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.