Articles

Gene therapy for lipid disorders

Lipid disorders are associated with atherosclerotic vascular disease, and therapy is associated with a substantial reduction in cardiovascular events. Current approaches to the treatment of lipid disorders are...

Authors: Masa-aki Kawashiri and Daniel J Rader

Medical therapy versus interventional therapy in hypertropic obstructive cardiomyopathy

Medical treatment in symptomatic patients with hypertrophic obstructive cardiomyopathy aims to reduce the outflow tract gradients, and to improve diastolic dysfunction and rhythm disorders. Surgical myectomy i...

Authors: Hubert Seggewiss

Pacing in congestive heart failure

Despite the major advances in medical drug therapy, heart failure remains a syndrome associated with high mortality and morbidity. Biventricular or left ventricular (LV) short atrioventricular (AV) delay pacin...

Authors: Jayne A Morris-Thurgood and Michael P Frenneaux

Debate: Do all patients with heart failure require implantable defibrillators to prevent sudden death?

Sudden death is a major cause of mortality in patients with ventricular dysfunction. The highest risk occurs among patients with less severe functional impairment. Current methods of risk stratification are in...

Authors: Henry H Hsia, Mariell L Jessup and Francis E Marchlinski

Debate: Do all patients with heart failure require automatic implantable defibrillators for the prevention of sudden death?

Recent clinical trials indicate that approximately two-thirds of patients in New York Heart Association (NYHA) class II and III, who comprise almost 90% of patients with heart failure, die suddenly. Patients i...

Authors: Sidney Goldstein

Debate: Do all patients with heart failure require implantable defibrillators to prevent sudden death?

Authors: Jacobus Lubsen

Clinical applicability of molecular biology: the case of the long QT syndrome

The clinical applicability of molecular cardiology has been questioned at length and by many clinical investigators. The congenital long QT syndrome (LQTS) provides an excellent example of how tight the relati...

Authors: Peter J Schwartz

Results of the Ticlid or Plavix Post-Stents (TOPPS) trial: do they justify the switch from ticlopidine to clopidogrel after coronary stent placement?

In the Ticlid or Plavix Post-Stents (TOPPS) trial, 1016 patients undergoing successful coronary stent placement were randomized to receive aspirin and either ticlopidine or clopidogrel. In this trial, the dosa...

Authors: Peter B Berger

Debate: The slippery slope of surrogate outcomes

Surrogate outcomes are frequently used in cardiovascular disease research. A concern is that changes in surrogate markers may not reflect changes in disease outcomes. Two recent clinical trials (Heart and Estr...

Authors: Ralph B D'Agostino Jr

Angiotensin receptor blockers in heart failure after the ELITE II trial

Specific blockers of the angiotensin type1 receptor, angiotensin receptor blockers (ARBs), have been introduced as an alternative to angiotensin-converting enzyme inhibitors (ACEi) for the treatment of heart f...

Authors: Ronnie Willenheimer

Debate: Are surrogate end-point studies worth the effort?

Surrogate end-points of cardiovascular disease can provide useful information in cross-sectional, prospective and interventional studies. They provide information on association with risk factors, natural hist...

Authors: Jonathan Valabhji and Robert S Elkeles

Low-molecular-weight heparins in the treatment of venous thromboembolism

Venous thromboembolism is a common disease that is associated with considerable morbidity if left untreated. Recently, low-molecular-weight heparins (LMWHs) have been evaluated for use in acute treatment of de...

Authors: Walter Ageno and Menno V Huisman

Debate: Does it matter how you lower blood pressure?

Whether it matters how pressure is lowered has been debated since antihypertensive drugs proved to prevent cardiovascular events. However, in clinical trials, while the stroke benefit predicted by a given diff...

Authors: Michael H Alderman

Current Controlled Trials in Cardiovascular Medicine: a new journal for a new age (http://cvm.controlled-trials.com)

Authors: Curt Furberg and Bertram Pitt

Use of intravenous antiarrhythmics to identify concealed Brugada syndrome

Cardiology has recently witnessed the production of an overwhelming amount of data through the advances made in genetics and molecular biology research. Understanding of genetics has tremendous potential to ai...

Authors: Ramon Brugada

Design of a trial evaluating myocardial cell protection with cariporide, an inhibitor of the transmembrane sodium-hydrogen exchanger: the Guard During Ischemia Against Necrosis (GUARDIAN) trial

Direct myocardial cell protection in patients with unstable angina or evolving myocardial infarction (MI) could prevent cell necrosis or reduce its extent, and minimize the risk of MI and death associated with...

Authors: Pierre Theroux, Bernard R Chaitman, Leif Erhardt, Andreas Jessel, Thomas Meinertz, Wolf-Ulrich Nickel, John S Schroeder, Gianni Tognoni, Harvey White and James T Willerson

Why do antioxidants fail to provide clinical benefit?

The results of recent randomized trials to test the influence of antioxidants on coronary-event rates and prognosis in patients with coronary-artery disease were disappointing. In none of these studies did the...

Authors: Ascan Warnholtz and Thomas Münzel

Long-term outcome after coronary stenting

The present review assesses the data on long-term outcome after coronary stenting. Histological, angiographical and intravascular imaging data have shown that the insertion of stents constitutes only a transie...

Authors: Adnan Kastrati, Donald Hall and Albert Schömig

Medical errors: how the US Government is addressing the problem

November's Institute of Medicine (IOM) report on medical errors has sparked debate among US health policy makers as to the appropriate response to the problem. Proposals range from the implementation of nation...

Authors: Kevin A Schulman and John J Kim

Importance of the TIMI frame count: implications for future trials

Although the TIMI (Thrombolysis In Myocardial Infarction) flow grade classification scheme is widely used to assess angiographic outcomes, it is limited by poor reproducibility and its categoric nature. The co...

Authors: Mark A Appleby, Andrew D Michaels, Michael Chen and C Gibson Michael

Debate: When should we intervene in unstable angina - Time for an old look?

Current treatment modalities for patients with acute coronary syndromes center on early diagnosis, risk stratification and, increasingly, early treatment including invasive approaches. The appropriate timing o...

Authors: Warren K Laskey

Genetic counselling for hypertrophic cardiomyopathy: are we ready for it?

Hypertrophic cardiomyopathy (HCM) is a dominant genetic disorder of the myocardium associated with dysfunctional contractile proteins. The major risk of HCM is sudden cardiac death, which may occur even in asy...

Authors: Hans-Peter Vosberg

Current Controlled Trials: an opportunity to help improve the quality of clinical research

Some problems with the quality of controlled clinical trials can be addressed by following these procedures: registering all trials at inception; using systematic reviews to inform the design of new studies; p...

Authors: Iain Chalmers

Clinical trials in developing countries: Discussions at the “9th International Symposium on Long Term Clinical Trials”, London, UK, 19-20 June 2000

This symposium provided a useful forum for the discussion of issues relating to the design and conduct of clinical trials. There is a need for greater awareness of the complexity of modern day trials, in which...

Authors: Rachel N Johnatty

Debate: A subversive view of subsets - a dissident clinician's opinion

Clinical trialists and statisticians are very wary of subgroup analysis, for good reasons. Clinicians have to deal with situations in which subgroups of patients differ widely from one another in their prognos...

Authors: Desmond G Julian

Debate: Subgroup analyses in clinical trials: fun to look at - but don't believe them!

Analysis of subgroup results in a clinical trial is surprisingly unreliable, even in a large trial. This is the result of a combination of reduced statistical power, increased variance and the play of chance. ...

Authors: Peter Sleight

Implications of recent hypertension trials for the generalist physician: whom do we treat, and how?

The publication of the results of the Swedish Trial in Old Patients with Hypertension-2 (STOP-2) and the termination of the doxazocin arm of the Antihypertensive and Lipid Lowering Treatment to Prevent Heart A...

Authors: Lee Green

Noninferiority trials

Noninferiority trials are intended to show that the effect of a new treatment is not worse than that of an active control by more than a specified margin. These trials have a number of inherent weaknesses that...

Authors: Steven M Snapinn

Debate: Unstable angina - When should we intervene?

The prognosis of patients who present with non-ST segment elevation acute coronary syndromes (ACS) is guarded. These patients can be risk-stratified on the basis of symptom complex, electrocardiographic ST seg...

Authors: Dean J Kereiakes