A comparison of non-HDL and LDL cholesterol goal attainment in a large, multinational patient population: The Lipid Treatment Assessment Project 2

ObjectiveThis study evaluated the success in attaining non-HDL-cholesterol (non-HDL-C) goals in the multinational L-TAP 2 study.Methods9955 patients ≥20 years of age with dyslipidemia on stable lipid-lowering therapy were enrolled from nine countries.ResultsSuccess rates for non-HDL-C goals were 86% in low, 70% in moderate, and 52% in high-risk patients (63% overall). In patients with triglycerides of >200 mg/dL success rates for non-HDL-C goals were 35% vs. 69% in those with ≤200 mg/dL (p < 0.0001). Among patients attaining their LDL-C goal, 18% did not attain their non-HDL-C goal. In those with coronary disease and at least two risk factors, only 34% and 30% attained respectively their non-HDL-C and LDL-C goals. Rates of failure in attaining both LDL-C and non-HDL-C goals were highest in Latin America.ConclusionsNon-HDL-C goal attainment lagged behind LDL-C goal attainment; this gap was greatest in higher-risk patients.     

Influence of obesity indices, metabolic parameters and age on cardiac autonomic function in abdominally obese men

Heart rate variability (HRV) is affected by age, hyperglycemia and accumulation of body fat. This study compares the predictive value of four measurements of adiposity/obesity on HRV and investigates the specific role of age, metabolic contributors and degree/distribution of fat in HRV alterations. The sample consisted of 97 non-diabetic and non-medicated men with features of the metabolic syndrome (50 ± 8 years of age, body mass index [BMI] 31 ± 3 kg/m², waist circumference [WC] 107 ± 9 cm, triglycerides 2.3 ± 0.7 mmol/L, fasting glucose 6.0 ± 0.5 mmol/L, insulin 156 ± 71 pmol/L; mean ± SD). WC, BMI, percent body fat (% fat, from dual energy X-ray absorptiometry) and visceral adipose tissue volume (VAT, from computed tomography) were used as measures of adiposity/obesity. HRV measures were obtained from 24-h, day- and night-time segments of Holter recordings. BMI presented no independent association with HRV. Percentage fat was the strongest obesity index to be associated with HRV: 24-h pNN50, rMSSD, HF and daytime pNN50, rMSSD, HF and LF (?0.27 ≤ std β ≤ ?0.20, P < .05). VAT was associated with 24-h SDNN, LF (std β = ?0.25 and ?0.20, P < .05, respectively) and daytime SDNN (std β = ?0.24, P < .05) while WC was associated with nighttime SDNN and SDANN (std β = 0.22 and 0.32, P < .05). In addition, age, fasting glucose, 2-h oral glucose tolerance test and triglycerides presented independent association with HRV. Adiposity/obesity measurements seem to be differently associated with HRV. An approach considering the combination of age, obesity and glucose metabolism factors could be helpful in the global cardiovascular risk management in abdominally obese men.     

Interventricular septal rupture caused by vehicular trauma

We report the case of a patient admitted at the emergency unit after a severe car accident. As ECG showed a ST segment elevation in all leads, the working diagnosis was coronary dissection. Coronary angiography revealed a large interventricular septal rupture, confirmed by echocardiography. After discussion and as haemodynamics permitted, 6 weeks of medical observation were decided. A surgical repair was then performed, and provided a perfect repair of the shunt. We discuss about the prevalence and management of this rare traumatic complication.     

Cryptococcal pneumonia in a patient with presumptive sarcoidosis and selective immunoglobulin A deficiency

Sarcoidosis is a multisystem granulomatous disease of unknown cause associated with impaired T-lymphocyte function and impaired cell-mediated immunity. Decreased cell-mediated immunity predisposes one to intracellular pathogens (eg, cryptococci).     

An Integrated Alcohol Abuse and Medical Treatment Model for Patients with Hepatitis C

Background  

Patients with chronic hepatitis C virus (HCV) infection have high rates of alcohol consumption, which is associated with progression of fibrosis and lower response rates to HCV treatment.