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Cardiovascular highlights from non-cardiology journals
Cryptogenic stroke due to undetected atrial fibrillation—longer ECG monitoring may be the key Up to 40% of ischemic strokes remain unexplained after routine evaluation and thus are considered cryptogenic. However, a number of these strokes may be due to an undetected episode of paroxysmal atrial fibrillation (AF) where anticoagulation can reduce the risk of subsequent ischemic stokes. Although a minimum of 24 hours of ECG monitoring is guideline recommended in the evaluation of ischemic stroke to identify AF, the optimal duration of monitoring remains undetermined. Among patients with cryptogenic stroke, two concurre...
Source: Heart - August 21, 2014 Category: Cardiology Authors: Bradley, S. M. Tags: Journal scan Source Type: research

Allopurinol reduces brachial and central blood pressure, and carotid intima-media thickness progression after ischaemic stroke and transient ischaemic attack: a randomised controlled trial
Conclusions Allopurinol lowered CBP and reduced CIMT progression at 1 year compared with placebo in patients with recent ischaemic stroke and TIA. This extends the evidence of sustained beneficial effects of allopurinol to these prognostically significant outcomes and to the stroke population, highlighting the potential for reduction in cardiovascular events with this treatment strategy. Trial registration number ISRCTN11970568.
Source: Heart - June 21, 2014 Category: Cardiology Authors: Higgins, P., Walters, M. R., Murray, H. M., McArthur, K., McConnachie, A., Lees, K. R., Dawson, J. Tags: Hypertension, Epidemiology Cardiac risk factors and prevention Source Type: research

Cardiovascular highlights from non-cardiology journals
Warfarin for atrial fibrillation in patients with chronic kidney disease – does the thromboembolic benefit outweigh the bleeding risk? Chronic kidney disease (CKD) predisposes to high risks for both thrombo-embolism and bleeding. As a result, understanding the risk-benefit profile for use of anticoagulation therapies among CKD patients with atrial fibrillation is important to optimize patient outcomes. However, clinical trials evaluating efficacy and safety of anti-coagulants for atrial fibrillation generally exclude CKD patients and observational studies have had conflicting results. Accordingly, this prospective co...
Source: Heart - June 9, 2014 Category: Cardiology Authors: Bradley, S. M. Tags: Journal scan Source Type: research

Resistant hypertension: resistance to treatment or resistance to taking treatment?
The treatment of hypertension has been a therapeutic success. A generation or more of effective drugs deserves considerable credit for their contribution to the substantial decline in age-related incidence of stroke, ischaemic heart disease and heart failure. And because almost all the drugs are long-since off patent, the cost of success comes cheaply. Indeed, National Institute of Health and Care Excellence (NICE) has branded treatment of hypertension as not only cost effective but cost saving.1 Yet not all patients achieve their blood pressure target and are labelled as ‘resistant hypertension’. A contentious...
Source: Heart - May 8, 2014 Category: Cardiology Authors: Brown, M. J. Tags: Drugs: cardiovascular system, Hypertension, Interventional cardiology, Epidemiology Editorials Source Type: research

Associations with anticoagulation: a cross-sectional registry-based analysis of stroke survivors with atrial fibrillation
Conclusions Anticoagulation was underused in this high-risk population, and those at highest risk were less likely to be treated. Strategies need to be developed to improve prescription of anticoagulation treatment.
Source: Heart - March 5, 2014 Category: Cardiology Authors: Abdul-Rahim, A. H., Wong, J., McAlpine, C., Young, C., Quinn, T. J. Tags: Drugs: cardiovascular system Cardiac risk factors and prevention Source Type: research

Current and new oral antithrombotics in non-valvular atrial fibrillation: a network meta-analysis of 79 808 patients
Conclusions In this network meta-analysis, novel oral anticoagulants were the most promising treatments to reduce stroke, stroke or systemic embolism, and all-cause mortality in patients with AF.
Source: Heart - February 10, 2014 Category: Cardiology Authors: Dogliotti, A., Paolasso, E., Giugliano, R. P. Tags: Drugs: cardiovascular system, Epidemiology Arrhythmias and sudden death Source Type: research

Ethnicity and prediction of cardiovascular disease: performance of QRISK2 and Framingham scores in a UK tri-ethnic prospective cohort study (SABRE--Southall And Brent REvisited)
Conclusions Neither score performed consistently well in all ethnic groups. Further validation of QRISK2 in other multi-ethnic datasets, and better methods for identifying high risk African Caribbeans and South Asian women, are required.
Source: Heart - December 6, 2013 Category: Cardiology Authors: Tillin, T., Hughes, A. D., Whincup, P., Mayet, J., Sattar, N., McKeigue, P. M., Chaturvedi, N., On behalf of the SABRE Study Group, Chaturvedi, Baker, Beauchamp, Coady, Collins, Forouhi, Gedroyc, Godsland, Hattersley, Heasman, Hughes, Key, Majeed, March, Tags: Open access, Drugs: cardiovascular system, Acute coronary syndromes, Epidemiology Source Type: research

Cognitive outcomes after acute coronary syndrome: a population based comparison with transient ischaemic attack and minor stroke
Conclusions Risk of cognitive impairment after ACS is similar to minor stroke and higher than TIA with implications for clinical practice including consent and adherence with medication. Differences in cognitive domain performance suggest a greater role for degenerative brain pathology in ACS which may be linked to vascular risk profile and cardiac factors.
Source: Heart - September 20, 2013 Category: Cardiology Authors: Volonghi, I., Pendlebury, S. T., Welch, S. J. V., Mehta, Z., Rothwell, P. M. Tags: Acute coronary syndromes, Drugs: cardiovascular system, Hypertension, Epidemiology, Tobacco use Source Type: research

Patent foramen ovale closure and brain ischaemic lesions
To the Editor The recently published meta-analysis by Wolfrum et al assessed the ability of percutaneous closure of patent foramen ovale (PFO) to reduce the incidence of recurrent stroke based on three randomised controlled clinical trials (RCT). This analysis did not demonstrate a superiority of the closure of PFO compared with medical therapy after 2–4 years of follow-up in patients with cryptogenic embolism.1 The closure was associated with lower, albeit nonsignificant, incidence of nonfatal stroke. The relatively low incidence of nonfatal strokes in the medical arm (<1% per year), could have contributed t...
Source: Heart - September 20, 2013 Category: Cardiology Authors: Ammirati, E., Comi, G., Camici, P. G. Tags: PostScript Source Type: research

The unnatural history of an atrial septal defect: Longitudinal 35 year follow up after surgical closure at young age
Conclusions Very long-term outcome after surgical ASD closure in childhood shows good survival and low morbidity. Early surgical closure prevents pulmonary hypertension and reduces the occurrence of supraventricular arrhythmias. Early postoperative arrhythmias are predictive for the need for pacemaker implantation during early follow-up, but the rate of late pacemaker implantation remains low. Although RVEF was unexpectedly found to be decreased in one-third of patients, the functional status remains excellent.
Source: Heart - August 15, 2013 Category: Cardiology Authors: Cuypers, J. A. A. E., Opic, P., Menting, M. E., Utens, E. M. W. J., Witsenburg, M., Helbing, W. A., van den Bosch, A. E., Ouhlous, M., van Domburg, R. T., Meijboom, F. J., Bogers, A. J. J. C., Roos-Hesselink, J. W. Tags: Congenital Heart Disease, Congenital heart disease, Drugs: cardiovascular system, Echocardiography, Hypertension, Clinical diagnostic tests, Epidemiology Source Type: research

Recent advances in the epidemiology, outcome, and prevention of myocardial infarction and stroke in sub-Saharan Africa
The early part of the new millennium witnessed reports of a growing burden of cardiovascular disease in Sub-Saharan Africa (SSA). However the contribution of ischemic heart disease and stroke to this increasing burden relative to that caused by hypertensive heart disease, cardiomyopathy and rheumatic heart disease was not clear. Over the last decade, data from the continent has begun to clarify this issue and suggests three main points. The burden of ischemic heart disease relative to other causes of heart disease remains low particularly in the black Africans majority. Stroke caused predominantly by hypertension is now a ...
Source: Heart - August 2, 2013 Category: Cardiology Authors: Ntsekhe, M., Damasceno, A. Tags: Drugs: cardiovascular system, Hypertension, Acute coronary syndromes, Epidemiology Global burden of cardiovascular disease Source Type: research

Trends in cardiovascular mortality and hospitalisations, and potential contribution of inhospital case-fatality rates to changes in national mortality in the Czech Republic 1994-2009
Conclusions During the study period, the overall CVD hospitalisation rates remained high but inhospital CFR declined considerably. The improved case-fatality seems to have made a substantial contribution to the decline in the national CVD mortality, particularly for AMI and stroke.
Source: Heart - February 18, 2013 Category: Cardiology Authors: Davidkovova, H., Kysely, J., Kriz, B., Vojtisek, P., Bobak, M. Tags: Health policy, Drugs: cardiovascular system, Hypertension, Acute coronary syndromes, Stable coronary heart disease, Epidemiology Source Type: research

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