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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.com)

Volume 5, No 3 - Summer 2004

Volume 5, No 3 - Summer 2004

Table of Contents

Improving the Pharmacological Regimen for Patients With Diabetes Mellitus Treatment Review
Type 2 diabetes mellitus afflicts nearly 17 million people in the United States, and prevalence rates are expected to double within 2 decades. Although there has been a downward trend in cardiovascular morbidity and mortality in recent years, cardiovascular disease remains the leading cause of death among patients with diabetes. This observation has led many to reevaluate current treatment goals and pharmacologic regimens for at-risk patients with type 2 diabetes mellitus. This review focuses on the current adjunctive pharmacologic treatment regimen that is well-suited for these patients. [Rev Cardiovasc Med. 2004;5(3):139–147]
Circadian Variations in Cardiovascular Disease:Chronotherapeutic Approaches to the Management of Hypertension Treatment Update
Blood pressure (BP) exhibits strong circadian variation, and this variation may contribute to the increase of acute cardiovascular events that peak in the morning hours. Reducing morning BP may prevent these occurrences, so identifying data on the true duration of action of antihypertensive agents is essential. Ambulatory BP monitoring has uncovered important differences in commonly used once-daily therapies and has provided insights into the cardiovascular risks associated with BP variability. This article will explore chronotherapeutic antihypertensive agents that have been formulated to address the circadian challenges in controlling BP, and will consider the implications of chronotherapeutics in managing cardiovascular disease. [Rev Cardiovasc Med. 2004;5(3):148-155]
Aspirin Resistance: Current Concepts Treatment Review
Aspirin is an effective antiplatelet agent with proven benefit in the prevention of atherothrombotic complications of cardiovascular disease. The antithrombotic effects of aspirin, however, are variable among individuals and this might explain, in part, why the absolute risk of recurrent vascular events in patients receiving aspirin therapy remains relatively high (8%–18% after 2 years). Although formal diagnostic criteria are lacking, aspirin resistance generally describes the failure of aspirin to produce an expected biological response or the failure of aspirin to prevent atherothrombotic events. Aspirin resistance has been reported to occur in 5% to 45% of the general population; therefore, its detection is potentially of clinical importance. The biological mechanisms, population prevalence, laboratory methods for detection, and clinical relevance of aspirin resistance are discussed in this review. [Rev Cardiovasc Med. 2004;5(3):156-163]
Cardiac Mass in the Setting of Acute Myocardial Infarction
When a middle-aged woman with a complex cardiac history presented with a cardiac mass in the setting of an evolving myocardial infarction, it created a diagnostic dilemma. This case report describes the diagnostic evaluation of such a patient and discusses the rare finding of an intramyocardial hematoma. [Rev Cardiovasc Med. 2004;5(3):170-175]
HIV Disease and an Atherosclerotic Ascending Aortic Aneurysm
Cardiovascular dysfunction appears to be an important complication of human immunodeficiency virus (HIV) infection and is being reported with greater frequency. There have been recent reports in the literature of HIV patients who suffer from vascular lesions such as large artery vasculopathy secondary to vasculitis, as well as accelerated atherosclerosis of the coronary arteries. The latter has been linked to patients on protease inhibitors that are used as part of a highly active antiretroviral therapy (HAART) regimen and have also been implicated in a lipodystrophy syndrome. We report a rare case of an HIV-infected patient on HAART who presented with a large ascending aortic aneurysm associated with symptomatic severe aortic regurgitation. A noteworthy finding on pathological analysis of the aorta was an etiology of accelerated atherosclerosis rather than the more expected vasculitis. [Rev Cardiovasc Med. 2004;5(3):176-181]