Cardiology

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.

Ever since the observation in the 1950s that high-density lipoprotein (HDL) cholesterol was inversely correlated with coronary artery disease, there have been confounding data that have not been reconciled.

Management of atrial fibrillation remains one of the most difficult challenges for physicians and patients.

In journals for cardiac surgeons and anesthesiologists, the term heparin rebound has predominantly described an anticoagulant condition. In journals for cardiologists and internists, however, the term has been used to describe a procoagulant state. Because precision is one of the fundamental rules in medicine, it may be helpful to foster a more precise understanding of this term.

New fibrate effective in treating mixed dyslipidemia when combined with rosuvastatin

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.

As outlined by the authors, use of metformin is an appealing option because it is safe, produces few side effects, and is a cost-effective way to target some of the defects known to contribute to the metabolic defects associated with diabetes.

In the cohort study conducted by Ahmed and colleagues, the investigators assessed whether diabetes was associated with worse outcomes in heart failure regardless of the associated risk factors and comorbidities.

We recruited 973 patients (mean age, 81 years) with atrial fibrillation from the primary care setting and randomly assigned them to receive anticoagulation with warfarin or aspirin.

The article by Mant and colleagues concerning the Birmingham Atrial Fibrillation Treatment of the Aged (BAFTA) study is a welcomed addition to the now vast literature regarding the relative benefits of warfarin anticoagulation in patients with atrial fibrillation.