A new feature in Circulation will debut in October, 2002 to provide an outlet for advice and opinions from experts from around the world about topics in cardiovascular medicine, health policy, and patient care issues. Dr Dean Kereiakes has agreed to be Section Editor for the new feature. Editor Dr James T. Willerson said he hopes the new section “will provide timely, useful advice on the recognition and management of important cardiovascular problems and will expand the clinically relevant format of Circulation.” The new section will appear in both the print and online editions of the journal.
Does Fitness Fight Inflammation?
Fitness appears to be associated with lower levels of C-reactive protein in the blood—at least among Native American and Caucasian middle-aged women, according to researchers from the University of Utah School of Medicine, the University of South Carolina School of Public Health, and the University of North Carolina at Greensboro, who reported their results in this issue of Circulation (Circulation. 2002;106:403–406). The association does not appear to be true for African American women, the researchers noted.
The researchers, led by Michael J. LaMonte, PhD, MPH, of the Division of Cardiology at the University of Utah School of Medicine, performed cross-sectional associations between fitness and blood levels of C-reactive protein in 44 African American, 45 Native American, and 46 Caucasian women whose average age was 55 and whose average body mass index was 28. They assessed the women’s fitness with a maximal treadmill exercise test and then determined the concentration of C-reactive protein in their blood.
In the group of women taken as a whole, C-reactive protein concentration correlated significantly with fitness levels, waist girth, insulin, and triglycerides. Higher levels of C-reactive protein were found in Caucasian estrogenic medication users and Native American diabetics. Age-adjusted exercise times were highest for Caucasians and lowest for African Americans.
The inverse relationship between fitness and C-reactive proteins levels was maintained among Native American and Caucasian women, even after adjusting for body mass index and other variables. However, after such adjustments, there was a lack of association among African Americans.
Average C-reactive protein concentration was significantly higher among African American women than in women of the other two ethnic groups. “Potential mechanisms for racial differences in CRP (C-reactive protein) are unknown,” the authors wrote.
They found that the relationship between measures of fat and C-reactive protein was significant and positive. “This relationship suggests fitness may be an important determinant of plasma CRP, even among women with increased body fat, and carries important public health implications given the recent increase in CHD (congestive heart disease), obesity, and type 2 diabetes among women and minorities,” the authors wrote.
They concluded, “Higher fitness levels appear to have an antiinflammatory effect that may be a mechanism for lowering CHD and type 2 diabetes.”
Following the Rule in Triaging Patients With Possible Myocardial Infarction
Use of a clinical decision-making tool in the emergency department improved the ability of physicians to determine which patients should be admitted to cardiac care unit and which should not, according to a study published in the July 17, 2002, issue of the Journal of the American Medical Association (JAMA. 2002;288:342–350).
In this study, physicians from the Departments of Medicine and Emergency Medicine at Cook County Hospital and Rush Medical College in Chicago used a previously validated clinical decision rule as the standard of care in their emergency department. The rule predicts major heart problems within 72 hours after evaluation in the emergency department. Patients are classified into 4 risk groups: high, moderate, low, and very low, according to electrocardiographic findings and the presence or absence of 3 other factors, which include systolic blood pressure <100 mm Hg, rales heard above both lung bases, and known unstable ischemic heart disease.
In this study, researchers compared patients seen in the emergency department for 4 weeks before implementation of the triage rule. Those in the intervention group were enrolled for 14 weeks after the rule was fully put into effect. (There was a 3-month pilot-testing period.)
When researchers monitored 326 consecutive patients in whom cardiac ischemia was first suspected but were sent home direct from the emergency department, they identified no complications or deaths in 300 patients who could be followed and found no record of death of the 26 lost to follow-up.
Among 947 intervention-group patients who did not experience major complications, 350 were sent to an observation unit or unmonitored ward. The efficiency of the clinical rule was then found to be 36% compared with only 21% in the preintervention group, the authors reported.
Of the 35 patients in the intervention group who experienced major cardiac complications, 33 were sent to the coronary care unit or telemetry unit, and 2 were sent to the observation unit. Safety in the intervention group, however, was not significantly higher than in the preintervention group, the authors reported.
The authors concluded, “Use of the decision rule improved our physicians’ decisions. It reduced unnecessary admission to inpatient monitored beds without increasing complications in patients triaged instead to a short-stay observation unit. This improvement was achieved primarily by identifying very low-risk patients and not admitting them to inpatient telemetry beds.” They advised longer studies to measure the clinical rule’s impact on long-term morbidity and morality, use of resources in the hospital, and cost-effectiveness.