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(Circulation. 2005;112:1.)
© 2005 American Heart Association, Inc.

Issue Highlights

	PERIODONTAL DISEASE AND CORONARY HEART DISEASE: A REAPPRAISAL OF THE EXPOSURE, by Beck et al.

Top PERIODONTAL DISEASE AND CORONARY... EFFECTS OF CANDESARTAN ON... STATIN TREATMENT AFTER ONSET... Images in Cardiovascular... Book Review Correspondence

 
There currently is great interest in understanding the role of certain chronic infections as risk factors for cardiovascular disease. In this regard, prior studies have suggested that chronic periodontal disease is associated with increased cardiovascular risk, although it remains possible that the confounding effects of smoking and other classical risk factors explain the association. In this issue of Circulation, Beck and colleagues investigated the relation between periodontal disease and prevalent coronary heart disease in 5002 participants in the fourth examination of the Atherosclerosis Risk in Communities Study. They observed that elevated serum IgG antibodies to several oral pathogens were associated with coronary heart disease, but findings on oral examination were not. Although further prospective studies of this question are needed, the present study suggests that the host response to oral infection may be more important for cardiovascular risk than the local extent of periodontal disease. See p 19.

	EFFECTS OF CANDESARTAN ON THE DEVELOPMENT OF A NEW DIAGNOSIS OF DIABETES MELLITUS IN PATIENTS WITH HEART FAILURE, by Yusuf et al.

Top PERIODONTAL DISEASE AND CORONARY... EFFECTS OF CANDESARTAN ON... STATIN TREATMENT AFTER ONSET... Images in Cardiovascular... Book Review Correspondence

 
Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers (ARBs) have been associated with a lower incidence of diabetes mellitus in clinical trials of hypertensives and other high-risk patients. However, it is less clear if use of renin-angiotensin axis inhibitors lowers the risk of diabetes in patients with heart failure. In this issue of Circulation, Yusuf and colleagues analyze data from the CHARM trial to assess the risk of developing new-onset diabetes (a prespecified secondary outcome) in more than 5000 heart failure patients randomized to candesartan (an ARB) or placebo. The investigators report that candesartan use was associated with a 22% reduction in incidence of diabetes compared with placebo. The reduction in incidence of diabetes was consistent across clinical subgroups (age, sex, body mass index) and was particularly striking in patients with a relatively preserved ejection fraction. The authors emphasize that use of ARBs in heart failure patients provides added value by lowering the future risk of diabetes. See p 48.

	STATIN TREATMENT AFTER ONSET OF SEPSIS IN A MURINE MODEL IMPROVES SURVIVAL, by Merx et al.

Top PERIODONTAL DISEASE AND CORONARY... EFFECTS OF CANDESARTAN ON... STATIN TREATMENT AFTER ONSET... Images in Cardiovascular... Book Review Correspondence

 
The clinical benefits achieved with HMG-CoA reductase inhibitors have been shown to extend well beyond the recognized lipid-lowering effects of these agents. The pleiotropic effects attributed to statins include increased bioavailable nitric oxide, increased antioxidant properties, inhibition of inflammatory responses, and improvement of endothelial dysfunction. Interestingly, investigators have recognized that these pleiotropic effects may be exploited to offer a therapeutic advantage in clinical situations other than atherothrombotic vascular disease. For example, Merx et al have previously shown that the antiinflammatory effects of statins mediate responses to sepsis; pretreatment with statins improved survival in a murine model of sepsis. In this issue of Circulation, Merx et al extend their previous work and examine the effects of initiating statin therapy after sepsis has been established. These studies may have implications for how clinicians treat sepsis in the future. See p 117.

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	Images in Cardiovascular Medicine

Top PERIODONTAL DISEASE AND CORONARY... EFFECTS OF CANDESARTAN ON... STATIN TREATMENT AFTER ONSET... Images in Cardiovascular... Book Review Correspondence

 
Detection of Luminal-Intimal Border and Coronary Wall Enhancement in Intravascular Ultrasound Imaging After Injection of Microbubbles and Simultaneous Sonication With Transthoracic Echocardiography. See p e1.

Detection of Carotid Atherosclerotic Plaque Ulceration, Calcification, and Thrombosis by Multicontrast Weighted Magnetic Resonance Imaging. See p e3.

Primary Lymphoma of the Heart. See p e5.

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	Book Review

Top PERIODONTAL DISEASE AND CORONARY... EFFECTS OF CANDESARTAN ON... STATIN TREATMENT AFTER ONSET... Images in Cardiovascular... Book Review Correspondence

 
Computed Tomography of the Coronary Arteries. See p e7.

	Correspondence

Top PERIODONTAL DISEASE AND CORONARY... EFFECTS OF CANDESARTAN ON... STATIN TREATMENT AFTER ONSET... Images in Cardiovascular... Book Review Correspondence

 
See p e9.

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Detection of Luminal-Intimal Border and Coronary Wall Enhancement in Intravascular Ultrasound Imaging After Injection of Microbubbles and Simultaneous Sonication With Transthoracic Echocardiography

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Letter Regarding Article by McNair et al, "SCN5A Mutation Associated With Dilated Cardiomyopathy, Conduction Disorder, and Arrhythmia" • Response

W.A. Groenewegen, A.A.M. Wilde, William P. McNair, Lisa Ku, Matthew R.G. Taylor, Pam R. Fain, Eugene Wolfel, and Luisa Mestroni
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Periodontal Disease and Coronary Heart Disease: A Reappraisal of the Exposure

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Circulation 2005 112: 19-24. [Abstract] [Full Text]

Effects of Candesartan on the Development of a New Diagnosis of Diabetes Mellitus in Patients With Heart Failure

Salim Yusuf, Jan B. Ostergren, Hertzel C. Gerstein, Marc A. Pfeffer, Karl Swedberg, Christopher B. Granger, Bertil Olofsson, Jeffrey Probstfield, John V. McMurray on behalf of the Candesartan in Heart Failure—Assessment of Reduction in Mortality and Morbidity Program (CHARM) Investigators
Circulation 2005 112: 48-53. [Abstract] [Full Text]

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