April 2007

A 62-year-old man with paroxysmal atrial fibrillation (AF) presents to his physician’s office for a discussion of treatment options for his AF.

A 66-year-old man with a history of coronary heart disease, hypertension, type 2 diabetes mellitus, and hyperlipidemia presented to the clinic for follow-up after recent hospitalization for unstable angina.

A 68-year-old man with type 2 diabetes and no history of coronary heart disease presented to a diabetes clinic.

A 44-year-old man with newly diagnosed 3-vessel coronary disease was scheduled for 4-vessel coronary artery bypass graft surgery.

We assessed preoperative cardiac physiology using echocardiography in patients undergoing cardiac surgery to identify predictors of postoperative atrial fibrillation. Subjects with enlarged left atrial volume had a 5-fold greater risk of postoperative atrial fibrillation, independent of age and other risk factors, than those without enlarged left atrial volume. Left atrial volume appears to be a powerful tool to stratify patients according to risk before surgery and to effectively target preventive therapy.

Atrial fibrillation that occurs after cardiac surgery remains a source of increased morbidity and prolonged length of hospital stay.

Diabetes and inflammation influence the development of atherosclerosis. We performed a study that showed the inflammatory markers high-sensitivity C-reactive protein and lipoprotein-associated phospholipase A2 were lowered with the use of fenofibrate, simvastatin, and combination therapy. The anti-inflammatory effects were most pronounced among patients with elevated baseline inflammatory markers. Combination therapy significantly altered lipid concentrations and exerted a greater positive effect on low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglycerides than monotherapy with either drug.

The principal finding of this study is that among patients with type II diabetes and mixed dyslipidemia, treatment with simvastatin, fenofibrate, or their combination was associated with reductions in inflammatory biomarkers high-sensitivity C-reactive protein (hsCRP) and lipoprotein-associated phospholipase A2 (Lp-PLA2).

In patients with lone paroxysmal atrial fibrillation (AF) and normal cardiac function, in the absence of hypertension, myocardial infarction, and cardiac insufficiency, perindopril (Aceon) or losartan (Cozaar) and low-dose amiodarone (Cordarone) therapy are more effective in preventing recurrence of AF than low-dose amiodarone alone. Adding losartan or perindopril to amiodarone therapy can inhibit left atrial enlargement.

Atrial fibrillation (AF) is the most common arrhythmia, accounting for approximately one third of all patient discharges with arrhythmia as the principal diagnosis and the greatest number of hospitalization days for arrhythmia each year.

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.