Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012

guías publicadas por la European Society of Cardiology sobre insuficiencia cardiaca.

1. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012. The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure association (HFA) of he ESc. European Heart Journal 2012; 33: 1787-1847.

Link: http://www.escardio.org/guidelines-surveys/esc-guidelines/GuidelinesDocuments/Guidelines-Acute%20and%20Chronic-HF-FT.pdf

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• AHA Scientific Statement

Sexual Activity and Cardiovascular Disease

A Scientific Statement From the American Heart Association

1. Glenn N. Levine, MD, FAHA, Chair; 
2. Elaine E. Steinke, RN, PhD, FAHA;
3. Faisal G. Bakaeen, MD; 
4. Biykem Bozkurt, MD, PhD, FAHA; 
5. Melvin D. Cheitlin, MD, FAHA; 
6. Jamie Beth Conti, MD; 
7. Elyse Foster, MD, FAHA; 
8. Tiny Jaarsma, RN, PhD, FAHA; 
9. Robert A. Kloner, MD, PhD; 
10. Richard A. Lange, MD, MBA, FAHA;
11. Stacy Tessler Lindau, MD; 
12. Barry J. Maron, MD; 
13. Debra K. Moser, DNSc, RN, FAHA;
14. E. Magnus Ohman, MD; 
15. Allen D. Seftel, MD; 
16. William J. Stewart, MD on behalf of the American Heart Association Council on Clinical Cardiology Council on Cardiovascular Nursing Council on Cardiovascular Surgery and Anesthesia, and Council on Quality of Care and Outcomes Research

Key Words:

• AHA Scientific Statements
• cardiovascular disease

Introduction

Sexual activity is an important component of patient and partner quality of life for men and women with cardiovascular disease (CVD), including many elderly patients.¹ Decreased sexual activity and function are common in patients with CVD and are often interrelated to anxiety and depression.^2,3 The intent of this American Heart Association Scientific Statement is to synthesize and summarize data relevant to sexual activity and heart disease in order to provide recommendations and foster physician and other healthcare professional communication with patients about sexual activity. Recommendations in this document are based on published studies, the Princeton Consensus Panel,^4,5 the 36th Bethesda Conference,^6–10 European Society of Cardiology recommendations on physical activity and sports participation for patients with CVD,^11–13 practice guidelines from the American College of Cardiology/American Heart Association^14–16 and other organizations,¹⁷ and the multidisciplinary expertise of the writing group. The classification of recommendations in this document are based on established ACCF/AHA criteria (Table).

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Table.

Applying Classification of Recommendation and Level of Evidence

Acute Cardiovascular Effects of Sexual Activity

Numerous studies have examined the cardiovascular and neuroendocrine response to sexual arousal and intercourse, with most assessing male physiological responses during heterosexual vaginal intercourse.^18–24 During foreplay, systolic and diastolic systemic arterial blood pressure and heart rate increase mildly, with more modest increases occurring transiently during sexual arousal. The greatest increases occur during the 10 to 15 seconds of orgasm, with a rapid return to baseline systemic blood pressure and heart …

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Effect of Aspirin on Vascular and Nonvascular Outcomes Meta-analysis of Randomized Controlled Trials

Image via WikipediaEffect of Aspirin on Vascular and Nonvascular Outcomes

Meta-analysis of Randomized Controlled Trials

Sreenivasa Rao Kondapally Seshasai, MD, MPhil; Shanelle Wijesuriya, MA, MBBChir; Rupa Sivakumaran, MA, MBBChir; Sarah Nethercott, MA, MBBChir;Sebhat Erqou, MD, PhD; Naveed Sattar, MD, PhD; Kausik K. Ray, MD 

Arch Intern Med. Published online January 9, 2012. doi:10.1001/archinternmed.2011.628

Background  The net benefit of aspirin in prevention of CVD and nonvascular events remains unclear. Our objective was to assess the impact (and safety) of aspirin on vascular and nonvascular outcomes in primary prevention.

Data Sources  MEDLINE, Cochrane Library of Clinical Trials (up to June 2011) and unpublished trial data from investigators.

Study Selection  Nine randomized placebo-controlled trials with at least 1000 participants each, reporting on cardiovascular disease (CVD), nonvascular outcomes, or death were included.

Data Extraction  Three authors abstracted data. Study-specific odds ratios (ORs) were combined using random-effects meta-analysis. Risks vs benefits were evaluated by comparing CVD risk reductions with increases in bleeding.

Results  During a mean (SD) follow-up of 6.0 (2.1) years involving over 100 000 participants, aspirin treatment reduced total CVD events by 10% (OR, 0.90; 95% CI, 0.85-0.96; number needed to treat, 120), driven primarily by reduction in nonfatal MI (OR, 0.80; 95% CI, 0.67-0.96; number needed to treat, 162). There was no significant reduction in CVD death (OR, 0.99; 95% CI, 0.85-1.15) or cancer mortality (OR, 0.93; 95% CI, 0.84-1.03), and there was increased risk of nontrivial bleeding events (OR, 1.31; 95% CI, 1.14-1.50; number needed to harm, 73). Significant heterogeneity was observed for coronary heart disease and bleeding outcomes, which could not be accounted for by major demographic or participant characteristics.

Conclusions  Despite important reductions in nonfatal MI, aspirin prophylaxis in people without prior CVD does not lead to reductions in either cardiovascular death or cancer mortality. Because the benefits are further offset by clinically important bleeding events, routine use of aspirin for primary prevention is not warranted and treatment decisions need to be considered on a case-by-case basis.

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