May 2006

A 50-year-old woman with angina pectoris, hyperlipidemia, and hypertension was admitted to our clinic because of a possible transient ischemic attack.

After an anterior acute myo­cardial infarction 7 years ago, a 74-year-old man had re­ceived treatment with aspirin, simvastatin (Zocor), and a beta blocker.

A 72-year-old woman with symp­toms of palpitations and fatigue for the past several months was seen in the outpatient department.

A 68-year-old man with increasing shortness of breath during moderate physical exertion consulted his family physician.

We evaluated the effects of rate control treatment versus sinus rhythm restoration and maintenance in patients with persistent atrial fibrillation in a substudy of the Rate Control Versus Electrical Cardioversion (RACE) trial. Rhythm control treatment was associated with greater cardiovascular morbidity and mortality in women. Because treatment did not improve quality of life in these patients, rate control may be considered as first-choice therapy for women.

IIn their review, Rienstra and Van Gelder summarize their findings from the Rate Control Versus Electrical Cardioversion (RACE) study.

The previous installment of this series on clinical research highlighted some im­portant fundamentals in cohort studies and randomized controlled trials (RCTs). In this article, additional issues that are critical to the understanding of RCTs are discussed, including causal inference, the use of surrogate measures, and the principle of intention to treat (ITT).

We examined the prevalence and risks associated with undiagnosed diabetes mellitus among more than 7000 patients who had undergone coronary artery bypass graft surgery. At the perioperative and postoperative stages, patients with undiagnosed diabetes showed a significantly higher morbidity and mortality rate.

Lauruschkat and colleagues entitled their article "Undiagnosed diabetes mellitus in coronary artery bypass graft sur­gery."

We assessed the relationship between high-density lipoprotein (HDL) cholesterol level and carotid plaque progression in 1952 men and women with preexisting carotid atherosclerosis over a period of 7 years. The HDL cholesterol level was inversely related to plaque growth. The plaques that became more echogenic during follow-up had a lower growth rate compared with those that became more echolucent. These findings suggest that HDL cholesterol stabilizes plaques and counteracts their growth by reducing their lipid content and inflammation.

The report by Johnsen and colleagues details the changes in plaque composition and size as defined by duplex ultrasound at 2 time points 7 years apart

Standard congestive heart failure treatment begins with an angiotensin-converting enzyme (ACE) inhibitor to which a beta-blocker is added once the target dose of the ACE inhibitor has been reached. We compared morbidity and mortality between standard treatment and treatment using the reverse sequence, that is, the beta-blocker bisoprolol was given to patients first, followed by the ACE inhibitor enalapril. Results showed that both sequence strategies were safe and effective, with a survival trend in favor of the bisoprolol-first strategy.

The development of new and innovative mechanical and pharmacologic therapies for the broad spectrum of cardiovascular disease has led to dramatic changes in the makeup of clinical practice.