January 2006

A 75-year-old former dentist was admitted to our department for evaluation of chronic angina pectoris.

We found that lower cholesterol levels in middle age predicted lower total mortality and better physical quality of life in old age after 39 years of follow-up. No difference was seen in the mental component of quality of life. These findings support current guidelines for cholesterol goals and show that a low risk-factor level in midlife can affect long-term mortality and morbidity, postpone physical disability, and improve quality of life in old age.

In their study, Strandberg and Strandberg (page 13) found that during a 39-year follow-up of initially healthy men, aged 30 to 45 years (mean, 38 years), low serum cholesterol levels predicted better survival, better physical function, and better quality of life in old age, without adversely affecting mental functioning.

We analyzed the results of the Trial of Invasive Versus Medical Therapy in the Elderly with Chronic Coronary Artery Disease (TIME) in which invasive treatment was compared with optimized medical treatment in patients with chronic angina aged 75 years and older. Patients with diabetes had higher mortality than nondiabetic patients, but revascularization improved overall survival similarly in diabetic and nondiabetic patients.

It is difficult to make generalizations about treatment of elderly diabetic patients with coronary artery disease (CAD).

We compared blood pressure control among white and African American hypertensive men in Veterans Affairs (VA) and non-VA sites, and found that the dis parity between the two ethnic groups was 40% less at VA sites. Better access to care and medications for African Americans at the VA sites may explain the difference.

The article by Rehman and colleagues (page 27) offers two important observations about the control of hypertension in African American men.

Using data from 8,725 participants in the Framingham Heart Study who were followed for 176,166 person-years, we estimate that the lifetime risk of developing atrial fibrillation (AF) is 1 in 4 for men and women aged 40 years and older. Even when there is no antecedent congestive heart failure or myocardial infarction, the lifetime risk of AF is high (1 in 6). This significant lifetime risk highlights the major public health problem resulting from AF and the need for further study into causes, prevention, and treatment.

Data from the Framingham study provide yet more valuable prognostic information, this time related to the most common cardiac arrhythmia, atrial fibrillation.

Pharmacologic inhibition of the renin-angiotensin aldosterone system (RAAS) has become a widely accepted ap­proach to lowering blood pressure (BP).