Preventive Cardiology (Prev Cardiol)

Publications in this journal

• Article: Is there a need to continue anticoagulation following "successful" atrial fibrillation ablation?

  Howard L Levitt, Saddad Z Toor, Neil L Coplan
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  ABSTRACT: Atrial fibrillation (AF) is the most common clinically significant arrhythmia worldwide, and its incidence is increasing. There has been increasing interest in ablation therapy to treat atrial fibrillation. One reason some patients undergo AF ablation might be to obviate the need for warfarin therapy, although current guidelines do not support this rationale. The current review shows that it is difficult to define a true "cure" postablation, as many of these patients will go on to experience future paroxysms of AF (either symptomatic or silent). The mechanism underlying embolism in patients with AF is not completely understood, and no long-term evidence exists that "successfully ablated" patients return to a baseline risk of stroke comparable to an AF-naive population. The authors recommend continued long-term anticoagulation post-AF ablation in patients satisfying CHADS criteria for elevated stroke risk.
  Preventive Cardiology 02/2009; 12(1):39-42.
• Article: Jupiter and accomplish.

  Philip R Liebson
  Preventive Cardiology 02/2009; 12(2):114-9.
• Article: Current approaches to the challenge of coronary heart disease risk assessment: C-reactive protein mania and imaging-itis?

  Ezra A Amsterdam, C Tissa Kappagoda
  Preventive Cardiology 02/2009; 12(1):1-2.
• Article: Ongoing Telmisartan Alone and in Combination With Ramipril Global Endpoint Trial (ONTARGET): implications for reduced cardiovascular risk.

  Philip R Liebson, Ezra A Amsterdam
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  ABSTRACT: The recently published Ongoing Telmisartan Alone and in Combination With Ramipril Global Endpoint Trial (ONTARGET) in patients with vascular disease or high-risk diabetes, as the largest published comparative trial of these agent classes, provides further evidence concerning the comparison between the angiotensin-receptor blockers (ARBs) and the angiotensin-converting enzyme inhibitors (ACEIs). In this trial, telmisartan (an ARB) was non-inferior to ramipril (an ACEI) in reducing fatal and nonfatal cardiovascular events. Moreover, ONTARGET is an example of a high-quality noninferiority trial. However, the combination of the 2 agents was associated with more adverse effects without an increase in benefit. The study differed from several other comparative studies in which the dose and choice of ACEI was left to individual physicians. Further, in ONTARGET, the ACEI was not titrated to the maximum dose and patients with heart failure were excluded.
  Preventive Cardiology 02/2009; 12(1):43-50.
• Article: Maintenance of cardiovascular risk goals in veterans with diabetes after discharge from a cardiovascular risk reduction clinic.

  Paul A Pirraglia, Tracey H Taveira, Lisa B Cohen, Andrea Dooley, Wen-Chih Wu
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  ABSTRACT: The authors evaluated maintenance of achieved cardiovascular risk control after discharge from a pharmacist-coordinated cardiovascular risk reduction clinic. Using data from 2001 to 2004 divided by financial quarters (ie, 3-month periods), the authors performed survival analysis of diabetic patients who had attained at least one cardiovascular risk goal in the clinic. Mean times to failure were 7.1 +/- 0.21 quarters for hemoglobin A1c, 7.6 +/- 0.29 quarters for low-density lipoprotein cholesterol (LDL-C), and 2.5 +/- 0.24 quarters for systolic blood pressure (SBP). Body mass index predicted glycemic control failure (hazard ratio [HR], 1.08; 95% confidence interval [CI], 1.01-1.15; P = .02), insulin use predicted LDL-C control failure (HR, 3.08; 95% CI, 1.15-8.22; P = .03), and baseline SBP predicted SBP control failure (HR, 1.02; 95% CI, 1.01-1.03; P = .0003). The authors found good durability of effect for most cardiovascular risk targets. Worse control at entry predicted failure after successful attainment of a cardiovascular goal. More sustained attention or booster interventions for patients with worse control at entry may be necessary.
  Preventive Cardiology 02/2009; 12(1):3-8.
• Article: National Cholesterol Education Panel III guidelines performance role in preventing myocardial infarction in a large cohort without a history of coronary artery disease: Korea Acute Myocardial Infarction Registry study.

  Yeonyee E Yoon, Juan J Rivera, Dong-A Kwon, In-Ho Chae, Myung-Ho Jeong, Seung-Woon Rha, Roger S Blumenthal, Khurram Nasir, Hyuk-Jae Chang
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  ABSTRACT: The Third Report of the Adult Treatment Panel National Cholesterol Education Program (NCEP-ATP III) guidelines are widely used for the primary prevention of a coronary event. These guidelines were developed using experimental data from studies that enrolled mostly Caucasian patients. The pathogenesis of atherosclerosis varies with ethnicity. Given these two circumstances, the authors sought to investigate the performance of the guidelines in a large Asian cohort. The Korea Acute Myocardial Infarction Registry (KAMIR) includes data collected between November 2005 and December 2006 from 41 referral centers in South Korea. A retrospective review of the clinical data was performed. After patients with a history of coronary heart disease (CHD), CHD equivalent, and those taking lipid-lowering medications were excluded, 2969 individuals (76% men; 61+/-12 years) were enrolled. The recommendations for lipid-lowering treatments according to the NCEP-ATP III were examined in the context of the cohort. A total of 38%, 66%, and 8% of the study participants had hypertension, were smokers, and had a family history of premature CHD, respectively. When patients were stratified by the number of risk factors present and their 10-year CHD risk, 69% diagnosed with an acute myocardial infarction did not qualify for drug therapy. Irrespective of the age group examined (young, intermediate, and old), the percentage of patients who did not qualify for a lipid-lowering pharmacologic intervention was higher than 60%. NCEP-ATP III underestimates CHD risk in individuals of Asian descent. Further studies are needed to improve primary CHD prevention in this patient population.
  Preventive Cardiology 02/2009; 12(2):109-13.
• Article: Use of carotid ultrasound to identify subclinical vascular disease and evaluate cardiovascular disease risk: summary and discussion of the American Society of Echocardiography consensus statement.

  James H Stein, Claudia E Korcarz, Wendy S Post
  Preventive Cardiology 02/2009; 12(1):34-8.
• Article: Diabetes control and cardiovascular risk, Part II: Intensive glucose control--UKPDS follow-up.

  Philip R Liebson
  Preventive Cardiology 02/2009; 12(1):51-8.
• Article: The problem of stent thrombosis associated with drug-eluting stents and the optimal duration of dual antiplatelet therapy.

  Susana Ayyanathan, David Hersh, Neil L Coplan, Kirk Garratt
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  ABSTRACT: Drug-eluting stents have significantly reduced the problem of restenosis, but there is an association between drug-eluting stents and stent thrombosis that can be a significant clinical problem resulting in myocardial infarction or death. The risk for stent thrombosis increases in certain clinical situations and has been reduced through the use of dual antiplatelet therapy for prolonged periods. Until new therapies are developed, it is essential that patients who have had drug-eluting stents implanted continue with dual-antiplatelet therapy for at least 1 year and possibly for an indefinite period.
  Preventive Cardiology 02/2009; 12(2):59-64.
• Article: Factors associated with low levels of subclinical vascular disease in older adults: multi-ethnic study of atherosclerosis.

  Erin D Michos, Kenneth M Rice, Moyses Szklo, Gregory L Burke, David S Siscovick, Russell P Tracy, R Graham Barr, Jennifer A Nettleton, Philip Greenland, David R Jacobs, Wendy Post
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  ABSTRACT: Coronary artery calcium (CAC), carotid intima-media thickness (CIMT), and reduced ankle brachial indices (ABI) are markers of subclinical vascular disease strongly associated with aging. The authors identified factors associated with low levels of subclinical vascular disease in 1824 participants 70 years and older in the Multi-Ethnic Study of Atherosclerosis. A total of 452 had low CAC (<25th percentile), 441 had low CIMT (<25th percentile), 1636 had normal ABI (>0.9), and 165 had a combination index indicating favorable values for all 3 parameters. This combination index was independently associated with younger age (odds ratio [OR] 2.5 per 1 SD [95% confidence interval (CI), 1.8-3.6]), female sex (OR 3.0 [95% CI, 1.9-4.8]), lower body mass index (OR 1.6 per 1 SD [95% CI, 1.2-2.0]), absence of hypertension (OR 1.8 [95% CI, 1.2-2.6]), absence of dyslipidemia (OR 1.6 [95% CI, 1.04-2.4]), and never-smoking (OR 1.7 [95% CI, 1.1-2.6]). No significant associations were observed for C-reactive protein, education, diet, or physical activity. Favorable levels of multiple traditional risk factors, but not several novel risk factors, were associated with subclinical markers of successful cardiovascular aging.
  Preventive Cardiology 01/2009; 12(2):72-9.
• Article: Association of total cholesterol/ high-density lipoprotein cholesterol ratio with proximal coronary atherosclerosis detected by multislice computed tomography.

  Deepu Nair, Thomas P Carrigan, Ronan J Curtin, Zoran B Popovic, Stacie Kuzmiak, Paul Schoenhagen, Scott D Flamm, Milind Y Desai
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  ABSTRACT: The authors assessed the association between an elevated total cholesterol to high-density lipoprotein cholesterol (TC/HDL-C) ratio (> or = 4) and proximal coronary artery disease (CAD), as observed on multislice computed tomography. Coronary multislice computed tomographic angiography (96% on 40- or 64-slice) was performed in 295 individuals (39% women; mean age, 54 +/- 13 years) without documented CAD who were referred for coronary evaluation. Significant CAD was defined as > or = 50% stenosis in the left main, proximal left anterior descending, or > or = 2 epicardial vessels. Proximal plaque was defined as presence of any plaque in left main or proximal left anterior descending vessels. Individuals with an elevated TC/HDL-C ratio vs those without had a higher prevalence of proximal plaque (62% vs 48%, P = .04) and significant CAD (19% vs 9%, P = .009). On multivariate logistic regression analysis, only age, sex, and TC/HDL-C ratio > or = 4 were associated with significant CAD and proximal plaque.
  Preventive Cardiology 01/2009; 12(1):19-26.
• Article: QT dispersion and heart rate predict the risk of sudden unexpected cardiac death in men: the Manitoba Follow-Up Study.

  Thomas Edward Cuddy, Priyanka S Halli, Robert B Tate
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  ABSTRACT: As many as half of all sudden cardiac deaths are unexpected, with no preceding symptoms or signs of cardiac problems. Since 1948, the Manitoba Follow-up Study has prospectively recorded routine medical information and resting electrocardiographic (ECG) findings from a cohort of 3983 men. During 58 years of follow-up, 180 men experienced sudden unexpected cardiac death (SUCD). Heart rate, the longest QT interval, the shortest QT interval, and their difference and QT dispersion (QTD) on ECGs recorded prior to SUCD and 5 years and 10 years earlier were compared with QT intervals on ECGs of age-matched controls. QTD and heart rate each were significantly (P < .01) and independently associated with increased risk for SUCD. Only primary prevention can reduce the risk for SUCD. Hence, this relationship between QTD and heart rate and SUCD emphasizes the importance of longitudinal noninvasive QT measurements on routine ECGs in healthy men.
  Preventive Cardiology 01/2009; 12(1):27-33.
• Article: Appropriateness of cholesterol management in primary care by sex and level of cardiovascular risk.

  Ann Hiott Barham, David C Goff, Haiying Chen, Aarthi Balasubramanyam, Erica Rosenberger, Denise E Bonds, Alain G Bertoni
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  ABSTRACT: A study was undertaken to ascertain the appropriateness of lipid screening and management per the Third Report of the Adult Treatment Panel National Cholesterol Education Program (ATP III) guideline in a sample of North Carolina primary care practices. Demographics, cholesterol values, and comorbid conditions were abstracted from the medical records from 60 community practices participating in a randomized practice-based trial (Guideline Adherence for Heart Health). Eligible patients were aged 21 to 84 years, seen during the baseline period of June 1, 2001, through May 31, 2003, and who were not taking lipid-lowering therapy. Multivariable logistic regression was utilized to assess whether age, sex, race/ethnicity, diabetes, cardiovascular disease, ATP III risk category, or pretreatment low-density lipoprotein (LDL) influenced treatment. Among 5031 eligible patients, 1711 (34.5%) received screening lipid profiles. Screening rates were higher with older age, diabetes, and cardiovascular disease. No large differences were seen by sex. Among patients screened (mean age, 51.6 years; 57.9% female), 76.6% were appropriately managed within 4 months. In adjusted analyses, older age was associated with less appropriate treatment (odds ratio [OR] per 5 years, 0.91; P=.01), and patients with LDL cholesterol <or=130 mg/dL (OR, 18.8; P<.001) and the low-risk group (OR, 27.5; P<.001) were more likely to be managed appropriately compared with patients with LDL >or=190 mg/dL and those at high risk. Among 375 patients eligible for drug treatment, those with LDL levels between 131 and 159 mg/dL were much less likely to be treated (OR, 0.15; P<.001) compared with those with LDL >190 mg/dL, whereas risk category did not influence treatment. The challenge facing implementation of ATP III guidelines is much greater for intermediate- and high-risk patients than for low-risk patients.
  Preventive Cardiology 01/2009; 12(2):95-101.
• Article: Coronary heart disease and dyslipidemia: a cross-sectional evaluation of prevalence, current treatment, and clinical control in a large cohort of Spanish high-risk patients: the PRINCEPS study.

  Francisco Díaz de Rojas, Trinidad De Frutos, Ana Ponte, Joaquin Mateos Chacón, Gustavo C Vitale
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  ABSTRACT: The authors assessed a large cohort of patients with coronary heart disease (CHD) or at high risk for developing CHD in terms of lipid profile, lipid-lowering treatment, and attainment of National Cholesterol Education Program (NCEP) target low-density lipoprotein cholesterol (LDL-C) levels. The investigation was a cross-sectional study involving Spanish outpatients treated in primary or secondary care facilities. From a total of 26,598 attending patients, 12,128 with CHD or CHD risk equivalents were recruited by 1875 physicians; 49% had CHD and 69% had multiple risk factors. Only 25% of patients attained LDL-C values <100 mg/dL, 76.6% patients received lipid-lowering therapy (statins in 95.4% of cases), and 54% of physicians considered that a treatment change was required (the most frequent choice was the addition of ezetimibe to current statin therapy). In this large cohort of high-risk coronary patients, only 25% attained a target LDL-C of <100 mg/dL. These results highlight a need for improved patient care and physician awareness/training.
  Preventive Cardiology 01/2009; 12(2):65-71.
• Article: Control of lipids at baseline in the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial.

  Georgia Pambianco, Manuel Lombardero, Vera Bittner, Alan Forker, Frank Kennedy, Ashok Krishnaswami, Arshag D Mooradian, Rodica Pop-Busui, Jamal S Rana, Annabelle Rodriguez, Michael Steffes, Trevor J Orchard
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  ABSTRACT: In order to examine lipids, a major treatment parameter in those with diabetes and heart disease, the authors analyzed baseline data from the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial. The study consisted of 2368 participants with type 2 diabetes and coronary artery disease from 49 sites in 6 countries (2295 provided lipid measurements). Fifty-nine percent of participants had a low-density lipoprotein (LDL) cholesterol level < 100 mg/dL. Levels of total, LDL, and non-high-density lipoprotein (HDL) cholesterol and triglycerides differed by age group (younger than 55, 55-64, and 65 years and older); they were lowest in those aged 65 years. Women had higher total, LDL, and non-HDL cholesterol values. Education was associated with lower total, LDL, and non-HDL cholesterol levels. LDL cholesterol and triglyceride values were lower in the United States and Canada. Adjustment for age, sex, education level, randomization year, and medication did not eliminate these differences. Geographic variation was seen and was not fully accounted for by demographic or treatment characteristics (all P values < .05).
  Preventive Cardiology 01/2009; 12(1):9-18.
• Article: Low-density lipoprotein reduction and magnitude of cardiovascular risk reduction.

  Catherine R Rahilly-Tierney, Elizabeth V Lawler, Richard E Scranton, J Michael Gaziano
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  ABSTRACT: The authors examined the relationship between the magnitude of low-density lipoprotein cholesterol (LDL-C) reduction and the magnitude of cardiovascular risk reduction. From the Veterans Integrated Service Network 1 databases, the authors selected 54,611 patients with prevalent ischemic heart disease, peripheral vascular disease or diabetes mellitus, and >or=2 documented LDL-C levels who were followed between 1997 and 2006. The outcome was defined as acute myocardial infarction or revascularization. Preoutcome LDL-C reduction was categorized as follows: <10 mg/dL, reference; >or=10 but <40 mg/dL, small reduction; >or=40 but <70 mg/dL, moderate reduction; >or=70 mg/dL, large reduction. Proportional hazards were used to determine the hazard ratio for the outcome for each LDL-C reduction category compared with the reference. Results revealed a graded relationship between the magnitude of reduction in LDL-C and cardiovascular risk reduction. Stratified analyses demonstrated these findings to be robust regardless of initial LDL-C levels or whether patients achieved "target" final LDL-C values of <100 mg/dL.
  Preventive Cardiology 01/2009; 12(2):80-7.
• Article: Using impedance cardiography to detect subclinical cardiovascular disease in women with multiple risk factors: a pilot study.

  Arthur P Demarzo
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  ABSTRACT: Early detection of cardiovascular disease (CVD) could initiate appropriate treatment and prevent progression. This study used impedance cardiography (ICG) waveform analysis with postural change to detect functional CVD in women older than 40 years with no history of CVD and >or=2 of the following risk factors: cigarette smoking, poor diet, physical inactivity, central adiposity, family history of premature CVD, hypertension, and dyslipidemia. A study group of 32 women underwent ICG in standing and supine positions. An age-matched control group had 20 women with an active lifestyle, no risk factors, and no history of CVD. All women in the control group had normal ICG data. All women in the study group had some abnormal ICG data, with 28 (87.5%) having multiple ICG abnormalities. ICG data indicated that 13 (40.6%) had ventricular dysfunction, 14 (43.8%) had high vascular resistive load, and 30 (93.8%) had elevated vascular pulsatile load. The data suggest that subclinical CVD, detectable by ICG, is prevalent in women older than 40 years with multiple risk factors. Abnormal ICG results could expedite the initiation of customized treatment as part of a preventive approach to CVD.
  Preventive Cardiology 01/2009; 12(2):102-8.
• Article: Use of an electronic medical record to characterize cases of intermediate statin-induced muscle toxicity.

  Ravi K Mareedu, Falgun M Modhia, Elenita I Kanin, James G Linneman, Terrie Kitchner, Catherine A McCarty, Ronald M Krauss, Russell A Wilke
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  ABSTRACT: Statin use can be accompanied by a variety of musculoskeletal complaints. The authors describe the clinical characteristics of case patients who experienced adverse statin-induced musculoskeletal symptoms within a large population-based cohort in Central Wisconsin. Case status was determined based on elevated serum creatine kinase (CK) levels and the presence of at least 1 physician note reflecting an increased index of suspicion for statin intolerance. From the medical records of nearly 2 million unique patients, the authors identified more than 20,000 potential study patients ( approximately 1%) having CK data and at least 1 exposure to a statin drug. Manual screening was completed on 2227 patients with CK levels in the upper 10th percentile. Of those screened, 267 met inclusion criteria (12.0% eligibility) and 218 agreed to participate in a retrospective study characterizing the risk determinants of statin-induced muscle toxicity. Three categoric pain variables were graded retrospectively (distribution, location, and severity of pain). The presenting complaints of the case patients were extremely heterogeneous. The number of patients with a compelling pain syndrome (diffuse, proximal muscle pain of high intensity) increased at higher serum CK levels; the number of patients with indeterminate pain variables decreased at higher serum CK levels. The lines reflecting these relationships cross at a CK level of approximately 1175 U/L, approximately half the threshold level needed to make a clinical diagnosis of "myopathy" (ie, CK >10-fold the upper limit of normal).
  Preventive Cardiology 01/2009; 12(2):88-94.
• Article: ENHANCE and ONTARGET.

  Philip R Liebson
  Preventive Cardiology 02/2008; 11(3):179-82.
• Article: Obesity and bariatric surgery: two studies.

  Philip R Liebson
  Preventive Cardiology 02/2008; 11(1):56-9.