Update for primary healthcare providers: recent statin trials and revised National Cholesterol Education Program III guidelines.

Statins produce large, clinically important beneficial effects on total low-density lipoprotein (LDL) cholesterol and triglycerides while raising high-density lipoprotein (HDL) cholesterol--each of which increases the risks for cardiovascular disease (CVD). In randomized trials of secondary and primary prevention, and their meta-analyses, statins confer statistically significant, clinically important reductions in myocardial infarction, stroke, and CVD death. In 2001, the National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP) III included LDL as the primary target, recommending optional goals of < 100 mg/dL for high-risk patients, < 130 mg/dL for moderate-risk patients, and < 160 mg/dL for low-risk patients.

Alcohol consumption and coronary heart disease: a causal and protective factor.

Although heavy alcohol consumption is one of the leading causes of preventable deaths, light to moderate consumption of alcohol is associated with a reduced risk of coronary heart disease and total mortality. These benefits have been found in both men and women who consume as little as one to six alcoholic beverages per week regardless of whether the source is wine, beer, or liquor. Further, apparent benefits include a reduced risk for the development of peripheral arterial disease, ischemic stroke, sudden cardiac death, and angina.

Malfunction of a biventricular pacing device?

A patient with dilated cardiomyopathy and recurrent admissions for heart failure presented 3 days after implantation of a biventricular pacemaker to the emergency department. Due to significant bradycardia, he was initially diagnosed with pacemaker malfunction. Subsequent interrogation of the device revealed a normally functioning biventricular pacemaker.

Randomized trials of vitamin E in the treatment and prevention of cardiovascular disease.

Background: Observational epidemiological studies consistently show that individuals who choose to take high amounts of vitamin E through diet or supplements experience cardiovascular benefits, for which basic research provides plausible mechanisms. However, because the size of the postulated benefit is small to moderate, the confounding inherent in observational studies is as great as the effect size. Before the availability of randomized evidence, about 1 in 4 adults was taking vitamin E supplements in the United States.

An update on aspirin in the primary prevention of cardiovascular disease.

Background: In 1988, the aspirin component of the Physicians' Health Study, a randomized, double-blind, placebo-controlled trial of 22 071 apparently healthy men was terminated early, due principally to a statistically extreme (P<.00001) 44% reduction in the risk of a first myocardial infarction (MI). The Cardio-Renal Drugs Advisory Committee recommended that the US Food and Drug Administration approve professional labeling of aspirin to prevent first MI.