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The time course of events after acute coronary syndromes (ACS) might influence the timing and duration of therapeutic interventions. In this paper the authors study the timing of death, reinfarction, stroke, and major bleeding within 6 months of ACS in 46,829 patients enrolled in the Global Registry of Acute Coronary Events (GRACE). Their data shows that the timing of events after ACS was affected by ST category and influenced by GRACE risk score within each electrocardiographic category of ACS. They recommend that risk stratification should, therefore, include multiple risk factors rather than ST shift alone.
The metabolic syndrome is a major public-health concern worldwide, and the Japanese are attempting to address the issue at a national level. Their criteria for this syndrome, in contrast to various others, include measurement of waist circumference. Here, Fujita discusses country-specific impact of the metabolic syndrome, using the evolution of the Japanese diagnostic criteria as a model.
The distribution of fat within the body, particularly visceral fat is an important determinant in the development of various cardiovascular and metabolic disorders, and is influenced by angiotensin II and the renin–angiotensin system. Given these issues, this Article examines he relationship of obesity to cardiovascular disease and metabolic syndrome and the effectiveness of obesity management.
Proteinuria is a useful early marker for progressive renal dysfunction. Angiotensin II is centrally involved in all stages of renal pathophysiology, and angiotensin-II-receptor blockers can be useful therapeutic agents in preventing the development of overt kidney disease. This Article discusses the role of angiotensin II in cardiovascular and renovascular disease, and the effectiveness of angiotensin-II-receptor blocker therapy.
Cardiovascular mortality and morbidity remain high despite a variety of therapies being available. New avenues for therapy are, therefore, continually sought. Here, whether the relationship that exists between cardiovascular and renal disease could provide such an opportunity is discussed, in the context of treatment strategies directed at the renin–angiotensin–aldosterone system.
The definition of this syndrome, its utility as a predictor of cardiovascular risk, and the treatment implications of diagnosis remain unsettled. In this Article, de Zeeuw and Bakker argue that, while the most commonly used definitions of the metabolic syndrome perform poorly in estimatation of cardiovascular risk, the concept is nonetheless useful.
Proliferator-activated receptor-γ has a key role in glucose and lipid metabolism and activation lead to benefits in patients with diabetes. Telmisartan can robustly activate this nuclear receptor as well as blocking the angiotensin II type 1 receptor. This Article assesses whether this dual effect affords telmisartan additional benefits over other angiotensin-II-receptor blockers.
Endothelial dysfunction is an early manifestation of atherosclerotic disease. Circulating cells that express CD34, including endothelial and hematopoietic progenitor cells, might play a part in the development and progression of atherosclerosis. In this paper the authors evaluate the association between coronary endothelial dysfunction and concentrations of circulating CD34+cell subsets.
Cardiac rehabilitation, in most developed countries, is a proven means of reducing mortality but it is grossly underutilized owing to factors involving both the health system and patients. These issues have not been investigated concurrently. In this paper the authors describe a prospective study with a multilevel design to show that the most relevant physician perceptions of such programs are program quality and perceived benefit. For patients, they are barriers to cardiac rehabilitation, which might be conveyed during pre-referral discussions. Work to improve physicians' perceptions and patients' understanding of rehabilitation services might improve use.