This month’s edition of features a report from French physician Dr Bruno Verges which examined 560 patients (199 of whom were diabetic) hospitalized for acute myocardial infarction. Diabetes was associated with high levels of the peptide BNP, which in turn correlated with an increased incidence of cardiogenic shock. The authors conclude that the demonstration of elevated BNP levels can provide valuable prognostic information in these high-risk patients with diabetes, and Dr Michael Rich concurs in his commentary. Is body build an independent risk factor for cardiovascular events in hypertensive patients? This is the question posed in the hypertension section article by Drs Giovanni de Simone and Paulette A. Lyle in their study of 9079 patients enrolled in the LIFE (Losartan Intervention For Endpoint) Study. Surprisingly, both underweight and overweight patients were at increased risk, and Drs John Maesakaand Bill Miyawaki comment on this finding. In the heart failure section, Drs Keyur B. Shah and Stephen S. Gottlieb evaluated the adequacy of laboratory monitoring in 840 pa­tients treated with spironolactone for congestive heart failure. Since this drug is prone to cause hyperkalemia—sometimes with severe complications for patient safety—the authors were surprised to find many patients did not have follow up potassium or creatine concentrations obtained. The clinical implications of this important study are described for by Dr George Mallis. Finally, in a combined article in the stroke and arrhythmia sections from Dr Horst Sievertand associates from Germany, the authors describe a new percutaneous procedure for reducing the incidence of stroke in high-risk patients with atrial fibrillation of nonrheumatic etiology. Two multi-center trials in 111 patients demonstrated the safety and efficacy of occluding the left atrial appendage with a cage-like device introduced via a cardiac catheterization procedure. This impressive development may represent an alternative treatment for preventing strokes in high risk atrial fibrillation patients who have difficulty with anticoagulation treatment for 1 reason or another. Dr Stanley Katzadds his cautious approval for this approach in his commentary.
A final feature in this issue is another in a series that we launched this year. “Maintaining Certification” is designed to help you prepare for an examination in either Internal Medicine or the subspecialty of Cardio­vas­cular Disease. We’d appreciate hearing from you on whether this is meeting your needs and how we can make this feature more useful.