SO, et al. Circulation 2009;119:123-30. Conclusion: Female gender and black race are risk factors for adverse events after vein bypass surgery for limb salvage.Summary: This article represents another of the many interesting post hoc analyses derived from the PREVENT III, a multicenter clinical trial of patients undergoing vein bypass for critical limb ischemia (J Vasc Surg 2006;43:742-51). The PREVENT III database represents the largest prospective cohort of patients who underwent surgical treatment for critical limb ischemia. The database includes 1404 lower extremity vein graft operations performed for critical limb ischemia at 83 North American centers. The patients had intensive ultrasound surveillance of the bypass graft and clinical follow-up for 1 year.This particular analysis was designed to examine the interactions of race and gender as they affect graft patency, limb salvage, and mortality. Proportional hazards and propensity scoring was used to examine relationships of patient demographics to relevant clinical end points. These included perioperative events and 1-year outcomes of graft patency, limb salvage, and patient survival. Propensity score models adjusting for covariants that included institution, comorbidities, technical factors, and adjunctive medications were used to examine associations between race, gender, and outcomes.The PREVENT III trial had 249 black patients (131 men and 118 women). Black men were at increased risk for early (30-day) graft failure (hazard ratio [HR], 2.832; 95% confidence interval [CI], 1.393-5.759; P ϭ .0004). This held true even when analysis was restricted to exclude high-risk venous conduits. Black patients also had reduced secondary patency (HR, 1.49; 95% CI, 1.08-2.06; P ϭ .016) and reduced limb salvage (HR, 2.02; 95% CI, 1.27-3.20; P ϭ .003) at 1 year. Black women were the most disadvantaged, with an increased risk of graft thrombosis (HR, 2.02 for secondary patency; 95% CI, 1.27-3.20; P ϭ .003) and an increased risk for major amputation (HR, 2.38; 95% CI, 1.18-4.83; P ϭ .016) at 1 year. Perioperative mortality and 1-year mortality, however, were similar across race and gender groups.Comment: It has been previously suggested that African Americans and women have poorer results with vascular surgery. The findings in this study are therefore not all that surprising. The authors suggest the data raise the possibility of an altered response to vein bypass surgery in there subgroups. It is certainly not obvious what this biologic response would be. Nevertheless, the clinical implication is that African American women undergoing vein graft bypass surgery are a particularly high-risk group that may benefit from very aggressive postoperative surveillance and medical management.

Calcific Aortic Valve Disease (CAVD) is a highly prevalent cardiovascular disorder accounting for a rising economic and social burden on aging populations. In spite of continuing study on the pathophysiology of disease, there remain no medical therapies to prevent the progression of CAVD. The discovery of biomarkers represents a potentially complementary approach in stratifying risk and timing of intervention in CAVD, and has the advantage of providing insight into causal factors for the disease. Biomarkers have been studied extensively in atherosclerotic cardiovascular disease, with success as additive for clinical and scientific purposes. Similar research in CAVD is less robust, however, the available studies of biomarkers in CAVD show promise for enhanced clinical decision-making and identification of causal factors for the disease. This comprehensive review summarizes available established and novel biomarkers in CAVD, their contributions toward an understanding of pathophysiology, their potential clinical utility, and provides an outline to direct future research in the field.

The role of HDL-C in modulating atherosclerotic disease is as yet uncertain. However, new findings and therapies targeting HDL-C show early promise and may provide an important intervention in attenuating the burden of ASCVD in the future.

These results highlight the superiority of text mining algorithms applied to electronic cardiovascular procedure reports in the identification of phenotypes of interest for cardiovascular research.