Interleukin-18 in Serum Predicts Mortality
Interleukin-18 (IL-18), which plays a central role in the “inflammatory cascade,” is also a strong independent predictor of death from cardiovascular causes in patients with coronary artery disease, according to researchers led by Stefan Blankenberg, MD, of Johannes Gutenberg-University in Mainz, Germany, and INSERM U515, Faculté de Médecine Pitié-Salpétrière, in a report appearing in this week’s issue of Circulation (Circulation. 2002;106:24–30).
In this prospective study of 1229 patients with coronary artery disease, the researchers measured baseline concentrations of IL-18 and monitored patients for a mean of 3.9 years. During that time, 95 of the patients died of cardiovascular causes. The patients who died had median serum IL-18 concentrations of 68.4 pg/mL compared with 58.7 pg/mL in those who survived—a significant difference. Even after adjusting for confounding factors, IL-18 remained a strong predictor of mortality in patients with coronary artery disease, regardless of what their status was at the time they were admitted to the hospital. “This finding strongly supports the possibility, already suggested by experimental work, that inhibiting IL-18 might constitute a new therapeutic strategy for plaque stabilization,” the researchers concluded.
Health Status Predicts Outcome
Low scores on the Seattle Angina Questionnaire, a disease-specific health status measurement for patients with coronary artery disease, were associated with increased risk of mortality and hospital admission for acute coronary syndrome in a study led by John A. Spertus, MD, MPH, of Mid America Heart Institute and University of Missouri–Kansas City (Circulation. 2002;106:43–49). The 5558 patients who enrolled in the study were recruited from 6 internal medicine clinics at Veterans Affairs Medical Centers. All had coronary artery disease, had filled out the questionnaire, and had been monitored ≥1 year. The researchers found that age was the only strong predictor of death and that a history of prior hospitalizations was the only factor that was a stronger predictor of acute coronary syndromes than the Seattle Angina Questionnaire. The authors concluded that the Seattle Angina Questionnaire might serve an important role in stratifying risks for patients with coronary artery disease.
In an accompanying editorial (Circulation. 2002;106:5–7), John S. Rumsfeld, MD, PhD, of the University of Colorado Health Sciences Center in Denver, quoting the Institute of Medicine’s Committee on Quality Healthcare in America, noted that “patient-centered care gives patients opportunities to be ‘involved in medical decision making,’ and guides care providers ‘in attending to their patients’ physical and emotional needs, and maintaining or improving their quality of life.’” He noted that the study by Dr Spertus and colleagues supports “adding health status measurement to our current clinical armamentarium. Using health status data in clinical practice can provide a way for patients to participate further in their care, in this case by providing information useful in their risk stratification.”
He noted, however, that the study does not prove that standardizing measurements of health status does not translate into better patient outcomes. “This is an important focus for future research in this field.”
Limiting Smallpox Vaccination
Ever since the rash of anthrax cases that raised fears of bioterrorism in the wake of the tragedy of September 11, 2001, public health officials and the public have been haunted by the specter of the release of the virus that causes smallpox, against which few in the US population have had any protection since the disease was declared eradicated in 1980.
In spite of this, a panel of specialists on the federal Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices rejected a proposal to offer vaccine to every American. At a meeting in Atlanta on June 20, the panel decided that only the first-responders should be immunized immediately, meaning that only 15 000 people in the healthcare and law enforcement fields would receive the vaccine, according to an article in the New York Times published on June 21, 2002.
The panel said that the risk-benefit ratio did not favor mass immunizations. In an outbreak, public health officials would be advised to follow the strategy of ring vaccination in which those who have the disease are isolated and those who have come into contact with them receive vaccine.
On June 24, 2002, a panel of the National Academy of Sciences admitted that it is impossible to defend against all potential terrorist threats. However, it recommended that the government tighten controls on nuclear materials, make certain that medicine to ward off biological attacks become available in a timely fashion, upgrade security on all modes of transportation, and act to secure sources of energy used to light and control environments of homes and businesses.
Included in the report issued by the American Association for the Advancement of Science was a paper by D.A. Henderson, MD, Chairman of the Department of Health and Human Services’ Council on Public Health Preparedness. “Bioterrorism is not going to go away,” wrote Dr Henderson. “We are concerned with a comparatively short list of dangerous diseases that would be catastrophic and potentially destabilizing. They are smallpox, anthrax, plague, tularemia, botulinum toxin, and the group of diseases that manifest themselves as hemorrhagic fevers.”
Statins Protect After Revascularization
Fluvastatin appears to help reduce incidence of cardiac events in patients with ordinary cholesterol levels after they have undergone a percutaneous coronary intervention—either by balloon angioplasty or placement of a stent, according to researchers led by Patrick W.J.C. Serruys, MD, PhD, of the Academic Hospital in Rotterdam, the Netherlands, in a report in the June 26, 2002, issue of the Journal of the American Medical Association (JAMA. 2002;287:3215–3222).
In the study, researchers enrolled 1677 patients in the Lescol Intervention Prevention Study (LIPS). Patients were given either fluvastatin or placebo within 2 days after percutaneous coronary intervention. The patients were monitored for an average of 3.9 years. Of the 844 patients in the statin group, 181 suffered a major adverse cardiac event during that period. Of the 833 in the placebo group, 222 had a major adverse cardiac event.
In an accompanying editorial (JAMA. 2002;287:3259–3260), George Sopko, MD, MPH, of the National Heart, Lung, and Blood Institute, said that the LIPS study complements others that support the benefits of statin therapy. “Prevention of restenosis and cardiac events in patients who have had percutaneous revascularization is of enormous public health importance. Substantial amounts of effort and monies have been spent on multiple drug strategies, but with limited success,” he wrote. “The findings of Serruys et al suggest that statin therapy offers a rational intervention to prevent cardiac events and restenosis in patients after their first PCI [percutaneous coronary intervention].”