Humans ; Myocardial Reperfusion Injury/prevention & control* ; Melatonin/therapeutic use* ; Mitochondria ; Myocardial Infarction

Writing Committee of Korean clinical practice guidelines for secondary prevention of stroke has reviewed recent randomized controlled trials of cilostazol published after the first edition of Korean clinical practice guidelines that considered evidences published before June 2007. Two clinical trials and 1 meta-analysis which compared cilostazol directly with aspirin in the prevention of stroke in patients with cerebral infarction or transient ischemic attack (TIA) were identified and included for the current guideline update. Review of findings indicates that cilostazol as compared to aspirin achieved a greater reduction of stroke as well as composite vascular events of stroke, myocardial infarction, and vascular death. For safety, cilostazol was associated with fewer major bleeding events than aspirin. Accordingly, new recommendations for cilostazol are made for prevention of stroke in the setting of noncardioembolic stroke or TIA. Changes in the guidelines necessitated by new evidences will be continuously reflected in future guidelines.
Aspirin ; Cerebral Infarction ; Hemorrhage ; Humans ; Ischemic Attack, Transient ; Myocardial Infarction ; Secondary Prevention ; Stroke ; Tetrazoles ; Writing

Background: Secondary preventive therapies play a key role in the prevention of adverse outcomes after coronary artery bypass grafting (CABG). However, medication adherence after CABG is often poor, and conventional interventions for improving adherence have limited success. With increasing penetration of smartphones, health-related smartphone applications might provide an opportunity to improve adherence. Carefully designed trials are needed to provide reliable evidence for the use of these applications in patients after CABG. Methods: The Measurement and Improvement Studies of Surgical Coronary Revascularization: Medication Adherence (MISSION-2) study is a multicenter randomized controlled trial, aiming to randomize 1000 CABG patients to the intervention or control groups in a 1:1 ratio. We developed the multifaceted, patient-centered, smartphone-based Heart Health Application to encourage medication adherence in the intervention group through a health self-management program initiated during hospital admission for CABG. The application integrated daily scheduled reminders to take the discharge medications, cardiac educational materials, a dynamic dashboard to review cardiovascular risk factors and secondary prevention targets, and weekly questionnaires with interactive feedback. The primary outcome was secondary preventive medication adherence measured by the Chinese version of the 8-item Morisky Medication Adherence Scale at 6 months after randomization. Secondary outcomes included all-cause death, cardiovascular rehospitalization, and a composite of death, myocardial infarction, stroke, and repeat revascularization. Discussion: Findings will not only provide evidence regarding the feasibility and effectiveness of the described intervention for improving adherence to CABG secondary preventive therapies but also explore a model for outpatient health self-management that could be translated to various chronic diseases and widely disseminated across resource-limited settings. Trial Registration https://clinicaltrials.gov (NCT02432469).
Coronary Artery Bypass ; methods ; Humans ; Medication Adherence ; Myocardial Infarction ; prevention & control ; Secondary Prevention ; methods ; Smartphone ; Stroke ; prevention & control

BACKGROUNDThis study aimed at assessing the effect of noninvasive limb preconditioning on myocardial infarct size, and determining whether nitric oxide and neurogenic pathway play an important role in the mechanism of acute remote ischemic preconditioning (IPC).

METHODSForty Wistar rats were randomly divided into four experimental groups. In Group I, the rats underwent 30-minute occlusion of the left anterior descending coronary artery, and 120-minute reperfusion. In Group PL, the rats underwent four cycles of 5-minute occlusion and reperfusion of both hind limbs using a tourniquet before the experiment was continued as in Group I. In Group PL-N and Group PL-H, we administered L-nitro-arginine methyl ester (L-NAME) 10 mg/kg or hexamethonium chloride 20 mg/kg intravenously, 10 minutes before IPC. Infarct size as a percentage of the area at risk was determined by triphenyltetrazolium chloride staining.

RESULTSThere were no statistically significant differences in mean arterial pressure and heart rate among these groups at any time point during the experiment (P>0.05). The myocardial infarct size (IS) was decreased significantly in Group PL and Group PL-H compared with Group I, and the IS/AAR was 34.5%+/-7.6%, 35.9%+/-8.6% and 58.5%+/-8.5%, respectively (P< 0.05). The IS/AAR was 49.1%+/- 6.5% in Group PL-N, and there was no significant difference compared with Group I (P>0.05).

CONCLUSIONSNoninvasive limb IPC is effective in protecting the myocardium from ischemia reperfusion injury. Nitric oxide plays an important role in the mechanism of acute remote IPC, in which the neurogenic pathway is not involved.

Animals ; Blood Pressure ; Extremities ; blood supply ; Heart Rate ; Ischemic Preconditioning, Myocardial ; Myocardial Infarction ; prevention & control ; Myocardial Reperfusion Injury ; prevention & control ; Rats ; Rats, Wistar

Early restoration of blood flow to the ischemic myocardium not only saves myocardium but also induces reperfusion injury. While no specific therapy to reduce reperfusion injury has yet been established, recent laboratory studies have shown that G protein-coupled receptor (GPCR) agonists, insulin, and postconditioning can effectively prevent reperfusion injury in various experimental settings and animal species. The potential mechanisms underlying the cardioprotection initiated by these interventions may include activation of the reperfusion injury salvage kinase (RISK) pathway, inactivation of glycogen synthase kinase 3beta (GSK-3beta), and modulation of mitochondrial permeability transition pore (mPTP) opening. These encouraging laboratory findings may help us develop successful clinical strategies to salvage reperfused myocardium in patients with acute myocardial infarction.
Glycogen Synthase Kinase 3 ; metabolism ; Humans ; Mitochondrial Membrane Transport Proteins ; physiology ; Myocardial Infarction ; complications ; Myocardial Reperfusion Injury ; prevention & control ; Myocardium

BACKGROUND: The prediction of the absolute risk of ischemic heart disease (IHD) is commonly based on the risk prediction equations, originated from the Framingham Heart Study. METHOD: Framingham equation model was applied to participants from 2001 Korean National Health and Nutrition Examination Survey (KNHNES) to estimate the 5 year risk of IHD among Koreans ranging from 30 to 74 year-olds. The estimated risks were compared to the incidence and admission rates from two statistical reports among Koreans. Five year admission rate was estimated by the annual report from National Health Insurance Corporation (NHIC). RESULTS: The average ages (standard deviation) were 34.31(27.23) year-old for KNHNES and 48.26(12.87) year-old for Framingham population used in this study. The risk of IHD predicted by the Framingham equation model substantially exceeded the risks actually reported in Korea. Five-year predicted risks by Framingham equation model were 4.86% for men and 1.93% for women; whereas from incidence data in Korea, five-year risks for acute myocardial infarction (AMI) were for 0.47% for men and 0.18% for women. These AMI incidence was similar to the admission rate (0.34 for men and 0.15 for women) estimated by NHIC. Also, 5-year admission rate of IHD were 1.16 for men and 0.78 for women. The magnitude of risk overestimation by Framingham mode is approximately at least 150 to 320%. CONCLUSION: Korean guidelines for the management for high risk group of IHD need to develop and correct for overestimation to avoid inflation of costs in primary prevention.
Aged ; Female ; Heart ; Humans ; Incidence ; Inflation, Economic ; Korea ; Male ; Myocardial Infarction ; Myocardial Ischemia* ; National Health Programs ; Nutrition Surveys ; Primary Prevention

The causes of ischemic stroke are widely diverse, ranging from large artery atherosclerosis to cardioembolism, and it is important to use preventive therapy toward the goal reducing the future risk of recurrent ischemic stroke, myocardial infarction, and vascular death. Antithrombotic therapy is one of the fundamental medical approaches for secondary prevention of ischemic stroke, which is broadly divided into two general categories, those that exert their effect via platelet inhibition (antiplatelet agents), and those that influence various factors in the clotting cascade (anticoagulants). In general, the clinical guidelines recommend antiplatelet agents for patients with non-cardioembolic stroke, while anticoagulants is indicated for patients with presumed or proven cardioembolic stroke. Many clinical trials have attempted to test the efficacy and safety of antithrombotics in ischemic stroke. This review will discuss on currently available antithrombotic agents that have demonstrated efficacy for secondary prevention of ischemic stroke.
Anticoagulants ; Arteries ; Atherosclerosis ; Blood Platelets ; Fibrinolytic Agents ; Humans ; Myocardial Infarction ; Platelet Aggregation Inhibitors ; Secondary Prevention* ; Stroke*

BACKGROUND AND OBJECTIVES: The differential benefit of statin according to the state of dyslipidemia has been sparsely investigated. We sought to address the efficacy of statin in secondary prevention of myocardial infarction (MI) according to the level of triglyceride and high density lipoprotein cholesterol (HDL-C) on admission. SUBJECTS AND METHODS: Acute MI patients (24653) were enrolled and the total patients were divided according to level of triglyceride and HDL-C on admission: group A (HDL-C≥40 mg/dL and triglyceride<150 mg/dL; n=11819), group B (HDL-C≥40 mg/dL and triglyceride≥150 mg/dL; n=3329), group C (HDL-C<40 mg/dL and triglyceride<150 mg/dL; n=6062), and group D (HDL-C<40 mg/dL & triglyceride≥150 mg/dL; n=3443). We evaluated the differential efficacy of statin according to the presence or absence of component of dyslipidemia. The primary end points were major adverse cardiac events (MACE) for 2 years. RESULTS: Statin therapy significantly reduced the risk of MACE in group A (hazard ratio=0.676; 95% confidence interval: 0.582-0.785; p<0.001). However, the efficacy of statin was not prominent in groups B, C, or D. In a propensity-matched population, the result was similar. In particular, the benefit of statin in group A was different compared with group D (interaction p=0.042) CONCLUSION: The benefit of statin in patients with MI was different according to the presence or absence of dyslipidemia. In particular, because of the insufficient benefit of statin in patients with MI and dyslipidemia, a different lipid-lowering strategy is necessary in these patients.
Cholesterol, HDL* ; Dyslipidemias ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors* ; Myocardial Infarction* ; Prognosis ; Secondary Prevention* ; Triglycerides*

How to prevent and cure atherosclerosis (AS), reduce the occurrence and mortality of cardiovascular and cerebrovascular events is one of the hotspots in modern medicine researches. The understanding of AS experiences several dramatic transitions along with the deepening of researches, that is, from focusing on "vascular stenosis" to stressing "vulnerable plaque"; from taking the theory of "lipid deposit" as dominant to public acceptance of "inflammatory reaction" theory, and from "vulnerable plaque" to the new conception of "vulnerable patients". These changes bring forth the update concept and method of therapeutics, and also provide new opportunity and cut-in point for integrative Chinese and Western medicine in preventing and curing acute cardiovascular events.
Atherosclerosis ; drug therapy ; therapy ; Drugs, Chinese Herbal ; therapeutic use ; Humans ; Myocardial Infarction ; prevention & control ; Phytotherapy ; methods

OBJECTIVETo investigate the frequency of aborted AMI and clinical characteristics of the patients received prompt fibrinolytic therapy.

METHODS1120 patients with AMI were divided into two groups, true AMI group and aborted AMI group. Aborted AMI was defined as maximal creatine kinase-MB < or = 2 x upper limit of normal coupled with the presence of resolution of chest pain and 50% of ST-segment deviation within 2 hours after onset of therapy. We compared some characteristic of two groups such as the fibrinolytic time after symptom onset and the frequency of aborted AMI.

RESULTSThe reopening ratio of infarct was 80.5%. 7.1% of the patients escaped myocardial necrosis. Aborted AMI was highest frequency within the first hour (22.0%) than other time groups (P < 0.01); There were no significant differences in the frequency of Aborted AMI in UK group, SK group and rt-PA group (7.0%, 6.7%, 7.1%, P > 0.05); The rate of Killip III/IV, major arrhythmias, angina pectoris and mortality at 30 day in aborted AMI patients compared with those who had true AMI was 3.9% versus 17.1%, 18.0% versus 30.0%, 1.3% versus 8.0%, 0 versus 6.0%, respectively (P < 0.01).

CONCLUSIONPrompt fibrinolytic therapy improved the likelihood of aborted AMI and clinical outcomes. The frequency of aborted AMI has no relationship with fibrinolytic drug, but closely related to the starting time of treatment from symptom onset.

Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Myocardial Infarction ; drug therapy ; prevention & control ; Prognosis ; Thrombolytic Therapy