Hideya Niimura

Prognostic factors for the long-term survival in patients with vasospastic angina--analysis of effects of patients' characteristics and therapeutic drugs.

OBJECTIVES A retrospective study was conducted to elucidate contributing factors on the outcome of patients with vasospastic angina. SUBJECTS AND METHODS Two hundred ninety-two patients with angina in whom coronary vasospasm was documented were followed up (mean 4.3+/-3.6 years) to determine the relationship between the occurrence of cardiovascular events with available clinical factors including therapeutic drugs. Cardiovascular events were defined as fatal and non-fatal cardiovascular disorder events. RESULTS Several clinical variables including age, elevated creatinine level, low high-density lipoprotein (HDL) cholesterol level, presence of severe coronary artery stenosis, low left ventricular ejection fraction, low cardiac index (CI), large left ventricular mass, and use of beta-blockers proved to be significant risk factors for cardiovascular events. Further analysis by a stepwise regression analysis revealed that, older age (hazard ratio (HR)=1.42), low HDL cholesterol level (HR=0.877), presence of severe coronary artery stenosis (HR=49.32), and decreased CI (HR=14.18) proved to be independent prognostic factors. Ca antagonists were prescribed to 261 patients (89.4%). Among four Ca antagonists, there were significant differences in the frequency of cardiovascular events (2.6% with benidipine, 4.2% with nifedipine, 6.0% with diltiazem, 23.1% with amlodipine; amlodipine vs. benidipine, P<0.05) although the background characteristics of the four different patient groups were non-equivalent. CONCLUSION These results indicate that the morbidity of patients with vasospastic angina increased with older age, lower CI or HDL cholesterol, and presence of severe coronary artery stenosis, and that treatment with benidipine appeared to reduce cardiovascular events in patients with vasospastic angina.

Beneficial effect of combination therapy comprising angiotensin II receptor blocker plus calcium channel blocker on plasma adiponectin levels.

The study aim was to examine the effect of combination therapy comprising angiotensin receptor blocker plus calcium antagonist on post-treatment plasma adiponectin levels compared to pretreatment levels. There was a significant gender difference in the relationship between preadiponectin level and age. In the search for contributing factors for treatment-based changes in adiponectin levels, these effects of gender and age were considered in statistical analysis. The adiponectin level in the combination therapy group was further increased compared to that in each of the monotherapy groups, despite there being no significant difference in antihypertensive effect, indicating that the combined medication provided an effect beyond that of lowering blood pressure.

HIGHER CHYMASE DEPENDENT ANGIOTENSIN II-FORMING ACTIVITY IN THE CIRCULATING MONONUCLEAR LEUKOCYTE IS A SIGNIFICANT CONTRIBUTING FACTOR FOR ATRIAL FIBRILLATION

Authors: Keisuke Okamura, Yukiko Inoue, Yoshinari Uehara, Kenzo Matsumoto, Seiyo Maruyama, Shunichiro Sumi, Yusuke Fukuda, Shodai Furuyama, Sunao Kodama, Chie Andoh, Hideya Niimura, Kazumitsu Kubota, Hideaki Tohjoh, Kei Miyoshi, Shinichiro Miura, Yoshio Yamanouchi, Keijiro Saku, Hidenori Urata, Department of Cardiovascular Diseases,Fukuoka University Chikushi Hospital, Chikushino, Japan, Department of Cardiology, Fukuoka University, Fukuoka, Japan