Cardiology

The heart rate variability (HRV) is an indicator of the cardiac autonomic control. Two spectral components are usually recorded, viz. high frequency (0.15-0.50 Hz), which is due to vagal efferent activity and a low frequency component (0.05-0.15 Hz), due to sympathetic activity. The present study was conducted to study the HRV in two yoga practices, which have previously been reported to have opposite effects, viz , sympathetic stimulation (kapalabhati, breathing at high frequency, i.e., 2.0 Hz) and reduced sympathetic activity (nadisuddhi, alternate nostril breathing). Twelve male volunteers (age range 21 to 33 years) were assessed before and after each practice on separate days. The electrocardiogram (lead I) was digitized and off-line analysis was done. The results showed a significant increase in low frequency (LF) power and LF/HF ratio while high frequency (HF) power was significantly lower following kapalabhati. There were no significant changes following nadisuddhi. The results suggest that kapalabhati modifies the autonomic status by increasing sympathetic activity with reduced vagal activity. The study also suggests that HRV is a more useful psychophysiological measure than heart rate alone.

Randomized clinical trials of cardiac rehabilitation following myocardial infarction have typically demonstrated a lower mortality in treated patients, but with a statistically significant reduction in only one trial. To overcome the problem of not being able to detect small but clinically important benefits in mortality in randomized clinical trials of exercise and risk factor rehabilitation after myocardial infarction with small numbers of patients, we carried out a meta-analysis on the combined results of ten randomized clinical trials that included 4347 patients (control, 2145 patients; rehabilitation, 2202 patients). The pooled odds ratios of 0.76 (95% confidence intervals, 0.63 to 0.92) for all-cause death and of 0.75 (95% confidence intervals, 0.62 to 0.93) for cardiovascular death were significantly lower in the rehabilitation group than in the control group, with no significant difference for nonfatal recurrent myocardial infarction. These results suggest that, for appropriately selected patients, comprehensive cardiac rehabilitation has a beneficial effect on mortality but not on nonfatal recurrent myocardial infarction. (JAMA 1988;260:945-950) CARDIAC rehabilitation can be de¬ fined as the "sum of activity required to ensure cardiac patients the best possi¬ ble physical, mental, and social condi¬ tions so that they may by their own efforts regain as normal as possible a place in the community and lead an ac¬ tive life."1 Major objectives of cardiac rehabilitation include not only an im¬ proved functional capacity and quality of life but also a reduction in mortality and morbidity. It is difficult to assess whether either a significant improve¬ ment in quality of life or a significant reduction in mortality or morbidity is present in trials with few patients or whether the effect is consistent across trials. As a result, patients may not be referred to cardiac rehabilitation after myocardial infarction, possibly because some clinicians consider that the overall benefits are not worth the costs and the patient's efforts. The results of the lim¬ ited number of published randomized clinical trials of exercise and risk factor management after myocardial infarc¬ tion with relatively small sample sizes have not confirmed a significant effect on mortality and morbidity,2'" although in some there is an improved exercise tolerance,2,4" risk factor profile,4"'9 and psychosocial status, at least in the short term.1516 If cardiac rehabilitation after myocardial infarction was demonstrat¬ ed to reduce mortality by 20% or more, it might be more likely to be considered an important component of secondary prevention of coronary heart disease with a potentially large socioeconomic impact.

Given k independent samples of functional data the problem of testing the null hypothesis of equality of their respective mean functions is considered. So the setting is quite similar to that of the classical one-way anova model but the k samples under study consist of functional data. A simple natural test for this problem is proposed. It can be seen as an asymptotic version of the well-known anova F-test. The asymptotic validity of the method is shown. A numerical Monte Carlo procedure is proposed to handle in practice the asymptotic distribution of the test statistic. A simulation study is included and a real-data example in experimental cardiology is considered in some detail.

Vasquez A. Review of JAMA Cardiology’s 2018 “Associations of Omega-3 Fatty Acid Supplement Use with Cardiovascular Disease Risks”. Video presentation (http://www.ichnfm.org/jama2018n3) and official transcript (https://www.academia.edu/35935996) 2018 February.

It is hard to imagine that a narrow, one-way, coherent, moving, amplified beam of light fired by excited atoms is powerful enough to slice through steel. In 1917, Albert Einstein speculated that under certain conditions atoms could absorb light and be stimulated to shed their borrowed energy. Charles Townes coined the term laser (light amplification by stimulated emission of radiation) in 1951. Theodore Maiman investigated the glare of a flash lamp in a rod of synthetic ruby, creating the first human-made laser in 1960. The laser involves exciting atoms and passing them through a medium such as crystal, gas or liquid. As the cascade of photon energy sweeps through the medium, bouncing off mirrors, it is reflected back and forth, and gains energy to produce a high wattage beam of light. Although lasers are today used by a large variety of professions, one of the most meaningful applications of laser technology has been through its use in medicine. Being faster and less invasive with a high precision, lasers have penetrated into most medical disciplines during the last half century including dermatology, ophthalmology, dentistry, otolaryngology, gastroenterology, urology, gynaecology, cardiology, neurosurgery and orthopaedics. In many ways the laser has revolutionized the diagnosis and treatment of a disease. As a surgical tool the laser is capable of three basic functions. When focused on a point it can cauterize deeply as it cuts, reducing the surgical trauma caused by a knife. It can vaporize the surface of a tissue. Or, through optical fibres, it can permit a doctor to see inside the body. Lasers have also become an indispensable tool in biological applications from high-resolution microscopy to subcellular nanosurgery. Indeed, medical lasers are a prime example of how the movement of an idea can truly change the medical world. This review will survey various applications of lasers in medicine including four major categories: types of lasers, laser-tissue interactions, therapeutics and diagnostics.

Gagal jantung kongestif (Congestive Heart Failures) adalah sindrom klinis akibat penyakit jantung, ditandai dengan kesulitan bernafas serta retensi natrium dan air yang abnormal, yang sering menyebabkan edema. Kongesti ini dapat terjadi dalam paru atau sirkulasi perifer atau keduanya, bergantung pada apakah gagal jantungnya pada sisi kanan atau menyeluruh. Di RS Harapan Kita, setiap hari ada sekitar 400-500 pasien berobat jalan dan sekitar 65% adalah pasien gagal jantung  Meskipun terapi gagal jantung mengalami perkembangan yang pesat, angka kematian dalam 5-10 tahun tetap tinggi, sekitar 30-40% dari pasien penyakit gagal jantung lanjut dan 5-10% dari pasien dengan gejala gagal jantung yang ringan.

Ce logo a pour objet d'alerter le lecteur sur la menace que représente pour l'avenir de l'écrit, tout particulièrement dans le domaine universitaire, le développement massif du « photo-copillage ». Cette pratique qui s'est généralisée, notamment dans les établissements d'enseignement, provoque une baisse brutale des achats de livres, au point que la possibilité même pour les auteurs de créer des oeuvres nouvelles et de les faire éditer correctement est aujourd'hui menacée. Nous rappelons donc que la reproduction et la vente sans autorisation, ainsi que le recel, sont passibles de poursuites. Les demandes d'autorisation de photocopier doivent être adressées à l'éditeur ou au Centre français d'exploitation du droit de copie : 20, rue des Grands-Augustins, 75006 Paris. Tél. 01 44 07 47 70.

Secara ilmiah osteoporosis adalah penyakit rapuh tulang yang ditandai dengan hilangnya kepadatan tulang sehingga tulang mudah patah serta tidak tahan dengan benturan ringan. Dampak rokok terhadap kesehatan tulang belum diketahui pasti apakah penurunan massa tulang memang disebabkan oleh rokok, atau oleh faktor resiko lain. Misalnya secara umum tubuh para perokok cenderung lebih kurus. Berat badan ringan adalah salah satu faktor resiko massa resiko massa tulang rendah. Perokok juga cenderung lebih akrab terhadap alkohol, kurang aktif dan memiliki pola makan yang kurang baik. Dan wanita perokok umumnya memiliki kadar estrogen lebih rendah, dan cenderung lebih cepat mengalami menopause. Namun, beberapa literatur menyebutkan bahwa merokok dapat mengurangi penyerapan kalsium oleh tubuh.

Asian Indians exhibit unique features of obesity; excess body fat, abdominal adiposity, increased subcutaneous and intra-abdominal fat, and deposition of fat in ectopic sites (liver, muscle, etc.). Obesity is a major driver for the widely prevalent metabolic syndrome and type 2 diabetes mellitus (T2DM) in Asian Indians in India and those residing in other countries. Based on percentage body fat and morbidity data, limits of normal BMI are narrower and lower in Asian Indians than in white Caucasians. In this consensus statement, we present revised guidelines for diagnosis of obesity, abdominal obesity, the metabolic syndrome, physical activity, and drug therapy and bariatric surgery for obesity in Asian Indians after consultations with experts from various regions of India belonging to the following medical disciplines; internal medicine, metabolic diseases, endocrinology, nutrition, cardiology, exercise physiology, sports medicine and bariatric surgery, and representing reputed medi...

The European procedural guidelines for radionuclide imaging of myocardial perfusion and viability are presented in 13 sections covering patient information, radiopharmaceuticals, injected activities and dosimetry, stress tests, imaging protocols and acquisition, quality control and reconstruction methods, gated studies and attenuation-scatter compensation, data analysis, reports and image display, and positron emission tomography. If the specific recommendations given could not be based on evidence from original, scientific studies, we tried to express this state-of-art. The guidelines are designed to assist in the practice of performing, interpreting and reporting myocardial perfusion SPET. The guidelines do not discuss clinical indications, benefits or drawbacks of radionuclide myocardial imaging compared to non-nuclear techniques, nor do they cover cost benefit or cost effectiveness.

Doxorubicin (DOX) is a chemotherapeutic agent used for treatment of different cancers and its clinical usage is hindered by the oxidative injury-related cardiotoxicity. This work aims to declare if the harmful effects of DOX on heart can be alleviated with the use of Coenzyme Q10 (CoQ10) or L-carnitine. The study was performed on seventy two female Wistar albino rats divided into six groups, 12 animals each: Control group; DOX group (10 mg/kg); CoQ10 group (200 mg/kg); L-carnitine group (100 mg/kg); DOX + CoQ10 group; DOX + L-carnitine group. CoQ10 and L-carnitine treatment orally started 5 days before a single dose of 10 mg/kg DOX that injected intraperitoneally (IP) then the treatment continued for 10 days. At the end of the study, serum biochemical parameters of cardiac damage, oxidative stress indices, and histopatho-logical changes were investigated. CoQ10 or L-carnitine showed a noticeable effects in improving cardiac functions evidenced reducing serum enzymes as serum interleukin-1 beta (IL-1), tumor necrosis factor alpha (TNF-), leptin, lactate dehydrogenase (LDH), Cardiotrophin-1, Troponin-I and Troponin-T. Also, alleviate oxidative stress, decrease of cardiac Malondialdehyde (MDA), Nitric oxide (NO) and restoring cardiac reduced glutathione levels to normal levels. Both corrected the cardiac alterations histologically and ultrastructurally. With a visible improvements in-SMA, vimentin and eNOS immunohistochemical markers. CoQ10 or L-carnitine supplementation improves the functional and structural integrity of the myocardium.

Epidemiological, clinical and laboratory studies have provided definitive evidence that physical activity is able to improve fitness and reduce cardiovascular morbidity and mortality. Moreover, physical exercise also seems to significantly reduce the risk of developing other chronic diseases such as obesity, osteoporosis, diabetes, tumours and depression. Promoting physical activity in the general population is therefore one of the primary objectives of our healthcare institutions. Although the benefits of an active lifestyle have been demonstrated by numerous scientific data, only a few numbers of Italians and Europeans take up regular physical exercise. To promote physical activity, both in the general population and in subjects affected by cardiovascular diseases, the Italian Federation of Sports Medicine, the Italian Society of Sports Cardiology, the Italian Association of Hospital Cardiologists, the Italian Society of Cardiology, the Italian Association of Out-of-Hospital Cardiologists and the Italian Group of Cardiac Rehabilitation have promoted the constitution of a Task Force made up of experts in the fields of sports cardiology. The document produced by the Task Force is intended for healthcare professionals and deals with the role of physical activity in the prevention and treatment of cardiovascular diseases. It examines the beneficial effects of physical activity on the cardiovascular system, while analysing the possible risks involved and how they can be avoided. The rational principles underlying the prescription of physical activity in the cardiologic setting are described, as are the modalities for prescribing such activity.

The close, bidirectional relationship between depression and cardiovascular disease is well established. Major depression is associated with an increased risk of coronary artery disease and acute cardiovascular sequelae, such as myocardial infarction, congestive heart failure, and isolated systolic hypertension. Morbidity and mortality in patients with cardiovascular disease and depression are significantly higher than in patients with cardiovascular disease who are not depressed. Various pathophysiological mechanisms might underlie the risk of cardiovascular disease in patients with depression: increased inflammation; increased susceptibility to blood clotting (owing to alterations in multiple steps of the clotting cascade, including platelet activation and aggregation); oxidative stress; subclinical hypothyroidism; hyperactivity of the sympatho-adrenomedullary system and the hypothalamic-pituitary-adrenal axis; reductions in numbers of circulating endothelial progenitor cells and ...

Anamnesis: Datos de filiación, motivo de consulta, enfermedad actual, antecedentes personales, antecedentes familiares, antecedentes sociales, hábitos, revisión actual por sistemas. Checklist signos vitales, checklist piel, checklist cabeza: cráneo, ojos, oídos, nariz y senos paranasales, boca, faringe, checklist cuello, checklist respiratorio y pulmonar, checklist cardiaco.

In this article published in 2011, Dr Vasquez reviews his previously published "5-part Supplemented Paleo-Mediterranean Diet" originally published in 2004 and 2005. Five years later in 2016, this article was reprinted in Textbook of Clinical Nutrition and Functional Medicine. This diet plan was also reviewed at the 2013 International Conference on Human Nutrition and Functional Medicine: http://www.ichnfm.org/video-funct-inflam-1

Document relocated to https://www.academia.edu/39907759 for updates  [Unfortunately the PDF contains a few typographical errors; coauthor is Joseph Pizzorno] Evidence-based medicine—by definition—requires objective, reliable and accurate research and reviews from which to make the best decisions in patient care and public policy. The causes of inaccurate information, ranging from presumably innocent mistakes all the way to overt intentional fraud, affect all scientific and biomedical disciplines.[1] While these accidental and intentional errors can derail our understanding of diseases and thereby impact tens of thousands of affected patients, such inaccuracies in the field of nutrition have the ability to impact hundreds of millions of persons worldwide[2] because, whereas fractions of the population succumb to a specific disease that may “necessitate” drug therapy, the entire human population eats food and is thereby affected by nutrition research. Further, the science of nutrition is particularly contentious, territorial, and ironic. The great irony of nutrition research is that most of it is conducted by (medical) professionals with zero formal training in nutrition; clinical therapeutic nutrition is not taught in the vast majority of medical schools[3] [4] [5] nor in post-graduate medical training programs[6], including those specialties that are obviously impacted by dietary intake such as gastroenterology[7] and cardiology.[8] [9] Despite this absence of training in clinical nutrition, the medical profession deems and proclaims itself authoritative on all health-related topics, including the entire territory of clinical nutrition.[10] A major point of contention arises when unskilled and invalid research is published by medical authors (including nonphysician journalists[11]) in major journals, thereby mischaracterizing the validity of nutrition interventions (e.g., essentially always concluding that nutritional interventions are inefficacious or potentially hazardous) and then such research is used as political fodder in attempts to disparage, restrict and regulate the entire nutrition supplement industry[12] to the benefit of the medical profession and pharmaceutical industry. Several factors disrupting the integrity of this nutrition research are commonly found in studies published by “elite” universities in “top-tier” journals, which are then republished and distributed as “headlining news” in newspapers, magazines, and television via which they ultimately influence patient care, government policy and health outcomes for tens/hundreds of millions of people. This editorial provides several recent examples of questionable nutrition research and publications and thereafter describes possible causes and lists some proposed solutions.

Patient biopotentials are usually measured with conventional disposable Ag/AgCl electrodes. These electrodes provide excellent signal quality but are irritating for long-term use. Skin preparation is usually required prior to the application of electrodes such as shaving and cleansing with alcohol. To overcome these difficulties, researchers and caregivers seek alternative electrodes that would be acceptable in clinical and research environments. Dry electrodes that operate without gel, adhesive or even skin preparation have been studied for many decades. They are used in research applications, but they have yet to achieve acceptance for medical use. So far, a complete comparison and evaluation of dry electrodes is not well described in the literature. This work compares dry electrodes for biomedical use and physiological research, and reviews some novel systems developed for cardiac monitoring. Lastly, the paper provides suggestions to develop a dry-electrode-based system for mobile and long-term cardiac monitoring applications.

a b s t r a c t Galen's concept of the motions of the blood Galen demonstrated that the arteries contain blood and the motor power of the heart Galen postulated arteriovenous communications or anastomoses (capillaries) Galen's ebb-and-flow was supplanted by Harvey's circulation of blood History of medicine was the ultimate authority on all medical subjects for 15 centuries. His anatomical/physiological concepts remained unchallenged until well into the 17th century. He wrote over 600 treatises, of which less than one-third exist today. The Galenic corpus is stupendous in magnitude; the index of word-entries in it contains 1300 pages. Galen's errors attracted later attention, but we should balance the merits and faults in his work because both exerted profound influences on the advancement of medicine and cardiology. Galen admonished us to embrace truth as identified by experiment, warning that everyone's writings must be corroborated by directly interrogating Nature. His experimental methods' mastery is demonstrated in his researches, spanning every specialty. In his life-sustaining schema, the venous, arterial, and nervous systems, with the liver, heart, and brain as their respective centers, were separate, each distributing through the body one of three pneumata: respectively, the natural, the vital, and the animal spirits. He saw blood carried both within the venous and arterial systems, which communicated by invisible "anastomoses," but circulation eluded him. The "divine Galen's" writings, however, contributed to Harvey's singular ability to see mechanisms completely differently than other researchers, thinkers and experimentalists. Galen was the first physician to use the pulse as a sign of illness. Some representative study areas included embryology, neurology, myology, respiration, reproductive medicine, and urology. He improved the science and use of drugs in therapeutics. Besides his astounding reputation as scientist-author and philosopher, Galen was deemed a highly ethical clinician and brilliant diagnostician.

In nt te er rn na at ti io on na al l J Jo ou ur rn na al l o of f P Ph ha ar rm ma a S Sc ci ie en nc ce es s ABSTRACT Hyperlipidemia is one of the leading causes of mortality in developed as well as in developing countries like India. It attributes to the high risk of coronary heart disease and atherosclerosis which is referred as a silent killer. Obesity and Atherosclerosis are the most common cause of mortality and morbidity worldwide. A number of drugs are available that can lower the serum lipids. Their use can be limited by tolerability and adverse effects like hepatitis, rhabdomyolysis, myopathy etc. At present, herbal anti-hyperlipidemic drugs have gained importance to compensate the setbacks of modern allopathic drugs in this category. Many plants in Siddha medicine have been reported to be beneficial in hyperlipidemia. Several drugs in Siddha have been found to be beneficial in lowering the lipid levels without any major adverse effects. Numerous plants like Achyranthus aspera, Bauhinia purpurea, Cinnamomum tamala, Cissus quadrangularis, Commiphora mukul, Garcinia cambogia, Gymnema sylvestre, Terminalia arjuna, Solanum melongena, Sapindus emarginatus, etc., have been reported to have lipid lowering effect. This piece of writing reviews the anti-hyperlipidemic activity of the most familiar medicinal plants in siddha system of medicine. This item may be helpful for the researchers; academician and clinician about the potential siddha herbs having anti-hyperlipidemic activity. This review has opened the pathway to know the recent advancement of siddha medical system and also give the undeviating pledge for the society in the management of such chronic ailments.

Compilation document with 3 articles included: Evidence-based medicine-by definition-requires objective, reliable and accurate research and reviews from which to make the best decisions in patient care and public policy. The causes of inaccurate information, ranging from presumably innocent mistakes all the way to apparently intentional fraud, affect all scientific and biomedical disciplines. 1 While these accidental and intentional errors can derail our understanding of diseases and impact tens of thousands of affected patients, such inaccuracies in the field of nutrition can impact hundreds of millions of people worldwide. 2 While fractions of the population succumb to a specific disease that may need drug therapy, the entire human population eats food and is directly affected by nutrition research. Further, the science of nutrition is particularly contentious and territorial. A great irony of nutrition research is that most of it is conducted by healthcare professionals with little to no formal training in nutrition. Clinical therapeutic nutrition is not taught in the vast majority of medical schools 3-5 nor in postgraduate medical training programs 6 , including those specialties that are obviously impacted by dietary intake such as gastroenterology 7 and cardiology. 8,9 Despite this absence of training in clinical nutrition, the medical profession proclaims itself authoritative on all health-related topics, including the entire territory of clinical nutrition. 10 A major and serious problem arises when unskilled and invalid research is published by authors (including nonphysician journalists 11) in major journals which mischaracterizes the validity of nutrition interventions (e.g., essentially always concluding that nutritional interventions are inefficacious or potentially hazardous) and then such research is used politically and in the media to disparage, restrict and regulate practitoners and nutrition supplement industry 12 to the detriment of human health. Several factors disrupting the integrity of nutrition research are commonly found in studies published by "elite" universities in "top-tier" journals, which are then republished and distributed as "headlining news" in newspapers, magazines, and television via which they ultimately influence patient care, government policy and health outcomes for tens/hundreds of millions of people. This editorial provides several recent examples of questionable nutrition research and publications, lists possible causes and suggests some proposed solutions. Given that all aspects of healthcare are dependent upon the integrity of the educational, investigative and publication processes, the advancements of clinical medicine and population-wide health improvements are hindered by accidental and intentional ignorance in nutrition education and research. Recent examples of questionable nutrition publications from major journals In the following subsection, we review recent examples of questionable or inaccurate publications related to nutrition. Perceived shortcomings are documented with both citations here and links to more detailed and authoritative reviews and video presentations. In some instances, speculations regarding the cause and consequences of identified errors are provided. The next step in reestablishing credibility seems to us honesty and recognizing we all share a common goal of the health and wellness of the human community and the planet. Everyone agrees that the current healthcare system, despite its many incredible successes, is also showing its limitations and is no longer sustainable. We believe the solution starts with us the researchers and editors. A good first step might be formally recognizing the errors and showing how we can and intend to get better. Abstract

A R C A La rivista Cardiologia Ambulatoriale è pubblicata trimestralmente; il costo annuo è di 50,00 euro per le persone fisiche e di 60,00 euro per Enti e Società, da pagarsi tramite versamento sul conto corrente postale n. 51059202 intestato a Edi.Ermes S.r.l., Viale Forlanini 65, 20134 Milano. Il costo per l'estero è di 62,00 euro (persone fisiche) e di 72,00 euro (Enti e Società). I fascicoli singoli arretrati hanno un costo di 21,00 euro. A norma dell'art. 74 lett. C del DPR 26/10/72 n. 633 e del DM 09/04/93, il pagamento dell'IVA, assolta dall'Editore sugli abbonamenti o sui singoli numeri, è compreso nel prezzo di vendita. Pertanto non verrà in alcun caso rilasciata fattura. La rivista Cardiologia Ambulatoriale viene inviata per abbonamento. Gli abbonamenti e i numeri arretrati vanno richiesti tramite fax (02.70211283) o e-mail ([email protected]) a Edi.Ermes: uffi cio Abbonamenti. © by Edi.Ermes S.r.l. Tutti i diritti di proprietà letteraria e artistica sono riservati, compreso quello di traduzione. I manoscritti e le fotografi e, anche se non pubblicati, non si restituiscono. È vietata la riproduzione anche parziale (fotocopie, microfi lm ecc.) senza speciale autorizzazione dell'Editore. Aut. Trib. di Napoli n. 4342 del 22/12/1992.

Note article + attachments: Authors of a meta-analysis recently published in JAMA Cardiology concluded that omega-3 fatty acids have no significant association with fatal or nonfatal coronary heart disease or any major vascular events. This critical review examines participant profile, intervention dosage, bioavailability of intervention, and duration of therapy for the cited trials and determines that the conclusion of the meta-analysis is tentative at best.

Introduction: In professional rugby, different positional roles may require different levels of aerobic fitness. Forward and backline players from a team of elite rugby players were tested to evaluate the differences between the two groups. Methods: 28 male players, 15 backs and 13 forwards, underwent maximal treadmill cardiopulmonary exercise testing (CPX), lung spirometry, a 3 km timed run, and 21 body fat measurement. Results: Peak oxygen uptake was higher in backs than in forwards (peak VO 48.362.1 vs. 41.262.7 ml kg 2 21 min , P,0.05) with no significant difference in peak respiratory exchange ratio (1.0860.02 vs. 1.0760.02, P5NS), exercise time (1306639.7 vs. 1217625.1 s, P5NS) or time for 3 km run (667.5614.1 vs. 699.0620.7 s, P5NS). However, the forwards were taller and heavier (height 190.262.2 vs. 179.561.3 cm, P,0.001, body mass 10462.4 vs. 86.361.7 kg, P,0.0001) and had a higher fat content (body fat percentage 12.860.8 vs. 9.760.6%, P,0.01) and forced expiratory volume in 1 s (FEV1, 4.960.1 vs. 4.560.2 l, P,0.05).

Smoking and other forms of tobacco use are major risk factors for cardiovascular disease. The effect of cigarette smoking on cardiovascular health is evident even at the lowest levels of exposure. Yet, the adverse effects of smoking are reversible, with cardiovascular risk decreasing substantially within the first 2 years of smoking cessation. Significantly, the mortality from coronary heart disease is reduced more through smoking cessation than by other secondary preventive therapies such as cholesterol lowering. Smoking cessation is a highly effective way to improve cardiovascular health in smokers and extremely costeffective. However, smoking cessation therapies are not implemented maximally if they are implemented at all, perhaps because smoking is seen as a lifestyle choice or because smokers frequently relapse, as indicated by very low long-term quit rates. Too often, healthcare professionals, including lipidologists and cardiologists, do little to address their patients' smoking status, in spite of its impact on cardiovascular health. With the advent of new therapies to treat the nicotine addiction that results from smoking and other tobacco use, it is hoped that physicians will be more proactive in encouraging and implementing smoking cessation programs for their patients, with the goal of increasing long-term quit rates, and reducing the morbidity and mortality associated with cardiovascular disease.

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pidemiological studies have established a strong associ- ation between hypertension and coronary artery disease (CAD). Hypertension is a major independent risk factor for the development of CAD, stroke, and renal failure. The optimal choice of antihypertensive agents remains controver- sial, and there are only partial answers to important questions in the treatment of hypertension in the prevention and management of

Barometric pressure falls with increasing altitude and consequently there is a reduction in the partial pressure of oxygen resulting in a hypoxic challenge to any individual ascending to altitude. A spectrum of high altitude illnesses can occur when the hypoxic stress outstrips the subject's ability to acclimatize. Acute altitude-related problems consist of the common syndrome of acute mountain sickness, which is relatively benign and usually self-limiting, and the rarer, more serious syndromes of high-altitude cerebral edema and high-altitude pulmonary edema. A common feature of acute altitude illness is rapid ascent by otherwise fit individuals to altitudes above 3000 m without sufficient time to acclimatize. The susceptibility of an individual to highaltitude syndromes is variable but generally reproducible. Prevention of altitude-related illness by slow ascent is the best approach, but this is not always practical. The immediate management of serious illness requires oxygen (if available) and descent of more than 300 m as soon as possible. In this article, we describe the setting and clinical features of acute mountain sickness and highaltitude cerebral edema, including an overview of the known pathophysiology, and explain contemporary practices for both prevention and treatment exploring the comprehensive evidence base for the various interventions. (Prog Cardiovasc Dis 2010;52:467-484) An additional clinical assessment scoring is sometimes used. GI indicates gastrointestinal.