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251-351 - Admin of Veritas Storage Foundation HA 5.0 for Windows - Dump Information

Vendor : Symantec
Exam Code : 251-351
Exam Name : Admin of Veritas Storage Foundation HA 5.0 for Windows
Questions and Answers : 253 Q & A
Updated On : November 17, 2017
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251-351 Questions and Answers

251-351
  1. Gabconfig -c -x

  2. Gabconfig -c -n 2

  3. Gabconfig -x

  4. Gabconfig -n 2


Answer: B


Question: 243

Which three conditions must be met for a service group to fail over? (Choose three.)


  1. AutoFailover must be set to the default value.

  2. ManageFaults must be set to NONE.

  3. Frozen must be set to the default value.

  4. AutoStart must be set to the default value.

  5. At least one failover target must be running.


Answer: A, C, E


Question: 244

A failover service group containing non-persistent resources is configured to run on SystemA and SystemB in a two-node cluster. The service group is online on SystemA and offline on SystemB.

What will be the state of a resource on SystemB if the resource is inadvertently brought online outside of Veritas Cluster Server control, causing a concurrency violation?


  1. ONLINE

  2. OFFLINE

  3. FAULTED

  4. VIOLATED


Answer: B


Question: 245

What should you do when modifying a resource attribute in an online service group?


  1. Freeze the service group

  2. Disable the resource

  3. Disable the service group

  4. Freeze the resource


Answer: A


Question: 246

What does freezing a service group prevent?


  1. Veritas Cluster Server (VCS) notification of faults in the service group

  2. Monitoring of VCS resources in the service group

  3. Online and offline operations in the service group

  4. Modification of resource attributes in the service group


Answer: C


Question: 247 56

What is the default value for service group type when adding a new service group using the Java

console?

  1. Hybrid

  2. Failover

  3. Parallel

  4. Scalable


Answer: B


Question: 248

If two systems are specified in AutoStartList and SystemList for a failover service group, and all other service group attributes are set to default values, where is the service group brought online

when the cluster starts up?


  1. Both systems listed in AutoStartList

  2. The first system listed in AutoStartList only

  3. The first system listed in SystemList

  4. Neither system because AutoStartList is invalid


Answer: B


Question: 249

What is the recommended order for manually adding and testing new resources in a new service group?


  1. Add parent resources first, then add child resources and set them to critical

  2. Add all resources and set them to critical, then link them only after the service group is switched

  3. Add child resources first, then add parent resources and set them to non-critical

  4. Add all resources and set them to non-critical, then link them only after the service group is switched


Answer: C


Question: 250

What is used to initially configure a cluster?


  1. Haclusterconfig -initial

  2. Cluster Configuration Wizard

  3. Haconfig -initial

  4. Veritas Enterprise Administrator


Answer: B


Question: 251

In a service group with all resources online, what should you do to stop the top resource in a dependency tree from causing a failover when it is taken offline outside of Veritas Cluster Server?


  1. Freeze the resource persistently

  2. Set Probed to 0

  3. Set Critical to 0

  4. Set Enabled to 0


Answer: C 57

Question: 252

Which three attributes impact service group failover? (Choose three.)


  1. FailOver

  2. AutoFailOver

  3. Faulted

  4. FaultPropagation

  5. Frozen


Answer: B, D, E


Question: 253

You want to manage a cluster from a system that is outside the cluster. Which statement is true about using another system to run the Veritas Cluster Server Java console?


  1. The Java console is only supported on systems that have the Storage Foundation High Availability server components installed.

  2. You must obtain a license key and install the Storage Foundation High Availability client components on the system.

  3. You must verify that the system outside the cluster meets the same requirements as the

    cluster systems.

  4. You must install the client components from the Storage Foundation High Availability installation media on a supported Windows system.


Answer: D


58


Symantec 251-351 Exam (Admin of Veritas Storage Foundation HA 5.0 for Windows) Detailed Information

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  • When to accept as true with combination remedy in Dyslipidemia: A Case-analyze approach Case 1: Dyslipidemia in category 2 Diabetes

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    as a result of Jeanne has diabetes, the NCEP ATP III guidelines classify her as having a "CHD risk equivalent," putting her at highest CHD chance. definitely, girls with diabetes have a three to seven instances accelerated possibility for CHD, compared with a two to three times elevated chance in diabetic men.[24] based on both the NCEP and the American Diabetes affiliation, the LDL ldl cholesterol purpose for sufferers with diabetes is <a hundred mg/dL;[13,25] hence, Jeanne should lower her LDL cholesterol degree by using approximately forty five%. To do this, she is prescribed the dose of atorvastatin for you to get her to her LDL intention of forty mg/d (figure). This dose would also favorably have an effect on her different lipid parameters. She is also said a nutritionist for weight reduction counseling and counseled to begin a going for walks program for activity. because she has decrease-extremity swelling regardless of diuretic medication, her thiazide diuretic is changed to a loop diuretic. She is asked to come in 8 weeks to determine her progress. (although it is counseled that lipid ranges be analyzed 4 weeks after starting a statin in case a dose adjustment is required, this patient changed into also switching diuretics, making an attempt to drop extra pounds, and beginning an exercise routine—all of which necessitated an extended trial duration.)

    Comparative efficacy of the statins in reducing low-density lipoprotein ldl cholesterol (LDL-C)[14-18]

    via her next visit, Jeanne had misplaced 6 lb. She says she had all started to walk 3 instances per week and has less lessen extremity edema. Her blood force remains controlled at 128/76 mm Hg. Repeat fasting laboratory assessments are: glucose 128 mg/dL, HbA1c 6.9%, total cholesterol 195 mg/dL, triglycerides 260 mg/dL, HDL ldl cholesterol forty three mg/dL, calculated LDL ldl cholesterol one hundred mg/dL, and non-HDL cholesterol 152 mg/dL.

    despite the fact Jeanne's LDL cholesterol stage is practically at purpose, her triglyceride and non-HDL cholesterol levels nevertheless deserve to be reduced. may still her health practitioner continue with the existing statin dose, increase the dose, or accept as true with combination drug medication?

    The American Diabetes association thoughts for treating diabetic dyslipidemia consist of not simplest aggressive LDL reduction but also attaining triglyceride levels of <one hundred fifty mg/dL and HDL cholesterol levels >forty five mg/dL.[25] This affected person also has close-nephrotic-range proteinuria as a diabetic conclusion-organ complication, which contributes significantly to her combined dyslipidemia. The atorvastatin dose chosen for her has practically done her LDL cholesterol goal of <a hundred mg/dL however not her non-HDL cholesterol aim of <one hundred thirty mg/dL. Doubling the dose (to eighty mg) will reduce the LDL stage an extra 5%-7%[26] but will doubtless now not supply a satisfactory further reduction in triglycerides or raise in HDL to permit Jeanne to attain her non-HDL and HDL cholesterol dreams. therefore, aggregate therapy in place of a dose raise may be a more applicable alternative.

    adding a bile acid sequestrant, corresponding to cholestyramine or colesevelam, can reduce LDL ldl cholesterol degree an extra 15%-20%, which is fascinating; youngsters, there's a possibility with a resin that the triglyceride level will enhance (in some situations with the aid of as much as 20%-30%) instead of decrease. An alternative could be ezetimibe, a cholesterol absorption inhibitor, that may cut back LDL cholesterol up to 22% when introduced to ongoing statin remedy.[27] it's more desirable tolerated than bile acid resins and doesn't enhance triglycerides; youngsters, ezetimibe will not deliver satisfactory further advantages on HDL cholesterol and triglycerides to support Jeanne in reaching her dreams. both niacin and fibrates (gemfibrozil and fenofibrate) are helpful in reducing triglycerides and extending HDL ldl cholesterol, with niacin having the most efficient HDL cholesterol-elevating effect (see desk I ). besides the fact that children there was concern that niacin may additionally worsen glucose manage in diabetic patients, a contemporary look at means that a long-unencumber niacin formula has minimal effect on HbA1c in stable (fasting blood glucose ≤200 mg/dL) diabetes.[28] Combining niacin or a fibrate with the statin may produce an multiplied possibility of myopathy. All statins have warnings in their kit inserts[14-18] about concomitant use with fibrates or niacin, and the withdrawal of cerivastatin from the market following studies of rare episodes of rhabdomyolysis on account of its mixed use with gemfibrozil[29] highlights these warnings. Importantly, since the fibrates' basic excretory route is during the kidneys, their use in patients with renal insufficiency may additionally raise the chance of a drug interaction with statins. ultimately, as a result of our patient has a mild elevation in creatinine and because diabetic nephropathy can also irritate with time, the alternative of a fibrate isn't counseled. hence, if a low dose of niacin is prescribed and the affected person is monitored cautiously, combining extended-release niacin with the statin might produce favorable lipid responses during this patient.

    The decision is made to proceed atorvastatin 40 mg (taken in the morning) and to provoke 500 mg extended-free up niacin (Niaspan, Kos prescription drugs, Inc., Miami, FL) at bedtime for two weeks, with an increase to 1000 mg if tolerated. although most statins may still be taken in the evening, the indisputable fact that atorvastatin will also be taken at any time[30] is an expertise when given that aggregate remedy. Jeanne is instructed that niacin commonly reasons a flushing response however that taking an aspirin with the niacin could reduce its frequency and intensity. She is also steered to computer screen her glucose at home. After 6 weeks, repeat laboratory tests display glucose a hundred thirty mg/dL, HbA1c 6.9%, complete cholesterol 176 mg/dL, triglycerides 175 mg/dL, HDL cholesterol 48 mg/dL, calculated LDL ldl cholesterol ninety three mg/dL, and non-HDL ldl cholesterol 128 mg/dL. regardless of the combination therapy, her liver function continues to be inside reference latitude at alanine/aspartate aminotransferase 33/29. follow-up workplace visits to display screen lipid and glucose levels, in addition to compliance with remedy, are necessary. Hepatic transaminases should still be measured at 12 weeks of medication to be certain safeguard after which followed periodically at the clinician's discretion.


    Aortic stenosis and coronary ailment. evaluation of possibility factors

    common ARTICLE

    Aortic stenosis and coronary disorder. analysis of chance components

    Claudio Magalhães Rangel; Max Grinberg; Raul Cavalcante Maranhão; Laura Inês Ventura

    Instituto do Coração do clinic das Clínicas – FMUSP - São Paulo, SP - Brazil

    Mailing address

    summary

    aim: to research medical laboratorial aspects of the presence of coronary disorder in patients with aortic stenosis and consider the influence of possibility components in the building of obstructive coronary sickness.strategies: We studied sixty five sufferers who had extreme aortic stenosis with a demonstration for surgical procedure, a long time 51 to eighty five years, forty of them women. The coronary angiography evaluation resulted in two businesses: 26 (forty%) with obstructive coronary disorder and 39 (60%) without a coronary artery lesion. personal antecedents for coronary sickness (smoking, dyslipidemia, diabetes mellitus, arterial hypertension, family unit antecedents, sedentarism, and alcoholism) were analyzed. moreover, here assessments were made: electrocardiogram, echocardiogram with Doppler, and laboratory tests (blood glucose, complete ldl cholesterol and fractions, triglycerides, Apo-A1 and B, fibrinogen, lipoprotein (a) and fraction of triglycerides and ldl cholesterol removal in both agencies.effects: in the age analysis, the neighborhood with obstructive coronary ailment belonged to an older age latitude with statistical value (p<0.0001). signs of ischemia of the anterior wall identified on the electrocardiogram showed a significant relationship with the obstruction of an anterior interventricular artery (p<0.002). The univariate evaluation showed a major difference between the organizations involving averages of the aortic (p= 0.041), HDL (p=0.042), and fibrinogen (p=0.047) gradients. The community with coronary ailment presented a regular gradient and HDL degree lessen than the community with out obstructive coronary disease. For the fibrinogen variable, the standard within the neighborhood with out a coronary ailment changed into lower compared to that of the coronariopathy neighborhood. The multivariate logistic regression analysis showed fibrinogen ranges as an independent variable for coronary disorder (p<0.039).CONCLUSION: Fibrinogen changed into an independent chance aspect for the association between obstructive coronary disorder and aortic stenosis.

    keyword phrases: Stenosis of aortic valve, coronary artery disease, risk factors.

    Aortic stenosis in adults is characterised by way of degenerative ameliorations of the valve leaflets that encumber the proper emptying of the left ventricle, resulting in the building of muscular hypertrophy because of continual and modern pressure overload of the left ventricle. The leading factors of aortic stenosis are congenital, rheumatic, and degenerative or senile.

    The expression "risk factor"1 describes qualities that may well be found in suit individuals, which might be independently associated with the manifestation of a given disease. during this feel, a chance component can be described as any measurable trait or attribute in someone that might also cause a more desirable likelihood of his manifesting a undeniable disease2.

    A meta-evaluation of 33 studies confirmed a 37% prevalence of coronary disorder in sufferers with calcified aortic stenosis3. There are nevertheless unanswered questions concerning possibility elements for coronary artery sickness in aortic stenosis patients. in the analysis of chance components for coronary ailment, it isn't feasible to assert what degree of participation these factors have within the building of coronary disease linked to aortic stenosis. In inspecting possibility factors in an aortic stenosis patient, it will be extraordinarily essential from a scientific element of view to understand the likelihood of this affected person presenting an associated coronary disease. The answers to those questions may aid in opting for the chance of the aortic stenosis affected person additionally bearing an linked coronariopathy. We may verify the participation of every risk aspect, on my own or in mixture, in the construction of coronary disorder in aortic stenosis patients and lessen the morbidity/mortality of this association.

    strategies

    Sixty-five sufferers participated during this analysis, forty (61.5%) adult females, and 25 (38.5%) men. sufferers have been enrolled within the protocol in keeping with the following inclusion standards: presence of severe aortic stenosis, absence of another valve disease, age stronger than or equal to 50 years, no old cardiac surgical procedure, and absence of clinically gigantic renal, hepatic, hemic, or neoplastic disease.

    For each and every patient selected for the protocol, a case document kind become accomplished that blanketed age, gender, body mass index, risk components for coronary sickness, anamnesis statistics, electrocardiogram, and echocardiogram with Doppler. on the end of the interview, dates had been scheduled for laboratory assessments and cardiac catheterism.

    in the physique mass index contrast, anthropometric measurements of weight and peak were used for the body Mass Index (BMI) calculation the usage of the components BMI = weight (Kg) / height2 (m2)4.

    chosen risk elements have been smoking (dependancy of smoking more than five cigarettes a day for at least six months)5, HDL-ldl cholesterol below 35 mg/dL, LDL-cholesterol over 130 mg/dL6, diabetes mellitus (blood glucose degrees over a hundred and forty mg/dL after 12-hour overnight speedy)7, systemic arterial hypertension (patients with systolic arterial force over one hundred fifty mmHg and diastolic pressure over ninety mmHg)8, household antecedents (fogeys or siblings with heritage of coronary ailment, and a long time below fifty five years of age for guys and fewer than sixty five years of age for ladies)2, sedentarism (patients who reported actions corresponding to running lower than 30 minutes every week or sporadic participation in activities)2, and alcoholism (men with consumption of more than four doses a day or more than 20 doses a week and women with consumption of more than 3 doses a day or more than 12 doses a week)2.

    Anamnesis statistics had been described by using functional type based on the new york coronary heart affiliation classification9, angina by using the Canadian Cardiovascular Society10, syncope and signs and signs compatible with congestive coronary heart failure.

    A 12-lead electrocardiogram become performed on all sufferers using Hewlett Packard gadget, model 1700, in line with ordinary standards. considering that there are classic electrocardiographic changes in aortic stenosis, we are able to analyze the affiliation of anterior wall ischemia with colossal hurt of the anterior descending artery. we can now not assess causal relationship with different affected coronary arteries, since they can be confused with the traditional eletrocardiographic alterations that are present in extreme aortic stenosis.

    The echocardiogram with Doppler turned into carried out on all patients with ATL equipment, HDI 3000 mannequin; the maximal aortic valvar gradient was analyzed via applying BERNOULLI’s modified equation11, and the ejection fraction (EF) of the left ventricle by way of ability of the dice Method12,13.

    Blood test samples have been drawn in the morning after a 12-hour quick. Measurements of blood glucose, triglycerides, complete ldl cholesterol and fractions, fibrinogen, apoA1, apoB and Lp (a) have been conducted via the clinical Laboratory of the heart Institute. also included in this analyze were the plasma removing kinetics of synthetic chylomicrons, and this examination was carried out through the Lipids Laboratory of the coronary heart Institute.

    Cardiac catheterism was carried out on all patients enrolled in the examine as a pre-operative test with a purpose to analyze coronary anatomy and evaluate the want for myocardial revascularization associated to aortic valve replacement. The examine turned into performed using the SONES and SHIREY technique14. topics were regarded coronary sufferers when that they had as a minimum one subepicardial artery with an atherosclerotic method causing greater than 50% discount of the vessel lumen in comparison to the closest ordinary segment.

    The classification variables are presented descriptively on tables containing absolute (n) and relative (%) frequencies. The associations between these variables and the presence of coronary disease might be compared the usage of the chi-square test, verisimilitude ratio check, or Fisher’s exact test15. For the analysis of the incidence of coronary disease through age bracket, the ratio of verisimilitude verify was used15.

    continual variables are introduced descriptively in tables containing potential and normal deviation. The means of those variables as to the presence of coronary ailment had been compared with pupil’s t-test16. Gradient, blood glucose, triglycerides, Lp (a), and FTR (Ch) variables had been submitted to logarithmic transformation for parameter analysis.

    Variables that showed statistical significance within the univariate evaluation were used for the adjustment of a distinctive logistic regression model with a stepwise variable alternative procedure16.

    P values of p < 0.05 have been regarded massive.

    consequences

    ages of the 65 patients who participated within the examine diverse between fifty one and 85 years (mean 68), and forty (61.5%) of the topics have been women. Coronary angiography resulted in 26 (40%) sufferers with obstructive coronary disorder and 39 (60%) devoid of obstructive coronary sickness.

    We accompanied a stronger percentage of coronary disease incidences within the older age tiers. There changed into a change (p<0.0001) between the age brackets, i.e., the 71-eighty yr range had a bigger proportion of sufferers with ailment than the other age stages.

    A correlation between anterior ischemia seen on the electrocardiogram and damage of the anterior interventricular artery became followed. Of the 17 sufferers with lesions in this artery, eleven confirmed indications of anterior ischemia on the electrocardiogram (sixty four.71%) with p<0.002 (Fisher’s look at various). There turned into no gigantic affiliation between the groups with and devoid of coronary disorder as to gender, number of possibility elements, family unit antecedents, systemic arterial hypertension, diabetes mellitus, dyslipidemia, smoking, sedentarism, and alcoholism. No giant affiliation became stated between the companies with and with out coronary disease as to purposeful classification, angina, syncope, and coronary heart failure.

    We did look at a big difference between the agencies in term of capability of the maximal gradient (p = 0.041), HDL cholesterol (p = 0.042), and fibrinogen (p = 0.047) variables. sufferers with coronary sickness had lower values for the imply gradient and HDL than those without coronary disease. With the fibrinogen variable, patients devoid of coronary disorder had decrease imply degrees when in comparison to those with coronary sickness as is proven on desk 1.

    The have an effect on of the parameters analyzed in the presence of coronary disease is described on desk 2. best fibrinogen exerted a major have an impact on (p = 0.039) on the presence of coronary ailment.

    For the presence of coronary sickness in the logistic regression mannequin, the explanatory variables gradient, HDL, and fibrinogen have been considered. These variables showed statistical magnitude within the univariate evaluation. After the stepwise choice of variables, the fibrinogen variable confirmed importance. table 2 indicates that the estimated parameter for fibrinogen is advantageous, indicating a positive correlation as to the probability of coronary disease (the superior the price of fibrinogen, the superior the probability of coronary disease).

    Chart 1 shows the distribution of sensitivity and specificity values for different coronary disorder probabilities. The maximum cost factor for both indices is the probability cost of 0.42.

    A 0.forty two likelihood corresponds to a fibrinogen price of 370, that's, if the sufferers with values over 370 are classified as coronary patients and those with values under 370 are considered not unwell, we have a 57.7% sensitivity and a 63.2% specificity (Charts 1 and a couple of)

    dialogue

    The incidence of coronary sickness in sufferers submitted to aortic valve replacement is estimated between 7% and 66%17,18. A meta-analysis with 33 stories confirmed a 37% occurrence of coronary sickness in sufferers with calcified aortic stenosis3. In our sequence, the forty% prevalence of coronary ailment proved to be in the usual of the above mentioned latitude, as had also been confirmed in neatly-carried out reports performed by way of LUND et al19 Mautner et al20 and Paquay et al21.

    The ordinary age of 70 years was akin to these referred to by different authors reminiscent of VEKSHTEIN22 and BESSONE23. In our sequence, the age imply did not exhibit a statistical change between the two organizations even with the older age range in the coronariopathy patients. a undeniable correlation was observed between age and coronariopathy expense, the place the older age bracket has a better likelihood of coronary sickness linked to aortic stenosis22,23. Our maximum age imply is in settlement with that found in most scientific literature.

    The presence of coronary disease in sufferers with aortic stenosis has been the focal point of many experiences, and a few have recommended a correlation between chance elements and the presence of coronary disease in aortic valve disorder patients18,24-26. The participation of possibility components for coronary disorder has no longer been safely appreciated as a predictive aspect of coronary disorder in sufferers with aortic stenosis18,24,26,27. In some studies, the absence of chance factors and angina had been sufficient to exclude coronary sickness associated with valve disorders26. nonetheless, Acar et al28 and Pluta et al18 discovered a high chance factor incidence in sufferers with coronary sickness linked to aortic stenosis, whereas Carstens et al29 and Exadactylos et al30 did not look at a correlation between the presence of chance components and the incidence of coronary disorder linked to aortic stenosis. In our community of sufferers, the superior number of possibility factors did not raise the incidence of coronary ailment, a proven fact that agrees with the reviews of Carstens29 and Exadactylos30.

    Some authors24,31,32 have followed that the aortic gradient tends to be smaller in sufferers with than in these devoid of angina, specially when the angina is extreme. This statement could be caused via the brilliant prevalence of coronary disorder associated with moderate aortic stenosis. Berndt et al33 demonstrated that the aortic gradient changed into smaller in patients that had coronary disease, which was additionally a outcome noted in our study 251-351. a number of authors18,24,28,31,32 had this identical outcome, which raises the hypothesis that myocardial ischemia or infarct might doubtlessly reduce the gradient throughout the aortic valve.

    a number of studies in literature34-38 observed that reduced tiers of HDL-c boost the chance of coronary ailment, certainly if triglyceride degrees are also elevated. Our examine showed higher HDL-c levels in sufferers with aortic stenosis with out coronary ailment, reinforcing the theory of a insurance plan factor for coronary disorder. This point identified in our examine is a crucial aspect because, when faced by using a given affected person’s situation, it allows us, together with different components, to assess the probability of his proposing coronary sickness associated with aortic stenosis.

    The degree of plasmatic fibrinogen has been proven to be a predictor of coronary ailment in a number of prospective studies39,40. Seven prospective studies41,42 have referred to an increase in the incidence of coronary disorder when fibrinogen ranges are high. The participation of fibrinogen as a possibility component within the coronary disease of a patient with a valve disorder has no longer yet been suggested in literature.

    In our analysis, this correlation turned into statistically huge on the univariate evaluation (desk 1) and on the logistic regression mannequin (table 2). We studied it as a vital element in inspecting the probability of a affected person with aortic stenosis having an linked coronary ailment, on the grounds that with the revolutionary raise of fibrinogen ranges, the probability of this affiliation also rises (Chart 2).

    In conclusion, the commentary of fibrinogen degrees in scientific observe could be indicative of the accelerated prevalence of obstructive coronary ailment in sufferers with aortic stenosis. This influence turned into considered in our research, the place the level of fibrinogen changed into an impartial risk element for the association of obstructive coronary sickness and aortic stenosis, as the highest ranges improved the probability of this affiliation. This point, together with an evaluation of the aortic gradient, age latitude, electrocardiogram, and HDL-c level, can be extraordinarily crucial in the diagnosis and medication of this group of sufferers, enhancing the scientific observe-up of this population.

    REFERENCES

    1. Doyle J. risk components in coronary heart disease. N Y State J Med 1963;63:1317-20.        [ Links ]

    2. timber D, De Backer G, Faergeman O, Grahan I, Mancia G, Pyörälä okay. Prevention of coronary coronary heart sickness in medical apply. Recomendation of the 2d Joint assignment drive of European and others Societies on Coronary Prevention. Eur heart J 1998;19:1434-503.        [ Links ]

    3. Mauter GC, Roberts WC. pronounced frequency of coronary arterial narrowing via angiogram in affected person with valvular aortic stenosis. Am J Cardiol 1992;sixty nine:539-40.        [ Links ]

    4. Larsson B. obesity and physique fats distribution as predictors of coronary coronary heart disorder. In: Marmot M, Elliott P. Ed. Coronary coronary heart sickness Epidemiology. From Aetiology to Public fitness. Oxford: Oxford university Press, 1992:233-forty one.        [ Links ]

    5. Auerbach O, Hammond EC, Garfinkel L. Smoking when it comes to atherosclerosis of the coronary arteries. N Engl J Med 1965;273:775-9.        [ Links ]

    6. Assman G, Schulte H. Relation of excessive- density lipoprotein ldl cholesterol and triglycerides to incidence of atherosclerosis coronary artery disorder (the PROCAM experience). Am J Cardiol 1992;70:733-7.        [ Links ]

    7. Garcia MJ, McNamara PM, Gordon T, Kannel WB. Sixteen yr observe-up analyze. Morbidity and mortality in diabetics in Framinghan inhabitants. Diabetes 1974;23:105-11.        [ Links ]

    8. III Consenso Brasileiro de Hipertensão Arterial. Campos do Jordão, SP, 12-15 fev. 1998.        [ Links ]

    9. The standards Committee of the ny coronary heart association: ailments of the coronary heart and Blood Vessels; Nomenclature and standards for prognosis. 6th ed. Boston: Little Brown, 1964.        [ Links ]

    10. Campeau L. Grading of angina pectoris. Circulation 1976;fifty four:522-3.        [ Links ]

    11. Hatle L, Angelsen B, Thomsdal A. Noninvasive assesment of aortic stenosis with the aid of Doppler ultrasound. Br heart J 1980;43:284-92.        [ Links ]

    12. Triulzi MO, Wilkins GT, Gillan LD. usual grownup pass sectional echocardiographic valves: LV volumes. Echocardiography 1985;2:153-70.        [ Links ]

    13. Sahn DJ, DeMaria A, Kisslo J, Weyman A. The commitee on M-mode standartization of the American Society of Echocardiography. techniques involving quatitation in M-mode echocardiographic mensurements. Circulation 1978;58:1072-83.        [ Links ]

    14. Sones FM, Shirley EK. Cinecoronary artheriography. Mod concepts Cardiovasc Dis 1972;31:735-eight.        [ Links ]

    15. Rosner B. Fundamentals of Biostatistics. 2nd Ed. Boston: PWS Publishers, 1986.        [ Links ]

    16. Hosner DW, Lemeshow S. applied Logistic Regression. new york: John Wiley & Sons, 1989.        [ Links ]

    17. Nunley DL, Grunkemerer GL, Starr A. Aortic valve substitute with coronary bypass grafting. J Thorac Cardiovasc Surg 1983;eighty five:705-eleven.        [ Links ]

    18. Pluta W, Buszman P, Lekston A, Pasyk S. Coronary artery stenosis in pacients with vascular coronary heart disease. Cor Vasa 1989;31:451-7.        [ Links ]

    19. Lund O, Nielsen TT, Pilegaard HK, Manussen okay, Knudsen MA. The have an impact on of coronary artery disease and pass grafting on early and late survival after valve substitute for aortic stenosis. J Thorac Cardiovasc Surg 1990;3:327-37.        [ Links ]

    20. Mautner GC, Cannon RO third, Mautner SL, Hunsberger SA, Roberts WC. medical components useful in predicting aortic valve constitution in sufferers > 40years of age with remoted valvular aortic stenosis. Am J Cardiol 1993;72:194-8.        [ Links ]

    21. Paquay PA, Anderson G, Diefenthal H, Nordstrom L, Richman HG, Gobel FL. Chest pain as a predictor of coronary artery disease in patients with obstrutive aortic valve disease. Am J Cardiol 1976;38:863-9.        [ Links ]

    22. Vekshtein VI, Alexander RW, Yeung AC, Plappert T, St John Sutton MG, Ganz P et al. Coronary atherosclerosis is associated with left ventricular dysfunction and dilatation in aortic stenosis. Circulation 1990;eighty two:2068-74.        [ Links ]

    23. Bessone LN, Pupello DF, Hiro SP, Lopez-Cuenca E, Glatterer MS, Ebra G. Surgical administration of aortic valve disorder within the aged : a logitudinal analysis. Ann Thorac Surg 1988;.forty six:264-9.        [ Links ]

    24. Vandeplas A, Willems JL, Piessens J, de Geest H. Frequency of angina pectoris and coronary artery sickness in severe isolated valvular aortic stenosis. Am J Cardiol 1988;62: 117-20.        [ Links ]

    25. Sheiban J, Trevi GP, Benussi P, Marini A, Accardi R.; Di Bona E et al. Incidence of coronary artery disease in sufferers with valvular coronary heart ailment. Z Kardiol 1986;75(Suppl 2):seventy six-9.         [ Links ]

    26. Ramsdale DR, Bennett DH, Bray CL, Ward C, Beton DC, Faragher EB. Angina, coronary possibility elements and coronary artery sickness in patients with valvular sickness. A potential look at. Eur coronary heart J 1984;5:716-26.        [ Links ]

    27. Wilson RF. Catheterization of sufferers with aortic valve disorder. In: The Aortic Valve sickness. Philadelphia: Hanley and Belfus, 1991; 7:fifty seven-70.        [ Links ]

    28. Acar J, Vahanian A, Dicimetiere PH, Berdah J, Aouate PH, Sienczewski JA et al. should coronary arteriography be carried out in all sufferers who bear catheterization for valvular heart sickness? Z Kardiol 1986;75(Suppl 2):53-60.        [ Links ]

    29. Carstens V, Haum A, Grond M, Behrenbeck DW. Incidence of coronary artery disease and necessity for coronary angiography in sufferers with valvular coronary heart disorder. Z Kardiol 1986; 75(Suppl 2):eighty three-5.        [ Links ]

    30. Exadactylos N, Sugrue DD, Oakley CM. incidence of coronary artery sickness in sufferers with remoted aortic valve stenosis. Br coronary heart J 1984;20:121-four.        [ Links ]

    31. Mandal AB, grey IR. importance of angina pectoris in aortic valve stenosis. Br coronary heart J 1976;38:811-5.        [ Links ]

    32. Morrison GW. Incidence of coronary artery disorder in patients with valvular heart sickness. Br coronary heart J 1980;forty:630-7.        [ Links ]

    33. Berndt TB, Hancock EW, Shumway NE, Harrison DC. Aortic valve replacement with and with out coronary artery bypass surgical procedure. Circulation 1974;50:967-71.        [ Links ]

    34. Assmann G, Cullen P, Schulte H. The Münster heart look at (PROCAM). outcomes of comply with-up at 8 years. Eur heart J 1998;19:A2-A11.        [ Links ]

    35. Manninen V, Huttunen J, Heinimem O, Tenkanem L, Frick M. Relationships between baseline lipid and lipoprotein values and the incidence of coronary heart sickness within the Hensink heart analyze. Am J Cardiol 1989;sixty three:42H-7H.        [ Links ]

    36. Gordon T, Kannel WB, Castelli WP. Lipoproteins, cardiovascular and demise: The Framingham look at. Arch Intern Med 1981;141:1128-31.        [ Links ]

    37. Lipid research medical institution program. The Lipid research sanatorium Coronary basic Prevention Trial outcomes I. discount within the incidence of coronary coronary heart disease. JAMA 1984;251:351-sixty four.        [ Links ]

    38. Davies C, Rifikind B, Brenner H. A single cholesterol measurement undertimate the possibility of CHD. An empirical example from the Lipid research Clinics mortality observe-up study 251-351. JAMA 1990;264:3044-6.        [ Links ]

    39. Wilhelmsen L, Svärdsudd okay, Korsan-Bengtsen okay, Larsson B, Welin L, Tibblin J. Fibrinogen as a chance elements for and myocardial infarction. N Engl J Med 1984;311:501-5.        [ Links ]

    40. Meade T. Fibrinogen and different clotting factors in heart problems. In: Francis Jr R., ed. Atherosclerosis Vascular ailment, Hemosthasis, and Endothelial characteristic. ny: Marcel Dekker, 1992:1-34.        [ Links ]

    41. Meade TW, North WRS, Chakrabarti R. Haemostatic function and cardiovascular death: early consequences of a prospective study 251-351. Lancet 1980;v.i:1050-4.        [ Links ]

    forty two. Cremer P, Najel D, Labrot B. Lipoprotein Lp(a) as predictor of myocardial infarction in comparision to fibrinogen , LDL cholesterol and different chance elements: consequences from the prospective Gottingen risk Incidence and incidence examine (Grips). Eur J Clin make investments 1994;24:444-531.        [ Links ]

    Mailing tackle:Claudio Magalhães RangelRua Itapeva, 24001332-000 – São Paulo, SP - BrazilE-mail: cmsrangel@terra.com.br

    bought on 10/13//04Accepted on 03/17/06


    Islamicate Networks syllabus (= Islamic heritage & culture intro.)No result found, are attempting new key phrase!The last assignment (in lieu of a remaining examination) incorporates a ultimate entry and a last practise ... [selections], The Fihrist, 1-5, 246-251, 351-378 (skim), 583-597. OR * Shawkat Toorawa, "The Presence and Insistence of Books," Ibn Abī Ṭāhir Ṭayfūr ...
    Non-natural Dosing of Statins in Statin-intolerant patients—Is It worth a are attempting?Stone NJ, Robinson JG, Lichtenstein AH, Bairey Merz CN, Blum CB, Eckel RH, et al. 2013 ACC/AHA guideline on the medication of blood ldl cholesterol to reduce atherosclerotic cardiovascular chance in adults: a report of the American college of Cardiology/American heart affiliation task drive on follow guidelines. Circulation. 2014;129:S1–S45. this is probably the most fresh proof-primarily based approach to cholesterol decreasing. indications for statin remedy moreover way of life to cut back CVD risk (including coronary heart disorder and stroke) are outlined and supported via extensive literature.PubMedCrossRefGoogle pupil


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