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Am Fam Physician. 2000;61(12):3679-3680

Treatment of Depression May Prevent Recurrent Cardiac Events

(49th Annual Scientific Session of the American College of Cardiology) Results of a two-part study showed a significantly higher incidence of recurrent acute ischemic cardiac events among patients with depression than in patients without depression, despite similar co-morbidities, and showed that the treatment of depression following unstable angina (UA) or acute myocardial infarction (MI) may reduce further acute ischemic cardiac events. The Zung Self Assessment Questionnaire was mailed to 253 patients two weeks after discharge from the hospital for treatment of UA or MI. Depression was present in 70 of the 166 patients who responded to the survey. Depressed patients tended to be older than patients without depression, but there was no difference in history of previous MI, diabetes mellitus, hypertension, smoking, or history of cardiac revascularization among the two groups. The two groups were also similar with regard to previous cardiac catheterization; severity of angiographic coronary artery disease; use of therapy with aspirin, beta blockers, angiotensin-converting enzyme inhibitors or lipid-lowering agents; and presence of left ventricular ejection fraction on initial admission for UA or MI. Twelve of the 70 patients with depression participated in a four-month randomized trial involving psychotherapy with or without paroxetine (Paxil). The incidence of readmission for acute MI or UA was 31.5 percent among patients with untreated depression, 13.8 percent among nondepressed patients and 8.3 percent among patients with depression who received treatment.—tasnseem z. naqvi, m.d., et al.,Cedars-Sinai Medical Center, University of California–Los Angeles.

Exercise Effective Alternative to PTCA/Stent in Patients with CAD

(American College of Cardiology) Regular physical exercise appears to be an effective alternative to an interventional approach (percutaneous transluminal coronary angioplasty [PTCA] and stent implantation) in patients with symptomatic but stable coronary artery disease (CAD) and may result in significant increases in functional work capacity and peak oxygen uptake (V O2max). This was the conclusion of a study of 42 male patients with coronary artery stenosis (amenable to PTCA/stent implantation) with evidence of local ischemia determined by radionuclide scintigraphy. Patients were prospectively randomized to a training group (22 patients) or an intervention group (20 patients). Patients in the training group exercised at 70 percent of their V O2max on a bicycle ergometer for 20 minutes daily, while patients in the intervention group underwent PTCA with stent implantation. All of the patients underwent a symptom-limited bicycle ergospirometry at baseline and after six months. After six months, patients in both groups demonstrated a significant improvement in clinical status. Compared with patients in the intervention group, patients in the training group showed significant increases in functional work capacity (25 percent) and V O2max (18 percent). The authors conclude that the significantly higher improvement in functional work capacity after training may result in a better quality of life for patients.—claudia walther, et al., University of Leipzig, Heart Center, Leipzig, Germany.

Ramipril Reduces Risk of Stroke and Other Cerebrovascular Events

(American College of Cardiology) Results of a randomized placebo-controlled trial showed that the use of ramipril (Altace), but not vitamin E, reduces the risk of stroke and other cerebrovascular events in patients by about one-third in both primary and secondary prevention as well as among patients with or without hypertension. A total of 9,451 high-risk patients who were at least 55 years of age and had either previous cardiovascular disease or diabetes plus one risk factor were randomized to receive ramipril (up to 10 mg per day) or placebo, and vitamin E (400 IU per day) or placebo, for a mean of 4.5 years. Ramipril reduced the risk of strokes, transient ischemic stroke and carotid endarterectomy. Ramipril was similarly effective in reducing the risk of a stroke among patients with or without previous cerebrovascular disease. Vitamin E did not reduce the risk of fatal or nonfatal stroke.—jackie bosch, msc, et al., McMaster University, Hamilton, Canada.

Unhealthy Diet Could Lead to Early Atherosclerosis in Teenagers

(American College of Cardiology) Results of a study showed that the majority of students screened (age range: 13 to 18 years) exceeded the daily dietary recommendations for intake of total or saturated fat, that almost one half of students exceeded the recommended intake of cholesterol, and that diet is as much of a risk factor for the initial stages of atherosclerosis in adolescents as it is in adults. A total of 249 students from three diverse-population high schools were screened for the typical risk factors: age, sex, height, weight, blood pressure, and fasting blood cholesterol (total, high-density lipoprotein [HDL], low-density lipoprotein [LDL]), triglycerides, glucose and uric acid. The thickness of the carotid artery wall was evaluated with ultrasound by the quantitative intima-media thickness test (QIMT) as a measure of the earliest morphologic evidence of atherosclerosis. Over 80 percent of the students exceeded dietary recommendations for intake of total or saturated fat, and 49 percent exceeded the recommended dietary intake of cholesterol. According to definitions recommended for teenagers, some of the students were hypercholesterolemic (37 percent for total cholesterol and 29 percent for LDL) and some were hypertensive (11 percent for systolic, 3 percent for diastolic). Body mass index scores correlated directly with total cholesterol, LDL cholesterol, ratio of total cholesterol to HDL cholesterol, triglycerides, uric acid, and systolic blood pressure. The authors recommend that health educators develop strategies to reduce atherosclerosis among teenagers and prevent later adult cardiovascular disease.—albert sanchez, drph, et al.,Pacific Health Education Center, Bakersfield, California.

Heart Rate Recovery After Exercise Is Excellent Predictor of Mortality

(American College of Cardiology) A decreased heart rate recovery (HRR) following graded treadmill exercise was found to be a powerful and independent predictor of mortality in healthy adults enrolled in the Lipid Research Clinic Prevalence Study. A total of 5,234 patients without heart failure, coronary or vascular disease, and rhythm disturbances, and who were not on beta blockers or digoxin, underwent treadmill testing and were followed for 12 years. The average age of the patients was 45 years, and 61 percent of patients were male. HRR was defined as the heart rate change from peak to two minutes recovery. An abnormal HRR (defined as 42 beats or fewer) was present in 1,719 (33 percent) of the patients. A total of 325 deaths occurred during the follow-up period. A low HRR was predictive of death in univariate analyses as well as after adjustment for age, gender, resting blood pressure, diabetes, smoking, cholesterol and medications.—christopher r. cole, et al., Cleveland Clinic Foundation, Cleveland, Ohio.

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