April 2008

A 75-year-old man presented with increasing exertional chest pain over the previous few months.

A 42-year-old generally healthy, but overweight, adult male was enrolled in the Prospective Registry Evaluating Myocardial Infarction: Events and Recovery (PREMIER) trial.

The current guidelines for the management of heart failure in women are based upon data collected from studies predominantly enrolling men. However, because important differences exist in the sex-based pathogenesis of and prognosis for heart failure, the current risk-benefit analyses that guide the evidence-based management of heart failure in women demands prospective assessment.

Our increasing ability to intervene in high-risk patients—with lower risks and greater chances for successful outcomes—is felt across the broad spectrum of cardiovascular disease. This is particularly evident in patients with dilated cardiomyopathy (DCM).

Lifestyle recommendations for the prevention and treatment of hypertension include weight loss, reduced sodium intake, increased physical activity, limited alcohol intake, and the Dietary Approaches to Stop Hypertension (DASH) diet. The 18-month results of the Prospective Registry Evaluating Myocardial Infarction: Events and Recovery (PREMIER) randomized clinical trial showed that individuals with prehypertension and stage 1 hypertension can make and sustain many of these lifestyle changes over the long term, thereby reducing their risk of cardiovascular disease.

Roughly 40% of cases of hypertension are attributable to genetic factors and perhaps 40% to lifestyle factors, particularly diet, salt intake, weight, and exercise.

We evaluated the cardioprotective effects of intensive statin therapy before major vascular surgery in a prospective study of 359 subjects. After multivariate analysis, lower low-density lipoprotein (LDL) cholesterol was associated with decreased myocardial ischemia, troponin T release, and 30-day and late cardiac events. Furthermore, higher doses of statins were associated with better cardiac outcome, even after adjusting for LDL cholesterol.

In a recently published prior paper, Dr Feringa and his colleagues called attention to the prevalence of postoperative cardiac abnormalities in patients undergoing noncardiac vascular surgery.

We conducted an observational study to compare singleantiplatelet therapy with dualantiplatelet therapy among patients requiring long-term warfarin therapy after coronary stenting. Results showed that there was no difference in mortality or myocardial infarction between the 2 treatment regimens at 6 months, with no excess in-hospital bleeding; however, larger trials are needed to determine firm recommendations.

In this period of heightened concern over the increased risk of late and very late stent thrombosis with the use of drug-eluting stents, it is worthwhile to examine the anticoagulation regimens given after insertion of a stent.