Factor V Leiden (FVL) and prothrombin G20210A are independent predictors for a first-ever episode of venous thromboembolism, but it is uncertain whether they also predict recurrence. This meta-analysis of 13 studies involving more than 3000 patients with first-ever venous thromboembolism demonstrates that heterozygous factor V Leiden and prothrombin G20210A are associated with a 1.4-fold and a 1.7-fold increase, respectively, in the odds of recurrent venous thromboembolism. These increases in risk are lower than the risk for a first event and by themselves are unlikely to merit extended-duration anticoagulation in affected persons.
The Helsinki Heart Study was a double-blind, placebo-controlled primary prevention trial among dyslipidemic middle-aged men to test the efficacy of gemfibrozil in the prevention of coronary heart disease. After the 5-year trial, all participants were offered free gemfibrozil treatment, and two thirds of participants in both groups chose the treatment. This 18-year follow-up showed significantly lower coronary heart disease mortality in the group that had started gemfibrozil treatment 5 years earlier than the other group, and the benefit was greatest among those with high body mass index, high triglyceride level, or low high-density lipoprotein cholesterol level.
Angiotensin-converting enzyme (ACE) inhibitors have an undisputed efficacy in patients with coronary artery disease and left ventricular dysfunction. This meta-analysis, analyzing 7 trials with long-term (at least 2 years) ACE inhibitor therapy vs placebo in such patients, documents the efficacy of these medications in terms of secondary prevention, with significant reductions in all-cause mortality, cardiovascular mortality, nonfatal myocardial infarction, stroke, resuscitated cardiac arrest, congestive heart failure, myocardial revascularization, and new-onset diabetes in patients without previously known diabetes.
Postmenopausal hormone therapy has been associated with an increased risk of venous thromboembolism (VT), including deep vein thrombosis and pulmonary embolism, in observational studies and secondary prevention clinical trials. The Women's Health Initiative (WHI) estrogen trial enrolled 10 739 women without a uterus aged 50 to 79 years. Participants were randomized to receive conjugated equine estrogen (0.625 mg/d) or placebo. Over an average of 7.1 years, VT occurred in 111 women randomized to estrogen and in 86 women randomized to placebo (hazard ratio [HR], 1.32). Deep VT was reported in 85 women randomized to estrogen and in 59 women randomized to placebo (HR, 1.47). There were no significant interactions between estrogen use and age, body mass index, or most other VT risk factors. Compared with WHI VT findings for estrogen and previous WHI findings for estrogen plus progestin, the HR for estrogen plus progestin was significantly higher than that for estrogen alone (P = .03), even after adjusting for VT risk factors. An early increased VT risk was associated with use of estrogen, especially within the first 2 years, but this risk elevation was less than that for estrogen plus progestin.
This study tested the hypothesis that hyponatremia, a simple marker of neurohormonal activation during the acute phase of infarction, may predict the long-term development of heart failure and death. The study included 978 patients with acute myocardial infarction who survived the index event and were followed up for a median of 31 months after hospital discharge. Hyponatremia (serum sodium level <136 mEq/L) was present during the hospital course in 108 patients (11.0%). In a multivariable Cox model, hyponatremia was an independent predictor of postdischarge death (hazard ratio, 2.0) and readmission for heart failure (hazard ratio, 1.6).
Kaplan-Meier plot showing the crude cumulative incidence of admission for the treatment of heart failure (HF) according to sodium level.
In This Issue of Archives of Internal Medicine. Arch Intern Med. 2006;166(7):711. doi:10.1001/archinte.166.7.711