Albuminuria and hyperglycemia: Their impact on patients with diabetes

Cardiology Review

Season's greetings! This month's edition of once again kicks off with a case from our "Images in Cardiology" section. Readers-turned-contributors Drs Dev Vaz, Shawn D. Teague, and Jo Mahenthiran provide a case that illustrates how cardiac magnetic resonance imaging may be better suited in differentiating cardiac mass compared with echocardiography. As is customary, Section Editor Tasneem Z. Naqvi provides a context-setting introduction. Next up is an article in both the coronary artery disease (CAD) and diabetes sections, which concerns the role of several coronary risk factors (especially albuminuria in patients with diabetes) as a predictor of the development of CAD. Dr Elisa T. Lee and colleagues used a database of 4549 Native Americans to draw their conclusions. Since the incidence of CAD in this population is increasing these are important findings, emphasizes Dr Kathleen Wyne in her commentary. A second article in this combined subject category is from Drs John D. Horowitz and Yuliy Y. Chirkov from Australia. The authors report on the deleterious effects of hyperglycemia on platelet function in diabetic patients with acute coronary syndromes. The authors studied 76 diabetic patients and found that aggressive glycemic control with insulin therapy decreased platelet aggregability and was useful in this patient population. Dr Alan Wasserman comments on the clinical value of this technique, which has been used previously in the treatment of acute myocardial infarction. Our hypertension section features a study by Drs Susann Patschan and Juergen Scholze dealing with the optimal treatment of obesity-related hypertension. The authors used a drug-based weight loss approach (with sibutramine) combined with different anti-hypertensive drug regimens in 171 obese, hypertensive patients. This unique approach should be helpful in designing future treatment strategies for this ever-increasing patient population, notes Dr Leslie Cho in her accompanying commentary. A final study sees Dr Joanne D. Schuijf and colleagues from the Netherlands analyzing multislice computed tomography (CT) coronary angiography, which is probably more widely known in the United States than magnetic resonance imaging. The authors studied 100 patients referred for CAD evaluation and found patients with a normal study had a zero event rate after 1 year follow-up.Dr Richard Stewart is duly impressed with their results and the independent prognostic value that multislice CT coronary angiography added to the patients' baseline clinical characteristics. Completing this month's issue is another set of preparatory questions for the Maintenance of Certification Exam in Cardiovascular Disease.

—Peter F. Cohn