May 2008

One size doesn't fit all, yet we often approach medicine as if it does.

The importance of blood lipids in the risk of ischemic heart disease in older people is unclear; as a result, cholesterol-lowering drug therapy is not widely prescribed for older individuals without diagnosed cardiovascular disease. We conducted a study to determine the relationship between death from ischemic heart disease and the level of cholesterol, cholesterol fractions, and apolipoproteins

In the United States, 42% of acute myocardial infarctions (MIs) and more than 60% of deaths attributable to acute MIs occur in the 6.1% of the population 75 years of age or older.

Prior studies have shown an association between heart failure and the presence of hypertension and left ventricular hypertrophy (LVH). We investigated the relationship between regression of electrocardiographic (ECG) LVH by Cornell product with antihypertensive regimens and new-onset heart failure in subjects with hypertension and baseline LVH.

As clinical cardiologists, we face an ever-changing landscape with regard to the management and care of hypertensive patients.

We evaluated the differences in higher systolic blood pressure (SBP) between boys and girls in a longitudinal adolescent cohort. Results showed that although boys have a 19% relative increase in the risk of higher SBP annually between the ages of 13 and 17 years, girls do not experience the same risk increase. Among both boys and girls, being overweight increases the likelihood of high SBP almost 3-fold, and every 5 additional hours of "screen time" (television viewing, video game playing, Internet use) is associated with a 4% relative increase in the likelihood of higher SBP levels. For every 5 additional sports-related or other active behaviors over a 7-day recall, there was an 8% relative reduction in high SBP risk. Annual blood pressure assessment in teens that continues into adulthood may facilitate early detection of adult hypertension. Weight control, increased physical activity, and reduced screen time may reduce the likelihood of higher SBP levels developing in adolescents.

Dasgupta has demonstrated that adolescent Canadian boys experience an increased risk of hypertension during longitudinal follow-up compared with girls.

Patients with type 2 diabetes mellitus have decreased platelet inhibition and decreased responsiveness to standard doses of clopidogrel compared with patients without diabetes. In this pilot study, we showed that increasing the maintenance dose of clopidogrel to 150 mg leads to enhanced platelet inhibition compared with the standard dose of 75 mg in patients with type 2 diabetes with suboptimal responsiveness. The clinical implications of these findings are unknown, however, and need to be evaluated in large-scale clinical trials.