Ischaemic heart disease

C reactive protein predicts death but not restenosis ▸ There is a lot of information about the role of C reactive protein (CRP) in predicting death/myocardial infarction (MI) in patents at risk of ischaemic heart disease. Data on its role in patients undergoing percutaneous coronary intervention is less clear. These studies of 1458 and 1152 patients suggested that CRP concentrations > 3 mg/dl and > 5 mg/dl, respectively, predicted death/MI as expected, but the occurrence of restenosis was not linked to CRP values. This confirms that the pathological process in a restenotic lesion is different to native atherosclerosis. Heart 2003;89:1279–1280

α2 Adrenergic agonists to reduce perioperative risk ▸ Approximately 4.5% of patients undergoing cardiac surgery will have a perioperative MI. The benefits of perioperative β blockade in patients at risk of coronary heart disease (CHD) is well proven. This study assessed a less used class of drugs that includes clonidine, dexemdetomidine, and mizaverol. A total of 23 trials comprising 3395 patients were included in the meta-analysis. Overall, α2 agonists reduced mortality (relative risk (RR) 0.64, 95% confidence interval (CI) 0.42 to 0.99, p = 0.05) and ischaemia (RR 0.76, 95% CI 0.63 to 0.91, p = 0.003) significantly. The same was true for vascular surgery. Although dominated by one large study, and unable to fully control for the effect of β blockers, this study at least suggests that α2 agonists my help if β blockers are contraindicated.

Merely reducing smoking may not prevent myocardial infarction ▸ A Danish pooled cohort study has followed more than 19 000 adults for a mean of nearly 14 years, with full information on smoking habits at five year intervals. During the course of the study, 2179 were diagnosed as having a myocardial infarction. As expected, heavy smokers (more than 15 a day) were at …