Cost utility of statins and aspirin

Once again this month, Cardiology Review features a selection of key, current research from the cardiology literature. In the lipid disorders section, Dr Michael Pignone presents a cost-utility analysis of statins, aspirin, or both in the primary prevention of coronary artery disease. The study population consisted of healthy, moderate-risk 45-year-old men followed for 10 years. The cost effectiveness of both drugs was evaluated for various levels of risk; Dr Richard Steingart offers his thoughts on the study in a commentary. In the CAD section, Dr Rainer Hoffman and colleagues compared various invasive and noninvasive imaging techniques for analyzing regional left ventricular function in 100 patients. Of all techniques used, contrast echocardiography demonstrated the highest accuracy in detection of regional wall abnormalities. Our commentator, Dr Alan Wasserman, adds his thoughts on how these various techniques impact cardiology practices. In the diabetes section, Drs Nithima Chaowalit and Patricia A. Pellikka studied the prognostic value of dobutamine stress echocardiography in 2349 patients with diabetes during a long (13-year) follow-up. They were able to create a simple risk-stratification model using age, failure to achieve target heart rate, and the percentage of ischemic segments on the echocardiogram. The usefulness of this test in clinical practice is discussed by Dr Luther Clark in his commentary. Our final contribution is in the arrhythmias section. Dr Robert Sheldon and Karyn Baggs from Canada evaluated 208 patients in 14 centers in 5 countries with a history of vasovagal syncope. Beta-blocker therapy is a commonly prescribed treatment for this condition, yet in this randomized, placebo-controlled trial it was shown to be ineffective. Dr Frank Mazzola comments on the clinical implications of this “negative” study. Finally, we round out the issue with another collection of questions designed to help with preparation for the Maintenance of Certification exam.