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J Am Coll Cardiol, 2008; 51:23-24, doi:10.1016/S0735-1097(08)01131-5
© 2008 by the American College of Cardiology Foundation
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INSIDE THIS ISSUE OF JACC

Inside This Issue of JACC


   Interventional Cardiology
Top
 Interventional Cardiology
Lipids and Vascular Disease
 Heart Failure
 Cardiac Imaging
 Peripheral Vascular Disease
 
CoStar Drug-Eluting Stent Fails in Large Clinical Trial.  
Figure 1
There is concern that the polymer used to attach the drug to drug-eluting stents (DES), which is nondegradable, may trigger late stent thrombosis. The CoStar stent is a novel DES platform designed to elute paclitaxel, from a bioresorbable polymer. The COSTAR (Cobalt Chromium Stent With Antiproliferative for Restenosis) II study was a noninferiority trial which randomized patients to either a CoStar or a Taxus stent with clinical and angiographic follow-up. Major adverse cardiac events at 8 months were 11% for CoStar versus 6.9% for Taxus. These results demonstrate that the CoStar DES is inferior to the Taxus DES. See page 1543. See figure.


   Lipids and Vascular Disease
Top
 Interventional Cardiology
 Lipids and Vascular Disease
Heart Failure
 Cardiac Imaging
 Peripheral Vascular Disease
 
Plant Sterols May Decrease Cholesterol But Increase Cardiac Risk.   Plant sterol esters (PSEs), which can be found in vegetable oils, fruits, and nuts, are widely used as a food additive to inhibit the absorption of cholesterol from the small intestine. Weingärtner and colleagues studied the effectiveness of PSEs at reducing cardiovascular risk in mice models. Supplementing mice chow with PSEs was found to impair endothelium dependent vasodilation and to increase infarct size in an occlusion-reperfusion model. Further studies showed that these PSEs can be incorporated into human atherosclerotic lesions. These findings suggest that while PSEs may lower serum cholesterol levels, they may raise rather than lower cardiovascular risk. See page 1553.


   Heart Failure
Top
 Interventional Cardiology
 Lipids and Vascular Disease
 Heart Failure
Cardiac Imaging
 Peripheral Vascular Disease
 
Presence of Retinopathy Predicts Risk of CHF in Diabetics.   Retinopathy is one of the hallmarks of microvascular disease. Cheung and colleagues graded retinal microphotographs from diabetics enrolled in the ARIC (Atherosclerosis Risk in Communities) study to determine the association between diabetic retinopathy and incident congestive heart failure (CHF). Those with retinopathy were 2.7 times more likely to be diagnosed with CHF during the 9 years of follow-up; this association held after adjusting for several risk factors. The authors hypothesize that diabetic retinopathy may represent systemic microcirculatory disease that places an increased impedance burden on the heart. See page 1573.


   Cardiac Imaging
Top
 Interventional Cardiology
 Lipids and Vascular Disease
 Heart Failure
 Cardiac Imaging
Peripheral Vascular Disease
 
Cardiovascular Magnetic Resonance Can Identify Areas of Salvaged Myocardium.  
Figure 2
Early reperfusion can limit the extent of myocardial necrosis, but the extent of this salvage is hard to quantify. The region of irreversible damage can be accurately identified with late enhancement (LE) on cardiac magnetic resonance imaging. Friedrich and colleagues hypothesized that T2 imaging, which is sensitive to water-bound protons, could detect areas of tissue edema that would result from temporary ischemia. Ninety-two post-myocardial infarction patients were imaged a median of 3 days after the event. Areas of high T2 intensity surrounded areas of LE and exceeded the infarct size by an average of 16%. This method appears valuable for quantifying the amount of myocardium salvaged by early reperfusion. See page 1581. See figure.


   Peripheral Vascular Disease
Top
 Interventional Cardiology
 Lipids and Vascular Disease
 Heart Failure
 Cardiac Imaging
 Peripheral Vascular Disease
 
PAD is a Potent Risk Marker for Cardiovascular Death.  
Figure 3
While peripheral arterial disease (PAD) is known to be a risk factor for cardiovascular events, the magnitude of this risk is poorly understood. Welten and colleagues followed nearly 3,000 subjects who underwent surgery for PAD, and compared them to a propensity-matched cohort of patients with coronary artery disease (CAD). The PAD patients were 2.4 times more likely to die and 46% of these deaths were secondary to cerebrocardiovascular events. Yet PAD patients received less cardiac medications. Long-term prognosis of vascular surgery patients is significantly worse than patients with CAD; this difference may be due to the fact that these patients receive less cardiac medications. See page 1588. See figure.


Related articles in JACC:

A Novel Bioresorbable Polymer Paclitaxel-Eluting Stent for the Treatment of Single and Multivessel Coronary Disease: Primary Results of the COSTAR (Cobalt Chromium Stent With Antiproliferative for Restenosis) II Study
Mitchell W. Krucoff, Dean J. Kereiakes, John L. Petersen, Roxana Mehran, Vic Hasselblad, Alexandra J. Lansky, Peter J. Fitzgerald, Jyotsna Garg, Mark A. Turco, Charles A. Simonton, III, Stefan Verheye, Christophe L. Dubois, Roger Gammon, Wayne B. Batchelor, Charles D. O'Shaughnessy, James B. Hermiller, Jr, Joachim Schofer, Maurice Buchbinder, William Wijns, and for the COSTAR II Investigators Group
JACC 2008 51: 1543-1552. [Abstract] [Full Text]  

Vascular Effects of Diet Supplementation With Plant Sterols
Oliver Weingärtner, Dieter Lütjohann, Shengbo Ji, Nicole Weisshoff, Franka List, Thomas Sudhop, Klaus von Bergmann, Karen Gertz, Jochem König, Hans-Joachim Schäfers, Matthias Endres, Michael Böhm, and Ulrich Laufs
JACC 2008 51: 1553-1561. [Abstract] [Full Text]  

Diabetic Retinopathy and Risk of Heart Failure
Ning Cheung, Jie J. Wang, Sophie L. Rogers, Frederick Brancati, Ronald Klein, A. Richey Sharrett, Tien Y. Wong, and for the ARIC (Atherosclerosis Risk In Communities) Study Investigators
JACC 2008 51: 1573-1578. [Abstract] [Full Text]  

The Salvaged Area at Risk in Reperfused Acute Myocardial Infarction as Visualized by Cardiovascular Magnetic Resonance
Matthias G. Friedrich, Hassan Abdel-Aty, Andrew Taylor, Jeanette Schulz-Menger, Daniel Messroghli, and Rainer Dietz
JACC 2008 51: 1581-1587. [Abstract] [Full Text]  

Long-Term Prognosis of Patients With Peripheral Arterial Disease: A Comparison in Patients With Coronary Artery Disease
Gijs M.J.M. Welten, Olaf Schouten, Sanne E. Hoeks, Michel Chonchol, Radosav Vidakovic, Ron T. van Domburg, Jeroen J. Bax, Marc R.H.M. van Sambeek, and Don Poldermans
JACC 2008 51: 1588-1596. [Abstract] [Full Text]  




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