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Update in Cardiology
2000-2001 Series: Update Sessions from ACP-ASIM's 2000 Annual Session
Margaret Ring Gillock, Editor; David Cramer, MD, Co-Editor; and Paul T. Kefalides, MD, Co-Editor
From the wealth of information on cardiology published in the past year, I have chosen several important articles that cover coronary artery disease and congestive heart failure—the major clinical concerns of cardiologists today. This Update also evaluates research on risk factor modification and secondary prevention, along with competing strategies for managing both stable and unstable coronary artery disease. Finally, the roles of β-blockers, spironolactone, and diuretics in treating congestive heart failure and the place of home-based management are examined.
Coronary Artery Disease: Primary Prevention
Risks of Cigar Smoking and the Efficacy of Cigarette Smoking Interventions Were Studied
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Iribarren C, Tekawa IS, Sidney S, et al. Effect of cigar smoking on the risk of cardiovascular disease, chronic obstructive pulmonary disease, and cancer in men. N Engl J Med. 1999; 340:1773-80.
All of us have encountered cigar smokers who claim never to inhale; in fact, I have yet to find one who admits to doing so! Nevertheless, Iribarren and colleagues' fairly impressive cohort study of nearly 18 000 men, about 1500 of whom smoked cigars, demonstrated a relative risk for coronary heart disease of 1.27 in cigar smokers after follow-up for as long as 25 years. Risk estimates for chronic obstructive pulmonary disease and cancers of the upper aerodigestive tract and lungs were also elevated. Cigar smoking has an effect similar to that of passive smoking, which reportedly increases cardiovascular events by about 25% (1). It seems wise, when taking a smoking history, to ask patients about cigars as well as exposure to ambient smoking.
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Jorenby DE, Leischow SJ, Nides MA, et al. A controlled trial of sustained-release bupropion, a nicotine patch, or both for smoking cessation. N Engl J Med. 1999; 340:1773-80.
Measures to help people stop smoking have improved dramatically in recent years. Jorenby …
