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A newly devised, high-sensitive assay is employed to determine the distribution, as well as the association of the cardiac troponin T levels with the various cardiovascular events. The analysis proves that the troponin T levels are highly associated with the coronary artery disease and often leads to cardiovascular death and heart failure.

A study was conducted to determine the optimal timing to start glycoprotein IIb/IIIa inhibitors for patients undergoing coronary invasive procedures. Results showed that administering eptifibatide before or after angiography did not have much effect but increased the risk of non-life threatening bleeding requiring blood transfusions

The study examines the link between functional genetic variants in cytochrome P-450 (CYP) genes, plasma concentrations of active drug metabolite, and platelet inhibition in response to clopidogrel in healthy subjects. Results show carriers of a reduced-function 'CYP2C19' allele have much lower levels of the active metabolite of clopidogrel, diminished platelet inhibition, and a higher rate of major adverse cardiovascular events, including stent thrombosis, than non-carriers.

The comparison results of a novel potent thienopyridine (prasugrel) with the standard thienopyridine (clopidogrel) in patients with acute coronary syndromes scheduled to have a coronary intervention are presented. Prasugrel therapy was found to be associated with significantly reduced rates of ischemic events, including stent thrombosis, but with an increased risk of major bleeding.

The antibiotic treatment of Chlamydia pneumoniae found within atherosclerotic plaques, and elevated titers of antibody to this organism linked to a higher risk of coronary events is studied. It is concluded that despite long-term treatment with a bactericidal antibiotic effective against Chlamydia pneumoniae, no reduction in the rate of cardiovascular events was observed.

A study is conducted enrolling 3491 patients in the age group of 18 to 75 years of age, who presented within 12 hours after the onset of an ST-elevation myocardial infarction and randomly assigned them to receive clopidogrel or placebo. In patients 75 years or younger who have myocardial infraction with ST-segment elevation, the addition of clopidogrel improves the patency rate of the infarct-related artery and reduces ischemic complications.

Patients who have low C-reactive protein (CRP) levels after Statin therapy have better clinical outcomes than those with higher CRP levels, regardless of the resultant level of low-density lipoprotein (LDL) cholesterol. Strategies of lower cardiovascular risk with Statins are listed.

The risk of Cardiovascular events may be reduced by Lipid-lowering therapy with statins. An intensive lipid-lowering statin regimen provides greater protection against death or major cardiovascular events for patients who have had an acute coronary syndrome.

Recommendations are presented for university hospitals and medical schools who want to accept industry support of research but also want to preserve academic freedom. Topics include the changes in biomedical research, conflicting expectations between hospitals, patients, companies, regulators, and legislators, and the implications of commercial relationships between industry and universities.

High blood levels of B-type natriuretic peptide in patients with symptoms of a heart attack or unstable chest pain is a sign of a poor prognosis, according to a study of 2,525 patients. This peptide is a hormone produced by the heart under certain conditions.

An aggressive treatment strategy including a class of anticoagulants called glycoprotein IIb/IIIa inhibitors and angioplasty of coronary artery bypass can lower mortality rates in patients with unstable angina and heart attacks.

Cardiovascular disease will likely become the leading cause of death worldwide by 2020, even as significant advances in the understanding and treatment of the disease are made. Despite valuable research, many patients with cardiovascular disease have no known risk factors, and established treatments do not substantially reduce deaths. Research into the cellular, biochemical and genetic aspects of cardiovascular disease and a broader application of prevention and treatment strategies may help reduce cardiovascular illnesses.

The blood serum marker troponin I may serve to identify an increased risk of death in patients with unstable angina or a heart attack. Troponin I, a part of the troponin regulatory mechanism, is not detected in the blood of healthy people and is highly specific for heart tissue. By day 42 of a study of cardiac patients, the 573 patients with troponin I levels above 0.4 nanograms (ng) per milliliter had a mortality rate almost four times that of 831 patients with lower troponin I concentrations. Risk of death increased significantly with each 1.0 ng increase of troponin I, even after adjustment for patient characteristics, such as electrocardiographic results and age.

The cholesterol-lowering drug pravastatin may be beneficial in patients with coronary artery disease and moderately high cholesterol levels. Researchers in the Cholesterol and Recurrent Events (CARE) study randomized 4,159 women and men who had suffered a heart attack and had moderately high cholesterol levels to take pravastatin or placebo. Over the 5-year study, pravastatin lowered total cholesterol 28%, LDL cholesterol 28%, triglycerides 14% and raised HDL cholesterol 5%. It also reduced by more than 20% the incidence of subsequent heart attacks as well as the need for angioplasty or bypass surgery.

Cardiology can be a division of the department of medicine and a separate subspecialty unit in medical schools and hospitals. Cardiology is the largest division in the department of medicine and has the highest revenue of all subspecialties. By the end of the 20th century, research will focus on improving imaging techniques, invasive cardiology, cardiovascular therapies, diagnostic methods and practice guidelines. Cardiovascular scientists will develop biological applications for the prevention and control of cardiac diseases. As the health care system is reformed, medical schools will train primary care doctors to care for patients with cardiac diseases. The research, education and medical care goals of cardiology can be accomplished by delegating general cardiology training and research to the departments of medicine. At the same time, the cardiology division will focus on comprehensive care, clinical research and subspecialty training.

Survival rates after a heart attack are similar in the US and Canada even though Canadian doctors are less likely to treat heart attack patients with drugs, angioplasty or coronary bypass surgery. Data were collected on 1,573 patients diagnosed with a heart attack at 93 US hospitals and 658 similar patients in 19 Canadian hospitals. The Americans were more likely to be given drugs such as beta-blockers, nitrates and calcium channel blockers. They were also more likely to undergo coronary angiography as well as heart surgery and angioplasty. However, rates of survival and recurrent heart attack were similar to those of the Canadian patients. The Canadian patients were more likely to have angina (chest pain) that limited their activity. Canadian physicians may be more reluctant to use resources because of the way Canadian health care is financed.

Long-term treatment with captopril may prevent cardiovascular events and increase survival in heart attack patients with asymptomatic left ventricular dysfunction. In patients with left ventricular dysfunction, the heart is not capable of pumping enough blood to the body. Of 2,231 heart attack patients with asymptomatic left ventricular dysfunction, 1,115 were treated with captopril and 1,116 received a placebo, an inactive substance, over an average of 42 months. Twenty percent of the patients treated with captopril died, compared with 25% of those who received a placebo. Eighty-four percent of the patients died from a cardiovascular cause. Treatment with captopril decreased the risk of death from all causes by 19%, and the risk of death from cardiovascular causes by 21%. Patients who have survived a heart attack have a higher risk of a heart attack or another cardiovascular event, compared to other individuals.

Publication of results of clinical trials using drugs to treat heart attack patients may influence the use of drugs by physicians. Two reports of clinical trials were published in 1988 that advocated the use of aspirin to prevent a first or second heart attack. Of 2,231 heart attack patients enrolled in the Survival and Ventricular Enlargement (SAVE) study who were followed over a three-year period, 16% used aspirin to prevent a first heart attack in Jan 1987, compared to 24% in Jan 1990. Approximately 39% of the patients used aspirin to prevent another heart attack before publication of the reports, compared to 72% after publication. Another study published in 1988 reported that diltiazem, a calcium channel blocker used to treat heart attack patients, had harmful side effects. Approximately 57% of the patients were treated with calcium channel blockers after a heart attack before publication of the study, compared with 33% after publication.

The open artery theory of heart attack therapy has once again become popular in the medical profession due to increased survival rates in clinical trials of tissue plasminogen activator (t-PA). The theory suggests that early restoration of blood flow through the affected artery will preserve heart muscle and ventricle function and lead to increased survival. T-PA, a drug that breaks up blood clots, restores blood flow faster than streptokinase when administered in an accelerated dosage with aspirin and heparin. In one study, blood flow was restored in 54% of the patients 90 minutes after they received the accelerated treatment. Streptokinase achieved the same outcome at about 180 minutes. The patients who had received t-PA had an improved survival rate 30 days after treatment. Early mortality in the t-PA group was reduced to 6.3%, compared to 10.7% in previous studies of streptokinase. The survival benefits of early blood flow restoration appear to last for four years.

Drug therapy for congestive heart failure has evolved dramatically in the past few decades. Digitalis and diuretic agents were the major drugs used to treat this condition for many years. Vasodilators, drugs that cause blood vessels to open wider, were first suggested as a treatment for congestive heart failure as early as 1956. They were initially shown to be effective in treating acute heart failure, but as recently as 1983, in an editorial in The New England Journal of Medicine, it was pointed out that their effectiveness in prolonging the survival of heart failure patients had not been proven. The editorial was in response to the approval by the Food and Drug Administration of the angiotensin-converting-enzyme (ACE) inhibitor captopril. In the August 1, 1991 issue of The New England Journal of Medicine, two new studies report findings on the effectiveness of enalapril, another ACE inhibitor, in increasing survival rates in patients with mild-to-moderate congestive heart failure. A report from the Studies of Left Ventricular Dysfunction (SOLVD) assessed survival in patients treated with enalapril or a placebo. Survival rates were greater in the enalapril group, particularly in the first six months after treatment was begun. The report by the Vasodilator-Heart Failure Trial (V-HeFT II) is their second study. In the first study from this group, vasodilator therapy with a hydralazine-nitrate combination increased survival rates in patients with congestive heart failure. In the current study, the hydralazine-isosorbide dinitrite combination was compared with enalapril. Results showed that survival rates were higher in the enalapril group, although both therapies were effective. The combination therapy was more beneficial, as measured by certain physiologic parameters. Taken together, these newly published studies demonstrate the effectiveness of ACE inhibitors and other vasodilators in treating congestive heart failure. Future work should focus on whether an ACE inhibitor alone or in combination with another type of vasodilator provides superior treatment. (Consumer Summary produced by Reliance Medical Information, Inc.)

There are several treatments for hypertrophic cardiomyopathy, including beta blockers, calcium channel blockers, disopyramide, and surgery. A relatively new treatment is nonsurgical septal reduction, which involves injecting alcohol into part of the heart to make it shrink. Hypertrophic cardiomyopathy is a type of heart failure caused by an enlarged heart.

Beta blockers can lower the risk of death in patients with heart failure. However, the drugs have adverse effects and patients should be started on the small doses which can be increased gradually.

Heart attacks that are preceded by recurrent chest pain cause less heart damage and may respond more quickly to anticlotting therapy than heart attacks that are not preceded by chest pain. Several reasons may explain the difference in damage. Chest pain, which is usually caused by partial blockage of the coronary arteries that feed the heart, may precondition some heart muscle to function with less blood. Partial blockage may also cause normally closed blood vessels to open and supplement the heart's blood supply. Patients with chest pain may also take aspirin and heparin which lessens the effect of the heart attack. After the heart attack, these patient may be more responsive to therapy because of chemical and cellular components of the blood clot causing the attack. On the other hand these patients may simply receive treatment sooner. In any case, this greater responsiveness to anticlotting therapy may guide physicians in deciding how to treat heart attacks.

Hypertrophic cardiomyopathy is characterized by an abnormally enlarged and constricted left ventricle, producing many symptoms related to abnormal contraction and relaxation of heart muscle. Calcium is involved in muscle contraction by its movement across cell membranes. It is suggested that the increased calcium concentration may cause the associated symptoms. New research found that the number of receptors for calcium on cardiac cells was higher in patients with hypertrophic cardiomyopathy. Heart muscle contraction and relaxation were affected by this abnormal entry of calcium into the cells, which explains the resultant symptoms; the abnormality may affect smooth muscles as well. It was also found that there are many patients with no obvious symptoms, confirming the mild nature of this disease in some patients. More studies regarding the genetic aspect of this disease are currently underway.