Cardiology

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.

The use of statins to treat hyperlipidemia is well established.

We evaluated trends in the treatment and mortality of patients with and without diabetes mellitus and acute myocardial infarction over the last decade. Despite improvements in the provision of evidence-based care, patients with diabetes did not derive improvements in long-term survival.

Two trends have collided in the last 10-20 years: 1) there is no question that both the prevalence and incidence of type 2 diabetes mellitus are on the increase; 2) conversely, the morbidity and mortality associated with acute coronary syndromes— especially myocardial infarction (MI)—are definitely declining.

We assessed the prognostic value of the 6-minute walk test (6-MWT) among 1592 subjects with differing degrees of left ventricular systolic dysfunction (LVSD). We found that the 6-MWT was an independent predictor of mortality, particularly among patients with more than mild LVSD. The 6-MWT provides less prognostic utility in patients with mild or lesser LVSD, however.

Heart failure affects approximately 5 million Americans, and more than 500 000 new cases are diagnosed each year.

We hypothesized that atherosclerotic renovascular disease (ARVD) might account for a growing proportion of end-stage renal disease in the United States because of shared risk factors and the aging of the population. We tested this hypothesis through an evaluation of 146 973 older patients starting dialysis therapy in the United States between 1996 and 2001.

The incidence of end-stage renal disease (ESRD) has nearly doubled in the United States between 1991 and 2000 and has been projected to increase by 50% by 2015.

Anomalous coronary arteries are rare congenital cardiac defects with varying symptomatology and controversial clinical significance. These should be considered as a differential diagnosis, particularly when coronary schemia occurs in a child or young adult.

Recent observational studies have suggested that statins have a protective effect against cancer. However, long-term statin users were shown to be healthier, less frail, and more adherent to therapy and screenings. We conducted a cohort study to evaluate the effect of statins on several common cancers in a large elderly population.

There has been an epidemiologic association of low total cholesterol levels with increased risk of cancer noted for several decades.

We assessed the pattern of use and the effectiveness of antithrombotic therapy in a cohort of high-risk elderly patients hospitalized for atrial fibrillation, with data derived from prescription, hospitalization, and mortality databases from 3 linked registries. Results showed that antithrombotic therapy was underused, even in patients with no comorbid conditions. In addition, patients exposed to antithrombotic therapy had a significantly lower mortality rate. The collection of epidemiological data by record linkage represents a flexible and readily available tool for monitoring and improving routine clinical care.

Multislice computed tomography (MSCT) detects proximal coronary atherosclerotic plaque or obstructive coronary artery disease (CAD) in "a significant proportion" of patients with a low or intermediate Framingham risk score, according to research conducted at the Cleveland Clinic in Ohio.

We evaluated 100 subjects who underwent multislice computed tomography (MSCT) to assess the presence and severity of coronary artery disease (CAD) and to determine the occurrence of coronary events (including cardiac death, nonfatal myocardial infarction, unstable angina requiring hospitalization, and revascularization) over a follow-up period of 16 months.

We developed a set of equations to predict the risk or probability of developing coronary artery disease (CAD) in 10 years among American Indians. The equations are based on the significant risk factors identified in the Strong Heart Study, a longitudinal study of cardiovascular disease in American Indians. The equations can be used in patient education and to evaluate the efficacy of CAD prevention and intervention programs.

The risk calculator reported in the Lee et al paper was developed to predict the 10-year cardiovascular (CV) disease probability in an American Indian population.

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.

Glucose-insulin-potassium (GIK) was initially advocated as a treatment of acute myocardial infarction (MI) to promote electrical stability.

To evaluate the interactions between the weight loss drug, sibutramine, and different antihypertensive treatments, we randomly assigned 171 subjects taking 3 antihypertensive treatment regimens to receive sibutramine or placebo. Our study showed for the first time that combination therapy with an angiotensin-converting enzyme inhibitor and a calcium channel blocker is more advantageous than a ß blocker/diuretic-based-regimen with regard to supporting the weight-reducing actions and metabolic changes induced by sibutramine.

Obesity is a growing epidemic in the United States and around the world.

The study presented in this issue of Cardiology Review by Schuijf and colleagues investigated various aspects of what is rapidly becoming an accepted imaging modality for the assessment of coronary artery disease.

We evaluated the prognostic value of cardiac magnetic resonance (CMR) stress testing with direct comparison of adenosine stress first-pass perfusion and dobutamine stress wall motion imaging among 513 subjects with known or suspected coronary heart disease over a median follow-up period of 2.3 years. Positive results on CMR stress testing identified subjects at high risk for subsequent cardiac events (nonfatal myocardial infarction or cardiac death), whereas normal CMR stress test results were associated with a very low annual cardiac event rate.