Cardiology

We assessed the association between the incidence of coronary heart disease and alcohol consumption among hypertensive men enrolled in the Health "Professionals" Follow-Up Study. Moderate alcohol consumption (1 to 2 drinks per day) was associated with a lower risk of myocardial infarction, as in the general population, but was not associated with the risks of stroke, total mortality, or mortality from cardiovascular causes. These results show that men with hypertension who drink moderately may not need to change their drinking habits.

Features of hypertrophic obstructive cardiomyopathy (HOCM) include obstruction at the left ventricular outflow tract (caused by a markedly thickened proximal interventricular septum) and systolic anterior motion of the mitral valve. The case discussed here illustrates several classic features of this disease including clinical presentation, diagnostic workup, and noninvasive and invasive management.

A significant reduction in the age-adjusted incidence of stroke in men and women and 30-day mortality in men was shown in a community-based cohort study with biennial assessment of vascular risk factors and active surveillance for incident stroke over the past 50 years. Lifetime risk, severity of stroke, and 30-day mortality in women were stable. Increased life expectancy results in an increase in lifetime risk. This increased longevity is balanced by improvements in risk factor management, yielding no significant change.

Stroke is an especially important disease to study in terms of secular trends because it is so common, deadly, and disabling.

We generally assume that having a good time must be bad for you,and no one would deny that irresponsible alcohol consumption takes a tremendous economic, social, and health-related toll on diverse populations all around the globe.

We conducted a multi-hospital population-based study of 2445 residents of a large New England metropolitan area hospitalized with acute heart failure and found that the long-term prognosis for these patients remains poor. More than one third of patients died in the first year after hospital discharge,and nearly 4 of 5 patients died over the 5-year follow-up period. Several demographic and clinical factors were associated with an adverse prognosis. It is important to know the factors that negatively affect long-term survival after hospital discharge for decompensated heart failure so that treatment can be directed toward specific high-risk groups.

When considering the article by Goldberg and colleagues, it seems reasonable to request a change in the title to "Survival after the diagnosis of  heart failure."

Statins are the most commonly used pharmacologic intervention in patients with increased cardiovascular risk. In addition to their beneficial effect on the atherogenic lipid profile, they have been shown to exert several pleiotrophic effects, including the reduction of low-grade inflammation. Thiazolidinediones (TZDs) are a new class of antidiabetic drugs that have been shown to improve insulin sensitivity and to reduce cardiovascular risk in patients with type 2 diabetes. Our study is the first to show a complementary effect of TZD and statin treatment on several cardiovascular risk factors in subjects without diabetes. These findings may have important implications for further discussion on cardiovascular risk reduction, especially for patients with metabolic syndrome.

The background required for assessing this paper by Hanefeld and Forst is derived from clinical studies using statin and peroxisome proliferator-activated receptors (PPAR)γ agonists.

This retrospective subanalysis of the Adenosine Sestamibi SPECT Post-Infarction Evaluation (INSPIRE) trial shows that early adenosine sestamibi stress testing is not only safe early after myocardial infarction (MI), but can also be very useful to identify patients at very low risk for events in the first year after discharge.

The effects of recurrent tachycardia after resolution of cardiomyopathy have not been thoroughly assessed. We evaluated and followed 24 patients with tachycardia-induced cardiomyopathy for more than 12 years. Our observations showed that patients with tachycardia-induced cardiomyopathy may be at long-term risk for sudden death. Surreptitious cardiomyopathy due to occult ultrastructural changes may persist. It has yet to be determined whether rapid and aggressive rate control would prevent structural damage to risk of sudden cardiac death.

We evaluated the prevalence of primary aldosteronism in subjects newly diagnosed with hypertension who were referred to specialized hypertension centers. An aldosterone-producing adenoma was diagnosed in the subjects with lateralized aldosterone secretion, adenoma at surgery and on pathologic evaluation, and a blood pressure fall after adrenalectomy. Evidence of excess autonomous aldosterone secretion without such criteria led to a diagnosis of idiopathic hyperaldosteronism. Aldosterone-producing adenoma and idiopathic hyperaldosteronism were conclusively diagnosed in 4.8% and 6.4% of the subjects, respectively. Thus, with a prevalence of 11.2%, primary aldosteronism is quite common in patients with newly diagnosed hypertension.

Traditionally, a diagnosis of primary hyperaldosteronism is considered when a patient has hypokalemia, either spontaneous or caused by a diuretic.

To determine whether alcohol-associated hypertension carries risks similar to those of hypertension in abstainers or light drinkers, we prospectively studied cardiovascular sequelae separately in heavy drinkers, light drinkers, and abstainers. The risk of all outcomes was progressively higher for increasing blood pressure categories, with similar associations in each alcohol category. These data indicate that the risks of hypertension are independent of the amount of alcohol intake.

Klatsky reports a link between elevated blood pressures and increased risk of hospitalizations for coronary heart disease and stroke that is independent of alcohol intake.

A number of electrocardiographic abnormalities have been described in athletes.1 Among these are sinus bradycardia and varying degrees of atrioventricular (AV) block. These findings have been attributed to the "athlete's heart," and are felt to be due to enhanced vagal tone seen with excellent physical conditioning. Secondarily it has also been suggested that there are intrinsic changes within the sinoatrial and AV nodes themselves, including prolonged sinus node recovery time and AV nodal Wenckebach, and these abnormalities persist following autonomic blockade.

Radiofrequency catheter ablation (RFA) is a cost-effective approach that has modified the treatment of patients with supraventricular tachycardia. In the Loire-Ardèche-Drôme-Isère-Puy-de-Dôme (LADIP) study, we compared RFA treatment with amiodarone therapy after the first episode of symptomatic atrial flutter. Results showed that RFA should be considered a first-line treatment, especially in elderly patients, because it has a better long-term success rate, the same risk of subsequent atrial fibrillation as amiodarone, and fewer secondary effects compared with amiodarone. Radiofrequency catheter ablation first-line therapy should be recommended in routine clinical practice, even when the atrial flutter is isolated without a previously documented atrial fibrillation episode.

Atrial flutter is an arrhythmia that occurs less commonly than atrial fibrillation and is often resistant to rate control and termination.

We compared the incidence of late clinical events after withdrawal of clopidogrel between subjects treated with drug-eluting stents (DES) and those treated with bare-metal stents. Death and myocardial infarction occurred more frequently among DES-treated subjects during the follow-up period. The results of this study indicate that there may be a penalty for the lower rate of restenosis and reinterventions after DES implantation, in particular, an increased rate of late stent thromboses.