Circulation. 2006;114:2753
(Circulation. 2006;114:2753.)
© 2006 American Heart Association, Inc.
Issue Highlights
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INCREASING USE OF CARDIOPULMONARY RESUSCITATION DURING OUT-OF-HOSPITAL VENTRICULAR FIBRILLATION ARREST: SURVIVAL IMPLICATIONS OF GUIDELINE CHANGES, by Rea et al.
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Even relatively brief interruptions of chest compressions, such
as pauses required for assessment of the cardiac rhythm by an
automatic external defibrillator, reduce survival in experimental
models of cardiac arrest. American Heart Association guidelines
for cardiopulmonary resuscitation have been revised accordingly
to include a single shock, rather than stacked defibrillation
shocks, followed by immediate resumption of cardiopulmonary
resuscitation and delayed reassessment of cardiac rhythm. Do
these changes improve patient outcomes? Rea and colleagues studied
outcomes from out-of-hospital cardiac arrest before and after
cardiopulmonary resuscitation protocol changes were implemented
in King County, Washington. They observed an improvement in
survival to hospital discharge. Recorded automatic external
defibrillator data showed increased time spent with chest compressions.
The findings provide support for minimizing interruptions in
cardiopulmonary resuscitation. The study also illustrates how
analysis of community data can provide reassurance that unanticipated
adverse effects do not offset potential benefits when protocol
changes supported by strong experimental evidence are applied
to out-of-hospital cardiac arrest victims. See p 2760 (and editorial
p
2754).
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ETHNIC AND GENDER DIFFERENCES IN AMBULATORY BLOOD PRESSURE TRAJECTORIES: RESULTS FROM A 15-YEAR LONGITUDINAL STUDY IN YOUTH AND YOUNG ADULTS, by Wang et al.
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In the United States, blacks experience a greater burden of
hypertension and associated cardiovascular disease compared
to whites. The reasons for these ethnic differences are incompletely
understood. In this issue of
Circulation, Wang and colleagues
evaluated longitudinal trajectories of 24-hour ambulatory blood
pressure (BP) using serial recordings obtained in black and
white children over a 15-year period. The authors observed that
black children had higher levels of both systolic and diastolic
BP during day and night from early adolescence onwards. A striking
finding was that black youth experienced a greater age-associated
increase in nocturnal systolic and diastolic BP compared to
whites. Black-white differences in age-associated changes in
day-time BP were less striking. The authors conclude that a
blunted nocturnal decline in BP that is more pronounced in adolescence
may contribute to the greater burden of hypertension in blacks.
If confirmed, these findings suggest the origins of adult hypertension
(and ethnicity-related differences in hypertension burden) may
lie in the patterns of 24-hour ambulatory BP in childhood. See
p
2780.
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RISKS ASSOCIATED WITH STATIN THERAPY: A SYSTEMATIC OVERVIEW OF RANDOMIZED CLINICAL TRIALS, by Kashani et al.
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Statins, one of the most commonly prescribed drugs, reduce the
risk of cardiovascular events, but there are concerns about
their association with an increased risk of musculoskeletal,
renal and hepatic complications. Clinical trials are the best
source of unbiased information about the presence and magnitude
of risk conferred by these medications. The study by Kashani
et al in this issue of
Circulation evaluated information about
the adverse effects of statins based on 35 trials of statin
monotherapy versus placebo, involving 74 102 patients. The investigators
assessed the risk of myalgias, creatine kinase elevations, rhabdomyolysis,
transaminase elevations, and discontinuation due to any adverse
event. A caveat is that the experience in the clinical trials
might underestimate risks of patients who are underrepresented
in the trials, such as those who are older, have more comorbidity,
or receive higher doses than specified in the trials. Nevertheless,
the present study provides the best current unbiased estimates
of the risks of statin therapy in the trial populations and
can be used to support clinical decision making. See p
2788.
Visit http://circ.ahajournals.org:
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Images in Cardiovascular Medicine
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A Quadricuspid Aortic Valve With Severe Aortic Regurgitation.
See p
e642.
Acute Coronary Syndrome due to Intramural Hematoma. See p e644.
Definitive Diagnosis of Obstructed Total Anomalous Pulmonary Venous Drainage in a Critically Ill Newborn With High-Resolution Computed Tomography. See p e646.
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Correspondence
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See p
e648.
Related Articles:
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Measuring Progress in Resuscitation: It’s Time for a Better Tool
- Joseph P. Ornato and Mary Ann Peberdy
Circulation 2006 114: 2754-2756.
[Extract]
[Full Text]
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A Quadricuspid Aortic Valve With Severe Aortic Regurgitation
- Michèle Desruennes, Richard Isnard, Alain Pavie, Philippe Cluzel, and Jean-Philippe Metzger
Circulation 2006 114: e642-e643.
[Extract]
[Full Text]
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Acute Coronary Syndrome due to Intramural Hematoma
- Hisanori Fujikura, Yoshiki Hata, Yoshihiro Morino, Atsushi Matsuzaki, Keiko Oikawa, Yuji Ikari, and Junichi Taguchi
Circulation 2006 114: e644-e645.
[Extract]
[Full Text]
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Definitive Diagnosis of Obstructed Total Anomalous Pulmonary Venous Drainage in a Critically Ill Newborn With High-Resolution Computed Tomography
- Phalla Ou, David S. Celermajer, Bertrand Stos, Eloi Marijon, Pascal Vouhé, Francis Brunelle, Damien Bonnet, and Daniel Sidi
Circulation 2006 114: e646-e647.
[Extract]
[Full Text]
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Letter by Brilakis and Banerjee Regarding Article, "Impact of Internal Mammary Artery Conduit on Long-Term Outcomes After Percutaneous Intervention of Saphenous Vein Graft"
- Emmanouil S. Brilakis and Subhash Banerjee
Circulation 2006 114: e648.
[Extract]
[Full Text]
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Risks Associated With Statin Therapy: A Systematic Overview of Randomized Clinical Trials
- Amir Kashani, Christopher O. Phillips, JoAnne M. Foody, Yongfei Wang, Sandeep Mangalmurti, Dennis T. Ko, and Harlan M. Krumholz
Circulation 2006 114: 2788-2797.
[Abstract]
[Full Text]
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Ethnic and Gender Differences in Ambulatory Blood Pressure Trajectories: Results From a 15-Year Longitudinal Study in Youth and Young Adults
- Xiaoling Wang, Joseph C. Poole, Frank A. Treiber, Gregory A. Harshfield, Coral D. Hanevold, and Harold Snieder
Circulation 2006 114: 2780-2787.
[Abstract]
[Full Text]
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