Postmenopausal Hormone Therapy: Does It Have a Role in Cardiovascular Prevention Today?

Cardiovascular disease is the leading cause of mortality in women. Results from observational studies consistently demonstrated lower heart disease rates among women who used hormone replacement therapy (HRT) compared to non-users. Data from two large randomized controlled trials showed mixed results. Subsequent post-hoc analysis found cardiovascular disease among HRT users to be lower than non-users in women 50 to 59 years of age or less than 10 years post-menopause. This has sparked much debate on the role of postmenopausal hormone therapy, especially in peri-menopausal women. Two hypotheses have been suggested to explain this divergent data: 1) HRT may be cardioprotective when introduced prior to atherosclerosis development but may be harmful in women with established CVD; or 2) HRT may be useful when started closer to menopause initiation and harmful when started later in life.     

Does Contractility Modulation Have a Role in the Treatment of Heart Failure?

Cardiac resynchronization therapy (CRT) is an established therapy for patients with systolic dysfunction, QRS duration greater than 120 ms, and New York Heart Association (NYHA) class III or IV symptoms. However, most patients with heart failure have QRS duration below 120 ms and 30% or more of CRT recipients are nonresponders. Cardiac contractility modulation (CCM) signals are nonexcitatory electrical impulses applied during the absolute refractory period that are intended to enhance contractile strength independent of QRS duration. Myocardial biopsy studies suggest that modulation of protein phosphorylation and gene expression underlie the mechanisms by which CCM exerts its effects. Two prospective randomized studies have investigated the impact of CCM on exercise tolerance and quality of life in patients with chronic heart failure. These studies have included predominantly patients with NYHA class III heart failure with QRS duration below 130 ms. This review summarizes results of these clinical studies and outlines additional studies underway to further clarify the role of CCM in the treatment of heart failure.     

Pulmonary Rehabilitation for Moderate COPD (GOLD 2) –Does it Have an Effect?

Background: Although pulmonary rehabilitation is an integrated part of standard care in patients with severe COPD, it is uncertain whether those with less severe COPD benefit from such treatment. The aim of the present survey was to evaluate the effect of rehabilitation in patients with moderate COPD and to determine their willingness to participate in rehabilitation. Material and methods: In a single-centre, randomized, placebo-controlled, unblinded clinical trial, participants comprised 61 of 133 referred subjects with moderate COPD. Of the 61 participants, 35 were randomized to receive rehabilitation and 26 subjects to receive standard COPD care from their GP. After randomization 19 subjects dropped out. Results: Effects of physical training were seen during the period of intervention. Compared with those receiving standard GP care, those receiving rehabilitation showed improvements in walking distance and leg strength as well as improvements in quality of life; however, the effect was temporary, and at 18 months’ follow-up there was no significant difference between the groups. Only 61 subjects of the referred group of 133 with moderate COPD accepted the offer of rehabilitation. Conclusion: Although an effect was found of pulmonary rehabilitation in subjects with moderate COPD, it disappeared over 18 months. Only a minority of patients with moderate COPD referred for rehabilitation accepted and completed the treatment offer.     

Mean Platelet Volume in Patients With Dilated Cardiomyopathy: Does it have a Role in Left Ventricular Thrombus Formation?

We assessed the clinical echocardiograhic, hematological, and biochemical parameters in patients with dilated cardiomyopathy (DCMP) and control individuals mainly focusing on the mean platelet volume (MPV) in terms of DCMP and left ventricle (LV) thrombus formation. Consecutive patients (n = 251) with DCMP and 266 patients without DCMP were studied. Mean platelet volume was significantly greater in patients with DCMP than in control patients (P < .05 for all comparisons). Comparing DCMP patients with LV thrombus (19 patients, 8%) and without LV thrombus (232 patients, 92%) showed that the prevalence of smokers was significantly higher and ejection fraction was significantly lower in patients with LV thrombus. We have shown that patients with DCMP have significantly higher MPV suggesting more platelet activation and the MPV of patients with DCMP and LV thrombus is comparable to those of patients without LV thrombus.     

Radiographic progression in rheumatoid arthritis: does it reflect outcome? Does it reflect treatment?

Although there is clear face validity that structural damage is related to outcome, it is difficult to prove this. Recently, more evidence became available that structural damage, as assessed on plain films, is indeed related to disease activity in clinical trials and therefore can be used to assess the effect of treatment. Also, a relationship between structural damage and outcome, mainly defined as physical disability, was established. Several examples of findings in recent publications are presented which lead to the following conclusions. There is a relation between the response to treatment measured as clinical disease activity and measured as radiographic progression in most clinical therapeutic trials. A strong relation between local inflammation and progression of damage in the individual joint is present. This is robust evidence for the hypothesis that inflammation leads to structural damage. There is a good relation between the damage in small and large joints as assessed on plain films. Damage measured in small joints is a good substitute for overall damage. Disease activity is always strongly correlated with functional disability throughout the disease course. There is an increasing relation between disability and structural damage with increasing disease duration.     

Hepatitis E: an emerging infectious disease in Germany?

Increased frequencies of HEV infections have been reported in several industrialized countries. We suggest that this finding might be explained by a better awareness of the disease and not by an increased incidence. Although reported HEV infections increased more than 6-fold in Germany in recent years, the seroprevalence remained unchanged (2 %).