Tight glycemic control in diabetic CABG surgery patients

This month’s edition of Cardiology Review features an article in the diabetes section by Dr. Harold L. Lazar and associates on the beneficial effect of maintaining blood glucose levels lower than 200 mg/dL. This study of 141 diabetic patients undergoing coronary artery bypass graft (CABG) surgery included 72 patients who were treated with a modified protocol for a glucose-insulin-potassium infusion and 70 control patients. Drs. Justin Levisay and Peter M. Buttrick comment on this benefical therapy.

In a combined article in the lipid disorders and heart failure sections, Drs. Andrew L. Clark and Stefan D. Anker of the United Kingdom evaluate the relationship between serum cholesterol levels and survival in patients with chronic heart failure. Their study included two groups of patients (an initial “derivation” group and a subsequent “validation” group). Their results appear to show that the lower the serum cholesterol level, the worse the prognosis. Dr. Roger S. Blumenthal and his associate Dr. Thomas Cimato offer their own thoughts on this provocative study in their commentary, which emphasizes the need for confirmatory trials.

Our entry for the stroke section this month is by Dr. Carlos J. Rodriguez and colleagues. These investigators report on medical therapy (warfarin versus aspirin) for preventing stroke recurrence or death in 69 patients with atrial septal aneurysm and 203 patients with patent foramen ovale. Forty-four patients had both abnormalities. Dr. Elliott G. Gross provides the commentary for this study.

In the hypertension section, Dr. Ramón C. Hermida and associates from Spain evaluate the seasonal variation in fibrinogen levels in 1,006 hypertensive patients. A relationship between these levels and risk of subsequent vascular events was found. The commentary is by Dr. Wendy S. Post.

Finally, Dr. Stephen P. Glasser presents the first in a series of articles on the fundamentals of clinical research. His first article provides a brief overview of the history of clinical research.