INSIDE THIS ISSUE OF JACC
Inside This Issue of JACC
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Interventional Cardiology
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DES Mortality Benefit Found in a Real-World Setting.
Shishehbor and colleagues compared all-cause mortality between patients receiving drug-eluting stents (DES) and bare-metal stents (BMS) while adjusting for untraditional mortality risk factors such as malignancy, depression, anemia, and low socioeconomic status. All-cause mortality was significantly lower in both unadjusted and adjusted Cox proportional models with DES. These results suggest that DES reduce the risk of mortality even after adjusting for the untraditional cardiac risk factors that make some patients more likely to receive a BMS due to perceived inability to comply with long-term antiplatelet therapy. See page 1041. See figure.
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Atherosclerosis
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Polymorphism in Hp Gene Associated With Increased Iron in Plaque.
Haptoglobin (Hp) is necessary for removing free hemoglobin (Hb), whose incorporated iron can act as an inflammatory stimulus. The Hp gene has 2 alleles (1 and 2); allele 2 is less efficient at neutralizing iron and has been associated with increased cardiovascular risk. Moreno and colleagues report that subjects with 2 copies of allele 2 (Hp 2-2) were up to 4 times more likely to have atherosclerotic plaques that stain positive for iron. These results support the proposition that Hp 2-2 individuals have impaired clearance of Hb from atherosclerotic plaques. See page 1049. See figure.
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Heart Failure
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BBs Show Similar Efficacy to Other Drugs for Primary Prevention of HF.
Hypertension doubles the risk of heart failure (HF). Because beta-blockers (BBs) are effective for the treatment of HF, some have postulated that they may more effectively prevent HF than other antihypertensive agents. Bangalore and colleagues. performed a meta-analysis of 12 trials with over 100,000 subjects with hypertension. Compared to placebo, BBs reduced blood pressure (BP) and the risk of HF. With similar reductions in BP, there was no incremental benefit with BB compared to other medications. Preventing HF correlates strongly with reducing BP regardless of the class of medication used. See page 1062.
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Heart Rhythm Disorders
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Azimilide Reduces Hospitalizations for Patients With ICDs.
Azimilide is an investigational Class III antiarrhythmic medication. This a secondary end point analysis of the SHIELD trial which randomized patients with symptomatic ventricular arrhythmias, who also had an implantable cardioverter-defibrillator (ICD), to either azimilide or placebo. The total number of emergency room (ER) visits and hospitalizations caused by arrhythmias or other cardiac events was compared. The 75-mg dose of azimilide significantly reduced both ER visits and hospitalizations by 37% and 47%, respectively, with 6 as the number needed to treat to prevent 1 such visit over 1 year. Azimilide significantly reduces the number of ER visits and hospitalizations in patients with an ICD and a history of symptomatic ventricular arrhythmias. See page 1076. See figure.
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Long-Term Impact of Drug-Eluting Stents Versus Bare-Metal Stents on All-Cause Mortality
- Mehdi H. Shishehbor, Sachin S. Goel, Samir R. Kapadia, Deepak L. Bhatt, Peter Kelly, Russell E. Raymond, John M. Galla, Sorin J. Brener, Patrick L. Whitlow, and Stephen G. Ellis
J. Am. Coll. Cardiol. 2008 52: 1041-1048.
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Haptoglobin Genotype Is a Major Determinant of the Amount of Iron in the Human Atherosclerotic Plaque
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Beta-Blockers for Primary Prevention of Heart Failure in Patients With Hypertension: Insights From a Meta-Analysis
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Azimilide Reduces Emergency Department Visits and Hospitalizations in Patients With an Implantable Cardioverter-Defibrillator in a Placebo-Controlled Clinical Trial
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J. Am. Coll. Cardiol. 2008 52: 1076-1083.
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Interventional Cardiology
Atherosclerosis
