Dalcetrapib Reduces Risk of New-Onset Diabetes in Patients With Coronary Heart Disease.

OBJECTIVE: Incident type 2 diabetes is common among patients with recent acute coronary syndrome and is associated with an adverse prognosis. Some data suggest that cholesteryl ester transfer protein (CETP) inhibitors reduce incident type 2 diabetes. We compared the effect of treatment with the CETP inhibitor dalcetrapib or placebo on incident diabetes in patients with recent acute coronary syndrome. RESEARCH DESIGN AND METHODS: In the dal-OUTCOMES trial, 15,871 patients were randomly assigned to treatment with dalcetrapib 600 mg daily or placebo, beginning 4-12 weeks after an acute coronary syndrome. Absence of diabetes at baseline was based on medical history, no use of antihyperglycemic medication, and hemoglobin A1c and serum glucose levels below diagnostic thresholds. Among these patients, incident diabetes after randomization was defined by any diabetes-related adverse event, new use of antihyperglycemic medication, hemoglobin A1c ≥6.5%, or a combination of at least two measurements of serum glucose ≥7.0 mmol/L (fasting) or ≥11.1 mmol/L (random). RESULTS: At baseline, 10,645 patients (67% of the trial cohort) did not have diabetes. During a median follow-up of 30 months, incident diabetes was identified in 403 of 5,326 patients (7.6%) assigned to dalcetrapib and in 516 of 5,319 (9.7%) assigned to placebo, corresponding to absolute risk reduction of 2.1%, hazard ratio of 0.77 (95% CI 0.68-0.88; P < 0.001), and a need to treat 40 patients for 3 years to prevent 1 incident case of diabetes. Considering only those with prediabetes at baseline, the number needed to treat for 3 years to prevent 1 incident case of diabetes was 25. Dalcetrapib also decreased the number of patients who progressed from normoglycemia to prediabetes and increased the number who regressed from diabetes to no diabetes. CONCLUSIONS: In patients with a recent acute coronary syndrome, incident diabetes is common and is reduced substantially by treatment with dalcetrapib.

Depressäo após infarto do miocárdio / Depression after myocardial infaction

A depressäo após o infarto do miocárdio é fator de piora do prognóstico, aumentando a mortalidade em 3,5 vezes. Os mecanismos provavelmente envolvidos compreendem a reduçäo da variabilidade da frequência cardíaca e o aumento da agregaçäo plaquetária, verificados na depressäo e amplificados em caso de isquemia coronariana. O diagnóstico destes pacientes é frequentemente negligenciado e o uso rotineiro de escalas de auto-avaliaçäo para depresäo em infartados é recomendado. O tratamento com inibidores de recaptaçäo da serotonina parece reverter alguns dos marcadores de risco e säo praticamente desprovidos de efeitos secundários ao nível cardiovascular sendo sugeridos como antidepressores de primeira escolha. A partir do exposto, o estudo, a detecçäo e o tratamento da depressäo pós-infarto passam a ser de fundamental importância para a sobrevivência dos pacientes

Depressao apos infarto do miocardio

A depressao apos o infarto do miocardio e fator de piora do prognostico, aumentando a mortalidade em 3,5 vezes. Os mecanismos provavelmente envolvidos compreendem a reducao da variabilidade da frequencia cardiaca e o aumento da agregacao plaquetaria, verificados na depressao e amplificados em caso de isquemia coronariana. O diagnostico destes pacientes e frequentemente negligenciado e o uso rotineiro de escalas de auto-avaliacao para depressao em infartados e recomendado. o tratamento com inibidores de recaptacao da serotonina parece reverter alguns dos marcadores de risco e cardiovascular sendo sugeridos como antidepressores de primeira escolha. A partir do exposto, o estudo, a deteccao e o tratamento da depressao pos-infarto passam a ser de fundamental importancia para a sobrevivencia dos pacientes.

Comparative Effects of Sertraline and Nortriptyline on Body Sway in Older Depressed Patients.

This study examined effects of nortriptyline and sertraline on the balance and stability of depressed geriatric inpatients. Body sway was measured with a stable force-platform at three timepoints: before starting antidepressant medication, 5-7 days after medication was initiated, and 1 week later. A group of healthy, unmedicated older volunteers was evaluated under the same conditions as patients. In sertraline-treated patients (n = 10), significant differences (P < 0.05) between baseline and the first week of treatment were found in the force-platform measurements of sway length (L) and area of the center of pressure (Ao), with patients' eyes both open and closed. This change in postural stability occurred in the absence of orthostatic hypotension. By the second week of treatment, neither variable was found to be significantly different from baseline. In the nonmedicated volunteers (n = 20) and in the group of patients receiving nortriptyline (n = 11), no significant changes in postural stability were found.