Cardiology

The ability to diagnose coronary artery disease (CAD) in women may be limited by the sensitivity and specificity of symptoms as well as of noninvasive testing. The choice of which test should be performed to evaluate the presence of CAD in women remains controversial. Currently American Heart Association/American College of Cardiology guidelines recommend initial evaluation with exercise electrocardiogram (ECG) testing. In a meta-analysis of 3721 women, however, exercise ECG had a sensitivity of 61% and a specificity of 70%1 as compared to 68% sensitivity and 77% specificity in men.

We evaluated the association between medication nonadherence and outcomes among subjects with diabetes mellitus. Nonadherent subjects had higher blood pressure, glycosylated hemoglobin, and low-density lipoprotein cholesterol levels. In addition, there was an association between medication nonadherence and an increased risk of all-cause hospitalization and all-cause mortality. These findings suggest that interventions are needed to increase medication adherence so that patients can realize the full benefit of prescribed therapies.

Diabetes mellitus is a chronic disease for which nonadherence to therapy is frequent.

We examined data from a large cohort of subjects with atrial fibrillation to determine whether men and women had different risks for atrial fibrillation-related thromboembolism. Women with atrial fibrillation who were not taking warfarin had a 60% higher rate of stroke than did men, independent of other clinical risk factors for stroke. When taking warfarin, both women and men had significant reductions in stroke risk without differences by sex in the rates of bleeding complications. These findings support the addition of female sex to traditional stroke risk stratification schemes for assisting in antithrombotic decision making for patients with atrial fibrillation.

More than 15 years ago, atrial fibrillation was shown to be an independent risk factor for ischemic stroke in the Framingham study.

The epidemiologic finding that women with heart failure have better overall survival than men may be because of the higher prevalence of diastolic heart failure or heart failure with preserved ejection fraction (HF-PEF) among women.

Heart failure in the United States affects 4.9 million people, of whom 2.5 million are women.

We performed a whole-country study using linked health care records in Finland and showed that stable angina as the initial symptomatic manifestation of coronary disease occurs as frequently in women as it does in men. Among easily recognized subgroups, the absolute rates of prognostic outcomes were similarly high in women and men.

Each municipality in Finland is responsible for arranging health care for its inhabitants.

A 65-year-old woman with a history of anxiety disorder, dyslipidemia, and recently diagnosed celiac sprue was transferred to the heart center after presenting to a peripheral community hospital with marked fatigue, progressively worsening dyspnea on exertion, and bilateral lower extremity swelling with associated bilateral arm tingling.

Despite advances in echocardiography, magnetic resonance imaging, and the ability to perform an endomyocardial biopsy, the underlying etiology of nonischemic left ventricular (LV) dysfunction often eludes clinical detection.

Postpartum cardiomyopathy is a serious disorder that can present from the third trimester to up to 5 months after pregnancy. Although spontaneous resolution of cardiac function occurs in more than half of patients (over a period of 6-12 months), the balance is left with persistent cardiac dysfunction. Cardiac dysfunction results in signs and symptoms of left heart failure, formation of apical or left ventricular thrombi, and arrhythmias and requires management similar to that in patients with nonischemic dilated cardiomyopathy.

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.