Cardiology

The increasing prevalence of atrial fibrillation in the elderly, especially compared with younger age groups, is striking (8% in persons > 80 years compared with 1% in those < 60 years).

After an acute coronary syndrome (ACS) event, elderly patients are at greater risk of death and nonfatal coronary events compared with younger patients. Despite this, elderly patients continue to receive less evidence-based therapy. Lipidlowering therapy with statins is now routine practice for the secondary prevention of coronary heart disease. Achieving the optional National Cholesterol Expert Panel goal of a low-density lipoprotein cholesterol level of < 70 mg/dL for ACS patients over 70 years of age could prevent nearly 80 deaths or nonfatal coronary events for every 1000 patients treated for 2 years with a number needed to treat of approximately 12.

Elderly patients with a history of an acute coronary syndrome (ACS) are at higher risk for subsequent cardiovascular events than younger patients.

Over a period of 14 years, we followed 282 patients aged 70 years or older who were hospitalized with heart failure. Median survival was 2.5 years, but 25% of patients died within 1 year, and 25% survived for at least 5 years following hospital discharge. A simple 7-item risk score based on data readily available at the time of hospitalization effectively stratified patients into low-, intermediate-, and high-risk categories for subsequent mortality.

Congestive heart failure does not necessarily "go away" in the elderly.

We assessed the association between the incidence of coronary heart disease and alcohol consumption among hypertensive men enrolled in the Health "Professionals" Follow-Up Study. Moderate alcohol consumption (1 to 2 drinks per day) was associated with a lower risk of myocardial infarction, as in the general population, but was not associated with the risks of stroke, total mortality, or mortality from cardiovascular causes. These results show that men with hypertension who drink moderately may not need to change their drinking habits.

Features of hypertrophic obstructive cardiomyopathy (HOCM) include obstruction at the left ventricular outflow tract (caused by a markedly thickened proximal interventricular septum) and systolic anterior motion of the mitral valve. The case discussed here illustrates several classic features of this disease including clinical presentation, diagnostic workup, and noninvasive and invasive management.

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.

Stroke is an especially important disease to study in terms of secular trends because it is so common, deadly, and disabling.

We generally assume that having a good time must be bad for you,and no one would deny that irresponsible alcohol consumption takes a tremendous economic, social, and health-related toll on diverse populations all around the globe.

We conducted a multi-hospital population-based study of 2445 residents of a large New England metropolitan area hospitalized with acute heart failure and found that the long-term prognosis for these patients remains poor. More than one third of patients died in the first year after hospital discharge,and nearly 4 of 5 patients died over the 5-year follow-up period. Several demographic and clinical factors were associated with an adverse prognosis. It is important to know the factors that negatively affect long-term survival after hospital discharge for decompensated heart failure so that treatment can be directed toward specific high-risk groups.

When considering the article by Goldberg and colleagues, it seems reasonable to request a change in the title to "Survival after the diagnosis of &#8198;heart failure."

Statins are the most commonly used pharmacologic intervention in patients with increased cardiovascular risk. In addition to their beneficial effect on the atherogenic lipid profile, they have been shown to exert several pleiotrophic effects, including the reduction of low-grade inflammation. Thiazolidinediones (TZDs) are a new class of antidiabetic drugs that have been shown to improve insulin sensitivity and to reduce cardiovascular risk in patients with type 2 diabetes. Our study is the first to show a complementary effect of TZD and statin treatment on several cardiovascular risk factors in subjects without diabetes. These findings may have important implications for further discussion on cardiovascular risk reduction, especially for patients with metabolic syndrome.

The background required for assessing this paper by Hanefeld and Forst is derived from clinical studies using statin and peroxisome proliferator-activated receptors (PPAR)&#947; agonists.

This retrospective subanalysis of the Adenosine Sestamibi SPECT Post-Infarction Evaluation (INSPIRE) trial shows that early adenosine sestamibi stress testing is not only safe early after myocardial infarction (MI), but can also be very useful to identify patients at very low risk for events in the first year after discharge.

The effects of recurrent tachycardia after resolution of cardiomyopathy have not been thoroughly assessed. We evaluated and followed 24 patients with tachycardia-induced cardiomyopathy for more than 12 years. Our observations showed that patients with tachycardia-induced cardiomyopathy may be at long-term risk for sudden death. Surreptitious cardiomyopathy due to occult ultrastructural changes may persist. It has yet to be determined whether rapid and aggressive rate control would prevent structural damage to risk of sudden cardiac death.