In patients at high CV risk without HF, ACE-Is and ARBs reduced the risk of the composite outcome of CV death, MI, and stroke. ACE-Is also reduced the risk of all-cause death, new-onset HF, and new-onset DM. Thus, ARBs represent a valuable option to reduce CV mortality and morbidity in patients in whom ACE-Is cannot be used.

Our study demonstrates that CCBs reduce the risk of all-cause mortality compared with active therapy and prevent heart failure compared with placebo. Furthermore, with the inclusion of recent trials, we confirm that they reduce the risk of stroke, also in comparison to angiotensin-converting enzyme inhibitors and do not increase the risk of cardiovascular death, myocardial infarction and major cardiovascular events.

ObjectivesThe purpose of this study was to verify whether intima-media thickness (IMT) regression is associated with reduced incidence of cardiovascular events.

Conclusion:One third of patients with fatal blunt trauma have thoracic aortic injuries. The majority of deaths occur at the scene of the injury.Summary: There have been recent paradigm shifts in the management of blunt thoracic aortic trauma, including more widespread imaging using CT scanning, aggressive blood pressure control of patients who reach the hospital alive, delayed treatment of thoracic aortic injuries and more frequent use of endovascular techniques for repair of blunt thoracic trauma. These changes appear to have resulted in a decline in mortality from 22% to 13% for patients with thoracic aortic injuries who reach the hospital alive (Demetriades D. J Trauma 2008;64:1415-8). Many patients with blunt thoracic injury, however, cannot benefit from these advnces because they die at the scene of the accident. To develop some sense of the magnitude of this problem the authors analyzed autopsy findings in a series of blunt traumatic fatalities. They reviewed autopsies for blunt trauma performed by the Los Angeles County Coroner's Office in 2005. Victims without thoracic aortic trauma were compared with those with a traumatic thoracic aortic injury with respect to patterns of associated injuries and differences in baseline characteristics. During the study time there were 881 fatal victims of blunt trauma received by the Los Angeles County Department of Coroner. Of these 304 (35%) underwent a full autopsy and were included in the analysis here. Average age was 43 Ϯ 21 years and 71% were men. The most common mechanism of injury was a motor vehicle accident (50%) and the second most common was a pedestrians struck by an auto (37%). 102 of the 304 victims (34%) had a thoracic aortic injury. The descending thoracic aorta was the site of injury in 66%. Compared to patients without thoracic aortic injuries those with thoracic aortic injuries were more likely to have a cardiac injury (44% versus 25%; P ϭ .001), hemothorax (86% versus 56%; P Ͻ .001), rib fractures (86% versus 72%; P ϭ .006), and intra-abdominal injury (74% versus 49%; P Ͻ .001). Death at the scene was more likely if you had a thoracic aortic injury (80% versus 63%; P ϭ .002).Comment: It is not surprising most patients with thoracic aortic injury die at the accident scene. Motor vehicle accidents serve as the greatest source of thoracic aortic injury. It is interesting that despite advances in automotive and safety engineering the prevalence of blunt thoracic aortic injury in motor vehicle accidents does not seem to have been impacted by engineering advances. The association of thoracic aortic injury with motor vehicle accidents appears very similar to that, identified by Parmley, et. al. fifty years ago (Parmley LF. Circulation 1958;17:1086-101). However, it is possible engineering advances may have reduced the fatality rate of blunt aortic thoracic trauma following motor vehicle trauma without affecting its prevalence.

In patients with HF, reduction of BNP or NT-proBNP levels was associated with reduced risk of hospital stay for HF worsening.

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Background: Outcomes of catheter ablation (CA) among patients with nonparoxysmal atrial fibrillation (AF) are largely disappointing.Objective: We sought to evaluate the feasibility, effectiveness, and safety of a single-stage stepwise endo-/epicardial approach in patients with persistent/ longstanding-persistent AF.Methods: We enrolled 25 consecutive patients with symptomatic persistent (n = 4) or longstanding-persistent (n = 21) AF and at least one prior endocardial procedure, who underwent CA using an endo-/epicardial approach. Our anatomical stepwise protocol included multiple endocardial as well as epicardial (Bachmann's bundle [BB] and ligament of Marshall ablations) components, and entailed ablation of atrial tachycardias emerging during the procedure. The primary outcome was freedom from any AF/atrial tachycardia episode after a 3-month blanking period. The secondary outcome was patients' symptom status during follow-up.Results: The stepwise endo-/epicardial approach allowed sinus rhythm restoration in 72% of patients, either directly (n = 6, 24%) or after AF organization into atrial tachycardia (n = 12, 48%). BB's ablation was commonly implicated in arrhythmia termination. After a median follow-up of 266 days (interquartile range, 96 days), survival free from AF/atrial tachycardia was 88%. Antiarrhythmic drugs could be discontinued in 22 patients (88%). As compared to baseline, more patients were asymptomatic at 9-month follow-up (0% vs. 56%, p = .02). Five patients (20%) developed mild medical complications, whereas one subject (4%) had severe kidney injury requiring dialysis. Conclusion:A single-stage endo-/epicardial CA resulted in favorable rhythm and symptom outcomes in a cohort of patients with symptomatic persistent/ This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.