Issue Highlights

Abstract

HomeCirculationVol. 116, No. 4Issue Highlights Free AccessIn BriefPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessIn BriefPDF/EPUBIssue Highlights Originally published24 Jul 2007https://doi.org/10.1161/CIRCULATIONAHA.107.183537Circulation. 2007;116:359BURDEN AND PROGNOSTIC IMPORTANCE OF SUBCLINICAL CARDIOVASCULAR DISEASE IN OVERWEIGHT AND OBESE INDIVIDUALS, by Ingelsson et al.Subclinical cardiovascular disease can be assessed using several routinely available tests that can measure atherosclerotic burden and target organ damage. The extent of subclinical disease in obesity and its prognostic importance has not been investigated systematically. In this issue of Circulation, Ingelsson and colleagues used data from 5 tests (electrocardiography, echocardiography, carotid ultrasound, ankle-brachial pressure, urinary albumin excretion) performed in the community-based Framingham Heart Study sample. The authors report a higher cross-sectional prevalence of subclinical disease in overweight and obese individuals (compared with those with a normal body mass index), and in those with increased waist circumference compared with those with a normal waist circumference. On prospective follow-up, the risk of overt cardiovascular disease was higher in overweight and obese individuals with evidence of subclinical disease, as compared with individuals without subclinical disease. These data suggest that overweight and obesity are associated with a high prevalence of subclinical disease, which in part contributes to the increased risk of overt cardiovascular disease in individuals with excess adiposity. See p 375.PREDICTION OF MODE OF DEATH IN HEART FAILURE: THE SEATTLE HEART FAILURE MODEL, by Mozaffarian et al.Therapeutic strategies to treat symptomatic heart failure are directed toward improving prognosis. Clinicians are very aware that the risk of death and other complications of heart failure vary considerably The Seattle Heart Failure Model incorporates commonly available clinical features, laboratory measurements, and medications used to provide some quantization of this nonhomogeneous risk. In this issue of Circulation, Mozaffarian and colleagues use information from several clinical trials and registries to evaluate the Seattle Heart Failure Model score to assess mode of death in over 10 000 ambulatory patients with symptomatic heart failure. With over 2000 deaths at an annualized rate of approximately 12%, there was a relatively greater increase in the proportion of deaths attributed to progressive pump failure versus sudden, unanticipated heart failure in those with higher scores. The authors appropriately conclude that such information warrants further study and may facilitate decision making regarding improvements in recommendations for implantable cardioverter-defibrillators. See p 392 (editorial p 360).MAST CELL STABILIZATION REDUCES HEMORRHAGE FORMATION AND MORTALITY AFTER ADMINISTRATION OF THROMBOLYTICS IN EXPERIMENTAL ISCHEMIC STROKE, by Strbian et al.Although thrombolysis is an established effective treatment of ischemic stroke, hemorrhagic complications and reperfusion injury limit the outcome of patients after this intervention. Mast cells are known to increase ischemic and hemorrhagic brain edema, possibly because of the release of vasoactive, proteolytic, and fibrinolytic mediators upon degranulation. In a mouse model of cerebral ischemia and reperfusion, the authors investigated this question and found that application of a tissue plasminogen activator, a commonly used treatment strategy in these patients, induces strong mast cell degranulation. Similarly, postischemic administration of a tissue plasminogen activator markedly increased hemorrhagic edema formation, an effect that was significantly reduced by pretreatment of the animals with the mast cell stabilizor, cromoglycate. These results were confirmed in genetically modified mast cell–deficient mice, suggesting that degranulation of these cells is involved in this major complication, as well as in stroke. Further, the potential clinical relevance of these results is interesting, as neurological outcome was improved and mortality reduced in this experimental animal model. Overall, these results point to new treatment modalities in acute stroke using mast cell stabilizers, such as cromoglycate or other molecules, in a relevant clinical setting. See p 411 (editorial p 363).Visit http://circ.ahajournals.org:Images in Cardiovascular MedicineApicoaortic Valve–Containing Conduit in a Patient With Relapsing Prosthetic Endocarditis. See p e88. Download figureDownload PowerPointIsolated Left Ventricular Noncompaction Enhanced by Echocontrast Agent. See p e90.CorrespondenceSee p e92. Previous Back to top Next FiguresReferencesRelatedDetails July 24, 2007Vol 116, Issue 4 Advertisement Article InformationMetrics https://doi.org/10.1161/CIRCULATIONAHA.107.183537 Originally publishedJuly 24, 2007 PDF download Advertisement