Mastaneh Ahmadi-Kashani

Efficacy of Alternate-Day Dosing Versus Daily Dosing of Atorvastatin

Background: Atorvastatin is a synthetic inhibitor of 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase. In placebo-controlled trials, it has been shown to achieve significant dose-dependent reductions in low-density lipoprotein cholesterol, total cholesterol, and triglycerides. This trial compared the efficacy of daily atorvastatin administration with that of alternate-day dosing.Methods: This was a randomized, prospective, nonblinded, controlled clinical trial. Fiftyfour patients with low-density lipoprotein cholesterol of 100 to 200 mg/dL were enrolled. Baseline fasting lipid profile (total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglycerides), liver function tests (aspartate transaminase and alanine aminotransferase), and creatine kinase were drawn. Patients were randomized to three atorvastatin dose groups. Group I received 10 mg of atorvastatin every day, Group II received 10 mg every other day, and Group III received 20 mg every other day. After 6 weeks of treatment with atorvastatin, fasting lipid profiles, liver function tests, and creatine kinase concentrations were redrawn. Compliance to treatment was assessed at each visit.Results: Of the 54 patients enrolled, 46 completed the study. All three regimens significantly reduced total cholesterol and low-density lipoprotein cholesterol compared to baseline. No statistically significant differences existed between the three groups in regards to total, or a percentage, decrease in total cholesterol and low-density lipoprotein cholesterol at 6 weeks compared to baseline. All regimens were well tolerated and none of the patients had a significant elevation of liver enzymes or creatine kinase during the course of the study.Conclusion: Alternate-day dosing of atorvastatin is an efficacious and safe alternative to daily dosing.

Mitral annulus calcification is associated with valvular and cardiac structural abnormalities.

IntroductionMitral annulus calcification (MAC) is a common finding on echocardiographic examination. The goal of this study was to evaluate associations between MAC and cardiac abnormalities using a large echocardiographic database.MethodsFor this study we retrospectively reviewed 24,380 echocardiograms performed for clinical reasons between the years 1984 and 1998.ResultsMAC was reported in 1,494 (6.1%) subjects. Using multivariate analysis, age, left ventricular hypertrophy (LVH), mitral regurgitation (MR), tricuspid regurgitation (TR), aortic stenosis (AS), left atrial (LA) enlargement and reversed E/A ratio were independently associated with MAC.)MAC was noted in 11.7 % of patients with MR vs. 4.3% without MR (OR: 2.0, CI 1.6–2.6, p < 0.0001), in 13.9% of those with TR vs. 4.5% without TR (OR: 3.8, CI 2.9–4.8, p < 0.0001), in 10.6% with LVH vs. 4.2% without LVH (OR: 1.9, CI 1.5–2.4, p < 0.0001), in 14.8% with AS vs. 5.5% without AS (OR: 1.4, CI 1.08–1.9, p = 0.01), in 9.4% with reversed E/A ratio vs. 3.8% without reversed E/A ratio (OR: 1.7, CI 1.4–2.2, p < 0.0001) and in 8.2% with LA enlargement vs. 4.8% without LA enlargement (OR: 1.3, CI 1.06–1.7, p = 0.02).ConclusionIn our study, MAC independently correlated with significant structural heart abnormalities. This suggests that identification of MAC may serve as a marker for other cardiac structural disorders.

Prevalence of Suspected Diastolic Dysfunction in Patients with a Clinical Diagnosis of Congestive Heart Failure

Introduction: The prevalence of diastolic left ventricular (LV) dysfunction in a population presenting with a suspected diagnosis of congestive heart failure (CHF) is questionable and widely variable in the current literature. To minimize the disparity, we evaluated a large echocardiographic database to investigate the prevalence of systolic and suspected diastolic LV dysfunction in those with a suspected clinical diagnosis of CHF. Methods: We retrospectively reviewed echocardiograms performed at our institution and evaluated the prevalence of abnormal LV systolic and diastolic function in those with a suspected clinical diagnosis of CHF. Diastolic dysfunction was defined as the presence of left atrial enlargement, left ventricular hypertrophy and reverse trans-mitral inflow ratio (E/A reversal). Results: Of the 636 echocardiograms with CHF as the primary diagnosis, 461 had measured LV function. Normal LV systolic function were found in 238 of the patients (48%). Isolated diastolic LV dysfunction was found in 166 patients (36%). Twelve percent of the patients with a suspected clinical diagnosis of CHF had normal LV systolic and diastolic function. Conclusion: Normal LV systolic function was seen in nearly one-half of the echocardiograms with a suspected clinical diagnosis of CHF. Suspected LV diastolic dysfunction was observed in one-third of the echocardiograms with a suspected clinical diagnosis of CHF.