Patient Care Endocrinology & Cardiology - October 2007 - (Page 5)

Research Digest Continued from page 2 with cystatin C was found to be independent of other variables, including obesity, baseline glucose, serum creatinine, and albumin-to-creatinine ratio. “Cystatin C has been shown recently to predict incident coronary heart disease events,” the authors conclude, “suggesting that the renal/heart disease connection may share common mechanisms. Our findings provide an important new avenue for future research, suggesting that mild renal impairment may occur early in the natural history of diabetes.” Donahue RP, Stranges S, Rejman K, et al. Elevated cystatin C concentration and progression to pre-diabetes: the Western New York Study. Diabetes Care. 2007;30(7):1724-1729. Increasing waist-to-hip ratio linked to atherosclerosis An increasing waist-to-hip ratio is independently associated with atherosclerosis and may be a better indicator of coronary artery calcification than either waist circumference or body mass index (BMI). Researchers at the University of Texas Southwestern Medical Center in Dallas studied 2744 adults (median age 45 years) who underwent electron-beam CT. Across the quintiles of waist-to-hip ratio and waist circumference, the researchers found that coronary artery calcification prevalence increased stepwise. But across the quintiles of BMI, they found significant differences in prev- Researchers fault recent meta-analysis on rosiglitazone Patients with diabetes who take rosiglitazone (Avandia) have neither an increased nor decreased risk of MI and cardiovascular death. Investigators at the University of California, Los Angeles, reviewed a recent, widely publicized meta-analysis of 42 clinical trials involving 27,847 patients that found that rosiglitazone was associated with a 43% increased risk of MI and a 64% increased risk of cardiovascular death. The researchers fault the original study’s authors for not assessing the sensitivity of their conclusions to several methodological choices and for not including all studies showing evidence of rosiglitazone’s cardiovascular effects. Using alternative meta-analytic approaches, they found lower odds ratios for MI and cardiovascular death that were not statistically significant. “In the end, we believe that only prospective clinical trials designed specifically to establish the cardiovascular benefit or risk of rosiglitazone will resolve the controversy about its safety,” the authors conclude. “In our opinion, available evidence does not justify what the authors of the original meta-analysis (as well as the media, the US Congress, and worried patient groups) decried as an ‘urgent need for comprehensive evaluations.’” Diamond GA, Bax L, Kaul S. Uncertain effects of rosiglitazone on the risk for myocardial infarction and cardiovascular death [Perspective]. Ann Intern Med. 2007;147(8):16. alence only between the first and fifth quintiles. After adjusting for standard cardiovascular risk factors, they found that waist-to-hip ratio—but not waist circumference or BMI—was independently associated with an increased risk of coronary artery calcification in the fifth versus the first quintiles (odds ratio, 1.91). See R, Abdullah SM, McGuire DK, et al. The association of differing measures of overweight and obesity with prevalent atherosclerosis: the Dallas Heart Study. J Am Coll Cardiol. 2007;50(8): 752-759. Apolipoprotein levels predict coronary heart disease risk Although serum levels of some apolipoproteins are as predictive of coronary heart disease as those of traditional lipids, they do not provide any extra riskprediction value over established risk factors such as the ratio of total cholesterol to HDL cholesterol (HDLC). The Framingham Heart Study studied 3322 middle-aged white subjects who were free of cardiovascular disease in 1987-1991. During a median 15year follow-up, 291 of the subjects developed coronary heart disease. After adjusting for nonlipid risk factors, the researchers found that the apolipoprotein Continued on page 19 OCTOBER 2007 PATIENT CARE ENDOCRINOLOGY & CARDIOLOGY 5

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Patient Care - Endocrinology & Cardiology - October 2007 Research Digest Contents Medicine in the News Recognizing and Managing Patients with the Metabolic Syndrome and Prediabetes Using Troponins to Evaluate Cardiac Injury The 15-Minute Visit Classified Advertising Clinical Clips

Patient Care Endocrinology & Cardiology - October 2007

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