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Bisoprolol reduces the perioperative incidence of death from cardiac causes and nonfatal myocardial infarction in high-risk patients who are undergoing major vascular surgery.

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Insulin resistance (IR) is pathogenic for type 2 diabetes and coronary artery disease (CAD). The K121Q polymorphism of the ENPP1/PC-1 gene is associated with IR. Our aim was to investigate the role of the 121Q variant on the risk of type 2 diabetes and CAD. Nondiabetic control subjects (n ‫؍‬ 638), type 2 diabetic patients without CAD (n ‫؍‬ 535), and type 2 diabetic patients with CAD (n ‫؍‬ 434) from Italy and the U.S. were studied. The proportion of 121Q carriers progressively increased in the three groups (27.4, 28.8, and 33.2%, respectively; adjusted P value ‫؍‬ 0.027). Among diabetic patients (n ‫؍‬ 969), 121Q carriers had an increased risk of developing type 2 diabetes before the age of 65 years (adjusted odds ratio [OR] 2.26, 95% CI 1.26 -4.03; P ‫؍‬ 0.006) and having a myocardial infarction (MI) (n ‫؍‬ 156) by 50 years of age (3.17, 1.46 -6.88, P ‫؍‬ 0.007). The 121Q variant was also associated with an increased risk for CAD (1.47, 1.01-2.18; P ‫؍‬ 0.049) in diabetic patients who did not smoke (n ‫؍‬ 546). In conclusion, the ENPP1/PC-1 121Q variant is associated with a progressive deterioration of the IR-atherogenic phenotype; among diabetic individuals, it is also associated with earlier onset of type 2 diabetes and MI. Diabetes 54:3021-3025, 2005

OBJECTIVE -Two single nucleotide polymorphisms (SNPs) at the adiponectin locus (ϩ45TϾG and ϩ276GϾT) have been associated with low circulating adiponectin levels, insulin resistance, and type 2 diabetes. We investigated whether these genetic markers are determinants of coronary artery disease (CAD) in type 2 diabetic patients. RESEARCH DESIGN AND METHODS-A total of 376 consecutive type 2 diabetic patients were studied: 142 case subjects with coronary stenosis Ͼ50% or previous myocardial infarction and 234 control subjects with no symptoms, no electrocardiogram (ECG) signs of myocardial ischemia, and a normal ECG stress test (n ϭ 189) and/or (n ϭ 45) with coronary stenosis Յ50%.RESULTS -No association with CAD was observed for the ϩ45 SNP (P ϭ 0.48). By contrast, a significant association was observed for the ϩ276 SNP, with T/T homozygotes having a lower risk of CAD than carriers of other genotypes (adjusted odds ratio [OR] 0.13 [95% CI 0.037-0.46], P ϭ 0.002). A similarly protective effect of the ϩ276 T/T genotype was observed in 110 case and 45 control subjects for whom the CAD status had been determined by angiography (0.04 [0.006 -0.30], P ϭ 0.002).Serum adiponectin, although clearly related to several features of the proatherogenic/insulinresistant phenotype, was not different between control subjects and CAD patients (26 Ϯ 17 vs. 25 Ϯ 13 g/ml).CONCLUSIONS -In conclusion, the ϩ276 GϾT polymorphism is a determinant of CAD risk in type 2 diabetic patients. This marker may assist in the identification of diabetic individuals at especially high risk of CAD, so that preventive programs can be targeted at these subjects. Diabetes Care 27:2015-2020, 2004T he prevalence of coronary artery disease (CAD) is two to four times more frequent in patients with type 2 diabetes than in nondiabetic individuals, representing the leading cause of death in this population (1-3). An important role in modulating the cardiovascular risk of diabetic patients is played by comorbidities such as dyslipidemia and hypertension or by environmental risk factors such as smoking. Factors intrinsic to the vascular wall, regulating its propensity to react to the diabetic milieu with endothelial dysfunction and activation of proinflammatory mechanisms, are also believed to be major players (4). These vascular pathways are under genetic control, but the genes that are involved are mostly unknown (5-7).Adiponectin is a circulating protein secreted by adipocytes that shares significant similarities with collagens VIII and X and complement protein C 1q (8,9). This adipokine has been recently shown to suppress the expression of class A scavenger receptors in macrophages, resulting in decreased uptake of oxidized LDL and reduced intracellular accumulation of cholesteryl esters (10). Adiponectin also has anti-inflammatory properties affecting the nuclear factor (NF)-B pathway and inhibiting monocyte adhesion to aortic endothelial cells (11,12). In addition to these effects on the vasculature, this molecule is a potent enhancer of insulin action on peri...

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Background Patients with left bundle branch block exhibit abnormal septal motion which may limit the interpretation of stress echocardiograms. This study sought to assess the diagnostic value of dobutamine-atropine stress echocardiography in left bundle branch block patients. Methods and ResultsSixty-four left bundle branch block patients (mean age 59 years, 24 men) with suspected coronary artery disease underwent dobutamine-atropine stress echocardiography and coronary arteriography. Myocardial ischaemia was defined as new or worsening wall thickening abnormalities. Coronary artery disease was quantitatively defined as a diameter stenosis d50% in a major epicardial artery. Rest septal motion was normal (apart from the early systolic septal notch) in 34 patients (53%) and abnormal in 30 patients (47%). Rest septal thickening was normal in 32 patients (50%) and abnormal in 32 patients (50%). All seven patients with a QRS duration d160 ms and an abnormal QRS axis had abnormal rest septal motion and thickening. Inter-observer agreement for ischaemia was 88%. In all but one patient disagreement was in the septum. For the anterior and posterior circulation, respectively, sensitivity was 60% (9/ 15) and 67% (8/12), specificity was 94% (46/49) and 98% (51/52), and accuracy was 86% (55/64) and 92% (59/64). Sensitivity for the anterior circulation tended to be better in patients with normal rest septal thickening (83% vs 44%).Conclusions Dobutamine-atropine stress echocardiography has excellent diagnostic specificity in left bundle branch block patients with suspected coronary artery disease. In patients with abnormal rest septal thickening, however, dobutamine-atropine stress echocardiography may lack good sensitivity for detection of coronary artery disease in the anterior circulation. Left bundle branch block patients who potentially most benefit from dobutamine-atropine stress echocardiography may initially be selected by their resting electrocardiogram.

In migraineurs with a large PFO and subclinical brain MRI lesions, a significant reduction in frequency and severity of migraine recurrence can be obtained by PFO closure when compared with frequency and severity in controls.