Statin wars: the heavyweight match--atorvastatin versus rosuvastatin for the treatment of atherosclerosis, heart failure, and chronic kidney disease.

Statins are a standard of care in many clinical settings, especially for dyslipidemia management, and are used for the primary and secondary prevention of cardiovascular disease. Importantly, not all statins are born equal. The statin class consists of a number of heterogenous drugs, which vary in properties such as potency in lowering low-density lipoprotein cholesterol levels, lipophilicity, renoprotection, increasing high-density lipoprotein cholesterol levels, lowering triglyceride levels, and effects on glucose metabolism and myocardial function.

Clinical factors associated with left ventricular ejection fraction disparity in patients with left ventricular dysfunction undergoing multimodality imaging.

Drug and device therapy for heart failure is increasingly determined based on left ventricular ejection fraction. Significant disparity frequently exists between echocardiographic and nuclear scintigraphic techniques, even when testing is performed nearly simultaneously in clinically stable patients. In 119 patients with left ventricular dysfunction who underwent both echocardiography and stress testing with nuclear imaging within seven days (but with significant disparity in reported left ventricular ejection fraction), we identified four clinical variables which were associated with left ventricular ejection fraction difference.

Physical activity, cardiorespiratory fitness, and exercise training in primary and secondary coronary prevention.

Substantial data have established that higher levels of physical activity (PA), participating in exercise training (ET), and higher overall cardiorespiratory fitness (CRF) provide considerable protection in the primary and secondary prevention of coronary heart disease (CHD). This review surveys data from epidemiological and prospective ET studies supporting the favorable impact of PA, ET, and CRF in primary CHD prevention. Clearly, cardiac rehabilitation and ET (CRET) programs have been underutilized for patients with CHD, particularly considering the effect of CRET on CHD risk factors, including CRF, obesity indices, fat distribution, plasma lipids, inflammation, and psychological distress, as well as overall morbidity and mortality.

Meta-analysis of carvedilol versus beta 1 selective beta-blockers (atenolol, bisoprolol, metoprolol, and nebivolol).

Because carvedilol is a unique vasodilating β blocker (BB) exerting antioxidant activity and pleiotropic effects, it was theorized that it may confer more potent beneficial effects on cardiovascular mortality and morbidity in acute myocardial infarction (AMI) and heart failure (HF) settings. A systematic review and meta-analysis was performed of randomized, controlled, direct-comparison trials that included adults receiving atenolol, bisoprolol, metoprolol, nebivolol, or carvedilol to evaluate the effects of carvedilol compared to other BBs on mortality, cardiovascular events, and hospital readmissions in the setting of AMI or systolic HF. Compared to β(1)-selective BBs used in HF (8 trials, n = 4,563), carvedilol significantly reduced all-cause mortality (risk ratio 0.

Regadenoson pharmacologic stress for myocardial perfusion imaging: a three-way comparison between regadenoson administered at peak exercise, during walk recovery, or no-exercise.

Background: Regadenoson (Reg) is being administered with increasing frequency either at peak exercise (ExPeak-Reg) or during a slow-down/walking recovery state (ExRec-Reg) rather than at rest (Rest-Reg). The aim of this study was to compare the clinical response of ExPeak-Reg, ExRec-Reg, and Rest-Reg.

Methods: We compared 531 patients divided equally between Rest-Reg, ExPeak-Reg, and ExRec-Reg matched for age, sex, and BMI.

Prevalence of grade II and III obesity among patients hospitalized with cardiovascular diagnoses in 2002 v. 2009.

Background: The prevalence of obesity has increased markedly over the past four decades; however, some reports suggest a recent plateau. There is little information available regarding recent changes in obesity prevalence among patients hospitalized with cardiovascular disease.

Objective: To define obesity trends among patients hospitalized with cardiovascular disease between 2002 and 2009 at an academic medical center.

Red blood cell fatty acid levels improve GRACE score prediction of 2-yr mortality in patients with myocardial infarction.

Background: Blood omega-3 and omega-6 fatty acid levels have been associated with reduced risk for total mortality in patients with stable coronary heart disease (CHD), but their relationships with mortality in the setting of myocardial infarction (MI) are unknown.

Objective: To determine the association between red blood cell (RBC) fatty acid levels measured at admission and 2-year mortality in MI patients, independent of the GRACE risk score, a traditional mode of risk stratification.

Design: Admission RBC fatty acid levels were measured in patients enrolled in a prospective, 24-center MI registry (TRIUMPH).

Cardiovascular damage resulting from chronic excessive endurance exercise.

A daily routine of physical activity is highly beneficial in the prevention and treatment of many prevalent chronic diseases, especially of the cardiovascular (CV) system. However, chronic, excessive sustained endurance exercise may cause adverse structural remodeling of the heart and large arteries. An evolving body of data indicates that chronically training for and participating in extreme endurance competitions such as marathons, ultra-marathons, Iron-man distance triathlons, very long distance bicycle racing, etc.

Net trophic transfer efficiencies of polychlorinated biphenyl congeners to lake trout (Salvelinus namaycush) from its prey.

Lake trout (Salvelinus namaycush) were fed bloater (Coregonus hoyi) in eight laboratory tanks over a 135-d experiment. At the start of the experiment, four to nine fish in each tank were sacrificed, and the concentrations of 75 polychlorinated biphenyl (PCB) congeners within these fish were determined. Polychlorinated biphenyl congener concentrations were also determined in the 10 lake trout remaining in each of the eight tanks at the end of the experiment as well as in the bloater fed to the lake trout.

The effects of statins on prevention of stroke and dementia: a review.

Stroke is the third leading cause of death in the United States and places a heavy toll on health care spending, especially in the elderly population. The prevalence of stroke increases with increasing age. Over the last 2 decades, there have been substantial data supporting the use of statins in the primary, as well as secondary, prevention of stroke.

Resident fishes display elevated organic pollutants in salmon spawning streams of the great lakes.

Pacific salmon (Oncorhynchus spp.) can transport bioaccumulated organic pollutants to stream ecosystems where they spawn and die. We quantified PCBs, DDE, and PBDEs in resident fishes from 13 Great Lakes tributaries to assess biotransport of pollutants associated with introduced Pacific salmon.

Meta-analysis of effect of dipeptidyl peptidase-4 inhibitors on cardiovascular risk in type 2 diabetes mellitus.

Patients with type 2 diabetes mellitus (DM) have a very high risk for major adverse cardiovascular (CV) events. Previous studies have shown that traditional oral diabetic medications, despite lowering blood glucose levels, generally do not improve CV outcomes. The safety of some oral hypoglycemic medications has been questioned.

Potential adverse cardiovascular effects from excessive endurance exercise.

A routine of regular exercise is highly effective for prevention and treatment of many common chronic diseases and improves cardiovascular (CV) health and longevity. However, long-term excessive endurance exercise may induce pathologic structural remodeling of the heart and large arteries. Emerging data suggest that chronic training for and competing in extreme endurance events such as marathons, ultramarathons, ironman distance triathlons, and very long distance bicycle races, can cause transient acute volume overload of the atria and right ventricle, with transient reductions in right ventricular ejection fraction and elevations of cardiac biomarkers, all of which return to normal within 1 week.

Simplified evaluation of the jugular venous pressure: significance of inspiratory collapse of jugular veins.

The evaluation of the jugular venous pulse (JVP) remains one of the most important elements of the physical examination. Unfortunately, the examination remains difficult for most clinicians since traditional methodology is not commonly used or understood. Echocardiography has shown that the right atrial pressure can accurately be predicted as normal by observing a 50% inspiratory collapse of the inferior vena cava.

Patients overestimate the potential benefits of elective percutaneous coronary intervention.

Objective: Although percutaneous coronary intervention (PCI) reduces mortality in the setting of myocardial infarction (MI), recent studies suggest that the benefits of PCI for chronic Coronary Artery Disease (CAD) are predominantly related to angina relief and improved quality of life. Whether patients in the current era understand these benefits of elective PCI, or perceive that they also derive protection against death and MI is unknown.

Patients & Methods: We surveyed 498 consecutive elective PCI patients a mean of 13.