The trial to assess chelation therapy 2 (TACT2): Rationale and design.

Background: Intravenous edetate disodium-based infusions reduced cardiovascular events in a prior clinical trial. The Trial to Assess Chelation Therapy 2 (TACT2) will replicate the initial study design.

Methods: TACT2 is an NIH-sponsored, randomized, 2x2 factorial, double masked, placebo-controlled, multicenter clinical trial testing 40 weekly infusions of a multi-component edetate disodium (disodium ethylenediamine tetra-acetic acid, or NaEDTA)-based chelation solution and twice daily oral, high-dose multivitamin and mineral supplements in patients with diabetes and a prior myocardial infarction (MI).

Chelation therapy to prevent diabetes-associated cardiovascular events.

Purpose Of Review: For over 60 years, chelation therapy with disodium ethylene diamine tetraacetic acid (EDTA, edetate) had been used for the treatment of cardiovascular disease (CVD) despite lack of scientific evidence for efficacy and safety. The Trial to Assess Chelation Therapy (TACT) was developed and received funding from the National Institutes of Health (NIH) to ascertain the safety and efficacy of chelation therapy in patients with CVD.

Recent Findings: This pivotal trial demonstrated an improvement in outcomes in postmyocardial infarction (MI) patients.

Trends in the care of patients with acute myocardial infarction at a university-affiliated Veterans Affairs Medical Center.

Background: Acute cardiac care of the veterans at Veterans Administration (VA) hospitals has been thought of as poor in quality. We examined the use of life-saving, evidence-based medical therapy in patients admitted with acute myocardial infarction to the University of Arkansas for Medical Sciences-affiliated VA Medical Center in Little Rock and compared the use of this therapy with other hospitals in Arkansas and in the rest of the nation.

Methods: Use of life-saving medical therapy in 117 patients admitted with acute myocardial infarction from January 2002 to December 2002 was compared with the National Registry of Myocardial Infarction database for the identical period.

Dietary recommendations in the prevention and treatment of coronary heart disease: do we have the ideal diet yet?

To respond to the question of the best "heart-healthy" diet, we reviewed the effects of common diets on lipids, their efficacy, advantages, and limitations. The high-protein, low-carbohydrate diet is effective for weight loss over the short term, but its long-term benefits remain unproved. The very low-fat diet decreases levels of total and low-density lipoprotein cholesterol and, with lifestyle modifications, may slow progression of coronary atherosclerosis.

The national cholesterol education program diet vs a diet lower in carbohydrates and higher in protein and monounsaturated fat: a randomized trial.

Background: In the United States, obesity is a major clinical and public health problem causing diabetes, dyslipidemia, and hypertension, as well as increasing cardiovascular and total mortality. Dietary restrictions of calories and saturated fat are beneficial. However, it remains unclear whether replacement of saturated fat with carbohydrates (as in the US National Cholesterol Education Program [NCEP] diet) or protein and monounsaturated fat (as in our isocaloric modified low-carbohydrate [MLC] diet, which is lower in total carbohydrates but higher in protein, monounsaturated fat, and complex carbohydrates) is optimal.

Metabolic syndrome: dietary interventions.

Purpose Of Review: Metabolic syndrome affects almost a quarter of the adult American population and its incidence is rising in the rest of the world. Its treatment involves both pharmacologic and nonpharmacologic interventions. In this review the authors focus on foods with potential benefits for this disease.

How to prevent unnecessary coronary interventions: identifying lesions responsible for ischemia in the cath lab.

Purpose Of Review: Coronary angiography is limited by the inability to identify intermediate coronary lesions responsible for ischemia. In the catheterization laboratory three techniques can be used for the evaluation of the physiologic significance of intermediate or borderline significant coronary stenoses: (1) pressure wire-derived coronary fractional flow reserve (FFR), (2) Doppler wire-derived measurement of coronary flow reserve (CFR), and (3) intravascular ultrasound (IVUS).

Recent Findings: All of these techniques have been validated for assessing the functional significance of intermediate stenoses, but also have inherent limitations.

ST-segment elevation myocardial infarction, severe anemia and nonobstructive coronary disease: case report and brief comment.

When the metabolic demand of the heart exceeds its oxygen supply, myocardial ischemia or infarction (MI) may occur. One of the causes of this condition is severe anemia. The type of MI associated with cases of supply-demand myocardial mismatch is usually a non-ST elevation infarction (Non-STEMI), and is most commonly seen in patients with underlying coronary artery disease.

Nonplatelet-mediated effects of aspirin.

Aspirin has nonplatelet-mediated effects that contribute to its efficacy in the primary and secondary prevention of coronary events. These include antiarrhythmic effects, as shown in animal studies, and antiatherosclerotic effects related to increase in nitric oxide synthesis/activity and reduction in inflammatory mediators. Epidemiological studies have also shown primary antiinflammatory properties.

Can we prevent in-stent restenosis?

Nowadays stent placement has replaced balloon angioplasty as the most commonly performed percutaneous coronary interventional procedure, mainly because of its better acute and chronic outcome. As a result, in-stent restenosis (ISR) has become a widespread problem. The incidence of ISR varies from 10% to 50% and depends on the absence or presence of several risk factors, such as small vessel size, longer lesions, and diabetes.

Update in internal medicine.

More than 500,000 new medical articles are published every year and available time to keep updated is scarcer every day. Nowadays, the task of selecting useful, consistent, and relevant information for clinicians is a priority in many major medical journals. This review has the aim of gathering the results of the most important findings in clinical medicine in the last few years.

Coronary arteriovenous fistula with a giant aneurysm: role of transesophageal echocardiography.

Congenital coronary arteriovenous fistulas are rare anomalies. Patients may present with congestive heart failure, ischemic chest pain, or endocarditis. In this case, transesophageal echocardiography provided valuable additional information to that obtained from cardiac catheterization, which was essential for the diagnosis and planning of surgical correction.