May 2007

A 50-year-old man with diabetes and hypertension was admitted to the hospital for severe, substernal chest pain.

A 72-year-old physically active man with a history of coronary artery disease and wellcontrolled hypertension developed gradual shortness of breath, initially with outdoor exertional physical activities and later with more usual activities. He also developed mild ankle and leg edema during the same time.

We conducted a meta-analysis of 13 randomized controlled trials involving 17 963 subjects to determine the effect of intensive statin therapy instituted within 14 days of hospitalization for acute coronary syndrome. Results showed that early, intensive statin therapy is safe and significantly decreases cardiovascular death and recurrent ischemia following acute coronary syndrome after 6 months of treatment.

There is now substantial evidence that treatment with statins improves clinical outcomes in patients with acute as well as chronic coronary heart disease, and in older1 as well as younger patients

We evaluated the effectiveness of the current American Diabetes Association guidelines for the detection of coronary artery disease (CAD) in asymptomatic patients with type 2 diabetes and assessed whether a more aggressive diagnostic strategy would permit detection of silent CAD at an earlier stage. The prevalence of myocardial perfusion defects and CAD in asymptomatic diabetic patients was high independent of risk factor profile, and an aggressive diagnostic approach in patients who would normally be excluded from screening permitted identification of CAD at an earlier stage, when coronary anatomy is more likely to respond to treatment.

Coronary artery disease (CAD) accounts for approximately 75% of deaths in patients with diabetes.1

A 67-year-old man with positive results on a stress myocardial perfusion test was found to have isolated anomalous origin of the left anterior descending coronary artery from a separate coronary ostium of the right sinus of Valsalva. This anomalous artery was not stenotic and coursed over the anterior free wall of the right ventricle, in front of the pulmonary artery. It did not appear to have an intra-arterial or intramyocardial course.

The case report by Gandhi and Rosenberg illustrates some of the concerns regarding coronary anomalies.

Diuretic use is associated with activation of neurohormones and disease progression in heart failure. Yet, diuretics are commonly prescribed, although little is known about their long-term effects. We performed a study based on propensity score matching, which indicated that in subjects with ambulatory, chronic, mild-to-moderate heart failure, diuretic use was associated with increased mortality and hospitalization. These findings call into question the wisdom of using long-term diuretic therapy in heart failure patients who are asymptomatic or minimally symptomatic.

Diuretic use has long been a mainstay in the management of symptomatic heart failure with pulmonary or systemic congestion, or both.

We investigated whether a program based on diffuse deployment of automated external defibrillators operated by trained volunteers and laypersons across the largest county in Italy would safely and effectively improve the current survival rate among patients with out-of-hospital cardiac arrest. Compared with historical control subjects, the new strategy resulted in a 3-fold increase in 1-year survival free of neurologic impairment.

Cardiac arrest (CA) is a leading cause of death in industrial countries, with approximately 350 000 fatal episodes each year in the United States alone.