Predicting cardiovascular morbidity and mortality

This month’s issue of Cardiology Review features a combined article in the CAD and Arrhythmias sections by Rachel Anderson and Dr Scott Solomon on sudden death after an acute myocardial infarction. The authors studied 14,609 survivors of an acute myocardial infarction whose course was complicated by left ventricular dysfunction.

They found that patients who died suddenly were older and had other clinical features to help identify them. Sudden death occurrence was highest in the first 30 days after infarction. Dr Stephen Borzak, our commentator for this article, agrees with the authors that their results emphasize the need for earlier implementation of strategies for preventing sudden death in selected patients. In the Hypertension section, Dr Takayoshi Ohkubo and colleagues from Japan obtained 4-hour ambulatory and casual blood pressure measurements in 1332 subjects. Their results indicate that conventional blood pressure measurements may fail to identify some individuals (those with “masked” hypertension) at high risk for in­creased cardiovascular morbidity. Dr Wendy Post comments on their findings. In a combined article in the Heart Failure and Diabetes sections, Dr Wolfram Doehner and associates from Germany and the United Kingdom evaluated the role of impaired insulin sensitivity as an independent risk factor for mortality in patients with chronic heart failure. Their interesting results have potential therapeutic implications, as described by our endocrine consultant, Dr Rosemarie Pasmantier.

Finally, in the Congestive Heart Failure section, Dr Lee Ingle from Great Britain describes the experience of 1077 elderly subjects with congestive heart failure who underwent the “6 minute walk test.” He found that changes in the distance walked correlated with changes in self-perceived lessening of symptoms of heart failure. I discuss the clinical implications of this study in my commentary.