Cardiology

Percutaneous closure of the patent foramen ovale (PFO) can be accomplished within 15 minutes using only fl uoroscopy for guidance. Local anesthesia and femoral vein puncture in the groin with a 9 French catheter can achieve about a 90% complete closure rate when the Amplatzer® PFO Occluder is used. Complications are extremely rare and physical restrictions are unnecessary starting a couple of hours after the intervention. Aspirin and clopidogrel (Plavix) are typically prescribed for a few months after the procedure, and the therapy concludes with transesophageal echocardiography at follow-up approximately 6 months later.

Migraines, including those with aura, are common and generally benign, affecting between 10% and 15% of the population.

The AMIS (Acute Myocardial Infarction in Switzerland) Plus prospective cohort study compared treatment and in-hospital outcomes between men and women with acute coronary syndrome (N = 26,452) admitted to Swiss hospitals between 1997 and 2007. The study reached several important conclusions: women had different baseline characteristics than men at admission, were treated with different drug regimens, and were significantly less likely to undergo percutaneous coronary intervention. After adjusting for these differences, researchers found no significant difference in the rates of in-hospital mortality between men and women, except for women aged 51 to 60 years, who were more likely to die in-hospital.

More than 1 million percutaneous coronary interventions (PCIs) are performed annually in the United States.

Although multivessel coronary artery disease (CAD) is commonly encountered in patients with acute coronary syndrome (ACS), no randomized controlled trials have evaluated the effi cacy of singlevessel percutaneous coronary intervention (PCI) versus multivessel PCI.

We found that lower cholesterol levels in middle age predicted lower total mortality and better physical quality of life in old age after 39 years of follow-up. No difference was seen in the mental component of quality of life. These findings support current guidelines for cholesterol goals and show that a low risk-factor level in midlife can affect long-term mortality and morbidity, postpone physical disability, and improve quality of life in old age.

In their study, Strandberg and Strandberg (page 13) found that during a 39-year follow-up of initially healthy men, aged 30 to 45 years (mean, 38 years), low serum cholesterol levels predicted better survival, better physical function, and better quality of life in old age, without adversely affecting mental functioning.

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.

It is difficult to make generalizations about treatment of elderly diabetic patients with coronary artery disease (CAD).

We compared blood pressure control among white and African American hypertensive men in Veterans Affairs (VA) and non-VA sites, and found that the dis parity between the two ethnic groups was 40% less at VA sites. Better access to care and medications for African Americans at the VA sites may explain the difference.

The article by Rehman and colleagues (page 27) offers two important observations about the control of hypertension in African American men.

Using data from 8,725 participants in the Framingham Heart Study who were followed for 176,166 person-years, we estimate that the lifetime risk of developing atrial fibrillation (AF) is 1 in 4 for men and women aged 40 years and older. Even when there is no antecedent congestive heart failure or myocardial infarction, the lifetime risk of AF is high (1 in 6). This significant lifetime risk highlights the major public health problem resulting from AF and the need for further study into causes, prevention, and treatment.

Data from the Framingham study provide yet more valuable prognostic information, this time related to the most common cardiac arrhythmia, atrial fibrillation.

Pharmacologic inhibition of the renin-angiotensin aldosterone system (RAAS) has become a widely accepted ap­proach to lowering blood pressure (BP).

Few medical treatment goals are more important yet more troublesome than the prevention of thromboembolic complications in patients with atrial fibrillation (AF).

We evaluated the prognostic role of metabolic syndrome after myocardial infarction and found that metabolic syndrome correlated with an increased risk of cardiovascular events and death. The risk of developing diabetes decreased with weight loss in patients with metabolic syndrome. These results indicate that a more aggressive approach to the treatment of patients with metabolic syndrome, particularly with regard to changes in lifestyle, would be beneficial.

If only we could do for diabetes what we have done in the past decade for hyperlipidemia.

Our study aimed to clarify whether white-coat hypertension represents a transient state in the development of hypertension outside medical settings. We followed up 128 subjects with white-coat hypertension and compared their risk of progression to home hypertension with that of 649 sustained normotensive subjects. After 8 years of follow-up, subjects with white-coat hypertension had an approximately 3-fold higher risk of eventually manifesting home hypertension. We concluded that patients with white-coat hypertension should be carefully monitored.

For 50 years, hypertension has been recognized as the most significant risk factor for the development of symptomatic cardiovascular disease in Western society.

We showed that a significant reduction in thoracic aortic plaques and low-density lipoprotein cholesterol levels occurred after 12 months of treatment with atorvastatin. In the abdominal aorta, however, the change in atherosclerotic plaques correlated with age. These results show that plaques in the thoracic and abdominal aortas may respond differently to lipid-lowering therapy, and other factors, such as aging, may be more important for plaque progression in the abdominal aorta.

It was not until Virchow identified the cellular contributions to thrombosis that physicians began to visualize arteries as dynamic tissues.

The recent Management of Atherothrombosis with Clopidogrel in High-risk Patients Trial showed that adding acetylsalicylic acid (aspirin) to clopidogrel in high-risk patients with recent ischemic stroke or transient ischemic attack is associated with a favorable but nonstatistically significant trend toward fewer vascular events. However, the risk of life-threatening bleeding is increased by the addition of aspirin to clopidogrel. These results do not support the routine use of aspirin in addition to clopidogrel in the patient population that was studied in MATCH.