Knocking on Winter's Door

Debabrata Mukherjee,

Editor in Chief

As winter comes knocking on our doors, I hope you will find time to sit with a hot cup of tea or coffee and enjoy this issue of Cardiology Review, which discusses many important articles and viewpoints that I am sure you will find enjoyable and useful reading.

In this issue of Cardiology Review, Drs. Navin Nanda and Siddharth Singh discuss the role of ¹⁸F-fluoride PET to identify ruptured and high-risk coronary atherosclerotic plaques. They suggest that clinical utility of ¹⁸F-NAF imaging in patients presenting with myocardial infarction may need more delineation, as most of these patients undergo coronary angiography and likely intervention. They state that the technique does hold promise to evaluate newer therapies for plaque stabilization by allowing in-vivo imaging of vulnerable plaques.

Drs. Kathleen M. Faulkenberg and Tracy E. Macaulay review the formulation of niacin with laropiprant, a prostaglandin D2 antagonist, aimed at reducing the incidence of flushing, thereby increasing patient adherence to lipid-lowering therapy with niacin. They note that although laropiprant reduced the flushing commonly associated with niacin therapy, it is arguable if the risk and other serious adverse events outweigh the benefit of lipid-lowering therapy with niacin.

Dr. Harold Lazar discusses the extent of coronary and myocardial disease and benefits from revascularization in LV dysfunction. He reports that coronary bypass surgery remains an important intervention in those patients with multivessel disease and low ejection fraction. These patients may have the most to gain but are at the highest risk for perioperative morbidity and mortality. Further studies will be necessary to determine which subgroups of patients will benefit most from this therapy. In the meantime, decisions regarding the need for CABG surgery in these high-risk patients will need to be made on an individual basis with careful evaluation of existing comorbidities, which may limit both short-term and long-term survival.

Dr. Eric Bates reflects on choosing the best revascularization strategy in patients with left main coronary artery disease (CAD) and opines that the best revascularization strategy for a patient with left main CAD is based on the complexity and extent of CAD, the magnitude of left ventricular systolic dysfunction, physician expertise, patient preference, and consultation between the interventional cardiologist and the cardiac surgeon. Included in this discussion should be the increased risk of early stroke, other surgical complications, and the potential of later saphenous vein bypass graft disease with bypass graft surgery and the increased risk of MI and repeat revascularization after PCI.

Dr. Ragavendra R. Baliga touches on an important social issue: the combined effect of physical activity and leisure time sitting on obesity risk. He points out that although lifestyle—including dietary and exercise patters—are shaped by cultural, environmental, technological, and economic factors, we need to modify factors with a range of initiatives from broad food and agricultural policies and targeted pricing and regulatory interventions, to specific harmful or beneficial exercise and dietary components.

Drs. Chintan Desai and Roger Blumenthal muse on noncardiovascular effects associated with statins and suggest that given the strong patient preferences that are often in play when discussing statin therapy, clinicians could further inform the risk discussion by estimating the risks of statin therapy on the basis of clinical characteristics, in a similar way to the estimation of bleeding risk with warfarin. In our clinical forum section, Drs. Gurm, Mohsin, and Quevedo engage in a lively debate on the role (if any) of beta-blockers in patients treated with primary PCI. Also, the compilation of major studies presented at European Society of Cardiology meetings by our insightful and talented managing editor, Ms Jackie Syrop, should keep you updated on the latest happenings in this field.

I hope that you will find these commentaries to be valuable and enjoyable. I encourage you to share your insights, thoughts, and personal experiences on the topics touched upon in this issue. On a broader level, I would love to hear feedback on how we can make this journal even better. My goal continues to be to make you look forward to every issue of Cardiology Review.

Debabrata Mukherjee

Editor-in-Chief