| ||||||||||||||||||||||||||||||||||||||||||||||||||||
(Circulation. 2004;110:643.)
© 2004 American Heart Association, Inc.
Issue Highlights |
OUTCOMES IN CHILDREN WITH IDIOPATHIC PULMONARY ARTERIAL HYPERTENSION, by Yung et al.
Long-term survival of children with idiopathic pulmonary arterial hypertension is poor without treatment. Yung et al report significantly improved outcomes in 77 children diagnosed between 1982 and 1995 and treated through 2002 with calcium channel blockade and/or epoprostenol. Ten-year survival was 81% in acute responders to vasodilator testing; 61% in all patients treated with epoprotstenol; and 78% in all children treated in the recent medical era. Acute responders to vasodilator testing should be treated with calcium channel blockers as first-line therapy. Patients who are nonresponders to vasodilator testing at diagnosis are considered for more aggressive therapy, such as epoprostenol. The decrease in survival and treatment success after 5 years in all children with idiopathic pulmonary arterial hypertension supports the role for transplant evaluation before treatment failure. See p 660.
CELIPROLOL, A VASODILATORY ß-BLOCKER, INHIBITS PRESSURE OVERLOAD–INDUCED CARDIAC HYPERTROPHY AND PREVENTS THE TRANSITION TO HEART FAILURE VIA NITRIC OXIDE–DEPENDENT MECHANISMS IN MICE, by Liao et al.
ß-Adrenergic receptor blockers exert beneficial effects in patients with heart failure. Although it is clear that the fundamental mechanism of this benefit is blockade of the ß-adrenergic receptor, additional properties of various ß-blockers may contribute to their overall effects. Celiprolol is a ß-1–selective blocker that also upregulates and/or activates the nitric oxide signaling system. In this issue, Liao et al provide evidence that enhancement of nitric oxide signaling by celiprolol may ameliorate many aspects of the pathological myocardial remodeling that occurs in response to pressure overload. Although the relative contributions that ß-adrenergic receptor blockade and nitric oxide enhancement contribute to the actions of celiprolol remain to be determined, this article suggests that enhancement of nitric oxide signaling could have therapeutic value in myocardial remodeling caused by hemodynamic overload. See p 692.
PREVALENCE OF AND RISK FACTORS FOR PERIPHERAL ARTERIAL DISEASE IN THE UNITED STATES: RESULTS FROM THE NATIONAL HEALTH AND NUTRITION EXAMINATION SURVEY, 1999–2000, by Selvin and Erlinger
We tend to forget that atherosclerosis is a generalized disease, not only affecting vascular territories we are most concerned with, ie, the brain and the heart, but also peripheral arteries. Indeed, peripheral arterial disease (PAD) is a neglected entity both scientifically and clinically. Thus, the NHANES survey on PAD is a timely reminder of its importance. The authors analyzed in a cohort of more than 2000 participants the ankle brachial index, a simple and effective test of PAD, and found that among adults more than 40 years of age, almost 5% fulfilled the criteria for PAD, corresponding to about 5 million in the United States and even more worldwide. The prevalence rose to almost 15% among those more than 70 years of age. Further risk factors for PAD were African-American ethnicity, smoking, and diabetes, as well as hypercholesteremia and impaired kidney function. Thus, NHANES reminds us to look for PAD with simple clinical tests and to use it in our management. See p 738.
Visit www.circ-ahajournals.org:
Image in Cardiovascular Medicine
Coronary Sinus Tachycardia Driving Atrial Fibrillation. See p e59.
|
Related Articles:
Circulation 2004 110: 692-699.
Circulation 2004 110: 738-743.
Circulation 2004 110: 660-665.
Circulation 2004 110: e59-e60.
| ||||||||||||||||||||||||||||||||||||||||||||||||||||