INSIDE THIS ISSUE OF JACC
Inside This Issue of JACC
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Clinical Trials
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Pioglitazone and Simvastatin Have Complementary Anti-Inflammatory Effects.
Both simvastatin and peroxisome proliferators-activated receptor (PPAR)
agonists independently reduce certain markers of inflammation, but there is less known about these effects with combination therapy or in people without diabetes. The PIOSTAT study randomized over 100 non-diabetics with coronary artery disease risk factors and elevated C-reactive protein (CRP) to either pioglitazone, simvastatin, or the combination and followed them for 12 weeks. Both monotherapies significantly reduced CRP levels; the combination was additive, especially in patients with the metabolic syndrome. This study suggests that patients with the metabolic syndrome may benefit from treatment with a PPAR agonist in addition to a statin. See page 290.
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Cardiovascular Disease and Risk
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Hyperglycemia Increases Platelet Aggregation.
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Page 307
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Worthley and colleagues tested the hypothesis that elevated glucose levels lead to increased platelet aggregation in 76 patients with acute coronary syndromes. All patients had baseline measurements of glucose, and platelet responsiveness; one-half of the patients then received intravenous insulin infusions to rapidly correct glucose levels, the other half received a standard subcutaneous insulin protocol. Platelet aggregation was found to correlate directly with glucose levels and with superoxide levels. Rapid correction of hyperglycemia restored platelet responsiveness to nitric oxide and decreased superoxide generation. This study suggests that elevated glucose levels lead to increased oxidative stress which inhibits the effectiveness of endothelial derived nitric oxide to block platelet aggregation. See page 304. See figure.
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Heart Rhythm Disorders
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Risk Stratification in Adults With LQTS.
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Page 333
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Sauer and colleagues report on long-term follow-up of over 800 adults with genotype-confirmed long QT syndrome (LQTS). The risk of future cardiac events was higher in female subjects, those with the LQT2 genotype, those with QTc >500 ms, and in those who had their first event prior to age 18 years. Beta-blockers reduced the rate of future cardiac by 60%, but had little effect in those with the LQT3 mutation. This study provides important information that can be used to assess the risk of future cardiac events in adults LQTS mutations. See page 329. See figure.
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Hypertrophic Cardiomyopathy
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Comparing Surgical Myectomy Versus Alcohol Ablation With Cardiac MRI.
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Page 353
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Both surgical septal myectomy and percutaneous alcohol septal ablation relieve left ventricular outflow tract obstruction in patients with hypertrophic obstructive cardiomyopathy (HOCM). Valeti and colleagues compared cardiac magnetic resonance images (MRI) from nearly 50 patients who had undergone one of these procedures. Septal myectomy results in a consistent area of myocardial resection in the anteroseptal region and relief of the gradient. Alcohol ablation leads to a more varied outcome, but usually results in a transmural infarction in the inferior base of the septum. Both procedures were successful in reducing the gradient, but alcohol had more right bundle branch block and right ventricular infarction. Magnetic resonance imaging may help to define the optimal application of percutaneous alcohol ablation. See page 350. See figure.
Related Article
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Anti-Inflammatory Effects of Pioglitazone and/or Simvastatin in High Cardiovascular Risk Patients With Elevated High Sensitivity C-Reactive Protein: The PIOSTAT Study
- Markolf Hanefeld, Nikolaus Marx, Andreas Pfützner, Werner Baurecht, Georg Lübben, Efstrathios Karagiannis, Ulf Stier, and Thomas Forst
J. Am. Coll. Cardiol. 2007 49: 290-297.
[Abstract]
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Clinical Trials
Cardiovascular Disease and Risk