INSIDE THIS ISSUE OF JACC
Inside This Issue of JACC
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Cardiovascular Risk
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High Glycemic Index Associated With Increased Cardiovascular Risk.
Rapidly absorbed carbohydrates induce high postprandial glucose and subsequently insulin release; this can be quantified as a food’s glycemic index. Glycemic load represents both quantity and quality of carbohydrate intake. Beulens and colleagues measured the typical daily glycemic index and glycemic load in over 15,000 healthy Dutch women. Both glycemic load and glycemic index were associated with an increased risk of vascular events over the next 9 years. This association remained after adjustment for several known cardiac risk factors and was particularly strong in overweight subjects. Switching to a high-carbohydrate diet, to replace a high-fat diet, may not reduce the risk of cardiovascular diseases. See page 14
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Heart Failure
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No Relationship Between TZD Use and HF Outcomes.
There continue to be many concerns regarding the safety of thiazolidines (TZDs) in patients with heart failure (HF). Aguilar and colleagues studied over 7,000 subjects with diagnoses of both diabetes and HF treated at VA ambulatory clinics. Over 2 years of follow-up, there were no differences in time to hospitalization for HF or time to death, after adjusting for baseline risks, in those treated with TZDs versus those treated with other antidiabetic medications. In this study of ambulatory patients with established HF, the use of TZDs was not associated with an increased risk of HF hospitalization or total mortality. See page 32
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Heart Failure
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Red Cell Distribution Width Found to Predict Risk of Death in CHF Patients.
Felker and colleagues mined the vast trove of data collected from the CHARM trials to identify risk factors for cardiovascular death and/or heart failure hospitalization. From the 36 laboratory values collected, red cell distribution width (RDW) showed the greatest correlation with subsequent risk. This finding was replicated in a model created from data in the Duke Databank, where RDW continued to be strongly associated with mortality (hazard ratio 1.3 per 1 standard deviation). Red cell distribution width may be a simple integrative measure of multiple pathologic processes in heart failure (e.g., nutritional deficiencies, renal dysfunction, hepatic congestion, inflammatory stress), explaining its association with clinical outcomes. See page 40
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Heart Failure
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Retinal Arteriolar Narrowing Associated With Left Ventricular Hypertrophy.
Investigators from MESA (Multi-Ethnic Study of Atherosclerosis) aimed to correlate retinal vascular changes with early cardiac morphologic alterations. The caliber of the retinal arteries and veins were systematically measured from retinal photographs in over 4,000 subjects who also underwent cardiac magnetic resonance imaging for measurement of left ventricular mass and volume. Narrower retinal arterioles were associated with increased left ventricular mass and smaller left ventricular volume. This association was consistent across different ethnic groups, was independent of blood pressure, smoking, and other risk factors, and was seen in men and women. This finding suggests that left ventricular remodeling and arteriolar narrowing are tightly intertwined, although whether one leads to the other or they are different manifestations of the same pathology remains to be determined. See page 48
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Related Articles
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High Dietary Glycemic Load and Glycemic Index Increase Risk of Cardiovascular Disease Among Middle-Aged Women: A Population-Based Follow-Up Study
- Joline W.J. Beulens, Leonie M. de Bruijne, Ronald P. Stolk, Petra H.M. Peeters, Michiel L. Bots, Diederick E. Grobbee, and Yvonne T. van der Schouw
J. Am. Coll. Cardiol. 2007 50: 14-21.
[Abstract]
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The Impact of Thiazolidinedione Use on Outcomes in Ambulatory Patients With Diabetes Mellitus and Heart Failure
- David Aguilar, Biykem Bozkurt, Allison Pritchett, Nancy J. Petersen, and Anita Deswal
J. Am. Coll. Cardiol. 2007 50: 32-36.
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Red Cell Distribution Width as a Novel Prognostic Marker in Heart Failure: Data From the CHARM Program and the Duke Databank
- G. Michael Felker, Larry A. Allen, Stuart J. Pocock, Linda K. Shaw, John J.V. McMurray, Marc A. Pfeffer, Karl Swedberg, Duolao Wang, Salim Yusuf, Eric L. Michelson, Christopher B. Granger for the CHARM Investigators
J. Am. Coll. Cardiol. 2007 50: 40-47.
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Retinal Arteriolar Narrowing and Left Ventricular Remodeling: The Multi-Ethnic Study of Atherosclerosis
- Ning Cheung, David A. Bluemke, Ronald Klein, A. Richey Sharrett, F.M. Amirul Islam, Mary Frances Cotch, Barbara E.K. Klein, Michael H. Criqui, and Tien Yin Wong
J. Am. Coll. Cardiol. 2007 50: 48-55.
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Cardiovascular Risk
Heart Failure