Inflammatory Markers=High Risk
High levels of C-reactive protein, interleukin-6, and tumor necrosis factor were strongly associated with the incidence of cardiovascular events in elderly patients who had no evidence of heart disease at study enrollment, said researchers in a report in this week’s issue of the journal Circulation (Circulation. 2003;108:2317–2322OpenUrl).
A total of 2225 subjects aged 70 to 79 years without baseline heart disease enrolled in the Health, Aging, and Body Composition study. They were followed up for an average of 3.6 years for coronary heart disease, stroke, and congestive heart failure. Interleukin-6 was associated significantly with all outcomes. Tumor necrosis factor was significantly associated with coronary heart disease, and C-reactive protein was associated with congestive heart failure events. If all three inflammatory markers were found to be in the highest tertile, the risk was especially high, said the researchers, led by Matteo Cesari, MD, of Wake Forest University School of Medicine, Winston Salem, NC.
Hypertrophic Cardiomyopathy Plus Coronary Artery Disease a Bad Mix
Patients with hypertrophic cardiomyopathy and concomitant severe coronary artery disease are at an increased risk of death, said researchers from the Mayo Clinic and Mayo Foundation in Rochester, Minn, in a report in this week’s issue of the journal Circulation (Circulation. 2003;108:2342–2348OpenUrl).
The researchers enrolled 433 adult patients with hypertrophic cardiomyopathy who also had severe coronary artery disease. All were over the age of 21 years, had a left ventricular ejection fraction of less than 50%, and had no prior history of surgical revascularization. Compared with patients who had mild or moderate coronary artery disease, those with the most severe disease had a markedly reduced survival rate. In patients with mild to moderate coronary artery disease and patients with no coronary artery disease, 10-year survival rates were 70.5% and 77.1%, respectively. By comparison, the 10-year-survival rate was 46.1% in patients with severe coronary artery disease.
The authors concluded that the risk of cardiovascular death in patients with hypertrophic cardiomyopathy and severe coronary artery disease far exceeds the historical death rates of coronary artery disease patients with normal left ventricular function.
Preventive Ablation in Wolff-Parkinson-White
Prophylactic ablation of the accessory pathway in patients with Wolff-Parkinson-White syndrome at high risk for arrhythmias significantly reduced the abnormal rhythms in a small study that appeared in the November 6, 2003, issue of The New England Journal of Medicine (N Engl J Med. 2003;349:1803–1811OpenUrlCrossRefPubMed).
In this study by researchers from San Raffaele University Hospital in Milan, Italy, the University Hospital Federico II in Naples, and the University of Texas Medical Branch in Galveston, Tex, 37 patients were assigned to radiofrequency catheter ablation of accessory pathways and 35 patients to no treatment. They were monitored for arrhythmic events over a 5-year follow-up period. Two patients in the group that received ablation had arrhythmic events, compared with 21 patients in the no-treatment group.
The researchers wrote, “We suggest expanding recommendations for invasive evaluation of asymptomatic patients with the Wolff-Parkinson-White syndrome. Patients without inducible arrhythmias do not require prophylactic ablation, since they remain asymptomatic for many years. Young patients with inducible arrhythmias may be divided into two subgroups. In those with inducible atrioventricular reciprocating tachycardia, whether or not it triggers sustained atrial fibrillation, ablation is mandatory, since arrhythmic events usually occur earlier. On the other hand, in patients with inducible, nonsustained atrial fibrillation, ablation may be deferred, because arrhythmic events are rare and usually develop later in life.”
Childhood Obesity and Cholesterol Levels Predict Atherosclerosis
Levels of low-density lipoprotein (LDL) and body mass index (BMI) in youngsters are associated with changes in carotid artery wall thickness, which is a marker of early atherosclerosis, said researchers from Tulane University Health Sciences Center in a report in the November 5, 2003, issue of the Journal of the American Medical Association (JAMA. 2003; 290:2271–2276).
Researchers led by Shengxu Li, MD, MPH, enrolled 486 adults aged to 25 to 37 years from Bogalusa, La, who had had at least three measurements of traditional risk factors for coronary artery disease since childhood. They found that carotid intima medial thickness (IMT) in these young adults with no evidence of heart disease was associated with the risk factors measured during their childhoods.
“The LDL-C level and BMI in childhood; LDL-C, high-density lipoprotein cholesterol [HDL-C], and systolic blood pressure in adulthood; and cumulative burden of LDL-C and HDL-C levels since childhood were independent risk factors for having increased carotid IMT in young adulthood,” the authors wrote.
In a second article (JAMA. 2003;290:2277–2283), Finnish researchers led by Oli T. Raitakari, MD, PhD, of the University of Turku also studied the relationship between cardiovascular risk factors measured in childhood and adolescence to carotid artery IMT measured in the adulthood. The study enrolled 2229 adults aged 24 to 39 years.
The researchers found that risk factors such as high levels of LDL cholesterol, systolic blood pressure, BMI, and cigarette smoking were associated with changes in carotid artery IMT.
Genetic Variation in Estrogen Receptors Associated With Heart Attack Risk
A common variation in genes associated with estrogen receptors was associated with a tripling of heart attack risk in patients with a common variation in the genes associated with estrogen receptors, said researchers from the Massachusetts Institute of Technology in Cambridge, Mass, in a study in the November 5, 2003, issue of the Journal of the American Medical Association.
The study involved 1739 men and women from the offspring study of the Framingham Heart Study. Subjects were followed up from 1971 to 1998. In this group, 20% had 2 alleles with the polymorphism ESR1 c.454-397T>C. Even after adjusting for demographics and risk factors, the genetic variation was significantly associated with atherosclerotic cardiovascular disease.
“These findings support the importance of estrogen receptors in CVD [cardiovascular disease] susceptibility, especially in men. Estrogen receptor variation also has potential to explain recent conflicting data regarding the effects of hormone therapy on CVD susceptibility in women,” the authors concluded.
ApoA-I Milano Regresses Coronary Atherosclerosis
In a preliminary study, a synthesized form of ApoA-I Milano—a naturally occurring variant of apolipoprotein A-I associated with longevity, low levels of high-density lipoprotein (HDL) cholesterol, and less atherosclerosis than expected at low HDL levels—caused coronary atherosclerosis to regress according to ultrasound measurements, said researchers from the Cleveland Clinic Foundation in a report in the November 5, 2003, issue of the Journal of the American Medical Association (JAMA. 2003;290:2292–2300OpenUrlCrossRefPubMed).
Recombinant ApoA-I Milano has been formulated in a complex with a naturally occurring phospholipid to mimic the properties of HDL. The complex is called ETC-216. Between November 2001 and March 2003, 57 patients with acute coronary syndromes were randomly assigned to receive either 5 weekly infusions of placebo or ETC-216. Intravascular ultrasound was performed within 2 weeks after the acute coronary syndromes, and then it was done again after the 5 weeks of treatment.
The mean atheroma volume decreased by 1.06% in the ETC-216 group, compared with an increase of 0.14% in the placebo group. The authors noted that although the results are promising, the numbers involved in the study are small and require confirmation in larger studies.