Обзор американских кардиологических журналов за неделю (ссылки)

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Study: Smoking doubles risk for AF

Chamberlain A. Heart Rhythm. 2011;doi:10.1016/j.hrthm.2011.03.038.

Among participants of the Atherosclerosis Risk in Communities study, those who smoked were twice as likely to develop atrial fibrillation as those who did not. Although at a lesser risk, former smokers were also at an increased for developing the arrhythmia.

“AF is a serious health issue that decreases quality of life and significantly increases the risk of stroke,” Alanna M. Chamberlain, PhD, study co-author from the department of health sciences research at Mayo Clinic in Rochester, Minn., said in a press release. “It is my hope that our study findings will shed more light on the impact that smoking has on CVDs, and help individuals realize they can play a role in preventing the development of AF.”

The prospective study involved individuals who were either current (n=4,005), former (n=4,950) or who had never been smokers (n=6,374). Chamberlain and colleagues examined the effect of smoking status on the risk of incident AF starting at baseline (1987-1989) and ending in December 2002.

During follow up, they reported 876 AF events among participants. Compared with those who never smoked, current (HR=2.05; 95% CI, 1.17-2.47) and former (HR=1.32; 95% CI, 1.10-1.57) smokers had an elevated risk for incident AF. Specifically, among smokers, those who smoked the heaviest, or those smoking the equivalent of one pack a day for 40 years, had the greatest risk for incident AF (HR=2.31). However, quitting smoking did moderately reduce the risk for AF vs. those who continued (HR=0.88).

These results, according to researchers, remained consistent regardless of gender or race of the participant, as well as whether the event was AF or atrial flutter.
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US lacking participants in NHLBI-backed randomized CV trials

Kim E. J Am Coll Cardiol. 2011;58:671-676.

The percentage of international participation in CV randomized controlled trials sponsored by the National Heart, Lung and Blood Institute was substantial when compared with US participation, results from a new study suggested.

Researchers used The NIH registry to search for phase III or IV CV randomized controlled trials (RCTs) funded by the NHLBI that had an outcome of MI, stroke or death and were published between 1997 and 2009. Of the 1,488 that were funded by the NHLBI, only 24 studies met the full criteria.

International participation (IP) was found in 19 trials that included 151,682 patients. The median IP was 9.5%. Across 11 coronary artery disease trials, nearly 50% of them had international enrollment. High IP was also found in high-risk trials and trials testing acute interventions.

Out of all CV RCTs, CAD trials had the most substantial rates of international enrollment. The researchers also noted that the most commonly listed international site was Canada (16 of 24 trials were conducted there), and that decreased participation of US patients in NHLBI-sponsored CV trials is a cause for concern.

In an accompanying editorial, Robert M. Califf, MD, of the Duke University School of Medicine, and Robert A. Harrington, MD, of the Duke Clinical Research Institute, both in Durham, N.C., reiterated the importance of both conducting more CV RCTs in the US and increasing participant enrollment at US-based sites.

“This report by Kim and colleagues represents a wake-up call. If we fail to heed it, we may see the US clinical research enterprise go the way of so many other American industries: lost to more efficient overseas competitors,” the authors wrote. “Such an outcome would be more than an economic disaster. It would also deprive the American public relevant, high-quality evidence essential for making appropriate decisions about health care.”
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More death certificates cite diabetes as underlying cause of death

McEwen LN. Diabetes Care. 2011;34:1529-1533.

Death certificates now list diabetes as the underlying cause of death more often than in previous years, data from the Translating Research into Action for Diabetes trial suggest.

Of 2,261 participants enrolled in the study who died from 2000 to 2007, 41% had diabetes listed on their death certificates and 13% cited the disease as the underlying cause of death. These findings indicated increased reporting of diabetes as the underlying cause of death over time, the researchers said, although the frequency of the disease’s appearance on death certificates in general remained unchanged.

In contrast, the listing of cardiovascular disease as an underlying cause of death declined significantly throughout the study period, a factor that may have played a role in the increased reporting of diabetes as an underlying cause of death, the researchers said. They attributed this trend to a decrease in the reporting of cardiac causes of death for men and cerebrovascular causes of death for women. Diabetes was more likely to be recorded anywhere on the death certificate in decedents with CVD cited as the underlying cause of death.

“Although diabetes listed as any cause of death was stable over time, we have observed a statistically significant increase in reporting of diabetes as the underlying cause of death on death certificates between 2001 and 2008 independent of age at death and duration of diabetes at death,” the researchers wrote. “If this trend is indeed occurring on a national level, it may complicate the interpretation of mortality rates ascertained from death certificates.”

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