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A new, observational study suggests that aspirin only marginally increases the bleeding risk in patients with diabetes mellitus, perhaps reflecting impaired platelet inhibition. Inconclusive evidence from small, randomized trials and mechanistic studies reinforces the need for larger trials to determine the relative cardioprotective benefits and bleeding risks of aspirin in these patients.
In the Heidelberg–EPIC study, an association was found between the use of calcium supplements and risk of myocardial infarction, corroborating published data. Given these findings and the absence of clear beneficial effect on fracture risk, the use of these supplements should be discouraged, and individuals advised to obtain calcium from a balanced diet.
High-quality cardiopulmonary resuscitation started as soon as possible after cardiac arrest increases the rate of return of spontaneous circulation and improves long-term neurologically intact outcome. The authors discuss the latest evidence for successful resuscitation and subsequent patient care.
In the past decade, improvements in procedural techniques and the understanding of electrophysiological mechanisms have led to the establishment of effective ablation strategies for almost all types of ventricular tachycardia. The underlying cardiac disease, the site of origin, and the electrophysiological mechanism of the arrhythmia should all be considered when choosing the optimal ablation strategy for an individual patient.
Depression increases the risk of cardiovascular disease and is a predictor of poor cardiovascular outcomes. The authors outline these epidemiological findings, describe the pathophysiological mechanisms that might underlie the risk of cardiovascular disease in patients with depression, and describe new data on the effects of successful treatment of depression on biological risk factors for coronary artery disease.
Dr Javier Escaned discusses the increasing problem of time-dependent failure of coronary artery bypass grafts, and the subsequent need for secondary revascularization. Issues such as the substrate and epidemiology of graft failure, the choice of secondary revascularization modality, the specific problems inherent in repeat CABG surgery and percutaneous coronary intervention, and the importance of secondary prevention are reviewed.
