Cardiology

Anomalous coronary arteries are rare congenital cardiac defects with varying symptomatology and controversial clinical significance. These should be considered as a differential diagnosis, particularly when coronary schemia occurs in a child or young adult.

Recent observational studies have suggested that statins have a protective effect against cancer. However, long-term statin users were shown to be healthier, less frail, and more adherent to therapy and screenings. We conducted a cohort study to evaluate the effect of statins on several common cancers in a large elderly population.

There has been an epidemiologic association of low total cholesterol levels with increased risk of cancer noted for several decades.

We assessed the pattern of use and the effectiveness of antithrombotic therapy in a cohort of high-risk elderly patients hospitalized for atrial fibrillation, with data derived from prescription, hospitalization, and mortality databases from 3 linked registries. Results showed that antithrombotic therapy was underused, even in patients with no comorbid conditions. In addition, patients exposed to antithrombotic therapy had a significantly lower mortality rate. The collection of epidemiological data by record linkage represents a flexible and readily available tool for monitoring and improving routine clinical care.

Multislice computed tomography (MSCT) detects proximal coronary atherosclerotic plaque or obstructive coronary artery disease (CAD) in "a significant proportion" of patients with a low or intermediate Framingham risk score, according to research conducted at the Cleveland Clinic in Ohio.

We evaluated 100 subjects who underwent multislice computed tomography (MSCT) to assess the presence and severity of coronary artery disease (CAD) and to determine the occurrence of coronary events (including cardiac death, nonfatal myocardial infarction, unstable angina requiring hospitalization, and revascularization) over a follow-up period of 16 months.

We developed a set of equations to predict the risk or probability of developing coronary artery disease (CAD) in 10 years among American Indians. The equations are based on the significant risk factors identified in the Strong Heart Study, a longitudinal study of cardiovascular disease in American Indians. The equations can be used in patient education and to evaluate the efficacy of CAD prevention and intervention programs.

The risk calculator reported in the Lee et al paper was developed to predict the 10-year cardiovascular (CV) disease probability in an American Indian population.

Diabetic patients with acute coronary syndromes are at higher risk for mortality, even if they have ST-segment elevation myocardial infarction. Diabetic patients with unstable angina/non–Q-wave infarction have impaired platelet responsiveness to nitric oxide, a physiological anti-aggregating autocoid. The extent of this impairment depends on the degree of hyperglycemia. Rapid correction of hyperglycemia with infused insulin restores responsiveness to nitric oxide, thus ameliorating platelet dysfunction.

Glucose-insulin-potassium (GIK) was initially advocated as a treatment of acute myocardial infarction (MI) to promote electrical stability.

To evaluate the interactions between the weight loss drug, sibutramine, and different antihypertensive treatments, we randomly assigned 171 subjects taking 3 antihypertensive treatment regimens to receive sibutramine or placebo. Our study showed for the first time that combination therapy with an angiotensin-converting enzyme inhibitor and a calcium channel blocker is more advantageous than a ß blocker/diuretic-based-regimen with regard to supporting the weight-reducing actions and metabolic changes induced by sibutramine.

Obesity is a growing epidemic in the United States and around the world.

The study presented in this issue of Cardiology Review by Schuijf and colleagues investigated various aspects of what is rapidly becoming an accepted imaging modality for the assessment of coronary artery disease.

We evaluated the prognostic value of cardiac magnetic resonance (CMR) stress testing with direct comparison of adenosine stress first-pass perfusion and dobutamine stress wall motion imaging among 513 subjects with known or suspected coronary heart disease over a median follow-up period of 2.3 years. Positive results on CMR stress testing identified subjects at high risk for subsequent cardiac events (nonfatal myocardial infarction or cardiac death), whereas normal CMR stress test results were associated with a very low annual cardiac event rate.

In Jahnke et al's study, the authors showed the prognostic value of yet another imaging modality—perfusion magnetic resonance (MR) imaging and dobutamine stress MR.

We conducted a substudy of the Rate Control Versus Electrical Cardioversion (RACE) study to evaluate cardiovascular morbidity, mortality, and the outcome of rate and rhythm control treatment in subjects with and without hypertension with persistent atrial fibrillation.

This review summarizes an important substudy of the Rate Control Versus Electrical Cardioversion (RACE) trial, which randomized 522 patients with atrial fibrillation (AF) to rate versus rhythm control treatment strategies and followed them for up to 2.3 years with a primary composite endpoint that included cardiovascular mortality, heart failure, thromboembolic complications, bleeding, severe adverse effects of anti-arrhythmic agents, and pacemaker implantation.

The use of anticoagulation therapy for atrial fibrillation has slowly increased in the last decade, yet many patients at relatively high risk for thromboembolic events are still not receiving anticoagulants. Patients receiving therapy that is intended to maintain sinus rhythm may be at higher risk for underuse of anticoagulation therapy than those receiving rate control therapies. In addition, the increase in the use of anticoagulation therapy appears to have been particularly notable among patients for whom it may not be indicated and in whom safer, less expensive antithrombotic therapies would suffice.

Atrial fibrillation (AF) is the most common clinical arrhythmia and is of enormous importance for public health in view of its significant mortality and morbidity.

We evaluated more than 26 000 subjects from 4 large trials that included subjects with non–ST-segment elevation acute coronary syndromes to determine the prognostic importance of creatine kinase-myocardial band (CK-MB) elevation after coronary artery bypass graft (CABG) surgery during the index hospitalization. Results showed that mortality at 6 months increased with increasing peak CK-MB ratios (CK-MB value post-CABG/CK-MB upper limit of normal), and peak CK-MB ratio was an independent predictor of 6-month outcome.

In their study consisting of coronary artery bypass graft (CABG) patients recruited from 4 major trials, Mahaffey found that creatine kinase-myocardial band (CK-MB) elevations following CABG surgery are independently associated with an increased risk of mortality in patients with non–ST-segment elevation acute coronary syndromes, especially if the peak CK-MB level is > 5 x the upper limit of normal (ULN).