Calcification and CHD in Young Men
CT evidence of coronary artery calcification strongly predicts premature coronary heart disease in young, healthy, physically active men, said Allen J. Taylor, M.D., of Walter Reed Army Medical Center, Washington, and his associates.
The researchers are conducting the ongoing Prospective Army Coronary Calcium project to assess the value coronary artery calcium in predicting coronary risk, beyond the predictive value of conventional risk assessment. This interim report on the data after a mean of 3 years of follow-up involved 1,983 healthy, asymptomatic Army personnel aged 40–50 years. More than 80% were white males, and all had presented for routine physical exams between 1998 and 2003.
Coronary artery calcification was identified in 22.4% of the subjects, and acute CHD events have occurred in nine men to date, at a mean age of 46 years. The presence of calcification raised the risk for CHD events by a factor of 12, after the data had been adjusted to control for subjects' Framingham risk scores, the investigators said (J. Am. Coll. Cardiol. 2005;46:807–14).
The findings “challenge the notion that plaque burden assessments should not be applied to younger populations at lower absolute CHD risk,” they noted. Further studies including women and ethnic minorities are needed to extend the findings to the general population, they added.
Coffee and Hypertension in Women
Coffee drinking doesn't appear to raise the risk of hypertension in women, reported Wolfgang C. Winkelmayer, M.D., and his associates at Brigham and Women's Hospital and Harvard Medical School, Boston.
Published studies have involved men only and have focused on acute changes in blood pressure. Caffeine's hypertensive effects are known to attenuate over time, they said (JAMA 2005;294:2330–5).
They studied caffeine intake and hypertension in two cohort studies: Nurses' Health Studies I comprised 61,091 normotensive nurses who were 30–55 years old when enrolled in 1976; Nurses' Health Studies II comprised a separate group of 94,503 nurses who were aged 25–42 years when enrolled in 1989. During a 12-year follow-up (NHS I, 1990–2002; NHS II, 1991–2003), 19,541 and 13,536 subjects, respectively, reported being diagnosed as having high blood pressure. Neither group showed a relationship between the development of hypertension and overall caffeine intake, intake of caffeinated coffee, or intake of decaffeinated coffee.
The results for caffeinated tea were termed “inconclusive.” There was no link between tea drinking and hypertension in the NHS I cohort, but a moderate rise in hypertension was seen with increasing tea consumption in the NHS II cohort.
There was a highly significant association between drinking regular or sugar-free caffeinated colas and developing hypertension in both cohorts. “We speculate that it is not caffeine but perhaps some other compound contained in soda-type soft drinks that may be responsible for the increased risk in hypertension,” they said.
Operator Volume Still Matters in PCI
Low procedure volume continues to put patients at greater risk for major adverse cardiovascular events in the era of PCI.
In a study of 18,504 consecutive PCIs performed by 165 operators at 14 Michigan hospitals in 2002, patients of low-volume operators had significantly higher rates of adverse cardiovascular events than patients of high-volume operators, according to Mauro Moscucci, M.D., of the University of Michigan Medical Center, Ann Arbor, and his associates (J. Am. Coll. Cardiol. 2005;46:625–32).
“Technological advancements have not yet completely offset the influence of procedural volume in determining proficiency of contemporary PCIs,” they said.
The researchers noted one encouraging change in recent years: Operator volume no longer appears to influence the rate of in-hospital mortality in PCI patients.
Retinopathy Flags Kidney Disease Risk
Retinal microvascular abnormalities may signal impending renal decline in the elderly, reported Matthew S. Edwards, M.D., of Wake Forest University, Winston-Salem, N.C., and his associates.
They assessed the link between these two conditions using data from the Cardiovascular Health Study, a longitudinal multicenter trial involving subjects aged 65 and older. In a subset of 1,394 subjects, a finding of retinal exudates and hemorrhages strongly correlated with declining renal function over the next 4 years, independent of the presence of diabetes or hypertension (Am. J. Kidney Dis. 2005;46:214–24).
Such retinopathy may be an early sign of diffuse, end-organ microvascular damage that will eventually involve the kidneys, and may affect other organs as well. “By extension, these findings potentially could identify individuals in need of aggressive treatment with agents designed to minimize microvascular complications, such as ACE inhibitors,” the researchers noted.
Mary Ann Moon