In this issue of Cardiology Review, key clinical trials and sessions presented at the American Heart Association (AHA) Scientific Sessions 2008 in New Orleans are reviewed by some of our editorial board members, who discuss the findings and provide clinical insights for practicing clinicians. The JUPITER (Justification for the Use of Statins in Prevention: An International Trial Evaluating Rosuvastatin) trial showed that treating apparently healthy individuals who have high levels of high-sensitivity C-reactive protein (hs-CRP) with rosuvastatin 20 mg significantly reduced the primary end point—a composite of nonfatal myocardial infarction (MI), nonfatal stroke, hospitalization for unstable angina, revascularization, and confirmed death from cardiovascular causes—by 44% compared with individuals treated with placebo. Drs Campbell and Blumenthal discuss this important trial and comment that it is likely that clinicians will now feel more comfortable recommending statin therapy for adults with low-density lipoprotein cholesterol levels below 130 mg/dL, but who have other risk factors. Measurements of hs-CRP will also increase in frequency for patients who do not otherwise qualify for aspirin or lipid-lowering therapy.
In a session chaired by one of our editorial board members, Dr Foody and colleagues discuss assessment of global cardiovascular risk to improve health outcomes. The panelists note that regardless of the method used to assess global cardiovascular disease (CVD) risk, the underlying key points are the same: multiple risk factors increase the risk for CVD in a multiplicative way; with respect to glucose-lowering agents, those that keep the risk for hypoglycemia and weight gain low should be used preferentially; management of resistant hypertension must begin with a careful evaluation of the patient to confirm the diagnosis and exclude factors associated with “pseudo-resistance”; and the potential for increased adverse events must be considered with the use of more aggressive lipid-altering therapies, including higher statin doses and combination therapy.
Dr Ferdinand reviews a session that indicated that the beliefs held by African Americans may affect adherence to antihypertensive medications. He suggests that although lifestyle is the bedrock of antihypertensive care, most patients will need at least 2 or more medications to achieve control, especially those who are middle-aged or older. He also notes that the keys to treating African Americans include a focus on prevention, assessment of patients at high risk, and early intervention, usually with combination therapy.
In a second report, Dr Ferdinand discusses the role of exenatide (Byetta), a synthetic peptide that has incretin-mimetic actions and enhances glucose-dependent insulin secretion by the pancreatic beta cells, suppresses inappropriately elevated glucagon secretion, and slows gastric emptying in the treatment of type 2 diabetes. A study presented at the AHA suggested that exenatide promotes insulin release only when there are elevated glucose concentrations and improves glycemic control by reducing fasting and postprandial glucose levels.
Dr Naqvi discusses new insights on echocardiographic evaluation of diastolic function. She suggests that new parameters, including coronary microvascular functional reserve and left ventricular diastolic flow reserve, could add significantly to the clinical care of patients with acute MI if Doppler flow reserve can be measured by transthoracic echocardiography.
In a second report by Dr Naqvi, and coauthored by Dr Sra, the authors discuss the impact of emerging imaging technologies in electrophysiology. They outline how current 3D imaging works and note that this modality allows for safer and more effective ablation of complex arrhythmias. The authors indicate that live 3D transesophageal echocardiography is already available and that 3D intracardiac imaging is on the cusp of availability. While use of 3D imaging likely won’t be commonplace for quite some time, it is important for clinicians to keep abreast of such developments as technology evolves and these modalities get incorporated in clinical practice.
I am hopeful that these expert perspectives from trials and sessions presented at the AHA 2008 will be useful to our readers in everyday patient care. We would love to hear your thoughts on these perspectives and whether you will change your practice based on the JUPITER trial results. You can e-mail us at email@example.com.