Authors

Mark Baker, CPA

B?rge G. Nordestgaard, MD, DMSc: From the Department of Clinical Biochemistry, Herlev Hospital, Copenhagen University Hospital

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Extreme lipoprotein(a) levels and myocardial infarction

We conducted a study to determine whether high lipoprotein(a) levels predicted the risk of myocardial infarction (MI) and ischemic heart disease. Unlike other studies, we measured lipoprotein(a) levels shortly after sampling and corrected for regression dilution bias.

Raphael A. Carandang, MD ? Philip A.Wolf, MD: From the Department of Neurology, School of Medicine, Boston University, Boston, Massachusetts.

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Trends in stroke over the past 50 years: The Framingham Study

A significant reduction in the age-adjusted incidence of stroke in men and women and 30-day mortality in men was shown in a community-based cohort study with biennial assessment of vascular risk factors and active surveillance for incident stroke over the past 50 years. Lifetime risk, severity of stroke, and 30-day mortality in women were stable. Increased life expectancy results in an increase in lifetime risk. This increased longevity is balanced by improvements in risk factor management, yielding no significant change.

Daniel Stulberg, MD

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Newborn with Facial Marks

This newborn was noted to have these facial lesions at time of birth. On further exam there is some erythema on the nape of the neck. The parents indicate that the color seems to be more or less prominent at various times. The pregnancy and delivery were otherwise uncomplicated.

Anthony J. DiMarino, MD

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Management of Acute GI Bleeding in Primary Care: An Update

Upper gastrointestinal bleeding is a common medical emergency that continues to be a significant cause of morbidity and mortality. It requires rapid and appropriate intervention to control the associated hemodynamic instability and prevent continued or recurrent bleeding. Etiology is the key to prognosis. Lower gastrointestinal bleeding usually ceases spontaneously but may also result in hemodynamic instability or symptomatic anemia. Recognizing the signs and symptoms of upper versus lower gastrointestinal bleeding is crucial for prompt and appropriate treatment.

H. Michael Lewellen, CFP

Alexander Green

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ABC's role in the community: A few words from the association's new president

Matthias E. Pfisterer, MD

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Revascularization in patients 75 years or older with diabetes mellitus and angina pectoris

We analyzed the results of the Trial of Invasive Versus Medical Therapy in the Elderly with Chronic Coronary Artery Disease (TIME) in which invasive treatment was compared with optimized medical treatment in patients with chronic angina aged 75 years and older. Patients with diabetes had higher mortality than nondiabetic patients, but revascularization improved overall survival similarly in diabetic and nondiabetic patients.

Ronnie Willenheimer, MD, PhD

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Initiating treatment for chronic heart failure

Standard congestive heart failure treatment begins with an angiotensin-converting enzyme (ACE) inhibitor to which a beta-blocker is added once the target dose of the ACE inhibitor has been reached. We compared morbidity and mortality between standard treatment and treatment using the reverse sequence, that is, the beta-blocker bisoprolol was given to patients first, followed by the ACE inhibitor enalapril. Results showed that both sequence strategies were safe and effective, with a survival trend in favor of the bisoprolol-first strategy.

Henry Stimpson

Anupama Shivaraju, MD1

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Community-acquired MRSA pericarditis

Only 2 cases of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) pericarditis have been reported in the English literature. Over the last 15 years, CA-MRSA has emerged as an increasingly common pathogen that is genetically and epidemiologically different from hospital-acquired MRSA (HA-MRSA).

Kyong-Mi Chang, MD

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Commentary

Gary W. Jay, MD, FAAPM, DAAPM

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Assessing and Treating Complex Migraine

Proper diagnosis and treatment requires that physicians and patients understand the symptoms and clinical presentation of this complicated migraine condition.

Yuliy Y. Chirkov, PhD: From the Cardiology Unit, Basil Hetzel Research Institute, The Queen Elizabeth Hospital, The University of Adelaide, South Australia, Austral

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Hyperglycemia and platelet function in diabetic patients: Relevance to acute myocardial ischemia and infarction

Diabetic patients with acute coronary syndromes are at higher risk for mortality, even if they have ST-segment elevation myocardial infarction. Diabetic patients with unstable angina/non–Q-wave infarction have impaired platelet responsiveness to nitric oxide, a physiological anti-aggregating autocoid. The extent of this impairment depends on the degree of hyperglycemia. Rapid correction of hyperglycemia with infused insulin restores responsiveness to nitric oxide, thus ameliorating platelet dysfunction.

Center for Heart Failure Research, University of Alabama at Birmingha

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Chronic diuretic use and increased mortality and hospitalization in heart failure

Diuretic use is associated with activation of neurohormones and disease progression in heart failure. Yet, diuretics are commonly prescribed, although little is known about their long-term effects. We performed a study based on propensity score matching, which indicated that in subjects with ambulatory, chronic, mild-to-moderate heart failure, diuretic use was associated with increased mortality and hospitalization. These findings call into question the wisdom of using long-term diuretic therapy in heart failure patients who are asymptomatic or minimally symptomatic.

Matthew Carr

Ella H. Bowman, MD, W. Jeffrey Brown, MS, RPh

Thomas R. Kosky, MBA

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Portfolio CHECK-UP

Harold L. Lazar, MD is professor of cardiothoracic surgery, Boston University School of Medicine, Boston, Massachusetts.

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Creatine kinase-MB elevation following coronary artery bypass graft surgery: What is its significance and should it be measured in all patients?

In their study consisting of coronary artery bypass graft (CABG) patients recruited from 4 major trials, Mahaffey found that creatine kinase-myocardial band (CK-MB) elevations following CABG surgery are independently associated with an increased risk of mortality in patients with non–ST-segment elevation acute coronary syndromes, especially if the peak CK-MB level is > 5 x the upper limit of normal (ULN).

Caitlyn Fitzpatrick

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HIV in Prison: How Inmates and Partners Are at Risk

Prisons are breeding grounds for STIs, including HIV. What can fix that?

Tony Yen, MD

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The EMR as a Catalyst for Quality

The EMR has long promised a brave new world in which clinical information is synthesized, individualized, and seamlessly delivered to the frontline clinician.

Margaret

Identifying the needs of the Haitians who were affected by the earthquake, finding a place to stay and work, and getting there would be impossible for us without the help and coordinated efforts of many people.

Germano Di Sciascio, MD: From the Department of Cardiovascular Sciences, Campus Bio-Medico University, Rome, Italy.

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Atorvastatin pretreatment in early percutaneous coronary intervention

According to results of the Atorvastatin for Reduction of Myocardial Damage During Angioplasty-Acute Coronary Syndromes (ARMYDA-ACS) trial, short-term pretreatment with high-dose atorvastatin prior to percutaneous coronary intervention improves clinical outcome in subjects with unstable angina and non-ST-segment elevation myocardial infarction. These findings support the upstream administration of high-dose statins in subjects with acute coronary syndrome treated with an early invasive strategy.