The peroxisome proliferator-activated receptors (PPARs) are nuclear fatty acid receptors, which contain a type II zinc finger DNA binding motif and a hydrophobic ligand binding pocket. These receptors are thought to play an important role in metabolic diseases such as obesity, insulin resistance, and coronary artery disease. Three subtypes of PPAR receptors have been described: PPARα, PPARδ/β, and PPARγ. PPARα is found in the liver, muscle, kidney, and heart. In the liver, its role is to up-regulate genes involved in fatty acid uptake, binding, β-oxidation and electron transport, and oxidative phosphorylation in subcutaneous fat but not in skeletal muscle. PPARδ/β is expressed in many tissues but markedly in brain, adipose tissue, and skin. PPARγ has high expression in fat, low expression in the liver, and very low expression in the muscle. The thiazolidinediones (TZD) are synthetic ligands of PPARγ. By activating a number of genes in tissues, PPARγ increases glucose and lipid uptake, increases glucose oxidation, decreases free fatty acid concentration, and decreases insulin resistance. Although, there is a rationale for the use of TZDs in patients with type 2 diabetes mellitus, clinical studies have produced conflicting data. While currently used TZDs are clearly associated with heart failure (HF) worsening; with regards to cardiovascular outcomes, pioglitazone seems to be related to a trend toward reduction in cardiovascular morbidity and mortality, whereas rosiglitazone may actually increase risk of cardiovascular events. We review the existing literature on TZDs and discuss role and cardiovascular safety of these agents for the contemporary treatment of diabetes. Other side effects of these agents i.e. increase in osteoporosis and possible risk of bladder cancer is also discussed.

Depression is frequently associated with diabetes mellitus (DM) and may worsen DM-related morbidity and mortality. We determined the potential association of glucose levels with depression in Hispanic patients admitted to the Cardiovascular Intensive Care Unit. Patients were given the Center for Epidemiologic Studies-Depression scale survey within 24 hours of admission. Glycated hemoglobin and fasting blood glucose levels within 30 days of admission were extracted. The HbA1c levels remained significantly associated with both presence of depression and depression levels. Histories of DM, myocardial infarction, and percutaneous coronary intervention as well as baseline brain natriuretic peptide levels were also significantly associated with depression levels. The presence of a significant association between glucose levels and depression in Hispanic patients indicates that there is a need for optimal management of glycemic levels. This may then lead to better health outcomes in Hispanics with cardiovascular disease.

Depression is a predictor of length of stay (LOS) and adverse outcomes in patients with cardiac disease. Our objective was to assess the impact of depression on LOS in a Hispanic population admitted to a cardiovascular intensive care unit (CVICU). This was a prospective study of 151 consecutive patients admitted to the CVICU. Patients were administered the Center for Epidemiologic Studies Depression (CES-D) scale survey within 24 hours of admission. Patients were followed until discharge to determine LOS and adverse outcomes. Depression was more prevalent in Hispanic patients than in nonHispanic patients based on the CES-D scores (41% vs 14%). Using multivariate analysis, the presence of depression was a significant predictor of increased LOS (P = .001). Depression has a significant impact on LOS in a Hispanic population. Appropriate treatment of depression may decrease LOS and has the potential to be cost effective in the current health care environment.

Atrial fibrillation (AF) is a common arrhythmia in clinical practice. An important component of the management of patients with AF involves prevention of thromboembolism and stroke. Coumarins, such as warfarin had been the only available oral antithrombotic agent for prevention of thromboembolism for many decades. Following intestinal absorption, coumarins inhibit multiple steps of the clotting cascade that leads to inhibition of coagulation factors II, VII, IX and X. In addition to delayed and variable inhibition of coagulation, coumarin therapy has a narrow therapeutic window for optimal balance of risk and benefit, which requires regular assessment of the international normalized ratio (INR) to monitor coagulation. A quest for safer, more effective therapies that do not need monitoring has led to the development of dabigatran, rivaroxaban, and apixaban. In this article, we review these newer antithrombotic agents and discuss role of these drugs in clinical practice.