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Knowledge o f cardiovascular changes in old age and th e ir th e ra p e u tic options is im p o rta n t. Old age can lead to hypertro p h y of th e le ft ventricle, d ia sto lic dysfunction, heart valve changes and pulm onary hypertension. P atients often develop a rte ¬ rial hypertension. V alvular changes are com m on in people over 100 years o f age (aortic stenosis and m itra l insufficiency). The risk o f coronary heart disease is 3 5% fo r men and 24% fo r wom en. In old age, sinus node dysfunction and a tria l fib rilla tio n are com m on. 25% o f all strokes are cardiac em bolism s in a tria l fib rilla tio n . Cardiac interventions in th e elderly are increasingly frequent and include coronary catheter revascularization or valve interventions (percutaneous a o rtic valve replacem ent or M itraC lip). O ptim al therapy in old age includes not only cardiovascular interventions also include drugs and a life style m o d ification and mainly serves to im proveth equality of life. [ABSTRACT FROM AUTHOR]

The differential safety and efficacy profiles of sirolimus-eluting stents when implanted in patients with multivessel coronary artery disease who have increased body mass indexes (BMIs) compared with those with normal BMIs are largely unknown. This study evaluated the impact of BMI on 1-year outcomes in patients with multivessel coronary artery disease treated with sirolimus-eluting stents as part of the Arterial Revascularization Therapies Study Part II (ARTS II). From February to November 2003, 607 patients were included at 45 centers; 176 patients had normal BMIs (<25 kg/m2), 289 were overweight (≥25 and ≤30 kg/m2), and 142 were obese (>30 kg/m2). At 30 days, the cumulative incidence of the primary combined end point of death, myocardial infarction, cerebrovascular accident, and repeat revascularization (major adverse cardiac and cerebrovascular events) was 3.4% in the group with normal BMIs, 3.1% in overweight patients, and 2.8% in obese patients (p = 0.76). At 1 year, the cumulative incidence of major adverse cardiac and cerebrovascular events was 10.8%, 11.8%, and 7.0% in the normal BMI, overweight, and obese groups, respectively (p = 0.31). In conclusion, BMI had no impact on 1-year clinical outcomes in patients with multivessel coronary artery disease treated with sirolimus-eluting stents in ARTS II. [Copyright &y& Elsevier]

A letter to the editor is presented in response to an article discussing chest pain in a patient with systemic mastocytosis, published in the May 6, 1993 issue.