Statins and diuretics—potential positive and negative effects of cardiac drug use

Cardiology Review

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Cardiology Review.

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leads off this month with 2 articles for which CME credits are available. In a combined article in the lipids and coronary artery disease sections, Dr Eddie Hultenand associates performed a meta-analysis of 13 randomized controlled trials that measured the effect of early and intensive statin therapy in 17,963 patients with acute coronary syndromes who were followed for 2 years. The positive findings of this study are commented on by Dr Luther ClarkDiabetes is represented this month in an article by Italian authors Drs Roldano Scognamiglioand Chiara FraccaroThe authors’ goal was to establish the effectiveness of current American Diabetes Association screening guidelines for identifying asymptomatic patients with type 2 diabetes with coronary artery disease. The authors used noninvasive screening and then coronary angiography to document the presence of coronary artery disease in their 1899 patients. Dr Rosemarie Pasmantierprovides her thoughts on the study for Screening modalities are given another look in a case report submitted by 2 of our readers that features multiple images of a coronary artery anomaly. Dr William Lawsonelaborates further on the issues surrounding screening for these anomalies. This month’s lineup also contains an article in the arrhythmia section dealing with an important public health issue: integrating emergency medical systems that are already in place with use of the new out-of-hospital automatic external defibrillators that are operated by lay volunteers. Once again, authors from Italy Dr Riccardo Cappatoand colleagues) investigated the deployment of the defibrillators in Brescia, a county of more than 1 million people. The primary end point was survival free of neurological impairment at the 1-year follow-up. The results are encouraging—a safe program with increased survival from out-of-hospital cardiac arrest—and while commentator Dr Ernst Raederfinds this positive, he also has some practical concerns. Finally, the heart failure section sees Dr Ali Ahmedevaluate the controversy surrounding possible harmful effects of long-term diuretic use (because of their activation of neurohormones) in patients with congestive heart failure. His population of 2782 patients was drawn from the Digitalis Investigation Group, and his findings of increased morbidity and mortality challenge the wisdom of the routine chronic use of diuretics in all heart failure patients. Dr George Mallis discusses the potential clinical implications of this provocative study.