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Concept: Cardiovascular diseases

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Background Data are lacking on the long-term effect on cardiovascular events of adding sitagliptin, a dipeptidyl peptidase 4 inhibitor, to usual care in patients with type 2 diabetes and cardiovascular disease. Methods In this randomized, double-blind study, we assigned 14,671 patients to add either sitagliptin or placebo to their existing therapy. Open-label use of antihyperglycemic therapy was encouraged as required, aimed at reaching individually appropriate glycemic targets in all patients. To determine whether sitagliptin was noninferior to placebo, we used a relative risk of 1.3 as the marginal upper boundary. The primary cardiovascular outcome was a composite of cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for unstable angina. Results During a median follow-up of 3.0 years, there was a small difference in glycated hemoglobin levels (least-squares mean difference for sitagliptin vs. placebo, -0.29 percentage points; 95% confidence interval [CI], -0.32 to -0.27). Overall, the primary outcome occurred in 839 patients in the sitagliptin group (11.4%; 4.06 per 100 person-years) and 851 patients in the placebo group (11.6%; 4.17 per 100 person-years). Sitagliptin was noninferior to placebo for the primary composite cardiovascular outcome (hazard ratio, 0.98; 95% CI, 0.88 to 1.09; P<0.001). Rates of hospitalization for heart failure did not differ between the two groups (hazard ratio, 1.00; 95% CI, 0.83 to 1.20; P=0.98). There were no significant between-group differences in rates of acute pancreatitis (P=0.07) or pancreatic cancer (P=0.32). Conclusions Among patients with type 2 diabetes and established cardiovascular disease, adding sitagliptin to usual care did not appear to increase the risk of major adverse cardiovascular events, hospitalization for heart failure, or other adverse events. (Funded by Merck Sharp & Dohme; TECOS ClinicalTrials.gov number, NCT00790205 .).

Concepts: Myocardial infarction, Atherosclerosis, Hypertension, Diabetes mellitus type 2, Diabetes mellitus, Obesity, Cardiovascular disease, Cardiovascular diseases

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This study sought to assess a novel physical rehabilitation intervention in older patients hospitalized for acute decompensated heart failure (ADHF).

Concepts: Hospital, Heart failure, Cardiovascular diseases, Acute decompensated heart failure

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Takotsubo cardiomyopathy is seen, though rarely, in anaphylaxis treated with epinephrine. Stress cardiomyopathy is most likely to occur in middle-aged women. The underlying etiology is believed to be related to catecholamine release in periods of intense stress. Catecholamines administered exogenously, and those secreted by neuroendocrine tumors (e.g., pheochromocytoma) or during anaphylaxis have been reported to cause apical ballooning syndrome, or takotsubo syndrome. However, reverse takotsubo stress cardiomyopathy is rarely seen or reported in anaphylaxis treated with epinephrine.

Concepts: Cardiomyopathy, Neuroendocrine tumor, Epinephrine, Norepinephrine, Cardiovascular diseases, Pheochromocytoma, Catecholamine, Takotsubo cardiomyopathy

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Although guideline-recommended therapies reduce major adverse cardiovascular events (MACE) in patients after myocardial infarction (MI) or those with atherosclerotic disease (ATH), adherence is poor.

Concepts: Myocardial infarction, Atherosclerosis, Blood vessel, Cardiovascular disease, Stroke, Low-density lipoprotein, Infarction, Cardiovascular diseases

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Adipokines, visfatin, apelin, vaspin and ghrelin have emerged as novel cardiovascular risk factors. We aimed to evaluate the effects of different exercise modalities on the aforementioned novel adipokines and carotid intima-media thickness in patients with Type 2 diabetes mellitus.

Concepts: Myocardial infarction, Atherosclerosis, Diabetes mellitus, The Canon of Medicine, Obesity, Cardiovascular disease, Intima-media thickness, Cardiovascular diseases

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: We investigated the relationship between the renin/aldosterone profiles of patients with essential hypertension and their prognosis using a long-term follow-up study design.

Concepts: Cardiovascular diseases, Medical conditions related to obesity

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The goal of this study was to compare the performance of several measures of carotid intima-media thickness (C-IMT) as predictors of cardiovascular events (CVEs), and to investigate whether they add to the predictive accuracy of Framingham risk factors (FRFs).

Concepts: Atherosclerosis, Cardiovascular disease, Prediction, Futurology, Common carotid artery, Intima-media thickness, Cardiovascular diseases

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B-mode ultrasound measurement of the carotid intima-media thickness (CIMT) is a widely used marker for atherosclerosis and is associated with future cardiovascular events. This article provides a review and meta-analysis of the published evidence on the association of CIMT with future cardiovascular events and its additional value to traditional cardiovascular risk prediction models.

Concepts: Atherosclerosis, Blood vessel, Cardiovascular disease, Systematic review, Low-density lipoprotein, Intima-media thickness, Cardiovascular diseases, Lipoprotein(a)

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Acute decompensated heart failure (ADHF) with associated volume overload is the most common cause of hospitalization in heart failure patients. When accompanied by worsening renal function, it is described as a cardiorenal syndrome and is a therapeutic challenge. Initial treatment commonly encompasses intravenous diuretics however, suboptimal results and high rehospitalization rates have led experts to search for alternative therapeutic strategies. Recent technological advances in extracorporeal therapies have made ultrafiltration a feasible option for treatment of hypervolemia in ADHF. Recent large randomized trials have compared the efficacy and safety of ultrafiltration with diuretics. Additionally, the benefits of novel pharmacologic approaches, including combining hypertonic saline with diuretics, have recently been studied. The aim of this review is to discuss the developments in both pharmacologic and extracorporeal methods for treating hypervolemia in ADHF and acute cardiorenal syndrome.

Concepts: Medicine, Heart failure, Randomized controlled trial, Hemodialysis, Hypovolemia, Cardiovascular diseases, Acute decompensated heart failure, Aquapheresis

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OBJECTIVE To report outcomes in free flap reconstructive surgery in the setting of calcified arteriosclerosis affecting the flap pedicle. DESIGN Retrospective review, including a detailed analysis of medical records, histopathologic findings, and a comprehensive review of the literature. METHODS A total of 1329 consecutive microvascular free tissue transfers were performed by 2 reconstructive surgeons at a university-affiliated tertiary care medical center from January 1, 1996, through December 31, 2011. Clinical notes, operative notes, and pathology reports were systematically reviewed to identify 44 patients (3%) with calcified arteriosclerosis involving the flap vascular pedicle. A comprehensive medical record review was performed for the included patients, detailing patient-related characteristics, flap survival, and incidence of perioperative complications. RESULTS A history of arteriosclerosis was identified preoperatively in 18 patients (41%). Eight patients (18%) were specifically recognized clinically and histologically to have a variant of arteriosclerosis known as Mönckeberg medial calcific sclerosis. In total, fibula osteocutaneous free flap was performed in 30 patients, radial forearm in 8 patients, rectus abdominus in 3 patients, latissimus dorsi in 2 patients, and parascapular in 1 patient. Perioperative complications occurred in 17 patients (39%), with the most common being pulmonary (14%) and cardiac (9%). Patient follow-up ranged from 3 to 137 months, with a mean postoperative follow-up of 21 months. The mean length of hospital stay was 12 days. There was a 0% incidence of total flap failure and a 7% incidence of partial flap necrosis. CONCLUSION Although technically challenging, successful microvascular free flap reconstruction can be achieved despite the presence of vascular calcifications affecting the flap vascular pedicle.

Concepts: Medicine, Atherosclerosis, Hospital, Cardiology, Surgery, Physician, Cardiovascular diseases, Free flap