Among patients with unstable angina or myocardial infarction without ST-segment elevation, prasugrel did not significantly reduce the frequency of the primary end point, as compared with clopidogrel, and similar risks of bleeding were observed. (Funded by Eli Lilly and Daiichi Sankyo; TRILOGY ACS ClinicalTrials.gov number, NCT00699998.).

Heart failure (HF) may contribute to the development of functional decline and frailty in older adults. Sixty HF patients with an ejection fraction ≤40% evaluated in 2004 and 2005 were reevaluated in 2008. Six‐minute walk distance (6MW), frailty score, and biomarkers (25‐hydroxyvitamin D, C‐reactive protein, and interleukin‐6 [IL‐6]) were measured. Participants were categorized at baseline and follow‐up into 3 groups: nonfrail/normal endurance (NF/NE), nonfrail/low endurance (NF/LE) and frail/low endurance (F/LE). Survival time was assessed according to frailty/endurance status and associated predictors of mortality. Forty‐three men, 17 women (mean age, 78±12 years) were contacted. At follow‐up, 20 had died, 20 participated, and 20 did not participate. There were no changes in frailty/endurance status over time (McNemar;P=.19). Deaths occurred in 18% of NF/NE, 45% of NF/LE, and 60% of F/LE persons. The NF/NE group had greater survival rates than the NF/LE (  P=.032) and F/LE (  P=.014) groups. The 6MW and frailty score were independently predictive of mortality, with hazard ratios of 0.82 (95% confidence interval, 0.72–0.94) and 1.64 (95% confidence interval, 1.19–2.26), respectively, as was New York Heart Association class and IL‐6. Backward stepwise Cox regression revealed that 6MW and frailty each were associated with mortality (P=.005) and highly correlated. Physical function is an important predictor of mortality in older adults with HF. The 6MW may be useful as a measure of frailty. Congest Heart Fail. 2010;16:208–213. © 2010 Wiley Periodicals, Inc.

The physiological changes in liver function in pregnancy are commonly transient, rarely permanent. Disorders arising in pregnancy, such as pre-eclampsia and eclampsia, acute fatty liver of pregnancy (AFLP), haemolysis, elevated liver enzyme and low platelets (HELLP) syndrome, cholestasis, hyperemesis gravidarum and isolated cases of raised liver enzymes can have serious implications. Proper interpretation of liver function tests (LFTs) at an early stage can lead to timely management and may reduce complications in both mother and fetus. Normal LFTs do not always mean that the liver is normal. A number of pitfalls can be encountered in the interpretation of basic blood LFTs. The commonly used LFTs primarily assess liver injury rather than hepatic function. Abnormal LFTs may indicate that something is wrong with the liver, and they can provide clues to the nature of the problem but this is not always the case. The various biochemical tests, their pathophysiology, and an approach to the interpretation of abnormal LFTs are discussed in this review. Commonly available tests include alanine transaminase, aspartate transaminase, alkaline phosphatase, bile acid, serum bilirubin, serum albumin and prothrombin time.

No abstract