Cardiology

We analyzed a subgroup of 2445 subjects with diabetes, macrovascular disease, and previous myocardial infarction (MI) from the Prospective Pioglitazone Clinical Trial in Macrovascular Events to determine the effects of pioglitazone on mortality and macrovascular morbidity. Pioglitazone was shown to decrease the occurrence of adverse cardiac outcomes, including recurrent MI, in these high-risk subjects. This additional benefit of pioglitazone in patients with diabetes and a previous MI suggests that it may be appropriate to include this medication in the management strategy of patients with MI.

Patients with type 2 diabetes have a 2- to 4-fold increased incidence of coronary artery disease than those without diabetes.

We evaluated the accuracy of the 64-slice computed tomography (CT) angiography scanner in subjects who were scheduled to undergo invasive angiography for possible stenosis in coronary artery bypass grafts. Results showed that the improved resolution of CT scanners with 64-slice technology allowed for a precise delineation of bypass graft occlusion or stenosis. It permitted an accurate noninvasive assessment of bypass grafts, even in subgroups of subjects with suboptimal scan conditions, such as those with arrhythmias or higher heart rates.

In their study, Meyer and colleagues investigated the accuracy of multislice computed tomography (MSCT) in the assessment of bypass grafts following coronary artery bypass graft (CABG) surgery.

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.

The current guidelines for the management of heart failure in women are based upon data collected from studies predominantly enrolling men. However, because important differences exist in the sex-based pathogenesis of and prognosis for heart failure, the current risk-benefit analyses that guide the evidence-based management of heart failure in women demands prospective assessment.

Our increasing ability to intervene in high-risk patients—with lower risks and greater chances for successful outcomes—is felt across the broad spectrum of cardiovascular disease. This is particularly evident in patients with dilated cardiomyopathy (DCM).

Lifestyle recommendations for the prevention and treatment of hypertension include weight loss, reduced sodium intake, increased physical activity, limited alcohol intake, and the Dietary Approaches to Stop Hypertension (DASH) diet. The 18-month results of the Prospective Registry Evaluating Myocardial Infarction: Events and Recovery (PREMIER) randomized clinical trial showed that individuals with prehypertension and stage 1 hypertension can make and sustain many of these lifestyle changes over the long term, thereby reducing their risk of cardiovascular disease.

Roughly 40% of cases of hypertension are attributable to genetic factors and perhaps 40% to lifestyle factors, particularly diet, salt intake, weight, and exercise.

We evaluated the cardioprotective effects of intensive statin therapy before major vascular surgery in a prospective study of 359 subjects. After multivariate analysis, lower low-density lipoprotein (LDL) cholesterol was associated with decreased myocardial ischemia, troponin T release, and 30-day and late cardiac events. Furthermore, higher doses of statins were associated with better cardiac outcome, even after adjusting for LDL cholesterol.

In a recently published prior paper, Dr Feringa and his colleagues called attention to the prevalence of postoperative cardiac abnormalities in patients undergoing noncardiac vascular surgery.

We conducted an observational study to compare singleantiplatelet therapy with dualantiplatelet therapy among patients requiring long-term warfarin therapy after coronary stenting. Results showed that there was no difference in mortality or myocardial infarction between the 2 treatment regimens at 6 months, with no excess in-hospital bleeding; however, larger trials are needed to determine firm recommendations.

In this period of heightened concern over the increased risk of late and very late stent thrombosis with the use of drug-eluting stents, it is worthwhile to examine the anticoagulation regimens given after insertion of a stent.