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Update in Cardiology
- From New York Medical College/Westchester Medical Center,Valhalla, New York.
2001–2002 Series: Update Sessions from ACP–ASIM's 2001 Annual Session
Margaret Ring Gillock, Editor; David Cramer, MD, Co-Editor; and Paul T. Kefalides, MD, Co-Editor
This year's Update in Cardiology features key reports in major areas of cardiovascular medicine: prevention, unstable coronary syndromes, chronic cardiovascular disease, arrhythmias, and peripheral vascular disease. Most of the papers reviewed are reports from large clinical trials, which are common in this field because of the wide prevalence of heart disease. Thus, it is often possible to make evidence-based management recommendations that are based directly on experience in large-scale trials.
Prevention of Cardiovascular Disease
Diuretic Therapy Outperformed an α-Blocker, Especially for Prevention of Heart Failure, in Patients at Risk for Coronary Heart Disease
The evidence from the most definitive studies indicates that less morbidity and fewer deaths occur when diuretics and β-blockers are used as first-line antihypertensive agents. Treatment with angiotensin-converting enzyme (ACE) inhibitors and calcium-channel blockers might be advantageous in certain patient groups. The Antihypertensive and Lipid-lowering Treatment to Prevent Heart Attack Trial (ALLHAT) is an ongoing trial of antihypertensive and lipid-lowering measures to prevent myocardial infarction in nearly 25 000 men and women 55 years of age or older who have systolic or diastolic blood pressure of 140 or 90 mm Hg, respectively, or are taking antihypertensive therapy and have at least one other risk factor for coronary heart disease. In the current study, ALLHAT participants were randomly allocated in a double-blind manner to receive either 12.5 to 25 mg of the diuretic chlorthalidone or 2 to 8 mg of doxazosin, an α-adrenergic blocker, each day. About twice as many patients took the diuretic. The median follow-up of 3.3 years was less than that planned; the data safety and monitoring committee stopped the trial because doxazosin was clearly less effective than chlorthalidone. Although rates of total mortality, fatal coronary heart disease, and nonfatal myocardial infarction did not differ, doxazosin recipients had a higher risk for stroke (relative risk, …
