Major recent trials in cardiovascular diseases

This article provides information and commentary on recent clinical trials related to primary prevention in cardiovascular diseases including lipids, hypertension, and diabetes. It also focuses on novel therapeutic advances in heart failure with devices and therapeutic agents. In addition, we explore trials looking at the effects of the investigational agents azimilide and dronedarone in the treatment of arrhythmias, application of established therapies/devices to larger populations, and the impact of hypercoagulability and aortic arch plaques on the incidence of stroke. Finally, we conclude with trials from the interventional arena evaluating new agents in the treatment of myocardial infarction, comparing percutaneous coronary intervention with coronary artery bypass grafting surgery in patients with diabetes, and reporting registry data on long-term treatment with dual antiplatelet therapy. Some of the preliminary data presented are from unpublished reports and may be subject to change in the final publications

Cardiac rehabilitation programs markedly improve high-risk profiles in coronary patients with high psychological distress

OBJECTIVES: Adverse behavioral profiles, particularly depression and hostility, increase the risk of coronary artery disease (CAD) and affect recovery after CAD events. We sought to determine the effects of outpatient phase II cardiac rehabilitation and exercise training (CRET) programs in CAD patients with high levels of psychological distress. METHODS: We studied 500 consecutive patients both before and after phase II CRET programs and compared 109 patients with the highest quintile of psychological distress (HD) with 115 patients with the lowest quintile of psychological distress (LD). RESULTS: At baseline, patients with HD were younger (P < 0.001), had higher weight (+11%; P < 0.001), body mass indices (BMI) (+9%; P < 0.01), triglycerides (+66%; P < 0.0001), and glycosylated hemoglobin (+9%; P = 0.03), and had higher scores for depression, hostility, anxiety, and somatization (all P < 0.0001), but had lower values for exercise capacity(-15%; P = 0.02), high-density lipoprotein (HDL) cholesterol (-10%; P < 0.01), and total quality of life (QoL) (-26%; P < 0.0001), and all 6 major components of QoL compared with LD. After CRET, patients with HD had significant reductions in weight (-2%; P < 0.01), % fat (-6%; P < 0.001), BMI (-2%, P < 0.01), and scores for anxiety (-49%), depression (-47%), somatization (-34%) and hostility (-38%) (all P < 0.0001), and increases in exercise capacity (+54%; P < 0.0001), HDL cholesterol (+10%; P < 0.0001), and total QoL (+23%; P < 0.0001), and the 6 components of QoL studied. Compared with patients with LD, those with HD had statistically greater improvements in HDL (P = 0.03), triglycerides (P = 0.03), BMI (P = 0.02), as well as all behavioral characteristics and QoL (P < 0.0001), and had similar improvements in all other factors assessed. CONCLUSIONS: These data support the routine assessment of high-risk behavioral characteristics in patients with CAD and demonstrate the marked improvements that occur after phase II CRET programs in CAD patients with high psychological distress

Obesity-risk factor, paradox, and impact of weight loss in cardiovascular diseases

Obesity is a highly prevalent metabolic disorder that is increasing in epidemicproportions all over the world and is an independent risk factor for several cardiovascular(CV) risk factors such as hypertension, diabetes mellitus, dyslipidemia and metabolicsyndrome.Obesity is also independently associated with CV diseases (CVD) such as coronaryheart disease (CHD), heart failure (HF) and arrhythmias. Chronically, obesity andassociated CV risk factors cause pathological alterations in the cardiac structure andfunction, leading to clinically symptomatic left ventricular dysfunction. It is well - knownthat being overweight or obese is associated with increased risk for most CVD, includingCHD and HF.However, once these CV conditions have already developed, overweight and obesesubjects have a better prognosis compared to those with normal weight or leaner subjects - a phenomenon called the 'Obesity Paradox'. This chapter reviews the adverse effectsof obesity on the CV system, evidence supporting the puzzling obesity paradox in variousCV populations, and concludes with the impact of weight loss in primary and secondaryprevention of CVD