INSIDE THIS ISSUE OF JACC
Inside This Issue of JACC
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Coronary Artery Disease
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MCP-1 Levels Predict Mortality in Both Post-ACS and Stable Patients.
De Lemos and colleagues measured monocyte chemoattractant protein (MCP)-1 levels in over 4,000 subjects enrolled in the A to Z (Aggrastat to Zocor) trial. Serial measurements of MCP-1 were performed at baseline, during hospitalization for an acute coronary syndrome (ACS), and at 4 months. After adjusting for standard risk predictors, an MCP-1 level >238 pg/ml was associated with an approximately 2 times higher risk for mortality. Findings were similar for both the baseline and 4-month measurements. This suggests that MCP-1 provides independent prognostic value in the acute and chronic phases after ACS and merits further evaluation as both a prognostic marker and a potential therapeutic target. See page 2117. See figure.
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Coronary Artery Disease
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Cardiovascular Mortality Rates Not Decreasing for Those <45 Years.
Advances in treatment for acute coronary syndromes and risk factor modifications have resulted in decreasing cardiovascular mortality; however, trends for obesity, diabetes, and blood pressure have been increasing among young adults. Ford and Capewell studied cardiovascular mortality rates from 1980 to 2002. Overall, the age-adjusted mortality rate showed a fairly steady decline of –2% to –3% per year. However, among women <54 years, the estimated annual percentage change (EAPC) in mortality increased from –5.4% for 1980 until 1989, to positive 1.5% from 2000 until 2002. Among men <54 years, the corresponding EAPCs were –6.2% and –0.5%. The recent increase in cardiovascular mortality for young women and declining gains in young men suggests that trends in cardiac risk factors related to increasing obesity are offsetting improvements in hospital care. See page 2128. See figure.
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Heart Failure
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Twice-Daily Sildenafil Improves Exercise Capacity in Subjects With CHF.
In patients with congestive hear failure (CHF), endothelial dysfunction (ED) may result in muscle underperfusion and exercise ventilation inefficiency; phosphodiesterase 5 inhibition might be beneficial by improving ED. Guazzi and colleagues randomized 46 subjects with CHF and an ejection fraction <45% to either placebo or sildenafil 50 mg twice a day for 6 months. Follow-up included brachial artery flow-mediated dilatation (FMD) and cardiopulmonary exercise testing. No changes were noted with placebo. Those assigned to sildenafil had reduced systolic pulmonary artery pressure, improved breathlessness score, increased FMD, and higher peak minute ventilation. Sildenafil improves exercise ventilation and aerobic efficiency in subjects with CHF and the effect is sustained over 6 months. See page 2136.
Related Articles
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Serial Measurement of Monocyte Chemoattractant Protein-1 After Acute Coronary Syndromes: Results From the A to Z Trial
- James A. de Lemos, David A. Morrow, Michael A. Blazing, Petr Jarolim, Stephen D. Wiviott, Marc S. Sabatine, Robert M. Califf, and Eugene Braunwald
J. Am. Coll. Cardiol. 2007 50: 2117-2124.
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Coronary Heart Disease Mortality Among Young Adults in the U.S. From 1980 Through 2002: Concealed Leveling of Mortality Rates
- Earl S. Ford and Simon Capewell
J. Am. Coll. Cardiol. 2007 50: 2128-2132.
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Long-Term Use of Sildenafil in the Therapeutic Management of Heart Failure
- Marco Guazzi, Michele Samaja, Ross Arena, Marco Vicenzi, and Maurizio D. Guazzi
J. Am. Coll. Cardiol. 2007 50: 2136-2144.
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Coronary Artery Disease
Coronary Artery Disease
