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Commencing Volume 19, Issue 1, MedReviews has ceased the publication of this journal. Reviews in Cardiovascular Medicine will continue to be published by IMRPress, Ltd. (www.imrpress.org)

Volume 3, No 1 - Winter 2002

Volume 3, No 1 - Winter 2002

Table of Contents

Update on Radiation for Restenosis Treatment Update
Coronary stenting is now used in most coronary interventions and reduces the restenosis rate to 20% or less. However, repeat in-stent restenosis occurs in 40%–60% of these patients. Radiation therapy, guided by intravascular ultrasound, can further reduce the incidence of repeat in-stent restenosis, and clinical trials have shown that all patient subgroups benefit from it. The mechanism appears to be reduction in neointimal hyperplasia. Studies are now evaluating use of medication with stents and radiotherapy, implantation of radiation-eluting stents, longer radiation sources to adequately cover lesions, and catheter balloons inflated with radioisotope solution. Intravascular radiation may soon be the standard of treatment for patients with in-stent restenosis and has the potential to reduce the recurrence rate to below 10%. [Rev Cardiovasc Med. 2002;3(1):1–6]
Alcohol, Heart Disease, and Mortality: A Review Prevention Review
Observational data suggest that moderate alcohol consumption is associated with reduced all-cause mortality compared with that associated with either abstinence or heavy drinking. Alcohol consumption reduces cardiovascular disease risk primarily by increasing production of high-density lipoprotein cholesterol, and possibly by increasing plasminogen, tissue plasminogen activator, and endothelial function, and decreasing platelet aggregability, fibrinogen, and lipoprotein(a). Red wine, containing antioxidants, has been purported to be especially cardioprotective. However, red wine consumption is not associated with reduced all-cause mortality in European countries, and American studies have found no relationship between the type of alcohol consumed and cardiovascular risk. Alcohol appears to be more cardioprotective if consumed with meals (possibly owing to protection against postprandial endothelial protection) and in moderation daily (as opposed to binge drinking). Despite the wealth of observational data, it is not absolutely clear that alcohol reduces cardiovascular risk, because no randomized controlled trials have been performed. Alcohol should never be recommended to patients to reduce cardiovascular risk as a substitute for the well-proven alternatives of appropriate diet, exercise, and drugs. Alcohol remains the number three cause of preventable premature death in this country, and the risk of alcohol habituation, abuse, and adverse effects must be considered in any patient counseling. [Rev Cardiovasc Med. 2002;3(1):7–13]
Beta-Blocker Therapy for Heart Failure: The Standard of Care Treatment Update
Sympathetic nervous system activation plays an important role in the genesis of symptoms, functional impairment, progressive ventricular dysfunction, and mortality in patients with heart failure. Prospective, randomized clinical trials of beta-blockers in patients with heart failure have demonstrated mortality reductions in patients across the spectrum of clinical presentations and etiologies. Additionally, these trials have provided important information regarding the indications, dosing, and extent of therapeutic benefits of the different beta-blockers studied in patients with heart failure. The recognition that beta-blockers relieve symptoms, reduce hospitalizations, and prolong survival in patients with heart failure represents one of the most important therapeutic advances in the treatment of this complex disorder. Beta-blockers, along with angiotensin-converting enzyme inhibitors and aldosterone antagonists, now represent the standard of care for patients with heart failure. [Rev Cardiovasc Med. 2002;3(1):14–21]
Doppler Hemodynamics
Your patient is in distress, and all an ECG can tell you is that he has had a previous heart attack. When are 2-dimensional (2-D) echocardiographic and Doppler studies appropriate options, and what special information can they provide? In the case presented, the Doppler recording profiled the hemodynamic status of the patient. Although the 2-D echocardiogram provided valuable information, only the Doppler study is shown to illustrate how sophisticated hemodynamic information can be gathered from Doppler examination. Check your review of the recording with the discussion on the next page. [Rev Cardiovasc Med. 2002;3(1):57–59]