Cardiology

Researchers at the Methodist Hospital in Houston, TX; Baylor University Medical Center in Dallas, TX; and The University of Utah School of Medicine in Salt Lake City, UT, are enrolling patients in a new clinical trial designed to help find the answer to that question.

A 77-year-old woman with diabetes, hypertension, and hypothyroidism was first assessed as an outpatient in 2004.

Patients with new-onset diabetes mellitus in the VALUE (Valsartan Antihypertensive Long-term Use Evaluation) trial had an increased incidence of atrial fibrillation compared with patients without diabetes. Clustering of risk factors or the presence of dysglycemia may make the heart more susceptible to arrhythmias.

The incidence of atrial fibrillation (AF), which is the most frequently encountered sustained cardiac arrhythmia, is increasing in the United States.

Treatment of type 2 diabetes should achieve and maintain euglycemia, thereby preventing complications from this progressive disease. Current antidiabetic therapies should be a part of a multimodal management program that includes diet, exercise, and blood pressure and lipid control. Oral antidiabetic drugs are still first-line therapy for type 2 diabetes, but intensification of therapy, including starting insulin, should occur every 2 to 3 months as needed to achieve euglycemia. The first insulin added is typically a basal insulin, which is effective in lowering fasting plasma glucose (FPG). A persistently elevated glycated hemoglobin (HgbA1C) level despite near or complete normalization of FPG, however, indicates postprandial hyperglycemia. In these cases, the addition of bolus insulin is required to reduce postprandial glucose (PPG). Several approaches to initiate and titrate insulin can be used based on FPG, PPG, HgbA1C, and patient factors.

The relationship of glucose levels to cardiovascular disease (CVD) risk, especially coronary heart disease (CHD), in observational data sets has been the subject of several studies. These studies have shown that the relationship between fasting (and postprandial glucose) and CHD risk is continuous and graded, and that this relationship extends below the currently defined threshold for diagnosing diabetes mellitus. The assumption has been that glycemic control in patients with diabetes mellitus should favorably affect CVD outcomes in randomized clinical trials; however, the results of several large trials have not consistently confirmed this hypothesis. In fact, ACCORD (Action to Control Cardiovascular Risk in Diabetes) data suggest a small increased risk in mortality for patients at high risk for CHD events.

According to the American Diabetes Association (ADA), 23.6 million children and adults have diabetes (8% of the US population) and another 5.7 million cases remain undiagnosed. Epidemiologists predict that these statistics will double by 2030, further taxing the healthcare system. Medical expenditures are approximately 2.3 times higher for diabetic versus nondiabetic patients, and the annual cost of diabetes is estimated to be $116 billion.

The American College of Cardiology and the American Heart Association announced the joint release of a comprehensive set of new practice guidelines on the management of adults with congenital heart disease.

A 43-year-old man with a strong family history of diabetes mellitus presented to his primary care physician requesting interventions to decrease his cardiovascular risk.

A 75-year-old woman with a history of hypertension, coronary artery disease, and diabetes had gradually worsening shortness of breath.

A 76-year-old woman was noted to have an irregular pulse while visiting her primary care physician for a blood pressure check.

A 61-year-old man presented to his primary care physician for a routine physical examination.

A 60-year-old man presented to his physician's office for a routine visit.

A 15-year-old boy is brought to your office by his mother for a check-up.

A 56-year-old man with type 2 diabetes mellitus, hypertension, and tobacco dependence presented to the emergency department with a 3-hour history of "crushing" substernal chest pain.

A 60-year-old man with left ventricular dysfunction resulting from nonischemic cardiomyopathy was followed in an ambulatory heart failure clinic.

A 60-year-old man was admitted to the hospital after experiencing an inferior ST-segment elevation myocardial infarction.

Two 42-year-old men with a serum cholesterol level of 225 mg/dL presented to our institution.

An 80-year-old woman presented to the emergency department after awakening with substernal chest pain, shortness of breath, and palpitations.

A 58-year-old man with stable coronary artery disease, hypertension, tobacco use, obesity, and a sedentary lifestyle presented to our institution for routine follow-up.

A 39-year-old mother of 2 teenage boys, who was also a nurse, became permanently aphasic because of a stroke.

A 75-year-old woman who experienced chest discomfort that caused her to awaken and persisted as retrosternal pain was admitted to the emergency department.

A 64-year-old white woman presented to a nearby emergency department after experiencing abrupt, intense chest pressure while playing tennis.

A 45-year-old white man presented to the emergency department with a 1-week history of intermittent pain in the middle of his chest, accompanied by upper abdominal discomfort.

A 70-year-old man with a history of hypertension and hyperlipidemia was admitted to the hospital with a non–ST-segment elevation myocardial infarction (MI).

A postmenopausal woman 66 years of age presented to the emergency department with new-onset chest discomfort at rest.