Long-term effects of low cholesterol, ethnic differences in blood pressure control, and lifetime risk of atrial fibrillation

This month’s first CME feature is in the lipid disorders section. Drs. Timo E. Strandberg and Arto Strandberg from Finland address the controversy surrounding the long-term effects of low (or lowered) serum cholesterol levels on mental function and quality of life in 3,490 initially healthy men. This evaluation offers encouraging conclusions for those committed to “the lower the better” philosophy, as Dr. Luther T. Clark discusses in his commentary.

Our second CME entry is a combined article in the diabetes and CAD/angina sections by Drs. Raban V. Jeger and Matthias E. Pfisterer from Switzerland in which they compare the benefits of revascularization therapy to a medical regimen in 291 elderly patients with diabetes. The advantages of the aggressive ap­proach are discussed by the authors and re-emphasized by Dr. William E. Lawson in his commentary.

In the hypertension section, Dr. Shakaib U. Rehman and associates compare ethnic differences in blood pressure control among 20,000 men at Veterans Affairs clinics versus other health care sites. They found significantly less disparity between African Ameri­cans and whites in the VA system compared with the non-VA health sites. Dr. Samuel J. Mann offers additional insights as the commentator for this article.

What is the lifetime risk for the development of atrial fibrillation? That is the question Dr. Donald M. Lloyd-Jones asks in his article in the arrhythmias and conduction disturbances section. Using the Framingham Heart Study database, he estimates the risk at 1 in 4 for men and women over 40 years of age. Dr. Stephen C. Vlay comments on these findings for Cardiology Review.

Finally, Dr. Stephen P. Glasser continues his Drugs in Trial reports with this month’s contribution on the reduction of cardiovascular events with perindopril. As with other angiotensin-converting enzyme inhibitors that were used in antihypertension studies, perindo­pril did more than simply lower blood pressure in 2 large trials that Dr. Glasser discusses.