Medical angioplasty - Hope and expectations: an optimistic overview

Primary and secondary prevention of cardiovascular diseases [CVD] are markedly overlooked worldwide. The use of these kinds of preventive methods will greatly improve outcome of or even reverse major CVD, especially coronary atherosclerosis. Comprehensive lifestyle changes combined with aggressive medical therapy [lipid lowering agents "statins", antiplatelet agents, beta-blockers and angiotensin-converting enzyme inhibitors] for patients suffering from coronary heart disease significantly reduce all major adverse cardiovascular events [MACE], especially in those with stable coronary artery disease [CAD], even if their coronary lesions are significant. The main mechanistic pathways for the significant reduction of MACE are: Stabilization of atheromatous plaques through endothelial function reparation, strengthening of the fibrous cap of the atheromatous plaque and reduction of atheroma burden, i.e., reversal of the process of coronary artery stenosis, the great dream of "medical angioplasty". Despite the compelling data indicating the great beneficial effects of both primary and secondary prevention of coronary atherosclerosis, the US national survey data reveals that only a minority of patients eligible by guidelines for these therapies in fact receive them. Hence, we strongly believe that our main duties as cardiologists is to improve the up-to-date knowledge of the practicing physicians about utility of aggressive medical therapy for both prevention and reversal of CVD, and also to promote useful primary and secondary prevention programs among physicians and patients. Meanwhile, further improvement and refinement of the current therapeutic modalities and introduction of new modalities for the management of lipid parameters other than LDL-C, such as HDL-C, triglyceride, lipoprotein [a], LDL particle size and susceptibility to oxidation may add further favourable effects in prevention and reversal of atherosclerotic process. Cardiologists should be just as aggressive with prevention as many have been with intervention. This optimistic overview is a valley cry to all practicing physicians; please depart from usual methods of intervention to preventive strategies which are largely overlooked

Frequency of methylenetetrahydrofolate reductase C677T polymorphism in patients with cardiovascular disease in Eastern Saudi Arabia

Homozygosity for the C677T mutation in the gene of the thermolabile enzyme 5, 10 methylenetetrahydrofolate reductase [MTHFR] associates with reduced enzyme activity, leading to mild hyperhomocysteinemia. We now know that an elevated level of homocysteine is an important risk factor for cardiovascular disease [CVD]. The objective of this study was to determine the prevalence of the C677T mutation in Saudi patients diagnosed with CVD. Over a period of 2 years [2003-2004] in a case control study, we determined the prevalence of the C677T mutation in 83 CVD patients and in 40 age and gender-matched controls in the Eastern Province of Saudi Arabia. We determined the MTHFR genotype by restriction fragment length polymorphism and allele specific hybridization procedures. The CVD group showed over representation of the C677T allele frequencies [20.5%] compared with unaffected controls [15%] [p=0.3]. Furthermore, the genotypic data indicated that the prevalence of homozygosity for the C677T mutation was dramatically higher in the CVD patients [10.8%] when compared with normal [0%] [p=0.058]. These results suggest that the MTHFR C677T variant mildly influences CVD. However, we require further investigation in large independent samples