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Recent Meta-analysis (recent + meta-analysi)
Selected AbstractsSystematic review of chorioamnionitis and cerebral palsyDEVELOPMENTAL DISABILITIES RESEARCH REVIEW, Issue 1 2002Yvonne W. Wu Abstract In a recent meta-analysis evaluating the relationship between chorioamnionitis and cerebral palsy, we found that chorioamnionitis is a risk factor for both cerebral palsy and cystic periventricular leukomalacia (cPVL). The current paper extends the meta-analysis by including studies published in the year 2000, and by further evaluating the causes of heterogeneity among individual study results. Using a random effects model, clinical chorioamnionitis was significantly associated with both cerebral palsy (RR 1.9, 95% CI 1.5,2.5) and cPVL (RR 2.6, 95% CI 1.7,3.9). Sources of heterogeneity included widely varying practices in the diagnosis of clinical chorioamnionitis, different gestational age characteristics, and varying study year. We conclude that based on the available literature, chorioamnionitis is a risk factor for both cerebral palsy and cPVL. MRDD Research Reviews 2002;8:25,29. © 2002 Wiley-Liss, Inc. [source] Has repetitive transcranial magnetic stimulation (rTMS) treatment for depression improved?ACTA PSYCHIATRICA SCANDINAVICA, Issue 3 2007A systematic review, meta-analysis comparing the recent vs. the earlier rTMS studies Objective:, To investigate whether the recent repetitive transcranial magnetic stimulation (rTMS) studies on depression using new parameters of stimulation have shown improved clinical results. Method:, We performed a systematic review and a meta-analysis of the rTMS studies on depression published in the past 12 months comparing these results with an earlier meta-analysis that analyzed the results of the initial rTMS studies on depression. Results:, Using our inclusion criteria, we selected the meta-analysis of Martin [Br J Psychiatry (2003) Vol. 182, 480,491] that included 13 studies (324 patients) and five studies for the recent meta-analysis (274 patients). The pooled effect size (standardized mean difference between pretreatment vs. post-treatment) from the random effects model was ,0.76 (95% confidence interval, CI, ,1.01 to ,0.51). This result was significantly larger than that of the earlier meta-analysis (,0.35, 95% CI ,0.66 to ,0.04). Conclusion:, Our findings suggest that recent rTMS clinical trials have shown larger antidepressant effects when compared with the earlier studies. [source] Rediscovering bile acid sequestrantsDIABETES OBESITY & METABOLISM, Issue 12 2009D. S. H. Bell Aim: In the recently published The Justification for the Use of statins in Primary prevention: an Intervention Trial Evaluating Rosuvastatin (JUPITER) mega-trial, rosuvastatin significantly reduced cardiovascular events at the expense of a small but significant increase in the risk of developing type 2 diabetes. The increased risk of new-onset diabetes was in keeping with a recent meta-analysis which suggested that statins, with the possible exception of pravastatin, marginally increase the risk of developing type 2 diabetes. Methods: Although the net effect of rosuvastatin was obviously very positive, we hypothesized that the addition of a bile aid sequestrant to a statin would not only further decrease lipid levels and potentially further decrease cardiovascular events but also protect against the development of diabetes. This is particularly relevant because the bile acid sequestrant, colesevelam, has recently been approved for therapy of diabetes. Results: Colesevelam like other bile acid sequestrants lowers low-density lipoprotein levels by 16% and C-reactive protein by 22% beyond the reductions that occur with statin therapy alone. Bile acid sequestrants confer lipid-lowering, glucose-lowering, and anti-inflammatory benefits, and have been shown to reduce risk of cardiovascular events. Conclusions: Therefore, colesevelam should be the most effective and logical agent to add to a statin in the diabetic and insulin-resistant patient, because in addition to lowering cardiac risk it may prevent the development of diabetes, as well as improving glycaemic control in the established diabetic patient. [source] Formaldehyde and leukemia: Epidemiology, potential mechanisms, and implications for risk assessment,ENVIRONMENTAL AND MOLECULAR MUTAGENESIS, Issue 3 2010Luoping Zhang Abstract Formaldehyde is widely used in the United States and other countries. Occupational and environmental exposures to formaldehyde may be associated with an increased risk of leukemia in exposed individuals. However, risk assessment of formaldehyde and leukemia has been challenging due to inconsistencies in human and animal studies and the lack of a known mechanism for leukemia induction. Here, we provide a summary of the symposium at the Environmental Mutagen Society Meeting in 2008, which focused on the epidemiology of formaldehyde and leukemia, potential mechanisms, and implication for risk assessment, with emphasis on future directions in multidisciplinary formaldehyde research. Updated results of two of the three largest industrial cohort studies of formaldehyde-exposed workers have shown positive associations with leukemia, particularly myeloid leukemia, and a recent meta-analysis of studies to date supports this association. Recent mechanistic studies have shown the formation of formaldehyde-induced DNA adducts and characterized the essential DNA repair pathways that mitigate formaldehyde toxicity. The implications of the updated findings for the design of future studies to more effectively assess the risk of leukemia arising from formaldehyde exposure were discussed and specific recommendations were made. A toxicogenomic approach in experimental models and human exposure studies, together with the measurement of biomarkers of internal exposure, such as formaldehyde-DNA and protein adducts, should prove fruitful. It was recognized that increased communication among scientists who perform epidemiology, toxicology, biology, and risk assessment could enhance the design of future studies, which could ultimately reduce uncertainty in the risk assessment of formaldehyde and leukemia. Environ. Mol. Mutagen., 2010. Published 2009 Wiley-Liss, Inc. [source] Lymphoma risk in inflammatory bowel disease: Is it the disease or its treatment?INFLAMMATORY BOWEL DISEASES, Issue 10 2007Jennifer L. Jones MD Abstract With the increasingly widespread use of immunosuppressive and biologic agents for the treatment of Crohn's disease and ulcerative colitis come concerns about potential long-term consequences of such therapies. Disentangling the potential confounding effects of the underlying disease, its extent, severity, duration, and behavior, and concomitant medical therapy has proven to be exceedingly difficult. Unlike the case in rheumatoid arthritis, the overwhelming preponderance of population-based evidence suggests that a diagnosis of inflammatory bowel disease (IBD) is not associated with an increased relative risk of lymphoma. However, well-designed studies that evaluate the potential modifying effect of IBD severity have yet to be performed. Although the results from hospital- and population-based studies have conflicted, the results of a recent meta-analysis suggest that patients receiving purine analogs for the treatment of IBD have a lymphoma risk ,4-fold higher than expected. Analyses of lymphoma risk in patients receiving biologic agents directed against tumor necrosis factor-alpha are confounded by concomitant use of immunosuppressive agents in most of these patients. Nevertheless, there may be a small but real risk of lymphoma associated with these therapies. Although the relative risk of lymphoma may be elevated in association with some of the medical therapies used in the treatment of IBD, this absolute risk is low. Weighing the potential risk of lymphoma associated with select medical therapies against the risk of undertreating IBD will help physicians and patients to make more informed decisions pertaining to the medical management of IBD. (Inflamm Bowel Dis 2007) [source] Understanding the biodiversity consequences of habitat change: the value of secondary and plantation forests for neotropical dung beetlesJOURNAL OF APPLIED ECOLOGY, Issue 3 2008Toby A. Gardner Summary 1Secondary and plantation forests are becoming increasingly widespread in the tropics. A recent meta-analysis on the impacts of land-use change on tropical forest dung beetles concluded that regenerating forests can be effective in helping to offset species loss following deforestation. However, our understanding of the extent to which these results can be generalized to new locations remains very poor. 2We attempted to overcome many of the design limitations that characterize previous studies by collecting spatially independent dung beetle samples from primary, secondary and Eucalyptus plantation forests in north-east Brazilian Amazonia across a large quasi-experimental landscape that minimized confounding edge and fragmentation effects. 3We recorded 9203 dung beetles, comprising 85 species. Species richness was significantly higher in primary forest and the majority of species were more abundant there than elsewhere, whereas secondary and plantation sites harboured an impoverished subset of primary forest species. 4Our data illustrate the low value of tropical secondary and plantation forests for dung beetles in our study area, and our conclusions are more pessimistic than those of earlier studies. 5Because of differences in the order of species rank-abundance and rank-biomass patterns, re-coding community data from abundance to biomass significantly altered the analytical weight of individual species in determining community patterns. Larger bodied beetles were more prone to local extinctions and abundance declines and this effect was consistent both within and between genera. 6Synthesis and applications. Our study demonstrates that secondary and plantation forests in a large neotropical landscape host exceptionally impoverished dung beetle communities. Furthermore, the depletion of beetle abundance combined with a reduction in average body mass in converted forests is likely to have detrimental consequences for the maintenance of dung beetle-mediated ecosystem services in these habitats. Differences in biogeographical and landscape context, and the influence of common limitations in sampling design, may explain why many other studies have painted a more optimistic picture of the conservation value of anthropogenic habitats. In the absence of further evidence we caution strongly against the claim that forest regeneration schemes on degraded land can effectively offset the loss of species following deforestation, and urge that conservation strategies prioritize the protection of remaining areas of primary forest. [source] Premenopausal Smoking and Bone Density in 2015 Perimenopausal WomenJOURNAL OF BONE AND MINERAL RESEARCH, Issue 4 2000Dr. A. P. Hermann Abstract The importance of cigarette smoking in relation to bone mass remains uncertain, especially in younger women. In a recent meta-analysis including 10 studies in premenopausal women no effect was seen in this age group. We used baseline data from a large national cohort study (Danish Osteoporosis Prevention Study [DOPS]) to study the cumulated effect of pre- and perimenopausal smoking on bone mineral density (BMD) measured shortly after the cessation of cyclic bleedings. Baseline observations on 2015 recently menopausal women were available. Eight hundred thirty-two women were current smokers and 285 were exsmokers. Significant negative associations of cigarette smoking coded as current, ex-, or never smoking were seen on bone mass in the lumbar spine (P = 0.012), femoral neck (P < 0.001), and total body (P < 0.001). Quantitatively, the differences between current smokers and never smokers were limited to 1.6, 2.9, and 1.9%, respectively. A statistical interaction was found between smoking and fat mass, indicating that women in the highest tertile of fat mass were unaffected by cigarette smoking. Serum vitamin D levels and osteocalcin were inversely related to the number of cigarettes smoked per day (r = 0.11 and P < 0.001; r = 0.17 and P = 0.04), respectively. Bone alkaline phosphatase (BALP) and urinary hydroxyproline (U-OHP) were unaffected by current smoking. The average cumulated effect of premenopausal smoking on bone is small but biologically significant. Reduced body mass in smokers explains part of the negative effect on the skeleton and a complex interaction between smoking and fat mass on the skeleton is indicated. Serum levels of 25-hydroxyvitamin D (25-OHD) and osteocalcin are lower in smokers, which may effect rate of bone loss. [source] Zidovudine with nevirapine for the prevention of HIV mother-to-child transmission reduces nevirapine resistance in mothers from the Western Cape, South AfricaJOURNAL OF MEDICAL VIROLOGY, Issue 6 2008G.U. van Zyl Abstract In the Western Cape province of South Africa, an intensified regimen for the prevention-of-mother-to-child-transmission-of-HIV consisting of zidovudine (AZT) from 34 weeks of pregnancy plus single dose (sd) nevirapine (NVP) during labor was instituted in 2004. The newborn baby receives a single dose of NVP and AZT for 7 days. Similar strategies in Thailand and Africa have been shown to be more effective in reducing transmission than NVP alone. The use of sd NVP only for the prevention-of-mother-to-child-transmission-of-HIV has a high risk of inducing resistance (25,69%) with an average of 35.7% by a recent meta-analysis and has been shown to adversely affect non-nucleoside reverse transcriptase inhibitor (NNRTI)-based antiretroviral therapy when initiated within 6 months. In this study the prevalence of resistance to NVP and AZT in mothers who had received the intensified regimen was measured. Specimens collected from mothers were genotyped by in-house PCR and sequencing. In specimens obtained within 60 days of delivery, acquired NVP resistance mutations were detected in 13 of 76 patients (17.1%, 95% confidence interval: 8.7,25.6%), which appears to be lower than in studies with sd NVP alone (37.5%, 95% confidence interval: 23.0,50.6%). J. Med. Virol. 80:942,946, 2008. © 2008 Wiley-Liss, Inc. [source] Therapy with antioxidants in human diabetic neuropathyJOURNAL OF NEUROCHEMISTRY, Issue 2003D. Ziegler Increased oxidative stress has been implicated in the pathogenesis of diabetic polyneuropathy (DPN). Antioxidant treatment with alpha-lipoic acid (ALA) has been shown to prevent or ameliorate experimental diabetic neuropathy, providing the rationale for treatment in humans. A recent meta-analysis including four controlled clinical trials provided evidence that treatment with ALA (600 mg/day i.v.) over 3 weeks is safe and significantly improves both neuropathic symptoms and deficits to a clinically meaningful degree in patients with symptomatic DPN. Moreover, oral treatment for 4,7 months tends to ameliorate neuropathic deficits and cardiac autonomic neuropathy. Clinical and postmarketing surveillance studies have revealed a highly favorable safety profile of this drug. Based on these findings, a pivotal long-term multicenter trial of oral treatment with ALA (NATHAN 1 Study) is under way aimed at slowing the progression of DPN. [source] Growth and Development of a Body of Knowledge: 16 Years of New Product Development Research, 1989,2004,THE JOURNAL OF PRODUCT INNOVATION MANAGEMENT, Issue 3 2008Albert L. Page In this study, a content analysis was performed on 815 articles focused on new product development (NPD) published in 10 selected leading marketing, management, NPD, and research and development (R&D) journals from 1989 to 2004. Journals selected were a combination of leading journals in the discipline and publications that included NPD articles. NPD articles were classified by a series of key attributes including methodology employed, domains of knowledge utilized, and broad topics explored. The resulting data were then studied to discern trends over time or common characteristics within domains, methodologies, or journals. The study of NPD has grown since the Journal of Product Innovation Management (JPIM) was launched in 1984. This study shows strong growth in the number of articles on NPD in each category of journal selected. The research in the articles has changed: The early focus on a few selected success factors or a staged development process has evolved and broadened over the 16-year period. More variables and more sophisticated models are being studied in NPD articles. The study found a continuing evolution in research topics and increased sophistication in quantitative techniques over the 16-year period. Overall this review of the NPD literature uncovers encouraging signs of a maturing discipline. However, there are concerns about continuing issues in methodology, insufficient study of service innovation, and continued focus on process characteristics instead of other antecedents of NPD success. The service sector seems to be understudied, even as the reality of a service economy is generally acknowledged. The call in a recent meta-analysis to focus more on market and product characteristics and less on process characteristics has not yet been heeded, even by marketing researchers. [source] Mycophenolate Mofetil and Calcineurin-Inhibitor Reduction: Recent ProgressAMERICAN JOURNAL OF TRANSPLANTATION, Issue 11 2009Josep M. Grinyó Mycophenolate mofetil (MMF) in combination with calcineurin inhibitors (CNIs) has greatly contributed to acute rejection rate reduction. Because of its immunosuppressive potency it was initially thought that MMF would help in reducing/avoiding CNI-related nephrotoxicity. Elective avoidance of CNI in induction and maintenance MMF-based immunosuppression has resulted in an increased risk for acute and chronic rejection. A recent meta-analysis suggests that CNI elimination in patients on MMF with progressive renal dysfunction is associated with a better outcome, although more data are needed to support any recommendation. So far, the more conservative approach involving CNI minimization with MMF has been associated with amelioration of renal function and low risk for rejection, providing an adequate risk/benefit balance. However, MMF with belatacept might pave the way for CNI-free induction and maintenance immunosuppression. Meanwhile, the assessment of immunological risk by new monitoring tools could be a prerequisite to further implement such CNI sparing strategies. [source] GS27P TECHNIQUES FOR CLOSURE OF MIDLINE ABDOMINAL INCISIONSANZ JOURNAL OF SURGERY, Issue 2007A. Ali Background A recent meta-analysis of randomised controlled trials of abdominal fascial closures concluded that in order to reduce incisional hernia rates without increasing wound pain, or the rate of dehiscence slowly absorbable continuous sutures appear to achieve the best results in abdominal fascial closures. We surveyed the techniques for abdominal fascial closure among general surgeons in Canberra, Australia. Methodology 49 out of 80 surgeons responded to the survey by form. The information collected included the seniority of the surgeon, the frequency of laparotomy closure, surgical technique and suture material utilised in abdominal fascial closure. Results 34 (69%) of the surgeons surveyed preferred a non-absorbable monofilament suture material for abdominal fascial closure with nylon being the most popular. Most (38, 78%) also preferred a non-absorbable monofilament suture in emergency surgery. 12 (24%) surgeons preferred to use slowly absorbable suture. The majority of surgeons (37, 76%) preferred continuous suture technique, whilst only 2 (4%) used continuous followed by interrupted suture closures. Only 5 (10%) complied with the dual recommendation of continuous suture technique and slowly absorbable suture. Conclusion The majority of surgeons preferred non-absorbable monofilament suture rather than slowly absorbable suture. Only 1 in 10 surgeons complied with both components of evidence base, which supports the use of slowly absorbable suture material and a continuous technique in abdominal fascial closure. A definitive RCT would confirm this observation. [source] Current concepts on human papillomavirus infections in childrenAPMIS, Issue 6-7 2010STINA SYRJÄNEN Syrjänen S. Current concepts on human papillomavirus infections in children. APMIS 2010; 118: 494,509. Current evidence is strong enough to conclude that human papillomavirus (HPV) can be transmitted both sexually and non-sexually. The debate on HPV infections in children still continues but it is more focused on HPV prevalence than on transmission modes. HPV DNA detection in amniotic fluid, foetal membranes, cord blood and placental trophoblastic cells all suggest HPV infection in utero, i.e. prenatal transmission. Based on recent meta-analysis, vertical transmission occurs in approximately 20% of cases. Most of the mucosal HPV infections in infants are incident, persistent infections in oral and genital mucosa being found in less than 10% and 2% respectively. The mother seems to be the main transmitter of HPV to her newborn, but subsequent HPV infections are acquired horizontally via saliva or other contacts. Bimodal peak prevalence is seen for skin warts, oral papillomas and recurrent respiratory papillomatosis (RRP) in younger and older age groups, suggesting similar epidemiology. Of the clinical HPV diseases, juvenile-onset-RRP and genital condylomata are problematic; the former because of its life-threatening potential and the latter because of possible sexual abuse. HPV6 and 11 are the most common genotypes in both the lesions. Early in life, infections by the high-risk HPV genotypes may also remain persistent for a considerable period, and should be of considerable importance for HPV vaccination strategies. [source] Association of a single-nucleotide polymorphism in CD40 with the rate of joint destruction in rheumatoid arthritisARTHRITIS & RHEUMATISM, Issue 8 2009Michael P. M. van der Linden Objective The severity of joint destruction in rheumatoid arthritis (RA) is highly variable from patient to patient and is influenced by genetic factors. Genome-wide association studies have enormously boosted the field of the genetics of RA susceptibility, but risk loci for RA severity remain poorly defined. A recent meta-analysis of genome-wide association studies identified 6 genetic regions for susceptibility to autoantibody-positive RA: CD40, KIF5A/PIP4K2C, CDK6, CCL21, PRKCQ, and MMEL1/TNFRSF14. The purpose of this study was to investigate whether these newly described genetic regions are associated with the rate of joint destruction. Methods RA patients enrolled in the Leiden Early Arthritis Clinic were studied (n = 563). Yearly radiographs were scored using the Sharp/van der Heijde method (median followup 5 years; maximum followup 9 years). The rate of joint destruction between genotype groups was compared using a linear mixed model, correcting for age, sex, and treatment strategies. A total of 393 anti,citrullinated protein antibody (ACPA),positive RA patients from the North American Rheumatoid Arthritis Consortium (NARAC) who had radiographic data available were used for the replication study. Results The TT and CC/CG genotypes of 2 single-nucleotide polymorphisms, rs4810485 (CD40) and rs42041 (CDK6), respectively, were associated with a higher rate of joint destruction in ACPA-positive RA patients (P = 0.003 and P = 0.012, respectively), with rs4810485 being significant after Bonferroni correction for multiple testing. The association of the CD40 minor allele with the rate of radiographic progression was replicated in the NARAC cohort (P = 0.021). Conclusion A polymorphism in the CD40 locus is associated with the rate of joint destruction in patients with ACPA-positive RA. Our findings provide one of the first non,HLA-related genetic severity factors that has been replicated. [source] Aspirin (100 mg) used for prevention of pre-eclampsia in nulliparous women: the Essai Régional Aspirine Mère,Enfant study (Part 1)BJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 5 2003Damien Subtil Objective To reduce the incidence of pre-eclampsia in nulliparous women, in accordance with the suggestion of a recent meta-analysis that low dose aspirin might decrease this incidence by more than half if used early enough in and at a sufficient dose during pregnancy (more than 75 mg). Design Multicentre randomised double-blinded placebo-controlled trial. Setting Twenty eight centres in Northern of France and one in Belgium. Population Three thousand and two hundred ninety-four nulliparous women recruited between 14 and 20 weeks. Methods Randomisation to either 100 mg aspirin or placebo daily from inclusion through 34 weeks. Main outcome measures Preeclampsia was defined as hypertension (,140 and or 90 mmHg) associated with proteinuria (,0.5 g/L). Results The aspirin (n= 1644) and placebo (n= 1650) groups did not differ significantly in the mothers' incidence of pre-eclampsia (28 of 1632 [1.7%] vs 26 of 1637 [1.6%]; relative risk, RR, 1.08, 95% CI 0.64,1.83), hypertension, HELLP syndrome or placental abruption, or in the children's incidence of perinatal deaths or birthweight below the 10th centile. The incidence of babies with birthweight below the third centile was significantly higher in the aspirin group, with no explanation. The incidence of maternal side effects was higher in the aspirin group, principally because of a significantly higher rate of haemorrhage. Conclusions Aspirin at a dose of 100 mg does not reduce the incidence of pre-eclampsia in nulliparous women. Aspirin (100 mg) is associated with an increase in bleeding complications. [source] Effect of homeopathy on analgesic intake following knee ligament reconstruction: a phase III monocentre randomized placebo controlled studyBRITISH JOURNAL OF CLINICAL PHARMACOLOGY, Issue 2 2008A. Paris What is already known about this subject ,,The efficacy of homeopathy is still under debate and a recent meta-analysis recommended further randomized double-blind clinical trials to identify any clinical situation in which homeopathy might be effective. What this study adds ,,The complex of homeopathy tested in this study (Arnica montana 5 CH, Bryonia alba 5 CH, Hypericum perforatum 5 CH and Ruta graveolens 3 DH) is not superior to placebo in reducing 24 h morphine consumption after knee ligament reconstruction. Aims The efficacy of homeopathy is still under debate. The objective of this study was to assess the efficacy of homeopathic treatment (Arnica montana 5 CH, Bryonia alba 5 CH, Hypericum perforatum 5 CH and Ruta graveolens 3 DH) on cumulated morphine intake delivered by PCA over 24 h after knee ligament reconstruction. Methods This was an add-on randomized controlled study with three parallel groups: a double-blind homeopathic or placebo arm and an open-label noninterventional control arm. Eligible patients were 18,60 years old candidates for surgery of the anterior cruciate ligament. Treatment was administered the evening before surgery and continued for 3 days. The primary end-point was cumulated morphine intake delivered by PCA during the first 24 h inferior or superior/equal to 10 mg day,1. Results One hundred and fifty-eight patients were randomized (66 in the placebo arm, 67 in the homeopathic arm and 25 in the noninterventional group). There was no difference between the treated and the placebo group for primary end-point (mean (95% CI) 48% (35.8, 56.3), and 56% (43.7, 68.3), required less than 10 mg day,1 of morphine in each group, respectively). The homeopathy treatment had no effect on morphine intake between 24 and 72 h or on the visual analogue pain scale, or on quality of life assessed by the SF-36 questionnaire. In addition, these parameters were not different in patients enrolled in the open-label noninterventional control arm. Conclusions The complex of homeopathy tested in this study was not superior to placebo in reducing 24 h morphine consumption after knee ligament reconstruction. [source] Reassessing the Cardiovascular Risks and Benefits of ThiazolidinedionesCLINICAL CARDIOLOGY, Issue 9 2008Andrew Zinn MD Abstract This article is designed for the general cardiologist, endocrinologist, and internist caring for patients with diabetes and coronary artery disease. Despite the burden of coronary disease in diabetics, little is known about the impact of commonly used oral hypoglycemic agents on cardiovascular outcomes. As the untoward effects of insulin resistance (IR) are increasingly recognized, there is interest in targeting this defect. Insulin resistance contributes to dyslipidemia, hypertension, inflammation, hypercoagulability, and endothelial dysfunction. The aggregate impact of this process is progression of systemic atherosclerosis and an increased risk of adverse cardiovascular outcomes. As such, much attention has been paid to the peroxisome-proliferator-activated receptor gamma (PPARg) agonists rosiglitazone and pioglitazone (thiazolidinediones [TZDs]). Many studies have demonstrated a beneficial effect on the atherosclerotic process; specifically, these agents have been shown to reduce markers of inflammation, retard progression of carotid intimal thickness, prevent restenosis after coronary stenting, and prevent cardiovascular death and myocardial infarction in 1 large trial. Such benefits come at the risk of fluid retention and heart failure (HF) exacerbation, and the net effect on plasma lipids is still poorly understood. Thus, the aggregate risk-benefit ratio is poorly defined. A recent meta-analysis has raised significant concerns regarding the overall cardiovascular safety of 1 particular PPARg agonist (rosiglitazone), prompting international debate and regulatory changes. This review scrutinizes the clinical evidence regarding the cardiovascular risks and benefits of PPARg agonists. Future studies of PPARg agonists, and other emerging drugs that treat IR and diabetes, must be designed to look at cardiovascular outcomes. 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