Evaluating the influence of clinical trials on practice patterns

Cardiology Review opens this month with a continuing medical education feature in the diabetes and coronary artery disease section. Drs. Justin L. Martin and Darren K. McGuire evaluated the influence of a large multicenter revascularization trial (BARI) on practice patterns in diabetic patients. Despite advice to the contrary, many diabetic patients still undergo angioplasty. Dr. William E. Lawson explores the complex issues involved in this provocative study in his thoughtful commentary.

Our second continuing medical education feature, in the stroke and arrhythmias section, is an article evaluating the prevalence of atrial fibrillation in ischemic stroke patients compared to an age- and sex-matched control population. Dr. Teresa S.M. Tsang and Marion E. Barnes studied 3,742 patients, half of whom had confirmed ischemic strokes. The authors found a surprising increase in the incidence of atrial fibrillation in both groups over a 30-year period. Dr. Douglas Dulli comments on the public health implications of their findings.

This month’s edition of Cardiology Review also features an article in the hypertension section by Dr. Richard B. Devereux and Paulette A. Lyle studying cardiovascular event rates after treatment with the angiotensin receptor blocker losartan compared with the beta blocking agent atenolol. In this series of hypertensive patients without clinically evident vascular disease, losartan was a superior drug, a somewhat surprising observation that stimulated an interesting commentary by Drs. Nobuyuki Miyawaki and John K. Maesaka.

In the lipid disorders section, Dr. Harold L. Lazar provides an overview of the role of lipids and HMG-CoA reductase inhibitor (statin) therapy, not in respect to coronary artery disease as one might expect, but rather in the deterioration of native and prosthetic heart valves! This report offers a new insight into an important clinical problem.

Our final feature this month is a combined stroke and coronary artery disease report. Dr. Stefano Savonitto and colleagues from Italy and the United States evaluated the occurrence of intracranial hemorrhage during treatment of acute myocardial infarction with both a platelet blocker and a thrombolytic agent. They found a higher risk of this complication in the elderly in their large (16,588 patients) multicenter study (GUSTO V). The “take-home message,” as Dr. Joseph S. Alpert emphasizes in his commentary, is that this type of stroke continues to be a worrisome problem during aggressive therapy of acute myocardial infarctions.