Circulation. 2005;111:955
(Circulation. 2005;111:955.)
© 2005 American Heart Association, Inc.
Issue Highlights
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PLATELET-ACTIVATING FACTOR ACETYLHYDROLASE ACTIVITY INDICATES ANGIOGRAPHIC CORONARY ARTERY DISEASE INDEPENDENTLY OF SYSTEMIC INFLAMMATION AND OTHER RISK FACTORS: THE LUDWIGSHAFEN RISK AND CARDIOVASCULAR HEALTH STUDY, by Winkler et al.
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Inflammatory reactions are known to enhance atherosclerosis.
Lipoprotein-associated phospholipase A
2, also known as platelet-activating
factor acetylhydrolase (PAH-AH), is a lipoprotein-bound enzyme
that may play a role in atherosclerosis via its antiinflammatory
actions. In this issue of
Circulation, Winkler and colleagues
study the association of this enzyme’s activity with angiographic
cardiovascular disease from >3000 patients in the Ludwigshafen
Risk and Cardiovascular Health Study. They report that PAH-AH
activity is not associated with unstable coronary syndromes
but is associated with angiographic cardiovascular disease independently
of LDL levels. The activity of PAH-AH also was associated with
select cardiovascular drugs, including (ß-blockers
and aspirin. Studies determining whether PAH-AH is just a marker
of atherosclerosis or is actively involved in atherogenesis
are ongoing. See p
980.
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ALISKIREN, A NOVEL ORALLY EFFECTIVE RENIN INHIBITOR, PROVIDES DOSE-DEPENDENT ANTIHYPERTENSIVE EFFICACY AND PLACEBO-LIKE TOLERABILITY IN HYPERTENSIVE PATIENTS, by Gradman et al.
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The renin–angiotensin system plays a pivotal role in the
pathogenesis of cardiovascular diseases and has long been a
key therapeutic target. Because angiotensin can be produced
through a number of pathways other than the classic system,
intensive interest has been paid to inhibiting its generation
at the initial step of the renin–angiotensin system cascade
by renin inhibitors. The clinical use of a number of agents
developed in the past 20 years to inhibit the active site of
renin, however, was limited because of low potency and short
duration of action. Aliskiren is a recently synthesized potent
nonpeptidic inhibitor with oral bioavailability. Gradman and
colleagues carried out the first placebo-controlled trial to
investigate the efficacy and safety of aliskiren in hypertension
treatment. They clearly demonstrated that once-daily oral treatment
with aliskiren lowered blood pressure effectively in patients
with mild-to-moderate hypertension. Because renin has high specificity
for only one substrate, side effects would be expected to be
low; in fact, incidence of adverse events was shown to be comparable
to that of placebo. This agent could be used for the management
of a variety of cardiovascular diseases in future. See p
1012.
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MAINTENANCE OF LONG-TERM CLINICAL BENEFIT WITH SIROLIMUS-ELUTING CORONARY STENTS: THREE-YEAR RESULTS OF THE RAVEL TRIAL, by Fajadet et al.
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The introduction of sirolimus drug-eluting stents for percutaneous
coronary revascularization procedures was heralded as the end
of restenosis, the Achilles heel of percutaneous interventional
procedures. Initial studies with sirolimus-eluting stents demonstrated
nearly complete elimination of restenosis at 6 months and markedly
decreased rates of associated major adverse events at 1 year
when compared with conventional bare metal stents. Over time,
however, it became apparent that restenosis continued to occur,
albeit at rates in the single digits; coronary intravascular
studies revealed that because of positive remodeling there was
evidence of stent malapposition; and unexplained stent thrombosis
emerged as a troubling adverse event. These events led some
to question the long-term durability of sirolimus stents. In
this issue of
Circulation, Fajadet et al present the 3-year
results of the RAVEL trial and demonstrate the continued superiority
of sirolimus drug-eluting stents. See p
1040.
Visit www.circ.ahajournals.org:
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Clinician Update
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Surgical Treatment of Atrial Fibrillation via Energy Ablation.
See p
e103.
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Images in Cardiovascular Medicine
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Mitral Valve Prolapse Associated With Accessory Mitral Valve.
See p
e107.
Provocable Pressure Gradient Across an Anomalous Left Main Coronary Artery: A Unique Diagnostic Tool. See p e108.
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Correspondence
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Letter Regarding Article by Klausen et al, "Very Low Levels
of Microalbuminuria Are Associated With Increased Risk of Coronary
Heart Disease and Death Independently of Renal Function, Hypertension,
and Diabetes." See p
e110.
Letter Regarding Article by Frigiola et al, "Pulmonary Regurgitation Is an Important Determinant of Right Ventricular Contractile Dysfunction in Patients With Surgically Repaired Tetralogy of Fallot. " See p e112.
Related Articles:
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Maintenance of Long-Term Clinical Benefit With Sirolimus-Eluting Coronary Stents: Three-Year Results of the RAVEL Trial
- Jean Fajadet, Marie-Claude Morice, Christoph Bode, Paul Barragan, Patrick W. Serruys, William Wijns, Constantino R. Constantini, Jean-Léon Guermonprez, Hélène Eltchaninoff, Didier Blanchard, Antonio Bartorelli, Gert-Jan Laarman, MarcoAntonio Perin, J. Eduardo Sousa, Gerhard Schuler, Ferenc Molnar, Giulio Guagliumi, Antonio Colombo, Ernesto Ban Hayashi, and Egon Wülfert
Circulation 2005 111: 1040-1044.
[Abstract]
[Full Text]
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Platelet-Activating Factor Acetylhydrolase Activity Indicates Angiographic Coronary Artery Disease Independently of Systemic Inflammation and Other Risk Factors: The Ludwigshafen Risk and Cardiovascular Health Study
- Karl Winkler, Bernhard R. Winkelmann, Hubert Scharnagl, Michael M. Hoffmann, Andrea Busse Grawitz, Markus Nauck, Bernhard O. Böhm, and Winfried März
Circulation 2005 111: 980-987.
[Abstract]
[Full Text]
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Aliskiren, a Novel Orally Effective Renin Inhibitor, Provides Dose-Dependent Antihypertensive Efficacy and Placebo-Like Tolerability in Hypertensive Patients
- Alan H. Gradman, Roland E. Schmieder, Robert L. Lins, Juerg Nussberger, Yanntong Chiang, and Martin P. Bedigian
Circulation 2005 111: 1012-1018.
[Abstract]
[Full Text]
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Surgical Treatment of Atrial Fibrillation via Energy Ablation
- Susan J. Hazel, Hugh S. Paterson, James R.M. Edwards, and Guy J. Maddern
Circulation 2005 111: e103-e106.
[Full Text]
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Mitral Valve Prolapse Associated With Accessory Mitral Valve
- Yutaka Iba, Satoshi Saito, Akihiko Kawai, and Hiromi Kurosawa
Circulation 2005 111: e107.
[Full Text]
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Provocable Pressure Gradient Across an Anomalous Left Main Coronary Artery: A Unique Diagnostic Tool
- Michael J. Lim, Michael Forsberg, and Morton J. Kern
Circulation 2005 111: e108-e109.
[Full Text]
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Letter Regarding Article by Klausen et al, "Very Low Levels of Microalbuminuria Are Associated With Increased Risk of Coronary Heart Disease and Death Independently of Renal Function, Hypertension, and Diabetes" • Response
- Auke H. Brantsma, Dick de Zeeuw, Hans L. Hillege, Klaus Klausen, Knut Borch-Johnsen, Bo Feldt-Rasmussen, Gorm Jensen, Peter Clausen, Henrik Scharling, Merete Appleyard, and Jan Skov Jensen
Circulation 2005 111: e110-e111.
[Full Text]
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Letter Regarding Article by Frigiola et al, "Pulmonary Regurgitation Is an Important Determinant of Right Ventricular Contractile Dysfunction in Patients With Surgically Repaired Tetralogy of Fallot" • Response
- T. Oosterhof, J.W.J. Vriend, B.J.M. Mulder, Alessandra Frigiola, Seamus Cullen, Andrew Redington, and Michael Vogel
Circulation 2005 111: e112.
[Full Text]
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ALISKIREN, A NOVEL ORALLY...