Circulation. 2006;113:1549
(Circulation. 2006;113:1549.)
© 2006 American Heart Association, Inc.
Issue Highlights
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RELATIONSHIP BETWEEN HOMOCYSTEINE AND MORTALITY IN CHRONIC KIDNEY DISEASE, by Menon et al.
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Prior studies relating plasma homocysteine to the risk of cardiovascular
disease in the general population have yielded inconsistent
results. Reduced glomerular filtration rate (GFR) is a risk
factor for cardiovascular disease, and plasma homocysteine is
related inversely to GFR. Therefore, the association of plasma
homocysteine with cardiovascular disease in some earlier reports
may have been confounded by inadequate adjustment for GFR. In
this issue of
Circulation, Menon and colleagues relate homocysteine
levels to all-cause and cardiovascular mortality in patients
with stages 3 to 4 chronic kidney disease enrolled in the Modification
of Diet in Renal Disease Study who were followed up for a median
duration of 10 years. The authors observed that plasma homocysteine
levels increased with worsening GFR. In analyses adjusting for
GFR (measured by the renal clearance of
125I-iothalamate), plasma
homocysteine was not associated with all-cause or cardiovascular
mortality. These observations suggest that plasma homocysteine
may be a marker of severity of kidney disease rather than an
independent risk factor in patients with stages 3 to 4 chronic
kidney disease. See p
1572.
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IMPACT OF DIABETES MELLITUS ON REGRESSION OF ELECTROCARDIOGRAPHIC LEFT VENTRICULAR HYPERTROPHY AND THE PREDICTION OF OUTCOME DURING ANTIHYPERTENSIVE THERAPY: THE LOSARTAN INTERVENTION FOR ENDPOINT (LIFE) REDUCTION IN HYPERTENSION STUDY, by Okin et al.
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Research has established that left ventricular hypertrophy (LVH)
is associated with excess morbidity and mortality. Moreover,
recent observational and randomized data support the concept
that LVH regression improves prognosis. Whether the benefits
of LVH regression are equivalent across various patient subgroups
is, however, uncertain. Dr Okin and colleagues examined over
9000 patients with hypertension in the Losartan Intervention
For Endpoint (LIFE) Reduction in Hypertension Study, 1195 of
whom had diabetes, to understand the benefits of LVH regression
in patients with diabetes. Consistent with prior studies, the
investigators observed that the prevalence of LVH was greater
among patients with diabetes. However, with a mean follow-up
of about 5 years, patients with diabetes had less electrocardiographic
LVH regression. Surprisingly, though the mortality benefit of
hypertension treatment in diabetes is established, LVH regression
per se was not predictive of improved prognosis in those with
diabetes. The data of Okin et al suggest that the pathogenesis
of the poor prognosis associated with LVH in diabetes is multifactorial
and merits further investigation. See p
1588.
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WOMEN HAVE HIGHER LEFT VENTRICULAR EJECTION FRACTIONS THAN MEN INDEPENDENT OF DIFFERENCES IN LEFT VENTRICULAR VOLUME: THE DALLAS HEART STUDY, by Chung et al.
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The clinical utility of ejection fraction is widely accepted,
and despite the well-recognized pitfalls, it remains an important
predictor of outcome in multiple different cardiac diseases.
In general, common cutpoints have been applied to men and women.
In this week’s journal, Chung et al acquired cardiac magnetic
resonance imaging in 1435 women and 1183 men from the Dallas
Heart Study. This carefully performed study in a probability-based
sample of Dallas residents aged 30 to 65 demonstrated that the
median left ventricular ejection fraction in women (75%) is
higher than in men (70%); this is secondary to a higher stroke
volume. This gender-associated difference in stroke volume is
independent of end-diastolic volume and other evaluated confounders.
Future work will be needed to assess the importance of this
finding in the study of cardiovascular diseases. See p
1597.
Visit http://circ.ahajournals.org:
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Clinician Update
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Gastrointestinal Complications of Dual Antiplatelet Therapy.
See p
e655.
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Images in Cardiovascular Medicine
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Severe Left Atrial Edema and Heart Failure After Atrial Fibrillation
Ablation. See p
e659.
Serial High-Spatial-Resolution, Multisequence Magnetic Resonance Imaging Studies Identify Fibrous Cap Rupture and Penetrating Ulcer Into Carotid Atherosclerotic Plaque. See p e660.
Diffuse Infiltration of Lymphoma of the Myocardium Mimicking Clinical Hypertrophic Cardiomyopathy. See p e662.
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Correspondence
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See p
e665.
Related Articles:
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Women Have Higher Left Ventricular Ejection Fractions Than Men Independent of Differences in Left Ventricular Volume: The Dallas Heart Study
- Anne K. Chung, Sandeep R. Das, David Leonard, Ronald M. Peshock, Farhana Kazi, Shuaib M. Abdullah, Russell M. Canham, Benjamin D. Levine, and Mark H. Drazner
Circulation 2006 113: 1597-1604.
[Abstract]
[Full Text]
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Gastrointestinal Complications of Dual Antiplatelet Therapy
- Neelima G. Vallurupalli and Samuel Z. Goldhaber
Circulation 2006 113: e655-e658.
[Full Text]
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Severe Left Atrial Edema and Heart Failure After Atrial Fibrillation Ablation
- Kevin E. Steel, Javier Roman-Gonzalez, and Carey L. O’Bryan, IV
Circulation 2006 113: e659.
[Full Text]
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Serial High-Spatial-Resolution, Multisequence Magnetic Resonance Imaging Studies Identify Fibrous Cap Rupture and Penetrating Ulcer Into Carotid Atherosclerotic Plaque
- Baocheng Chu, Chun Yuan, Norihide Takaya, Jason R. Shewchuk, Alexander W. Clowes, and Thomas S. Hatsukami
Circulation 2006 113: e660-e661.
[Full Text]
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Diffuse Infiltration of Lymphoma of the Myocardium Mimicking Clinical Hypertrophic Cardiomyopathy
- P.W. Lee, K.S. Woo, Louis T.C. Chow, H.K. Ng, Wilson W.M. Chan, C.M. Yu, and Anthony W.I. Lo
Circulation 2006 113: e662-e664.
[Full Text]
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Letter Regarding Article by Staat et al, "Postconditioning the Human Heart"
- Warren K. Laskey, Patrick Staat, Gilles Rioufol, Eric Bonnefoy, Gérard Finet, Xavier André-Fouët, Michel Ovize, Christophe Piot, Thien Tri Cung, Yves Cottin, Isabelle L’Huillier, and Jean-François Aupetit
Circulation 2006 113: e665.
[Full Text]
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Relationship Between Homocysteine and Mortality in Chronic Kidney Disease
- Vandana Menon, Mark J. Sarnak, Tom Greene, Xuelei Wang, Arema A. Pereira, Gerald J. Beck, John W. Kusek, Jacob Selhub, Allan J. Collins, Andrew S. Levey, and Michael G. Shlipak
Circulation 2006 113: 1572-1577.
[Abstract]
[Full Text]
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Impact of Diabetes Mellitus on Regression of Electrocardiographic Left Ventricular Hypertrophy and the Prediction of Outcome During Antihypertensive Therapy: The Losartan Intervention For Endpoint (LIFE) Reduction in Hypertension Study
- Peter M. Okin, Richard B. Devereux, Eva Gerdts, Steven M. Snapinn, Katherine E. Harris, Sverker Jern, Sverre E. Kjeldsen, Stevo Julius, Jonathan M. Edelman, Lars H. Lindholm, Björn Dahlöf for the LIFE Study Investigators
Circulation 2006 113: 1588-1596.
[Abstract]
[Full Text]
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