This article describes the experience of the Framingham Heart Study in the prediction of cardiovascular disease with C-reactive protein measurements and 8 years of follow-up. The study included 4446 adults free of cardiovascular disease at baseline; 283 developed major cardiovascular disease events. Categories of C-reactive protein were predictive of developing an event in age- and sex-adjusted models, but the effects were attenuated greatly in multivariable models.
In this article, Gehi and colleagues examined the association between current major depression and self-reported medication adherence in 940 outpatients with coronary heart disease. Among the 204 participants with major depression, 14% reported not taking their medications as prescribed compared with 5% of nondepressed participants (odds ratio, 2.8; 95% confidence interval, 1.7-4.7; P<.001), and this relation persisted after adjustment for potential confounding variables. Greater depressive symptom severity was associated with greater nonadherence. These results raise the possibility that medication nonadherence may contribute to adverse cardiovascular outcomes in depressed patients.
Data on the risks of subclinical hypothyroidism are limited. Rodondi and colleagues examined the risks of heart failure, coronary heart disease, stroke, peripheral arterial disease, and death in relationship to thyrotropin (TSH) levels in a prospective cohort of 2730 older adults. Compared with euthyroid participants, older adults with a TSH level of 7.0 mIU/L or greater had a 2- to 3-fold increased risk of congestive heart failure events. Both incident and recurrent heart failure events were increased in this group. Heart failure events were not increased among those with TSH levels between 4.5 and 6.9 mIU/L. Subclinical hypothyroidism was not associated with increased risk for coronary heart disease, stroke, peripheral arterial disease, or cardiovascular or total mortality.
In this article, Knoflach and colleagues demonstrated that subjects with common allergic diseases (allergic rhinitis and asthma) are at an increased risk of atherosclerosis. This finding was consistently obtained in 2 independent population samples, one consisting of male youngsters (aged 17 or 18 years) (Atherosclerosis Risk Factors in Male Youngsters [ARMY] Study) and the other of middle-aged and elderly men and women (aged 40 to 70 years) (Bruneck Study). The results of Knoflach and colleagues fit very well into the emerging concept that key components of allergies such as leukotrienes or mast cells are active players in human atherogenesis and further extend the list of chronic inflammatory and immune-mediated diseases that has been linked to an enhanced burden of atherosclerosis.
This study compared the process of care and outcomes of patients with heart failure in the United States and Canada. Among 28 521 US Medicare beneficiaries and 8180 Canadian patients who were hospitalized with heart failure, Ko et al found that more US patients underwent left ventricular ejection fraction assessment during hospitalization (61.2% vs 41.7%; P<.001). However, the use of β-blockers and angiotensin-converting enzyme inhibitors was not significantly different among those with documented left ventricular systolic dysfunction. The 30-day risk-standardized mortality was significantly lower for the US patients (8.9% vs 10.7%; P<.001), but 1-year risk-standardized mortality was not significantly different (32.2% vs 32.3%; P = .98).
Mortality rates at 30 days in the United States and Canada stratified by heart failure risk scores.
In This Issue of Archives of Internal Medicine. Arch Intern Med. 2005;165(21):2449. doi:10.1001/archinte.165.21.2449