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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 8, No 1 - Winter 2007

Volume 8, No 1 - Winter 2007

Table of Contents

HDL Function as a Target of Lipid-Modifying Therapy Diagnostic Update
High-density lipoprotein (HDL) is conventionally believed to possess many features that protect against atherosclerosis. However, these lipoproteins may be modified in certain individuals and/or circumstances to become pro-inflammatory. The ability of HDL to inhibit or paradoxically to enhance vascular inflammation, lipid oxidation, plaque growth, and thrombosis reflects changes in specific enzyme and protein components. The anti-inflammatory and pro-inflammatory functional properties of HDL can now be assessed using cell-based and cell-free assays. Acute or chronic systemic inflammation and the metabolic syndrome appear to render HDL pro-inflammatory. In contrast, statins and experimental agents such as apolipoprotein A-1 mimetics render HDL more anti-inflammatory. The 2 main classes of existing drugs for HDL modification are fibric acid derivatives, also known as “fibrates,” and niacincontaining compounds. In several controlled and prospective intervention studies, patients with low HDL-C and additional risk factors benefited from treatment with fibrates or niacin. However, an increase in HDL-C did not lead to a decrease in cardiovascular events in all trials. [Rev Cardiovasc Med. 2007;8(1):1-8]
The Relationship Among Risk Factor Clustering, Abdominal Obesity, and Residual Risk for Cardiovascular Events Diagnostic Update
Statins, angiotensin-converting enzyme inhibitors, and combination therapies have been shown to reduce the cardiovascular event rate in susceptible individuals, albeit with remaining significant residual risk. Some of the sources of residual risk, such as genetics and epigenetic phenomena, are not easily modifiable. Still, the risk imposed by these factors may be lowered by implementation of dietary, behavioral, and pharmacologic interventions. Abdominal obesity has emerged as one element in the cluster of factors linked to increased propensity for cardiovascular disease and type 2 diabetes. It is a potential therapeutic target to reduce residual cardiometabolic risk. Waist circumference has been shown to be a strong correlate of abdominal obesity, and measurement is a useful tool for the assessment of cardiometabolic risk. [Rev Cardiovasc Med. 2007;8(1):9-16]
Noninvasive Coronary Angiography Using Multislice Computerized Tomography Diagnostic Update
Multislice computerized tomography (MSCT) is a relatively new, noninvasive method for evaluating coronary stenosis. In symptomatic patients, the use of MSCT has been shown to be effective in identifying coronary lesions with comparable accuracy to the traditional, catheter-based invasive angiography. With the 64-slice MSCT scanner, units are acquired faster and the slices are thinner, resulting in improved temporal and spatial resolution and coronary artery imaging. Additional benefits of the 64-slice MSCT scanner as compared with the older generation scanners include a shorter period during which the patient must hold his or her breath, a wider range of acceptable heart rates, and the ability to image very obese patients and those with moderate coronary calcium with lower volumes of contrast. The 64-slice MSCT scanner has some limitations, but it demonstrates an improved image resolution that allows for a more precise evaluation. This new generation of MSCT scanners may eventually eliminate the need for invasive coronary angiography. [Rev Cardiovasc Med. 2007;8(1):17-20]
News from the SIS 2006 Emerging Technologies Symposium Meeting Review
Highlights from the Science, Innovation, Synergy (SIS) 2006 Emerging Technologies Symposium July 18-22, 2006, Seattle, WA [Rev Cardiovasc Med. 2007;8(1):21-24]
Best of the AHA Scientific Sessions 2006 Meeting Review
Highlights from the American Heart Association Scientific Sessions November 12-15, 2006, Chicago, IL [Rev Cardiovasc Med. 2007;8(1):25-35]
Acute Myocardial Infarction in a Patient With Systemic Lupus Erythematosus and Normal Coronary Arteries Case Review
Although cardiac manifestations such as pericardial, myocardial, and valvular involvement are common in patients with systemic lupus erythematosus (SLE), coronary artery involvement is less frequent. Clinical manifestations of coronary artery disease in SLE can result from accelerated atherosclerosis, arteritis, abnormal coronary flow reserve, spasm, and thrombosis. In SLE, the classic valvular abnormality consists of noninfective, verrucous vegetation. Thickening of the leaflets due to inflammation followed by fibrosis is common, occurring in about 50% of patients, whereas vegetations are present in about 40%. Mitral valve involvement is most common, with valvular regurgitation more frequent than valvular stenosis. The tricuspid valve and the aortic valve may also be affected. Its frequency varies widely: 13% to 74% in the general population. We report a case of a woman with acute myocardial infarction and normal coronary arteries, who was subsequently diagnosed with Libman-Sacks endocarditis and SLE. [Rev Cardiovasc Med. 2007;8(1):36-40]
Spontaneous Coronary Artery Dissection in a Woman on Fenfluramine Case Review
Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome, cardiogenic shock, and sudden cardiac death in women of reproductive age who have no traditional risk factors for coronary artery disease. The etiology, prognosis, and treatment of SCAD remain poorly defined. Coronary angiography is the gold standard for diagnosis. Management includes medical therapy and revascularization procedures using percutaneous intervention and coronary artery bypass grafting. Possible mechanisms of SCAD include rupture of atherosclerotic plaque or vasa vasorum, hemorrhage between the outer media and external lamina with intramedial hematoma expansion, and compression of the vessel lumen. We report a case of SCAD in a 39-year-old woman presenting with ST-elevation myocardial infarction midway through her menstrual cycle. Her medications included fenfluramine for obesity and hydrochlorothiazide, amlodipine, and atenolol for hypertension. [Rev Cardiovasc Med. 2007;8(1):41-44]