Patient Care Endocrinology & Cardiology - December 2007 - (Page 2)

Research Digest Job strain after first MI linked to future heart problems People who return to work after a first heart attack and deal with chronic job-related strain face an increased risk of recurrent coronary heart disease (CHD) events. Investigators in Canada analyzed data from a prospective cohort of 972 men and women aged 35 to 59. Job strain was an independent predictor of recurrent CHD (hazard ratio, 2.00) at 2.2 years and beyond, even after adjusting for 26 potential confounders. Aboa-Eboule C, Brisson C, Maunsell E, et al. Job strain and risk of acute recurrent coronary heart disease events. JAMA. 2007;298: 1652-1660. A quick summary of recent reports from leading medical journals Screening not equally useful in all chest-pain patients Although 64-slice CT coronary angiography (CTCA) is useful in screening symptomatic patients who are estimated to have low or intermediate risk of coronary artery disease (CAD), it appears to be of limited value in evaluating patients at high risk. Researchers in the Netherlands divided 254 patients who presented with angina or nonanginal chest pain—and were referred for conventional coronary angiography—into groups of low, intermediate, or high probability of significant CAD. Patients underwent 64-slice CTCA and conventional angiography. The post-test probability of significant CAD after a negative CT scan was 17% in the high-probability group and zero in the intermediate- and low-risk groups. After a positive CT scan, it was 96% in the high group, 88% in the intermediate group, and 68% in the low group. Meijboom WB, van Mieghem CA, Mollet NR, et al. 64-Slice computed tomography coronary angiography in patients with high, intermediate, or low pretest probability of significant coronary artery disease. J Am Coll Cardiol. 2007;50:1469-1475. Adding single insulin to oral drugs fails most diabetics Only a minority of patients with suboptimal glycemic control on oral drugs achieve target glycated hemoglobin A1c (HbA1c) levels with the addition of a single type of insulin. Basal insulin was slightly less effective than regimens with short-acting insulin but was associated with a lower risk of weight gain and hypoglycemic events. Researchers in the United Kingdom studied 708 patients with type 2 diabetes whose HbA1c levels were 7% to 10% who were taking the maximum tolerated dose of metformin and sulfonylurea. Patients were randomly assigned to biphasic insulin aspart bid, prandial insulin aspart bid, or basal insulin detemir qd or bid. The researchers found that HbA1c levels were reduced to 6.5% or less in 17% of the biphasic group, 23.9% of the prandial group, and 8.1% of the basal group. Holman RR, Throne KI, Farmer AJ, et al, for the 4-T Study Group. Addition of biphasic, prandial, or basal insulin to oral therapy in type 2 diabetes. N Engl J Med. 2007;357(15):1716-1730. HDL predicts risk of major cardiovascular events Levels of HDL cholesterol (HDL-C) predict the risk of major cardiovascular events even in patients whose LDL cholesterol (LDL-C) has been substantially lowered by statins. Investigators in Australia examined the risk of a first major cardiovascular event in 9770 patients based on levels of HDL-C and LDL-C during the third month of treatment with statins. The researchers found that HDL-C levels were a significant inverse predictor of major cardiovascular events. This relationship was reduced to borderline significance after taking the effect of statin treatment on LDL-C levels into account but was still significant even in patients with LDL-C levels below 70 mg/dL. Barter P, Gotto AM, LaRosa JC, et al. HDL cholesterol, very low levels of LDL cholesterol, and cardiovascular events. N Engl J Med. 2007; 357(13):1301-1310. For more medical news that matters to primary care, please see Medicine in the News, page 5, and Clinical Clips, page 28. Research Digest is prepared by the editors of Patient Care and HealthDay’s Physician’s Briefing (http://www.physiciansbriefing.com). 2 PATIENT CARE ENDOCRINOLOGY & CARDIOLOGY www.patientcareonline.com http://www.physiciansbriefing.com http://www.patientcareonline.com

Table of Contents Feed for the Digital Edition of Patient Care Endocrinology & Cardiology - December 2007

Patient Care Endocrinology & Cardiology - December 2007 Research Digest Contents Medicine in the News Options for Managing Diabetes: Three Types of Basal Insulin Therapy Using the New AHA Guidelines for Preventing Coronary Heart Disease in Women Cardiovascular and Metabolic Implications of Polycystic Ovary Syndrome Case & Comment Classified Advertising Clinical Clips

Patient Care Endocrinology & Cardiology - December 2007

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