Statins and antiplatelet agents

This month’s issue of Cardiology Review features a combined report on the prevalence and prognostic role of the metabolic syndrome (a surrogate for the more complex diagnosis of insulin resistance) in the coronary artery disease and diabetes sections. Dr Giacomo Levantesi and colleagues from Italy used the GISSI-Prevenzione Trial database of 11,323 patients with recent myocardial infarctions and found that both diabetic and “prediabetic” patients (ie, those with the metabolic syndrome) had higher death rates compared with control subjects. Not all cardiovascular event rates, however, were similar in both groups. Dr. Alan Wasserman comments on this paper. Is “white-coat” hypertension a risk factor for the development of sustained (home) hypertension? That is the question posed by Dr. Takashi Ugajin and associates from Japan in their study of 128 patients and 649 controls. Their results indicate that the answer to the question is yes and that patients with white coat hypertension should be carefully monitored. Dr Peter Buttrick, our commentator, concurs.

An article in the lipid section by Dr Yukihiko Momiyama and associates from Japan describes yet another use for the statins: regression of aortic plaques in the thoracic aorta and retardation of plaque progression in the abdominal aorta. Fifty patients were randomized in this prospective, open-label trial using initial and 12-month followup magnetic resonance imaging exams to evaluate statin benefits. The authors, and Dr Roger Blumenthal in his commentary, discuss the possible reasons for the discrepancies between the results in the thoracic and abdominal aorta.

In the stroke section, Dr Hans Christoph Diener from Germany was also interested in the effects of antiplatelet agents in preventing recurrent ischemic vascular events in 759 patients with prior transient ischemic attacks or strokes. Dr Diener found that clopidogrel alone was an excellent protective agent. Dr Douglas Dulli, our neurological consultant, voices both “disappointment and surprise” with the study results in an eloquent commentary.

Finally, in a related article in the arrhythmia section, Dr Francisco Perez-Gomez and colleagues from Spain compared the effects of antiplatelet agents, anticoagulants, and a combination of the two in preventing vascular events (systemic emboli or stroke) in patients with either valvular or nonvalvular causes of atrial fibrillation. Their total population was 1209 patients and their results favored a combined therapy approach, as Dr Frank Mazzola notes in his commentary.