Items in FPM with MESH term: Cardiovascular Diseases
Routine Vitamin Supplementation to Prevent Cancer and Cardiovascular Disease - Putting Prevention into Practice
Statin Therapy in Patients with Type 2 Diabetes - FPIN's Clinical Inquiries
Dietary Advice to Lower Cardiovascular Risk - Cochrane for Clinicians
Subclinical Hypothyroidism - Cochrane for Clinicians
NSAID Prescribing Precautions - Article
ABSTRACT: Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used, but have risks associated with their use, including significant upper gastrointestinal tract bleeding. Older persons, persons taking anticoagulants, and persons with a history of upper gastrointestinal tract bleeding associated with NSAIDs are at especially high risk. Although aspirin is cardioprotective, other NSAIDs can worsen congestive heart failure, can increase blood pressure, and are related to adverse cardiovascular events, such as myocardial infarction and ischemia. Cyclooxygenase-2 inhibitors have been associated with increased risk of myocardial infarction; however, the only cyclooxygenase-2 inhibitor still available in the United States, celecoxib, seems to be safer in this regard. Hepatic damage from NSAIDs is rare, but these medications should not be used in persons with cirrhotic liver diseases because bleeding problems and renal failure are more likely. Care should be used when prescribing NSAIDs in persons taking anticoagulants and in those with platelet dysfunction, as well as immediately before surgery. Potential central nervous system effects include aseptic meningitis, psychosis, and tinnitus. Asthma may be induced or exacerbated by NSAIDs. Although most NSAIDs are likely safe in pregnancy, they should be avoided in the last six to eight weeks of pregnancy to prevent prolonged gestation from inhibition of prostaglandin synthesis, premature closure of the ductus arteriosus, and maternal and fetal complications from antiplatelet activity. Ibuprofen, indomethacin, and naproxen are safe in breastfeeding women. Care should be taken to prevent accidental NSAID overdose in children by educating parents about correct dosing and storage in childproof containers.
NSAIDs and Cardiovascular Risk - Editorials
ABSTRACT: Almost 160 million persons live in areas of the United States that exceed federal health-based air pollution standards. The two air pollutants that most commonly exceed standards are ozone and particulate matter. Ozone and particulate matter can harm anyone if levels are sufficiently elevated, but health risk from air pollution is greatest among vulnerable populations. Both ozone and particulate matter can cause pulmonary inflammation, decreased lung function, and exacerbation of asthma and chronic obstructive pulmonary disease. Particulate matter is also strongly associated with increased cardiovascular morbidity and mortality. Children, older adults, and other vulnerable persons may be sensitive to lower levels of air pollution. Persons who are aware of local air pollution levels, reported daily by the U.S. Environmental Protection Agency as the Air Quality Index, can take action to reduce exposure. These actions include simple measures to limit exertion and time spent outdoors when air pollution levels are highest, and to reduce the infiltration of outdoor air pollutants into indoor spaces.
ABSTRACT: Dietary factors that influence lipid levels include modification of nutritional components, consumption of specific foods, use of food additives and supplements, and major dietary approaches. The most beneficial changes result from reducing intake of saturated and trans fats; increasing intake of polyunsaturated and monounsaturated fats; fortifying foods with plant stanols or sterols; isocalorically adding tree nuts to the diet; consuming one or two alcoholic drinks per day; and adopting a Portfolio, Mediterranean, low-carbohydrate, or low-fat diet. Smaller but still beneficial effects result from reducing intake of dietary cholesterol, increasing intake of soluble fiber and soy protein, and eating fatty marine fish or taking marine-derived omega-3 fatty acid supplements. Red yeast rice supplements have effects similar to those of statin medications and are better tolerated in some patients. Regular aerobic exercise has beneficial effects on lipid levels, particularly if performed for at least 120 minutes per week. Brief physician counseling will have relatively small effects on unselected patients, so efforts should be concentrated on patients who are motivated and ready to make lifestyle changes.