Objectives: This study was designed to evaluate whether different antihypertensive treatment regimens with similar blood pressure reduction have different effects on new- onset atrial fibrillation(AF). Background: It ...Objectives: This study was designed to evaluate whether different antihypertensive treatment regimens with similar blood pressure reduction have different effects on new- onset atrial fibrillation(AF). Background: It is unknown whether angiotensin II receptor blockade is better than beta- blockade in preventing new- onset AF. Methods: In the Losartan Intervention For Endpoint reduction in hypertension(LIFE) study 9,193 hypertensive patients and patients with electrocardiogram documented left ventricular hypertrophy were randomized to once- daily losartan or atenolol- based antihypertensive therapy. Electrocardiograms were Minnesota coded centrally, and 8,851 patients without AF by electrocardiogram or history, who were thus at risk of developing AF, were followed for 4.8± 1.0 years. Results: New- onset AF occurred in 150 patients randomized to losartan versus 221 to atenolol(6.8 vs. 10.1 per 1,000 person- years; relative risk 0.67, 95% confidence interval[CI] 0.55 to 0.83, p< 0.001), despite similar blood pressure reduction. Patients receiving losartan tended to stay in sinus rhythm longer(1,809± 225 vs. 1,709± 254 days from baseline, p=0.057) than those receiving atenolol. Moreover, patients with new- onset AF had two- , three- and five- fold increased rates, respectively, of cardiovascular events, stroke, and hospitalization for heart failure. There were fewer composite end points(n=31 vs. 51, hazard ratio=0.60, 95% CI 0.38 to 0.94, p=0.03) and strokes(n=19 vs. 38, hazard ratio=0.49, 95% CI 0.29 to 0.86, p=0.01) in patients who developed new- onset AF in the losartan compared to the atenolol treatment arm of the study. Furthermore, Cox regression analysis showed that losartan(21% risk reduction) and new- onset AF both independently predicted stroke even when adjusting for traditional risk factors. Conclusions: Our novel finding is that new- onset AF and associated stroke were significantly reduced by losartan compared to atenolol- based antihypertensive treatment with similar blood pressure reduction.展开更多
Context: Basic research provides plausible mechanisms and observational studies suggest that apparently healthy persons, who self-select for high intakes of vitamin E through diet or supplements, have decreased risks ...Context: Basic research provides plausible mechanisms and observational studies suggest that apparently healthy persons, who self-select for high intakes of vitamin E through diet or supplements, have decreased risks of cardiovascular disease and cancer. Randomized trials do not generally support benefits of vitamin E, but there are few trials of long duration among initially healthy persons. Objective: To test whether vitamin E supplementation decreases risks of cardiovascular disease and cancer among healthy women. Design, Setting, and Participants: In the Women’s Health Study conducted between 1992 and 2004, 39 876 apparently healthy US women aged at least 45 years were randomly assigned to receive vitamin E or placebo and aspirin or placebo, using a 2×2 factorial design, ane were followed up for an average of 10.1 years. Intervention: Administration of 600 IU of natural-source vitamin E on alternate days. Main Outcome Measures: Primary outcomes were a composite end point of first major cardiovascular event (nonfatal myocardial infarction, nonfatal stroke, or cardiovascular death) and total invasive cancer. Results: During follow-up, there were 482 major cardiovascular events in the vitamin E group and 517 in the placebo group, a nonsignificant 7%risk reduction (relative risk [RR], 0.93; 95%confidence interval [CI], 0.82-1.05; P=.26). There were no significant effects on the incidences of myocardial infarction (RR, 1.01; 95%CI, 0.82-1.23; P=.96) or stroke (RR, 0.98; 95%CI, 0.82-1.17; P=.82), as well as ischemic or hemorrhagic stroke. For cardiovascular death, there was a significant 24%reduction (RR, 0.76; 95%CI, 0.59-0.98; P=.03). There was no significant effect on the incidences of total cancer (1437 cases in the vitamin E group and 1428 in the placebo group; RR, 1.01; 95%CI, 0.94-1.08; P=.87) or breast (RR, 1.00; 95%CI, 0.90-1.12; P=.95), lung (RR, 1.09; 95%CI, 0.83-1.44; P=.52), or colon cancers (RR, 1.00; 95%CI, 0.77-1.31; P=.99). Cancer deaths also did not differ significantly between groups. There wa展开更多
Context: Increased baseline left ventricular(LV) mass predicts cardiovascular( CV) complications of hypertension, but the relation between lower LV mass and ou tcome during treatment for hypertension is uncertain. Obj...Context: Increased baseline left ventricular(LV) mass predicts cardiovascular( CV) complications of hypertension, but the relation between lower LV mass and ou tcome during treatment for hypertension is uncertain. Objective: To determine wh ether reduction of LV mass during antihypertensive treatment modifies risk of ma jor CV events independent of blood pressure change. Design, Setting, and Partici pants: Prospective cohort substudy of the Losartan Intervention For Endpoint Red uction in Hypertension(LIFE) randomized clinical trial, conducted from 1995 to 2 001. A total of 941 prospectively identified patients aged 55 to 80 years with e ssential hypertension and electrocardiographic LV hypertrophy had LV mass measur ed by echocardiography at enrollment in the LIFE trial and thereafter were follo wed up annually for a mean(SD) of 4.8(1.0) years for CV events. Main Outcome Mea sures: Composite end point of CV death, fatal or nonfatal myocardial infarction, and fatal or nonfatal stroke. Results: The composite end point occurred in 104 patients(11%). The multivariable Cox regression model showed a strong associati on between lower intreatment LV mass index and reduced rate of the composite C V end point(hazard ratio[HR], 0.78 per 1SD(25.3) decrease in LV mass index; 95 %confidence interval[CI], 0.65-0.94; P=.009) over and above that predicted by reduction in blood pressure. There were parallel associations between lower in treatment LV mass index and lower CV mortality (HR, 0.62; 95%CI, 0.47-0.82; P= .001), stroke (HR, 0.76; 95%CI, 0.60-0.96; P=.02), myocardial infarction (HR, 0.85; 95%CI, 0.62-1.17, P=.33), and allcause mortality (HR, 0.72; 95%CI, 0. 59-0.88, P=.002), independent of systolic blood pressure and assigned treatment . Results were confirmed in analyses adjusting for additional CV risk factors, e lectrocardiographic changes, or when only considering events after the first yea r of study treatment. Conclusion: In patients with essential hypertension and ba seline electrocardiographic LV hyper展开更多
左心耳封堵术（left atrial appendage ocllusion,LAAO）是近年来发展的通过微创导管术封堵左心耳以达到预防心房颤动患者发生血栓栓塞的新技术。Protect-AF（Watchman left atrial appendage system for embolic protection in patient...左心耳封堵术（left atrial appendage ocllusion,LAAO）是近年来发展的通过微创导管术封堵左心耳以达到预防心房颤动患者发生血栓栓塞的新技术。Protect-AF（Watchman left atrial appendage system for embolic protection in patients with atrial fibrillation）研究[1-4]是关于LAAO的第1个随机对照临床试验,本述评在分析该研究的基础上对LAAO的未来进行展望。1 LAAO的理论基础心房颤动是临床上最常见的持续性心律失常,普通人群中心房颤动发病率为0.5%~1.3%,展开更多
Context: Electrocardiographic left ventricular hypertrophy (LVH) is a strong p redictor of cardiovascular(CV) morbidity and mortality. However, the predictive value of changes in the magnitude of electrocardiographic ...Context: Electrocardiographic left ventricular hypertrophy (LVH) is a strong p redictor of cardiovascular(CV) morbidity and mortality. However, the predictive value of changes in the magnitude of electrocardiographic LVH criteria during an tihypertensive therapy remains unclear. Objective: To test the hypothesis that l esser severity of electrocardiographic LVH during antihypertensive treatment is associated with decreased CV morbidity and mortality, independent of blood press ure levels and reduction and treatment modality. Design, Setting, and Participan ts: Double-blind, randomized, parallel-group study conducted in 1995-2001 amo ng 9193 men and women with hypertension aged 55 through 80 years(mean, 67 years) , with electrocardiographic LVH by Cornell volt-age-duration product or Sokolo w-Lyon voltage criteria and enrolled in the Losartan Intervention For Endpoint Reduction in Hypertension(LIFE) study. Interventions: Losartan-or atenolol-bas ed treatment regimens, with follow-up assessments for at least 4(mean, 4.8 [SD, 0.9]) years. Main Outcome Measure: Composite end point of CV death, myocardial infarction(MI), or stroke in relation to severity of electrocardiographic LVH de termined at baseline and on subsequent electrocardiograms obtained at 1 or more annual revisits. Results: Cardiovascular death, nonfatal MI, or stroke occurred in 1096 patients (11.9%). In Cox regression models controlling for treatment ty pe, baseline Framingham risk score, baseline and in-treatment blood pressure, a nd severity of baseline electrocardiographic LVH by Cornell product and Sokolow -Lyon voltage, less-severe in-treatment LVH by Cornell product and Sokolow-L yon voltage were associated with 14%and 17%lower rates, respectively, of the c omposite CV end point(adjusted hazard ratio[HR], 0.86; 95%confidence interval[C I], 0.82-0.90; P< .001 for every 1050-mm ×ms[1-SD] decrease in Cornell produ ct; and HR, 0.83; 95%CI, 0.78-0.88; P< .001 for every 10.5-mm[1-SD] decrease in Sokolow-Lyon voltage). In parallel analyses, lower Corn展开更多
文摘Objectives: This study was designed to evaluate whether different antihypertensive treatment regimens with similar blood pressure reduction have different effects on new- onset atrial fibrillation(AF). Background: It is unknown whether angiotensin II receptor blockade is better than beta- blockade in preventing new- onset AF. Methods: In the Losartan Intervention For Endpoint reduction in hypertension(LIFE) study 9,193 hypertensive patients and patients with electrocardiogram documented left ventricular hypertrophy were randomized to once- daily losartan or atenolol- based antihypertensive therapy. Electrocardiograms were Minnesota coded centrally, and 8,851 patients without AF by electrocardiogram or history, who were thus at risk of developing AF, were followed for 4.8± 1.0 years. Results: New- onset AF occurred in 150 patients randomized to losartan versus 221 to atenolol(6.8 vs. 10.1 per 1,000 person- years; relative risk 0.67, 95% confidence interval[CI] 0.55 to 0.83, p< 0.001), despite similar blood pressure reduction. Patients receiving losartan tended to stay in sinus rhythm longer(1,809± 225 vs. 1,709± 254 days from baseline, p=0.057) than those receiving atenolol. Moreover, patients with new- onset AF had two- , three- and five- fold increased rates, respectively, of cardiovascular events, stroke, and hospitalization for heart failure. There were fewer composite end points(n=31 vs. 51, hazard ratio=0.60, 95% CI 0.38 to 0.94, p=0.03) and strokes(n=19 vs. 38, hazard ratio=0.49, 95% CI 0.29 to 0.86, p=0.01) in patients who developed new- onset AF in the losartan compared to the atenolol treatment arm of the study. Furthermore, Cox regression analysis showed that losartan(21% risk reduction) and new- onset AF both independently predicted stroke even when adjusting for traditional risk factors. Conclusions: Our novel finding is that new- onset AF and associated stroke were significantly reduced by losartan compared to atenolol- based antihypertensive treatment with similar blood pressure reduction.
文摘Context: Basic research provides plausible mechanisms and observational studies suggest that apparently healthy persons, who self-select for high intakes of vitamin E through diet or supplements, have decreased risks of cardiovascular disease and cancer. Randomized trials do not generally support benefits of vitamin E, but there are few trials of long duration among initially healthy persons. Objective: To test whether vitamin E supplementation decreases risks of cardiovascular disease and cancer among healthy women. Design, Setting, and Participants: In the Women’s Health Study conducted between 1992 and 2004, 39 876 apparently healthy US women aged at least 45 years were randomly assigned to receive vitamin E or placebo and aspirin or placebo, using a 2×2 factorial design, ane were followed up for an average of 10.1 years. Intervention: Administration of 600 IU of natural-source vitamin E on alternate days. Main Outcome Measures: Primary outcomes were a composite end point of first major cardiovascular event (nonfatal myocardial infarction, nonfatal stroke, or cardiovascular death) and total invasive cancer. Results: During follow-up, there were 482 major cardiovascular events in the vitamin E group and 517 in the placebo group, a nonsignificant 7%risk reduction (relative risk [RR], 0.93; 95%confidence interval [CI], 0.82-1.05; P=.26). There were no significant effects on the incidences of myocardial infarction (RR, 1.01; 95%CI, 0.82-1.23; P=.96) or stroke (RR, 0.98; 95%CI, 0.82-1.17; P=.82), as well as ischemic or hemorrhagic stroke. For cardiovascular death, there was a significant 24%reduction (RR, 0.76; 95%CI, 0.59-0.98; P=.03). There was no significant effect on the incidences of total cancer (1437 cases in the vitamin E group and 1428 in the placebo group; RR, 1.01; 95%CI, 0.94-1.08; P=.87) or breast (RR, 1.00; 95%CI, 0.90-1.12; P=.95), lung (RR, 1.09; 95%CI, 0.83-1.44; P=.52), or colon cancers (RR, 1.00; 95%CI, 0.77-1.31; P=.99). Cancer deaths also did not differ significantly between groups. There wa
文摘Context: Increased baseline left ventricular(LV) mass predicts cardiovascular( CV) complications of hypertension, but the relation between lower LV mass and ou tcome during treatment for hypertension is uncertain. Objective: To determine wh ether reduction of LV mass during antihypertensive treatment modifies risk of ma jor CV events independent of blood pressure change. Design, Setting, and Partici pants: Prospective cohort substudy of the Losartan Intervention For Endpoint Red uction in Hypertension(LIFE) randomized clinical trial, conducted from 1995 to 2 001. A total of 941 prospectively identified patients aged 55 to 80 years with e ssential hypertension and electrocardiographic LV hypertrophy had LV mass measur ed by echocardiography at enrollment in the LIFE trial and thereafter were follo wed up annually for a mean(SD) of 4.8(1.0) years for CV events. Main Outcome Mea sures: Composite end point of CV death, fatal or nonfatal myocardial infarction, and fatal or nonfatal stroke. Results: The composite end point occurred in 104 patients(11%). The multivariable Cox regression model showed a strong associati on between lower intreatment LV mass index and reduced rate of the composite C V end point(hazard ratio[HR], 0.78 per 1SD(25.3) decrease in LV mass index; 95 %confidence interval[CI], 0.65-0.94; P=.009) over and above that predicted by reduction in blood pressure. There were parallel associations between lower in treatment LV mass index and lower CV mortality (HR, 0.62; 95%CI, 0.47-0.82; P= .001), stroke (HR, 0.76; 95%CI, 0.60-0.96; P=.02), myocardial infarction (HR, 0.85; 95%CI, 0.62-1.17, P=.33), and allcause mortality (HR, 0.72; 95%CI, 0. 59-0.88, P=.002), independent of systolic blood pressure and assigned treatment . Results were confirmed in analyses adjusting for additional CV risk factors, e lectrocardiographic changes, or when only considering events after the first yea r of study treatment. Conclusion: In patients with essential hypertension and ba seline electrocardiographic LV hyper
文摘左心耳封堵术（left atrial appendage ocllusion,LAAO）是近年来发展的通过微创导管术封堵左心耳以达到预防心房颤动患者发生血栓栓塞的新技术。Protect-AF（Watchman left atrial appendage system for embolic protection in patients with atrial fibrillation）研究[1-4]是关于LAAO的第1个随机对照临床试验,本述评在分析该研究的基础上对LAAO的未来进行展望。1 LAAO的理论基础心房颤动是临床上最常见的持续性心律失常,普通人群中心房颤动发病率为0.5%~1.3%,
文摘Context: Electrocardiographic left ventricular hypertrophy (LVH) is a strong p redictor of cardiovascular(CV) morbidity and mortality. However, the predictive value of changes in the magnitude of electrocardiographic LVH criteria during an tihypertensive therapy remains unclear. Objective: To test the hypothesis that l esser severity of electrocardiographic LVH during antihypertensive treatment is associated with decreased CV morbidity and mortality, independent of blood press ure levels and reduction and treatment modality. Design, Setting, and Participan ts: Double-blind, randomized, parallel-group study conducted in 1995-2001 amo ng 9193 men and women with hypertension aged 55 through 80 years(mean, 67 years) , with electrocardiographic LVH by Cornell volt-age-duration product or Sokolo w-Lyon voltage criteria and enrolled in the Losartan Intervention For Endpoint Reduction in Hypertension(LIFE) study. Interventions: Losartan-or atenolol-bas ed treatment regimens, with follow-up assessments for at least 4(mean, 4.8 [SD, 0.9]) years. Main Outcome Measure: Composite end point of CV death, myocardial infarction(MI), or stroke in relation to severity of electrocardiographic LVH de termined at baseline and on subsequent electrocardiograms obtained at 1 or more annual revisits. Results: Cardiovascular death, nonfatal MI, or stroke occurred in 1096 patients (11.9%). In Cox regression models controlling for treatment ty pe, baseline Framingham risk score, baseline and in-treatment blood pressure, a nd severity of baseline electrocardiographic LVH by Cornell product and Sokolow -Lyon voltage, less-severe in-treatment LVH by Cornell product and Sokolow-L yon voltage were associated with 14%and 17%lower rates, respectively, of the c omposite CV end point(adjusted hazard ratio[HR], 0.86; 95%confidence interval[C I], 0.82-0.90; P< .001 for every 1050-mm ×ms[1-SD] decrease in Cornell produ ct; and HR, 0.83; 95%CI, 0.78-0.88; P< .001 for every 10.5-mm[1-SD] decrease in Sokolow-Lyon voltage). In parallel analyses, lower Corn
