Statin drugs: Is it always good news?

Cardiology Review

In our continued effort to expand coverage of women’s cardiovascular health issues in , this month’s issue kicks off with an overview article on possible gender differences in the prevalence, prognosis, and treatment of patients with heart failure by my Stony Brook colleagues Drs Puja Parikh and Hal Skopicki. Our bimonthly feature, Images in Cardiology, profiles a patient with chemotherapy-induced dilated cardiomyopathy (DCM) whose treatment strategy demonstrates a step-wise approach to the medical and surgical therapies available for patients with refractory DCM. This case comes from Images in Cardiology section editor Tasneem Z. Naqvi and colleagues from the University of Southern California and Fu Wai Hospital Chinese Academy of Medical Sciences, Beijing, China; doing double duty, Dr Skopicki offers his thoughts on the case in an introductory essay. A special bonus this month with this feature are

videos offering further insights into the case

. Also contributing this month are Dr William Vollmer and associates, who in a report in the Hypertension section detail the 18 month follow-up results of a randomized trial of 810 patients with either prehypertension or stage I hypertension. Comprehensive lifestyle modification of diet, weight loss, and physical fitness were superior to "advice-only" in controlling blood pressure. The clinical implications of this report are discussed by Dr Samuel Mann. In the Lipid Disorders section, Dr Martin Dunkelgrun and colleagues from the Netherlands correlated the intensity of statin therapy with myocardial ischemia, troponin elevation, and clinical cardiac outcome in 359 patients undergoing major vascular surgery. A beneficial—ie, cardioprotective—effect was observed with higher statin doses. Our vascular surgical consultant, Dr Louis Kozloff, offers cautionary thoughts on generalizing from this study. Statins also receive the attention of Drs Michael C. Nguyen and David Brieger, but from a slightly different perspective. These authors were concerned with the safety and effectiveness of combination warfarin and antiplatelet therapy in patient with stents who require warfarin for atrial arrthythmias or prosthetic valves. Is the incidence of bleeding complications with combination agents prohibitively large? Data from 800 patients was analyzed to help answer the question, and as Dr William Lawson notes in his commentary, the results are not as benign as one would hope. His recommendations: proceed with caution when combinations are used. Finally, the issue is topped off with more preparatory questions to help readers with the Maintenance of Certification exam. Enjoy!

—Peter F. Cohn