Predicting cardiovascular events

Cardiology Review® Online, March 2008, Volume 25, Issue 3

This month, Cardiology Review features a veritable smorgasbord of interesting articles. Our Images in Cardiology section features a case submitted by journal readers Dr Marc A. Miller and colleagues, in which an elderly African American man presents to the emergency department with back pain, the first in a series of events that lead, ultimately, to the diagnosis of an acute aortic occlusion. In our CAD section, Dr Pierfrancesco Agostoni and associates from Belgium conduct a secondary analysis of the Reduction of Restenosis in Saphenous Vein Grafts with Cypher Stent (RRISC) trial, finding increased late mortality with sirolimus-eluting stents compared with bare-metal stents when the 2 different types of stents are used in treating diseased saphenous vein grafts. A total of 75 patients were randomized to the 2 types of stents and followed for up to 3 years. In his commentary, Dr Richard Katz offers some possible approaches to the treatment of these diseased vein grafts based on the results of this and other trials. In the Arrhythmias category, Dr Jari Halonen and associates from Finland report on their prospective, double-blinded, randomized multicenter study of 241 patients undergoing coronary bypass surgery and/or aortic valve replacement. These patients received either 100 mg of hydrocortisone or placebo perioperatively. The incidence of postoperative atrial fibrillation was significantly reduced in the treated group, prompting Dr Eric Rashba to speculate on the potential anti-arrhythmic effects of corticosteroids. A contribution by Danish author Dr Børge G. Nordestgaard offers continuing education credits and emphasizes our ongoing commitment to covering women’s cardiovascular health issues in the aptly named In the Heart of Women category. Dr Nordestgaard considers the relationship between nonfasting triglyceride levels and the risks of developing certain cardiovascular end points in women as compared with men. The author studied 7,587 women and 6,394 men (with a mean follow-up of 26 years) and concluded that nonfasting triglyceride levels independently predicted myocardial infarction, ischemic heart disease, and death, particularly in women. Our commentators, Drs Sandeep Bansal and Roger Blumenthal, discuss the evolution of the nonfasting triglyceride test and wonder if the time has come for it to replace the traditional version, ie, the overnight fasting lipid profile. Finally, in a second continuing education piece, this one in the Heart Failure section, Drs Wayne L. Miller and Allan S. Jaffe consider the prognostic value of serial measurements of cardiac troponin and B-type natriuretic peptide in patients with congestive heart failure. They found that elevations of these biomarkers during outpatient follow-up in 190 patients with moderate-to-severe congestive heart failure carried an adverse prognosis impact. Our expert, Dr Sanjay Kaul, is excited by the potential of biomarkers, but cautions that the utility of these markers to guide clinical practice may yet be limited.

—Peter F. Cohn