Cardiology

Cardiovascular drugs affect women differently than they do men because of differences in pharmacokinetics, pharmacodynamics, and physiology. Results of recent studies on the use of cardiovascular agents in women are presented, with an emphasis on the need to include an appropriate proportion of women in future studies, to adapt the dosage to the weight of the patient, and to incorporate hormonal aspects into the analysis.

A patient's response to drugs may be influenced by many factors, including age, race, sex, ethnic background, metabolic phenotype, body fat content and distribution, and body size. Drug–drug and drug–disease interactions are also important.

Although several studies have found a positive association between body mass index (BMI) and stroke in men, the association in women is less clear. We evaluated women enrolled in the Women's Health Study and found that increased BMI was a strong risk factor for total and ischemic stroke. These results show that the number of total and ischemic strokes may be reduced if obesity is prevented.

The study by Kurth and Buring consisted of a prospective analysis among nearly 40 000 women participating in the Women's Health Study.

Depression at the time of coronary artery bypass graft (CABG) surgery is associated with a lack of functional benefits at 6 months after the surgery. These negative effects appear to be stronger for women than for men. Further research is needed to determine whether the treatment of depression after CABG surgery can improve outcomes. In the meantime, current guidelines recommend evaluation for symptoms of depression after CABG surgery and consideration of treatment for both men and women.

Mallik and Vaccarino remind us that heart disease kills more women than the next 7 causes of death combined.

A 36-year-old Hispanic man was diagnosed with type 1 diabetes in 1987 and dyslipidemia in 2001.

Increased serum lipid levels in diabetic pa­tients are associated with an increased risk of macular edema, retinal hard exudates, and secondary visual loss.

Detroit boasts the highest rate of PAD among its population of any US city, making it the number-one PAD "Hot Spot" in the country.

We compared the prognosis of patients with "white-coat" hypertension (WCHT) with that of patients with "masked" hypertension (MHT). The 10-year composite risk of stroke morbidity and cardiovascular mortality for patients with WCHT was similar to the risk for patients with sustained normal blood pressure, whereas the risk was markedly increased for patients with MHT and sustained hypertension. This indicates that conventional blood pressure measurements may fail to distinguish some patients at high or low risk.

A 65-year-old man diagnosed with essential hypertension had been treated with antihypertensive medication for 2 years at his physician's office. His systolic/diastolic blood pressure in the office had been controlled at about 130/80 mm Hg with 2 antihypertensive drugs taken in the morning after breakfast. Although he does not have any cardiovascular complications, he is a smoker, is obese, and has diabetes.

We evaluated the risk and timing of sudden death among high-risk patients after myocardial infarction (MI). Among survivors of acute MI with reduced left ventricular systolic function or heart failure, or both, the risk of sudden death from cardiac causes was highest in the first 30 days after MI. These findings indicate a need for early intervention to prevent sudden death during this vulnerable period.

Anderson and Solomon (page 17) elegantly elucidate the patterns of sudden death after myocardial infarction (MI) in their analysis of the Valsartan in Acute Myocardial Infarction Trial (VALIANT) database.

A number of studies have documented the incremental predictive ability of 24 hour ambulatory blood pressure (BP) monitoring over traditional office or casual BP monitoring for predicting adverse cardiovascular events.

We showed that impaired insulin sensitivity in patients with chronic heart failure (CHF) significantly predicted impaired survival. Insulin resistance relates to an advanced disease state and higher mortality independent of body composition and established prognosticators, implicating a pathophysiologic role for insulin sensitivity in CHF. Patients with CHF may possibly benefit from early treatment of impaired insulin sensitivity, but further research is needed.

The prevalence of obesity and heart failure has been increasing. A report linking the 2 found an increased risk of heart failure of 5% for men and 7% for women for each increment of 1 in body mass index (BMI).

We examined the relationship between the 6-minute walk test and self-perceived changes in symptoms in 1077 elderly patients with chronic heart failure. We found that changes in 6-minute walk test distance were sensitive to changes in self-perceived symptoms of heart failure.

In an era when high-tech procedures are becoming increasingly common in cardiology, it's refreshing to see continued interest in one of the lowest-tech diagnostic/prognostic procedures currently available: the 6-minute walk test.

We evaluated the effects of rate control treatment versus sinus rhythm restoration and maintenance in patients with persistent atrial fibrillation in a substudy of the Rate Control Versus Electrical Cardioversion (RACE) trial. Rhythm control treatment was associated with greater cardiovascular morbidity and mortality in women. Because treatment did not improve quality of life in these patients, rate control may be considered as first-choice therapy for women.

IIn their review, Rienstra and Van Gelder summarize their findings from the Rate Control Versus Electrical Cardioversion (RACE) study.

The previous installment of this series on clinical research highlighted some im­portant fundamentals in cohort studies and randomized controlled trials (RCTs). In this article, additional issues that are critical to the understanding of RCTs are discussed, including causal inference, the use of surrogate measures, and the principle of intention to treat (ITT).