Everolimus Stent Proves Effective
The use of an everolimus-eluting stent proved effective in a study involving 42 patients, said investigators involved in the FUTURE I (First Use To Underscore restenosis Reduction with Everolimus) trial in a report in this week’s edition of the journal Circulation (Circulation. 2004;109:2168–2171OpenUrlCrossRefPubMed).
Everolimus is similar to the first effective drug used in a stent—sirolimus. It too actively suppresses the immune system and proliferation. In this study, 42 patients with new coronary lesions were enrolled to receive either the everolimus-eluting stent (27) or a bare metal stent (15). At 30 days and at 6 months, the investigators, led by Eberhard Grube, MD, of the Heart Center Siegburg in Germany, found low rates of major adverse cardiac events. Between 6 and 12 months, no additional reports of major adverse cardiac events occurred. At 6 months, the rate of in-stent restenosis was 0% in the drug-eluting stent group, compared with 9.1% in the bare metal stent group. One patient in the bare metal stent group had an in-stent restenosis. The in-segment restenosis rates were 4% in the drug-eluting stent group and 9.1% in the bare metal stent group.
In this early clinical study, the researchers found that the everolimus-eluting stent was both safe and effective in reducing in-stent neointimal hyperplasia and restenosis.
Blood Pressure in the Young Growing
Blood pressure among children and adolescents in the United States has increased in the past decade, and researchers reporting in the May 5, 2004, issue of the Journal of the American Medical Association believe that increasing overweight in these groups is associated with it (JAMA. 2004;291:2107–2113OpenUrlCrossRefPubMed).
To reach this conclusion, Paul Muntner, PhD, of Tulane University in New Orleans, and his colleagues examined data collected about children and adolescents aged 8 to 17 as part of the third National Health and Nutrition Examination Survey (NHANES III) 1988–1994 and NHANES 1999–2000. A total of 3496 adolescents were included in the first survey and 2086 in the second.
During the period between the two surveys, average systolic blood pressure levels increased 1.4 mm Hg, and diastolic levels increased 3.3 mm Hg. Both figures represent significant differences and were significant in most subgroups, including non-Hispanic blacks, Mexican Americans, boys, girls, and children ages 8 to 12.
At the same time, the authors wrote: “The increase in body mass index (BMI) during this same period accounted for some of the increase in blood pressure. Given the relationship between BMI and blood pressure and the high and unabated increase in the prevalence of overweight in the United States, the incidence of hypertension is likely to increase. Additionally, factors other than the increase in overweight among children and adolescents appear to have contributed to the increase in blood pressure over the previous decade. Confirmation of the trends observed in the current study is needed. Factors that have resulted in higher blood pressure levels among children and adolescents in the United States also need to be identified. Additionally, effective primary and secondary hypertension prevention programs aimed at children and adolescents that include prevention of overweight, weight loss, increased physical activity, and dietary modification need to be developed and implemented. Such interventions could have a profoundly positive impact on the prevalence of high blood pressure in the United States.”
Lipid-Lowering Therapy May Reduce Death in Noncardiac Surgery
Treatment with lipid-lowering drugs may reduce the risk of death after noncardiac surgery, said Massachusetts researchers in a report in the May 5, 2004, issue of the Journal of the American Medical Association (JAMA. 2004;291:2092–2099OpenUrlCrossRefPubMed). However, they cautioned that their retrospective study should be confirmed by prospective clinical trials.
The researchers evaluated the hospital discharge and pharmacy records of 780 591 patients aged 18 and older who underwent major noncardiac surgery between January 1, 2000, and December 31, 2001, at 329 hospitals in the United States. Patients evaluated included those who lived until the second hospital day. They defined lipid lowering as therapy used during the first 2 hospital days.
Of the 780 591 patients, 77 082 received lipid-lowering treatment during the immediate period after surgery. Its use was associated with lower crude mortality of 2.13%, compared with 3.05% among those who did not receive the drugs. The risk of mortality remained lower in the treated group even after adjustment for variables. The researchers, led by Peter K. Lindenauer, MD, MSc, of the Division of Healthcare Quality, Baystate Medical Center, Springfield, Mass, estimated that 85 patients would have to be treated to prevent 1 death.
Abnormal Diastolic Function Causes Diastolic Heart Failure
The sources of diastolic heart failure—heart failure with a normal ejection fraction—are significant abnormalities in active relaxation and passive stiffness, ie, abnormal diastolic functions, said South Carolina researchers in the May 7, 2004, issue of the New England Journal of Medicine (N Engl J Med. 2004;350:1953–1959).
In this study, the researchers, led by Michael R. Zile, MD, of the Medical College of South Carolina, identified 47 patients who met the diagnostic criteria for diastolic heart failure and compared them with 10 patients with no evidence of heart disease. Left ventricular diastolic function was assessed by cardiac catheterization and echocardiography.
Researchers found that patients with diastolic heart failure had abnormal left ventricular relaxation and increased left ventricular chamber stiffness.
The researchers wrote: “We believe that the conclusions made in the current study are applicable to a wider population of patients, such as those described in the previous studies. Patients who meet the criteria for definite diastolic heart failure have abnormal active relaxation and increased passive stiffness. The predominant pathophysiological cause of heart failure in these patients is abnormal diastolic function. Therefore, it is appropriate to use the term ‘diastolic heart failure’ to describe the abnormalities in these patients.”
In an accompanying editorial (N Engl J Med. 2004;350:1930–1931), Margaret M. Redfield, MD, of the Mayo Clinic, noted that between 40% and 50% of patients with heart failure fit the profiles of diastolic heart failure. “Despite great progress in our understanding of and therapeutic approach to heart failure associated with systolic dysfunction, or systolic heart failure, we are now realizing that basic research and clinical investigations have failed to address nearly half of the epidemic of heart failure. Patients with diastolic heart failure tend to be older than those with systolic heart failure; more of them are female, more have hypertension, and fewer have recognized coronary artery disease.”
She notes that although the death rate after a diagnosis of diastolic heart failure is nearly equal to that of systolic heart failure, the most common causes of mortality among those with diastolic heart failure have not been identified. She noted that the report in the New England Journal is particularly important. “It is the largest comprehensive study to date of diastolic function in patients with diastolic heart failure, and it supports the theory that primary abnormalities in diastolic function are indeed present in patients with diastolic heart failure and that left ventricular hypertrophy is not required for diastolic dysfunction to occur. The authors acknowledge that other mechanisms may contribute to the propensity for diastolic heart failure but conclude that abnormalities in diastolic function are key. The importance of the study by Zile et al goes beyond their conclusions regarding the pathophysiology of diastolic heart failure. After a decade of controversy over whether this syndrome even exists, this study and a few others have begun to address the pathophysiological mechanisms that are responsible for half of the heart-failure epidemic. Further studies to confirm the findings of Zile et al and to investigate other pathogenic mechanisms are crucial.”