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INSIDE THIS ISSUE OF JACC
Inside This Issue of JACC
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Atheroma Composition and Metabolic Syndrome
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Metabolic Syndrome Associated With Lipid-Rich Plaques.
Although the metabolic syndrome (MetS) is known to increase the risk of future cardiovascular events, little is known about its effects on the components of atherosclerotic plaques. Amano and colleagues performed integrated backscatter intravascular ultrasound on non-hemodynamically significant lesions in patients with and without criteria for MetS. Although the percent diameter stenoses were similar, those with MetS had higher percentages of lipid in the plaque and reduced areas of fibrosis. These lipid-rich plaques are thought to be more prone to rupture and may explain some of the increased risk seen with MetS. See page 1149.
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Hypertension
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Efficacy of Aliskiren for Blood Pressure Control.
Aliskiren is an orally bioavailable renin inhibitor that is being investigated for the treatment of hypertension. This 8-week trial investigated the safety and efficacy of aliskiren in patients with hypertension. The 300-mg dose provided a significant reduction of 14.7 mm Hg for systolic blood pressure and 11.1 mm Hg for diastolic blood pressure, with sustained 24-h efficacy. The adverse event rate was similar to placebo. Aliskiren provides significant blood pressure-lowering effects and appears to be well tolerated; its long serum half-life and sustained blood pressure lowering show great promise for the treatment of hypertension. See page 1157. See figure.
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Heart Failure
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ACE Inhibitors May Help to Wean From LVAD Support.
Although left ventricular assist devices (LVADs) can serve as a bridge to transplant, only a small minority of patients are able to be successfully weaned. Klotz and colleagues hypothesized that there may be further deterioration in the properties of the extracellular matrix (ECM) during LVAD use and that angiotensin-converting enzyme (ACE) inhibitors might reverse this deterioration. Pre- and post-LVAD cardiac biopsy specimens were compared as were the passive pressure volume loops of explanted hearts. Hearts treated with ACE inhibitors had reduced levels of angiotensin II and cross-linked collagen. Left ventricular mass and myocardial stiffness were also improved by ACE inhibitor usage. Angiotensin-converting enzyme inhibitors may be useful in restoring properties of the ECM such that LVADs may be used as a bridge to recovery, rather than a bridge to transplant. See page 1166. See figure.
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Biomarkers
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Utility of Various BNP Sampling Protocols.
Two articles in this issue assess the prognostic utility of novel B-type natriuretic peptide (BNP) testing protocols. Kwan and colleagues examined the utility of short-term changes in BNP levels to aid in the risk-stratification of patients presenting with chest pain. Whereas elevated BNP levels strongly predicted subsequent adverse events, there was no benefit to serial measurements in the first 24 h. Lam and colleagues noted that both circulating BNP and N-terminal-pro-B-type natriuretic peptide may be cleaved by aminodipeptidases, removing the first 2 amino acids. They developed assays to measure these products and compared the diagnostic utility of these proteins versus standard BNP assays. The cleaved forms of BNP were found in a minority of both control subjects and those with heart failure, however, neither was superior to commercially available assays for the detection of heart failure. Although both of these studies add to our understanding of the release and processing of BNP, neither method improves on the diagnostic utility of currently available methods. See pages 1186 and 1193.
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Atheroma Composition and...
Hypertension
