Atorvastatin and quinapril inhibit blood coagulation in patients with coronary artery disease following 28 days of therapy.

BACKGROUND: We evaluated the antithrombotic effects of statins and angiotensin-converting enzyme inhibitor (ACEI) drugs in patients with coronary artery disease (CAD). METHODS AND RESULTS: Blood coagulation at the site of microvascular injury was assessed in 26 males with CAD before and after treatment with quinapril (10 mg day-1; n=13) or atorvastatin (40 mg day-1; n=13) for 4 weeks and an additional 4 weeks of combined therapy (quinapril+atorvastatin). Rates of prothrombin and factor V activation (FVa), fibrinogen (Fbg) cleavage and FVa inactivation showed that both quinapril and atorvastatin decreased the rates of: formation of thrombin B-chain (by 30.6%, P=0.007; and by 34.3%, P=0.003), formation of thrombin-antithrombin complexes (by 30.4%, P=0.0002; and by 40%, P=0.001), FV activation (by 19.1%, P=0.03; and by 21.8%, P=0.005) and Fbg depletion (by 29.2%, P=0.004; and by 32.7%, P=0.001). Atorvastatin alone accelerated FVa inactivation (P=0.005). A further 4 weeks of combined therapy enhanced most anticoagulant effects only when atorvastatin was added to quinapril. CONCLUSIONS: In CAD patients, atorvastatin and quinapril slowed blood clotting at the site of microvascular injury after 28 days of therapy. Addition of atorvastatin to quinapril, but not quinapril to the statin, enhanced the anticoagulant effects. Our findings might help explain the reduced risk of myocardial infarction or stroke in patients treated with statins and/or ACEIs and the lack of clinical benefits from ACEI added to prior statin therapy in patients at cardiovascular risk.

Ascending aortic blood pressure waveform may be related to the risk of coronary artery disease in women, but not in men.

Recent studies have demonstrated that fractional pulse pressure and fractional diastolic pressure are related to the risk of coronary artery disease. However, the effect of the ascending aortic pressure waveform on the risk of coronary artery disease in men and women analyzed separately has not been reported. The objective of the study was to assess the relation between ascending aortic blood pressure waveform and the presence of coronary artery disease in men and in women. The study group consisted of 447 patients (302 men and 145 women; mean age: 57.6+/-9.8 years) with preserved left ventricular function who were undergoing first diagnostic coronary angiography. After multivariate stepwise adjustments, the odds ratio (OR) and confidence interval (CI) of having coronary artery disease in women was (OR are reported for standard deviation increase in each variable): pulse pressure OR 1.61 (95% CI 1.06-2.46); fractional systolic pressure OR 1.72 (95% CI 1.08-2.71); fractional diastolic pressure OR 0.58 (95% CI 0.37-0.92); fractional pulse pressure OR 1.72 (95% CI 1.08-2.71); and pulsatility index OR 1.74 (95% CI 1.09-2.78). None of the studied variables was independently related to the presence of coronary artery disease in men. In conclusion, fractional systolic and diastolic pressure, pulse pressure, fractional pulse pressure and the ratio of pulse pressure to diastolic pressure may be independently related to the risk of coronary artery disease in women, but not in men.

[Pulse pressure as a predictor of restenosis after percutaneous transluminal coronary angioplasty]. / Wartosc cisnienia tetna w przewidywaniu czestosci wystepowania restenozy po zabiegach angioplastyki wiencowej.

UNLABELLED: The tension of the arterial wall increases the proliferation of the vascular smooth muscle cells which is one of the basic mechanisms of the reocclusion after percutaneous coronary intervention (PCI). The aim of the study was to evaluate the significance of the pulse pressure (PP) in predicting the restenosis after PCI. METHODS: We retrospectively studied 84 patients (average age 53.9 +/- 10.1; 69 males and 15 females)--35 patients with angiographically proved restenosis and 49 patients without restenosis matched according to age and gender. The pulse pressure in the ascending aorta was measured before PCI. The standard angiographic measurements took place before PCI and immediately after it. The restenosis was defined as recurrent stenosis > 50% on the follow-up angiogram which was performed up to 9 months after PCI. RESULTS: The mean pulse pressure was significantly higher in patients with restenosis (76.9 +/- 24.2 mmHg vs 61.3 +/- 17.5 mmHg, p < 0.001). The incidence rate of restenosis was 28.6% for the patients with the lowest PP and 55.2% for the patients with the highest PP (p < 0.05). The odds ratio after adjustment for sex, age, smoking status, hypercholesterolemia, diabetes mellitus, the type of lesions that underwent the PCI, maximal inflation pressure, time of inflation, minimal lumen diameter before and after the PCI, reference lumen diameter, stent implantation and mean blood pressure was 1.0, 2.83 (0.59-13.72) and 7.36 (1.12-68.11) for the patients with the lowest, middle and highest PP, respectively. The multiple-adjusted analysis showed that 10 mmHg increase in PP is associated with 72% increase in risk of restenosis (OR 1.72, CI 1.14-2.60, p < 0.01). CONCLUSION: Ascending aortic pulse pressure is an independent predictive factor for restenosis after percutaneous coronary intervention.

[Personality and restenosis after percutaneous transluminal coronary angioplasty]. / Osobowosc a restenoza po zabiegu przezskórnej angioplastyki wiencowej.

The paper is an attempt to find out which personality traits predispose to increased risk of restenosis in patients after first percutaneous transluminal coronary angioplasty (PTCA). The Eysenck Personality Questionnaire-Revised (EPQ-R) was used in 87 consecutive men (31 persons with university education, 26 secondary, and 20 occupational education; mean age 50 years, range from 32 to 72) on the second day after PTCA. Raw data were used in statistical analysis of EPQ-R. Restenosis was identified in coronary angiography within several weeks to 6 months after PTCA. Restenosis was detected in 25 patients. Groups with and without restenosis were compared with respect to EPQ-R parameters referring to neurotism (14.8 +/- 3.26 vs. 12.4 +/- 5.63; p < 0.01), extroversion (13.7 +/- 3.82 vs. 13.7 +/- 3.95; NS) and psychotism (5.7 +/- 3.20 vs. 7.2 +/- 4.8; p = 0.08). There was positive correlation between the level of neurotism and the frequency of restenosis (logistic regression coefficient = 0.225; OR = 1.252; p = 0.03), but not with age and the level of education. In contrast, psychotism did not correlate significantly with frequency of restenosis. In conclusion, neurotism appears to affect the frequency of restenosis, which means that emotional imbalance through reducing immunity to stress and skills of effective coping with it increases the risk of restenosis. Psychological intervention directed at developing the skills of coping with stress should be a part of the therapy in patients after PTCA.

[Stanols--a new perspective in treatment of hypercholesterolemia?]. / Stanole--nowa perspektywa w leczeniu hipercholesterolemii?

Since the unfavorable impact of hypercholesterolemia on the cardiovascular system has been proven, effective, inexpensive and easy to use cholesterol-lowering treatment options have been looked for. In the 1990s as the effect of a few decades of research, stanols have been introduced as new cholesterol-lowering agents. Stanols are derivates of plant sterols, which act through inhibition of intestinal cholesterol absorption. Their incorporation into normal diet fats has led to a significant reduction of both total and LDL cholesterol in investigated subjects, also in those on cholesterol-lowering diet or taking cholesterol-lowering drugs. When the dose considered optimal, i.e. 2-3 g/d, was used, the average reduction was 10% for total and 14% for LDL cholesterol. So far no adverse effects of stanols and no influence on the taste of food have been observed. The possible role of stanols in primary and secondary prevention of cardiovascular diseases still remains to be verified. It seems, however, that stanols have a potential to become a significant element in the treatment of hypercholesterolemia and in preventing its consequences.

[Primary coronary angioplasty in acute myocardial infarction]. / Pierwotna angioplastyka w zawale miesnia serca.

It is well established that recanalization of the infarct-related artery has an important role in prognosis after myocardial infarction. Recanalization can be achieved by the use of thrombolytic agents or by percutaneous transluminal coronary angioplasty. This article reviews the role of primary coronary angioplasty in the management of acute myocardial infarction, and summarises current opinions and indications of its use.

[Stents for treatment of transluminal percutaneous coronary angioplasty (PTCA) complications]. / Stenty w leczeniu powiklanej angioplastyki wiencowej (PTCA).

UNLABELLED: This study describes initial results of stent implantation in bailout situations in 38 patients with obstructive dissection after percutaneous transluminal coronary angioplasty (PTCA). Before stent introduction 1.8% of all patients after PTCA required emergency bypass grafting (CABG) because of postprocedural complications. In 1997 the rate of such emergency operations decreased to only 0.5% (p < 0.05). The success rate of stent deployment in patients included in the study was 95%. Mean final inflation pressure used for stent deployment was 12.0 +/- 2.3 atm. After stent implantation average residual stenosis was -0.81 +/- 5.75%. Of the 38 patients, 15 (40%) were treated before stent implantation with prolonged inflations with perfusion catheter. Bailout stenting was performed in 10 (25%) patients undergoing PTCA for restenotic lesions. The stents were placed in the left anterior descending coronary artery in 26 patients (69%), left circumflex coronary artery in 3 patients (8%), and in the right coronary artery in 9 patients (23%). Before bailout stenting 28 patients (75%) presented with type C and D dissection. One patient (2.5%) developed acute stent thrombosis. No episodes of subacute stent thrombosis were noted. During six-months clinical follow up no death and no Q-MI were observed. Angiographic follow up restenosis rate was 13/30 (43%), predominantly in patients treated with prolonged perfusion balloon inflations before stent implantation. The incidence of repeated PTCA and elective CABG due to restenosis was 12/30 (40%) and 1/30 (3%), respectively. There were no vascular complication at the puncture site. IN CONCLUSION: the introduction of coronary stenting has provided an excellent non-surgical modality for treatment of imminent or acute vascular closure complicating coronary angioplasty.

Effect of exercise rehabilitation on heart rate variability in hypertensives after myocardial infarction.

OBJECTIVE: The aim of the study was to find out whether the presence of hypertension affects heart rate variability in patients rehabilitated after myocardial infarction. DESIGN: Echocardiography, exercise testing and 24 h Holter monitoring were performed before and after 27 days of early postdischarge cardiac rehabilitation. PATIENTS: The study population consisted of 64 patients aged 34-65 years (mean+/-SD 51.6+/-6.6) discharged from hospital after a first myocardial infarction who were subdivided into two groups, group A comprising 34 patients with arterial hypertension which had lasted 4.8+/-2.1 years and group B comprising 30 normotensives. MAIN OUTCOME: We expected exercise rehabilitation to affect heart rate variability, exercise tolerance and myocardial ischemia in patients after myocardial infarction with and without arterial hypertension. RESULTS: At baseline no intergroup differences were seen in the duration of exercise, workload and heart rate variability parameters. All parameters increased significantly after cardiac rehabilitation (P < 0.01): SD of all normal RR intervals 123.4+/-30.0 versus 123.8+/-30.0 ms; SD of the averages of normal RR intervals in all 5-min segments of the entire recording 115.1+/-30.5 versus 116.3+/-28.3 ms; mean of the SD of all normal RR intervals for all 5-min segments of the entire recording 49.0+/-12.5 versus 48.3+/-11.8 ms; square root of the mean of the sum of the squares of differences between adjacent RR intervals 29.7+/-9.1 versus 28.0+/-8.5 ms; percentage of differences between adjacent RR intervals > 50 ms 7.9+/-6.0 versus 7.1+/-6.1% (group A versus group B, respectively, NS). The duration of exercise and the workload were significantly increased (the rise was higher in normotensives). No differences were seen in the frequency and severity of silent myocardial ischemia. CONCLUSIONS: Early stationary exercise rehabilitation after myocardial infarction improves heart rate variability parameters and exercise tolerance both in hypertensives and in normotensives.

Efficacy of a single dose of slow-release isosorbide dinitrate in the treatment of silent or painful myocardial ischemia in stable angina pectoris.

A double-blind study was performed in 32 patients with stable angina pectoris to assess the effects of slow-release isosorbide dinitrate (ISDN) (a single dose of 120 mg/day) on the frequency and duration of painless and painful ischemic episodes, and on electrocardiographic changes and exercise tolerance. Forty-eight-hour electrocardiographic monitoring and treadmill exercise tests were performed before, and at 20 and 21 days of therapy. Holter monitoring showed a significant decrease in the frequency of painful and silent episodes (p less than 0.001), and in the duration of painful (1,623 +/- 664 seconds vs 323 +/- 161 seconds; p less than 0.001) and silent episodes (2,818 +/- 1,496 seconds vs 223 +/- 102 seconds; p less than 0.001). The magnitude of painful and silent ST-segment depression was significantly reduced (2.7 +/- 0.9 mm to 0.7 +/- 0.7 mm and 2.0 +/- 1.1 mm to 0.7 +/- 0.5 mm, respectively; p less than 0.001). Time of exercise testing to the onset of ST-segment depression (442 +/- 137 seconds vs 858 +/- 110 seconds; p less than 0.001) or anginal pain was doubled (461 +/- 128 seconds vs 830 +/- 130 seconds; p less than 0.001). The work load increased from 6 to 10 METs (p less than 0.001). ISDN in a single dose of 120 mg/day is a valuable drug for stable angina pectoris, decreasing the frequency of silent and painful ischemic episodes and the magnitude of ST-segment depressions, and increasing exercise tolerance. It particularly shortened the duration of silent episodes. For patients' compliance, a once-daily dose of ISDN could be advantageous.

[Arrhythmia and silent myocardial ischemia in patients after myocardial infarction]. / Zaburzenia rytmu i ciche niedokrwienie miesnia sercowego u chorych po zawale serca.

In a group of 37 patients (30 men and 7 women aged from 36 to 67 years, men age 50.3) after a first acute myocardial infarction the frequency was analysed of the episodes of silent myocardial ischaemia with ST depression, and its correlation with arrhythmia was studied during outpatient ECG monitoring and exercise test on cycle ergometer. Outpatient ECG monitoring during 24 hours was done with a recorder Oxford Medilog MR-14 AM System 8-12 weeks after the onset of infarction. In the same patients the exercise test on cycle ergometer (KF-12 Medicor) was done by graded exercise method with workload increasing by 25 Watt every 3 minutes. The test was terminated after achieving 85% maximal heart rate or appearance of limiting signs. Each episode of ST depression by 1.0 mm or more lasting over 1 minute with horizontal or sloping ST depression 80 msec from point J was regarded in both cases as ischaemic. During outpatient ECG monitoring it was observed that 30 out of 37 (81.1%) had 138 episodes of ST depression, including 45 (32.6%) associated with pain and 93 (67.9%) painless (p less than 0.02). The mean maximal ST depression during painful and painless episodes was respectively 3.4 +/- 1.3 mm and 2.9 +/- 1.1 mm (p less than 0.03). Out of 30 patients 7 (23.3%) had 54 episodes of various arrhythmias, with bursts of ventricular ectopic beats, in one patient supraventricular tachycardia and in another one grade II atrioventricular block developed. These patients had also isolated ventricular ectopic beats. In 6 patients (20.0%) arrhythmia was temporarily associated with signs of ischaemia with ST depression.(ABSTRACT TRUNCATED AT 250 WORDS)

[The effects of lorcainide on the ECG pattern and left ventricular function in a patient with recurrent ventricular tachycardia]. / Wplyw Lorcainidu na orbaz ekg oraz funkcje lewej komory u chorego z nawracajacymi czestoskurczami komorowymi.

The paper presents an adverse effect of Lorcainide on the electrocardiographic pattern and left ventricular function in a patient with recurrent ventricular tachycardia in the course of arterial hypertension and ischemic heart disease. Based upon this case report a relatively new and not well known phenomenon of drug arrhythmogenesis is presented.