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In This Issue of Archives of Internal Medicine
Arch Intern Med. 2006;166:1937.
Lower Extremity Nerve Function in Patients With Lower Extremity Ischemia
In 478 persons with peripheral arterial disease (PAD) and 292 without PAD, this study determined whether lower extremity ischemia was associated with impaired lower extremity nerve function. Among nondiabetic participants, those with severe PAD had poorer peroneal nerve conduction velocity (NCV) compared with participants without PAD, participants with mild PAD, and participants with moderate PAD. Among 224 diabetic participants, PAD was associated with poorer peroneal NCV, sural nerve amplitude, and ulnar NCV compared with the absence of PAD. Results suggest that leg ischemia impairs peroneal nerve function. This association is less strong in patients with diabetes, perhaps because of the overriding influence of diabetes on peripheral nerve function.
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Impact of Chronic Kidney Disease on Health-Related Quality-of-Life Improvement After Coronary Artery Bypass Surgery
This prospective cohort study, involving 1055 patients, examined the change in physical function and mental health from baseline to 6 months after cardiac bypass grafting surgery (CABG). Subjects with severe chronic kidney disease (CKD) experienced no overall improvement in physical function, even after adjustment for baseline scores and a comprehensive set of demographic and clinical variables. In contrast, improvements in mental health were observed equally in all stages of CKD. The authors conclude that while patients with severe CKD may not experience improvement in physical functioning, more studies comparing these results with a similar cohort with CKD who do not undergo CABG are needed to adequately improve decision making in these patients.
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High Prevalence of Stroke Symptoms Among Persons Without a Diagnosis of Stroke or Transient Ischemic Attack in a General Population
Using data from 18 462 participants enrolled in a national cohort study, Howard et al found the prevalence of stroke symptoms to be high in a general population free of a prior diagnosis of stroke or transient ischemic attack. A total of 17.8% of the population older than 45 years reported at least 1 symptom. Stroke symptoms were more likely among African Americans compared with whites, those with lower income and less education, and those with fair to poor perceived health status. Symptoms were also more likely in participants with higher Framingham Stroke Risk Score, suggesting that at least some of these symptoms may represent stroke events that did not reach the threshold for clinical diagnosis.
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Recent Trends in the Care of Patients With Non–ST-Segment Elevation Acute Coronary Syndromes
Mehta et al evaluated the treatment of patients with high-risk non– ST-segment elevation acute coronary syndromes enrolled in the CRUSADE Quality Improvement Initiative between 2002 and 2004 to determine recent trends in adherence to guideline-based therapies (a total of 113 595 patients over 11 calendar quarters). The authors found that the use of each class I guideline recommendation, as well as overall adherence to the guidelines, improved significantly (P<.001) during the study period. In the acute care setting, the use of antiplatelet agents increased by 5% and  -blockers by 12%; at hospital discharge, use of antiplatelet agents increased by 3% and -blockers by 8%. Heparin use increased by 6% in the acute care setting. Use of glycoprotein IIb/IIIa inhibitors in the acute care setting also increased by more than 13%. At discharge, clopidogrel use increased by 22%, lipid-lowering agents by 11%, and angiotensin-converting enzyme inhibitors by 5%.
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Mannose-Binding Lectin and Mortality in Type 2 Diabetes
Activation of the complement system via mannose-binding lectin (MBL) may play a role in the pathogenesis of diabetic vascular complications. Hansen et al evaluated the association between serum MBL levels and mortality during 15 years of follow-up in a prospective study of 326 patients with type 2 diabetes mellitus. Patients with high levels of MBL at baseline ( 1000 µg/L) had a 50% higher risk of dying during follow-up compared with patients with low MBL levels. The mortality was further increased in patients with both high MBL and high C-reactive protein levels, and the combination of high MBL and high C-reactive protein was also a predictor of future development of microalbuminuria or macroalbuminuria. The authors conclude that measuring MBL may help identify high-risk patients and suggest that targeted down-regulation of the complement system could prove to be a new therapeutic option in diabetes.
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