Cardiology

Few medical treatment goals are more important yet more troublesome than the prevention of thromboembolic complications in patients with atrial fibrillation (AF).

We evaluated the prognostic role of metabolic syndrome after myocardial infarction and found that metabolic syndrome correlated with an increased risk of cardiovascular events and death. The risk of developing diabetes decreased with weight loss in patients with metabolic syndrome. These results indicate that a more aggressive approach to the treatment of patients with metabolic syndrome, particularly with regard to changes in lifestyle, would be beneficial.

If only we could do for diabetes what we have done in the past decade for hyperlipidemia.

Our study aimed to clarify whether white-coat hypertension represents a transient state in the development of hypertension outside medical settings. We followed up 128 subjects with white-coat hypertension and compared their risk of progression to home hypertension with that of 649 sustained normotensive subjects. After 8 years of follow-up, subjects with white-coat hypertension had an approximately 3-fold higher risk of eventually manifesting home hypertension. We concluded that patients with white-coat hypertension should be carefully monitored.

For 50 years, hypertension has been recognized as the most significant risk factor for the development of symptomatic cardiovascular disease in Western society.

We showed that a significant reduction in thoracic aortic plaques and low-density lipoprotein cholesterol levels occurred after 12 months of treatment with atorvastatin. In the abdominal aorta, however, the change in atherosclerotic plaques correlated with age. These results show that plaques in the thoracic and abdominal aortas may respond differently to lipid-lowering therapy, and other factors, such as aging, may be more important for plaque progression in the abdominal aorta.

It was not until Virchow identified the cellular contributions to thrombosis that physicians began to visualize arteries as dynamic tissues.

The recent Management of Atherothrombosis with Clopidogrel in High-risk Patients Trial showed that adding acetylsalicylic acid (aspirin) to clopidogrel in high-risk patients with recent ischemic stroke or transient ischemic attack is associated with a favorable but nonstatistically significant trend toward fewer vascular events. However, the risk of life-threatening bleeding is increased by the addition of aspirin to clopidogrel. These results do not support the routine use of aspirin in addition to clopidogrel in the patient population that was studied in MATCH.

The negative results of the Management of Atherothrombosis with Clopidogrel in High-risk patients (MATCH) Trial1 are disappointing and surprising, but perhaps this can be said about the conduct of the trial itself.

We investigated 1209 patients with valvular and nonvalvular atrial fibrillation who were treated with standard anticoagulant therapy, the cyclooxygenase inhibitor triflusal, or combined therapy with triflusal and an anticoagulant. Compared with patients receiving standard anticoagulation treatment, the addition of antiplatelet therapy to reduced-intensity anticoagulation in patients stratified for risk of stroke significantly reduced the vascular event rate.

Women with acute coronary syndromes continue to be undertreated with pharmacologic therapy and invasive procedures, despite the fact that they receive the same benefits from therapy as men. Although the older age at diagnosis for women adds complexity to clinical decision making, studies show that an aggressive medical or interventional approach to acute coronary syndromes is often warranted and should be based on patient size, comorbidity, and renal function.

Drs Pfeifer and Steingart (page 11) provide a timely report on recent findings affecting the assessment and treatment of women with acute coronary syndromes.

Cardiovascular drugs affect women differently than they do men because of differences in pharmacokinetics, pharmacodynamics, and physiology. Results of recent studies on the use of cardiovascular agents in women are presented, with an emphasis on the need to include an appropriate proportion of women in future studies, to adapt the dosage to the weight of the patient, and to incorporate hormonal aspects into the analysis.

A patient's response to drugs may be influenced by many factors, including age, race, sex, ethnic background, metabolic phenotype, body fat content and distribution, and body size. Drug–drug and drug–disease interactions are also important.

Although several studies have found a positive association between body mass index (BMI) and stroke in men, the association in women is less clear. We evaluated women enrolled in the Women's Health Study and found that increased BMI was a strong risk factor for total and ischemic stroke. These results show that the number of total and ischemic strokes may be reduced if obesity is prevented.

The study by Kurth and Buring consisted of a prospective analysis among nearly 40 000 women participating in the Women's Health Study.

Depression at the time of coronary artery bypass graft (CABG) surgery is associated with a lack of functional benefits at 6 months after the surgery. These negative effects appear to be stronger for women than for men. Further research is needed to determine whether the treatment of depression after CABG surgery can improve outcomes. In the meantime, current guidelines recommend evaluation for symptoms of depression after CABG surgery and consideration of treatment for both men and women.

Mallik and Vaccarino remind us that heart disease kills more women than the next 7 causes of death combined.

A 36-year-old Hispanic man was diagnosed with type 1 diabetes in 1987 and dyslipidemia in 2001.

Increased serum lipid levels in diabetic pa­tients are associated with an increased risk of macular edema, retinal hard exudates, and secondary visual loss.