Heads Up: May 8, 2008

The Strategies Editorial Advisory Board recommends the following recent papers:

Long-term Risk of Mortality and End-Stage Renal Disease Among the Elderly After Small Increases in Serum Creatinine Level During Hospitalization for Acute Myocardial Infarction

Small changes in serum creatinine levels during hospitalization for MI are associated with an independent higher risk of ESRD and death after 10 years of follow-up, according to a multisite study of Medicare beneficiaries that was recently published in the Archives of Internal Medicine. Its authors call for more focus on the mechanisms connecting acute kidney injury and risk of adverse events

High-Density Lipoprotein Cholesterol, High-Density Lipoprotein Particle Size, and Apolipoprotein A-1: Significance for Cardiovascular Risk

Although HDL-C is typically thought of as beneficial, a post-hoc analysis of data from two major studies—IDEAL and EPIC—suggests that at very high levels, it may actually increase the risk of coronary artery disease. In the IDEAL study, after adjustment for apolipoprotein A-I and apolipoprotien B, each standard deviation-increase in HDL-C (11.9 mg/dL) raised the risk of a major coronary event by 21%. Data from the EPIC trial showed that HDL-C particle size was significantly positively related with a major coronary event (OR 1.23, p =0.005). On the other hand, high plasma levels of apoA-1 did not appear to confer increased risk in any model.

Prognostic Value of Serial CRP Measurements in Left-Sided Native Valve Endocarditis

CRP measurements as well as changes in concentrations of the biomarker after a week of antimicrobial therapy in patients with native-valve endocarditis are strong predictors of poor outcomes, including death or major infection-related complications, concludes a prospective observational study published in the Archives of Internal Medicine. After a week of therapy, the adjusted odds ratio for poor outcome was 10.3 (95% CI, 2.2-49.4) for patients with CRP levels greater than 122 mg/dL versus those with CRP levels of 69 mg/dL or less. A decline in CRP levels also signified increased risk of poor outcome.

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