Impaired Autonomic Regulation Points to Cardiovascular Risk
When patients have a blood pressure at the high end of normal, they already carry a risk of cardiovascular disease that exceeds that of normal people. In a report in this week’s Circulation (Circulation. 2002;106:2673–2679), researchers led by Daniela Lucini, MD, PhD, of the Centro di Ricerca sulla Terapia Neurovegativa in Milano, Italy, found that there were already significant alterations in markers of autonomic regulations in individuals whose blood pressures were at the high end of normal.
The researchers performed an observational study on 300 subjects of both sexes with blood pressures that ranged from 90/60 mm Hg to 210/120 mm Hg. They were divided into 3 groups with average systolic pressures of 103, 133, and 163 mm Hg. Autonomic regulation was determined by analysis of the RR interval and systolic arterial pressure variability. Their studies uncovered significant alterations in markers of such regulation already apparent in individuals in the higher regions of blood pressure.
Aortic Valve Replacement in Patients With Regurgitation and Reduced Ejection Fraction
Aortic valve replacement in patients with severely reduced left ventricular ejection fraction results in higher operative mortality than in those with moderate reduction in or normal ejection fractions as well as increased rates of postoperative mortality and congestive heart failure. In this week’s issue of Circulation (Circulation. 2002;106:2687–2693), however, Han P. Chaliki, MD, of the Mayo Clinic in Rochester, Minn, and colleagues determined that the improvement in left ventricular ejection fraction and long postoperative survival without recurrence of heart failure means that they should not be denied the surgery.
C-Reactive Protein Is a Better Marker of Cardiovascular Risk Than Low-Density Lipoprotein
Measurements of C-reactive protein proved to be a stronger indicator of first cardiovascular events than low-density lipoprotein (LDL) in a study published in the November 14, 2002, issue of the New England Journal of Medicine (N Engl J Med. 2002;347:1557–1565).
In this study led by Paul M. Ridker, MD, of Brigham and Women’s Hospital and Harvard Medical School in Boston, Mass, researchers measured C-reactive protein and LDL cholesterol at baseline for 27 939 American women, who were then monitored for 8 years. The end points of the study were myocardial infarction, ischemic stroke, coronary revascularization, or death from cardiovascular causes.
As expected, both measurements had a strong association with cardiovascular events. After adjustment for comorbid conditions and demographics, the relative risks of first cardiovascular events increased with higher levels of C-reactive protein, more than doubling the risk at the higher levels. Relative risks associated with LDL were less dramatic, reaching only 1.5 in the highest levels.
The researchers said that the two measurements tended to identify different high-risk groups, meaning the screening for the two would provide better information on prognosis than screening for only one.
In an accompanying editorial, Lori Mosca, MD, MPH, PhD, of Columbia University in New York (N Engl J Med. 2002;347:1614), said more study is needed before adoption of C-reactive protein measurements as a screening tool. “In the interim, it is prudent to focus effort and resources on screening for and treatment of major conventional risk factors, levels of which are suboptimal worldwide.”
Declining Medical School Applications
Preliminary data reported by the Association of American Medical Colleges (AAMC) indicates that fewer than 34 000 people applied for entrance to medical school in 2002—the lowest in a 6-year decreasing trend. The 4% decrease over 2001 will, however, mark the end of the decline, AAMC officials said.
Basing their estimates on the numbers of people who took the Medical College Admission Test in 2002 and initial applications, AAMC officials predict an increase in applications in 2003.
“With our nation facing new health challenges and a possible physician shortage, the apparent flagging interest in the medical profession, as reflected by the shrinking applicant pool over the last several years, has been cause for some concern,” said AAMC President Jordan J. Cohen, MD. “These early projections for 2003, however, provide hope that this long decline may finally be over.”