Circulation. 2005;111:1455
(Circulation. 2005;111:1455.)
© 2005 American Heart Association, Inc.
Issue Highlights
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RISK OF CARDIOVASCULAR DISEASE BY HYSTERECTOMY STATUS, WITH AND WITHOUT OOPHORECTOMY: THE WOMEN’S HEALTH INITIATIVE OBSERVATIONAL STUDY, by Howard et al.
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It has long been appreciated that women who have undergone hysterectomy
with or without oophorectomy have excess cardiovascular disease
morbidity and mortality. Investigators have speculated that
the deficiencies in endogenous hormones produced by the uterus
and ovaries as well as alteration in iron stores might contribute
to the unfavorable outcome. To gain further insights into factors
that contribute to cardiovascular disease in women after hysterectomy,
researchers analyzed the geographically diverse Women’s
Health Initiative Observational database of almost 90 000 women.
The investigators confirmed the observation that hysterectomy
predicted a risk of cardiovascular disease events and total
mortality; however, they noted that black, Hispanic, and American
Indian women had higher hysterectomy rates than their white
counterparts. In addition, women who had undergone hysterectomy
had an unfavorable risk factor profile, including a higher prevalence
of hypertension, diabetes, obesity, and high cholesterol and
lower education, income, and physical activity levels. Of note,
the apparent increased risk of hysterectomy was significantly
reduced after adjusting for race/ethnicity and cardiovascular
risk factors. Although observational in design, the present
study may help reassure patients that hysterectomy per se may
not markedly alter cardiovascular risk. One possible clinical
implication of the present study is that patients and clinicians
might view the advent of hysterectomy as an opportunity to review
cardiovascular disease risk factor burden and pursue risk factor
modification when appropriate. See p
1462.
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RISK OF WORSENING RENAL FUNCTION WITH NESIRITIDE IN PATIENTS WITH ACUTELY DECOMPENSATED HEART FAILURE, by Sackner-Bernstein et al.
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Nesiritide is a commonly used treatment for patients with acute
decompensated heart failure in whom renal function is an identified
prognostic factor. Sackner-Bernstein et al examined public records
from US Food and Drug Administration files to determine whether
treatment with nesiritide was associated with changes in renal
function. In data from 5 randomized trials involving 1269 patients
with heart failure, they found that, as compared with control
subjects, patients who received nesiritide had a significant
risk of increasing the serum creatinine by
0.5 mg/dL. This effect
was not associated with a greater need for dialysis. This study
suggests that further evaluation of the effects of nesiritide
and its impact on outcomes may be warranted. See p
1487.
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IN VIVO CHARACTERIZATION OF CORONARY ATHEROSCLEROTIC PLAQUE BY USE OF OPTICAL COHERENCE TOMOGRAPHY, by Jang et al.
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Optical coherence tomography (OCT) is a high-resolution catheter-based
imaging technique that can provide detailed in vivo tomographic
assessment of coronary arterial plaques. Previous studies have
established the validity of the image findings to define plaque
components, as well as the feasibility of performing OCT during
catheterization and percutaneous coronary intervention procedures.
In this issue of
Circulation, Jang and colleagues deploy the
OCT technique in patients undergoing cardiac catheterization
after presenting with acute myocardial infarction, unstable
angina, or stable angina, and they define syndrome-specific
differences in the minimum thickness of the fibrous cap as well
as in the prevalence of thin cap fibroatheroma. These exciting
data move the field another step forward toward a goal of online
high-resolution detailed assessment of coronary plaque during
cardiac catheterization and enable the potential for differential
treatment strategies based on plaque morphology. See p
1551.
Visit www.circ.ahajournals.org:
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Images in Cardiovascular Medicine
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A "Mickey Mouse" Coronary Anomaly: Aorto-Left Atrial Fistula
With Aneurysm. See p
e162.
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Correspondence
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Letter Regarding Articles by Kereiakes and Willerson, Mehran
et al, and Kaplan et al, "Mini-Review: Expert Opinion." See
p
e164.
Letter Regarding Article by Khan et al, "Predictive Adaptive Responses to Maternal High-Fat Diet Prevent Endothelial Dysfunction but Not Hypertension in Adult Rat Offspring." See p e166.
Letter Regarding Article by Vita et al, "Serum Myeloperoxidase Levels Independently Predict Endothelial Dysfunction in Humans." See p e167.
Related Articles:
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Risk of Worsening Renal Function With Nesiritide in Patients With Acutely Decompensated Heart Failure
- Jonathan D. Sackner-Bernstein, Hal A. Skopicki, and Keith D. Aaronson
Circulation 2005 111: 1487-1491.
[Abstract]
[Full Text]
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Risk of Cardiovascular Disease by Hysterectomy Status, With and Without Oophorectomy: The Women’s Health Initiative Observational Study
- Barbara V. Howard, Lewis Kuller, Robert Langer, JoAnn E. Manson, Catherine Allen, Annlouise Assaf, Barbara B. Cochrane, Joseph C. Larson, Norman Lasser, Monique Rainford, Linda Van Horn, Marcia L. Stefanick, and Maurizio Trevisan
Circulation 2005 111: 1462-1470.
[Abstract]
[Full Text]
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In Vivo Characterization of Coronary Atherosclerotic Plaque by Use of Optical Coherence Tomography
- Ik-Kyung Jang, Guillermo J. Tearney, Briain MacNeill, Masamichi Takano, Fabian Moselewski, Nicusor Iftima, Milen Shishkov, Stuart Houser, H. Thomas Aretz, Elkan F. Halpern, and Brett E. Bouma
Circulation 2005 111: 1551-1555.
[Abstract]
[Full Text]
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A "Mickey Mouse" Coronary Anomaly: Aorto-Left Atrial Fistula With Aneurysm
- Matthews Chacko, Bruce W. Lytle, Richard D. White, and Robert E. Hobbs
Circulation 2005 111: e162-e163.
[Full Text]
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Letter Regarding Articles by Kereiakes and Willerson, Mehran et al, and Kaplan et al, "Mini-Review: Expert Opinion" • Response
- John Somberg, Warren Laskey, Douglass Morrison, Judah Weinberger, Dean J. Kereiakes, Aaron V. Kaplan, and Roxana Mehran
Circulation 2005 111: e164-e165.
[Full Text]
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Letter Regarding Article by Khan et al, "Predictive Adaptive Responses to Maternal High-Fat Diet Prevent Endothelial Dysfunction but Not Hypertension in Adult Rat Offspring" • Response
- Jordi Altimiras, Per Milberg, Imran Khan, Vasia Dekou, Lucilla Poston, Paul Taylor, and Mark Hanson
Circulation 2005 111: e166.
[Full Text]
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Letter Regarding Article by Vita et al, "Serum Myeloperoxidase Levels Independently Predict Endothelial Dysfunction in Humans" • Response
- Roland Walter, Katharina Schroecksnadel, Dietmar Fuchs, Joseph A. Vita, John F. Keaney, Jr, Noyan Gokce, Marie-Luise Brennan, Shirley A. Mann, Marlene Goormastic, Mehdi H. Shishehbor, Marc S. Penn, and Stanley L. Hazen
Circulation 2005 111: e167-e168.
[Full Text]
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