Circulation. 2006;113:2165
(Circulation. 2006;113:2165.)
© 2006 American Heart Association, Inc.
Issue Highlights
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CHARACTERISTICS AND BASELINE CLINICAL PREDICTORS OF FUTURE FATAL VERSUS NONFATAL CORONARY HEART DISEASE EVENTS IN OLDER ADULTS: THE CARDIOVASCULAR HEALTH STUDY, by Pearte et al.
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The aging of the population has brought increased focus onto
the high morbidity and mortality of coronary heart disease (CHD)
in the elderly. Pearte and colleagues examined the predictors
and the temporal trends in CHD mortality in community-dwelling
elderly adults participating in the Cardiovascular Heath Study.
They observed that traditional risk factors and indicators of
subclinical disease assessed before CHD event predicted an increased
risk of CHD fatality. For instance, antecedent heart failure
regardless of left ventricular systolic function conferred a
3-fold increased risk of death. The authors noted that although
case-fatality decreased slightly over time, CHD remains lethal
for almost one third of elderly individuals suffering a CHD
event. In the era of personalized medicine, the authors argue
that further efforts should be directed toward identifying effective
strategies to prevent poor outcomes in high-risk elderly patients
with CHD events. See p
2177.
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ROLE OF DIURETICS IN THE PREVENTION OF HEART FAILURE: THE ANTIHYPERTENSIVE AND LIPID-LOWERING TREATMENT TO PREVENT HEART ATTACK TRIAL, by Davis et al.
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High blood pressure is a key risk factor for congestive heart
failure (CHF). The Antihypertensive and Lipid-Lowering Treatment
to Prevent Heart Attack Trial (ALLHAT) was a randomized controlled
comparison of chlorthalidone, amlodipine, and lisinopril (representing
diuretics, calcium channel blockers, and angiotensin-converting
enzyme inhibitors) for prevention of cardiovascular disease
events in hypertensive patients. In this issue of
Circulation,
Davis and colleagues report on the relative effects of these
3 antihypertensive agents on rates of hospitalized/fatal CHF
in ALLHAT. The authors observed that comparative risks for CHF
in the 3 arms varied over time. In the first year of the trial,
patients in the amlodipine and lisinopril arms experienced a
2-fold greater risk of CHF compared to those in the chlorthalidone
arm. Beyond the first year, CHF risks were comparable for the
chlorthalidone and lisinopril arms, but higher in the amlodipine
arm. These differences in CHF rates in the 3 treatment arms
were not explained by prior medication use or by the blood pressure
level at baseline or on follow-up. These observations suggest
that diuretics may be superior to calcium channel blockers for
the prevention of CHF in hypertensive patients. See p
2201.
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OUTCOME OF WATCHFUL WAITING IN ASYMPTOMATIC SEVERE MITRAL REGURGITATION, by Rosenhek et al.
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Timing of surgery in patients with mitral regurgitation remains
a challenge. Several recent studies have recommended liberalization
of indications, particularly when mitral valve repair is feasible.
Current published guidelines recommend watchful waiting, but
the safety of this approach has not been prospectively evaluated.
In this week’s journal, Rosenhek et al describe 132 consecutive
asymptomatic patients with severe mitral regurgitation followed
up for an average of just over 5 years. Patients were followed
up with careful serial clinical evaluation and echocardiograms
and were referred for surgery when they met guideline-based
criteria. Overall survival was not different from expected survival.
During follow-up, 38 patients met the criteria for surgery.
Postoperative outcome was good in terms of survival, symptoms,
and postoperative left ventricular function. This important
prospective study provides further support for current guidelines
that recommend "watchful waiting" for asymptomatic patients
with severe mitral regurgitation. In addition, the study emphasizes
the importance of careful clinical and echocardiographic vigilance
in this setting. See p
2238.
Visit http://circ.ahajournals.org:
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Images in Cardiovascular Medicine
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Compression of the Pulmonary Vein After Right-Sided Pneumonectomy.
See p
e743.
Balloon Valvuloplasty of a Stenosed Bioprosthetic Tricuspid Valve. See p e745.
Percutaneous Closure of a Left Ventricular Free-Wall Rupture Site. See p e748.
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Book Review
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The Adrenergic Receptors in the 21st Century. See p
e750.
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Correspondence
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See p
e751.
Related Articles:
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Compression of the Pulmonary Vein After Right-Sided Pneumonectomy
- S.A. Smulders, J.T. Marcus, S. Holverda, M.A. Paul, P.E. Postmus, and A. Vonk-Noordegraaf
Circulation 2006 113: e743-e744.
[Full Text]
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Balloon Valvuloplasty of a Stenosed Bioprosthetic Tricuspid Valve
- M. Egred, K. Albouaini, and W.L. Morrison
Circulation 2006 113: e745-e747.
[Full Text]
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Percutaneous Closure of a Left Ventricular Free-Wall Rupture Site
- Patrick A. Gladding, Peter N. Ruygrok, Sally C. Greaves, Ivor L. Gerber, and Andrew W. Hamer
Circulation 2006 113: e748-e749.
[Full Text]
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The Adrenergic Receptors in the 21st Century
- Rui-Ping Xiao
Circulation 2006 113: e750.
[Full Text]
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Letter Regarding Article by Banki et al, "Acute Neurocardiogenic Injury After Subarachnoid Hemorrhage"
- Tomaso Gnecchi-Ruscone
Circulation 2006 113: e751.
[Full Text]
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Role of Diuretics in the Prevention of Heart Failure: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial
- Barry R. Davis, Linda B. Piller, Jeffrey A. Cutler, Curt Furberg, Kay Dunn, Stanley Franklin, David Goff, Frans Leenen, Syed Mohiuddin, Vasilios Papademetriou, Michael Proschan, Allan Ellsworth, John Golden, Pedro Colon, Richard Crow for the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) Collaborative Research Group
Circulation 2006 113: 2201-2210.
[Abstract]
[Full Text]
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Outcome of Watchful Waiting in Asymptomatic Severe Mitral Regurgitation
- Raphael Rosenhek, Florian Rader, Ursula Klaar, Harald Gabriel, Marcel Krejc, Daniel Kalbeck, Michael Schemper, Gerald Maurer, and Helmut Baumgartner
Circulation 2006 113: 2238-2244.
[Abstract]
[Full Text]
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Characteristics and Baseline Clinical Predictors of Future Fatal Versus Nonfatal Coronary Heart Disease Events in Older Adults: The Cardiovascular Health Study
- Camille A. Pearte, Curt D. Furberg, Ellen S. O’Meara, Bruce M. Psaty, Lewis Kuller, Neil R. Powe, and Teri Manolio
Circulation 2006 113: 2177-2185.
[Abstract]
[Full Text]
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