daa. The severity of MR decreased by one grade in 15% of patients and did not change in 66% of patients during follow-up. 4) Left-to-right shunt was detected in 19 patients(18%). The predictors were valve mobility, pulmonary artery pressure and pulmonary vascular resistance. 5) Follow-up catheterization(mean 14 months) identified restenosis in six of 16 patients. The predictors of restenosis were sex, total echosecore, and left atrial volume. 6) The hemodynamic data at follow-up were good compared with prePMV data(p<0.01), but follow-up miral valve area decreased than that of postPMV(p<0.05). Immediate decrease in pulmonary vascular resistance followed by progressive improvement during follow-up. 7) Immediate complications of PMV were peripheral arterial embolism in one patient(1%), pericardial effusion in two(2%), transient arrhythmia in four(4%), left-to-right shunt in nineteen(18%) and increase in the grade of MR in twenty-six(24%). This study suggests, that PMV produces excellent immediate and follow-up results and is a safe and effective procedure in the nonsurgical treatment of mitral stenosis.
Arrhythmias, Cardiac ; Echocardiography ; Embolism ; Follow-Up Studies* ; Hemodynamics ; Humans ; Mitral Valve ; Mitral Valve Insufficiency ; Mitral Valve Stenosis* ; Pericardial Effusion ; Pulmonary Artery ; Vascular Resistance