February 2008

A 60-year-old Chinese man was diagnosed with atrial fibrillation 2 years earlier, when he presented with mild dyspnea.

A 55-year-old man with hypertension but no history of coronary or vascular disease presented for evaluation.

A 55-year-old white woman with no symptoms presented for a routine annual physical examination.

We conducted a study among 15 714 Dutch middle-aged women consuming modest-glycemic-load diets. Results showed that high dietary glycemic load and glycemic index increased the risk of cardiovascular disease. This association was particularly evident among overweight women. Recommendations to follow a high-carbohydrate diet may therefore not be optimal in the prevention of cardiovascular diseases.

Ruptured or vulnerable plaques exist not only at the culprit lesion but also in the whole coronary artery in some acute coronary syndrome (ACS) patients.Goldstein et al found features of instability of nonculprit plaques in nearly 40% of patients by angiography,1 whereas actual rupture in a remote site other than the angiographic culprit lesion was found in approximately 13% to 79% of cases when evaluated by intravascular ultrasound.

What is glycemic load and why is it important?

We evaluated a multiethnic cohort of subjects with nonrheumatic atrial fibrillation hospitalized over a 6-year period to determine the racial and ethnic differences in the risk of intracranial hemorrhage (ICH) and the effect of warfarin treatment on ICH risk. Treatment with warfarin was associated with a 2-fold greater risk of ICH in whites, a 4- to 5-fold greater risk in both blacks and Hispanics, and a 15-fold greater risk in Asians. After adjusting for established stroke risk factors and warfarin use, Asians were 4 times as likely as whites to have ICH, whereas blacks and Hispanics were twice as likely.

One of the great advances in medical practice arose from studies on atrial fibrillation in the 1990s.

Low-density lipoprotein (LDL) cholesterol-lowering therapy decreases C-reactive protein (CRP) levels, but the importance of LDL cholesterol-independent effects is uncertain because of the variability in measuring LDL cholesterol and CRP levels in any individual patient. In this study, this variability was reduced by comparing average changes in LDL cholesterol and CRP levels after treatment with lipid-lowering therapy across different studies.

Extrapolating experimental findings to humans requires one to remember 2 basic dictums: (1) drugs do a lot of stuff; and (2) animal and in vitro findings are often wrong.