Carotid plaque and increased carotid IMT are associated with the presence and severity of coronary calcification and disease on CTA in ambulatory subjects.

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Aims: Recently, serum aldosterone levels have been reported to play a significant role in cardiac hypertrophy. One study of Japanese patients correlated aldosterone levels with the degree of left ventricular hypertrophy (LVH) in those undergoing hemodialysis. However, the role of aldosterone in LVH in non-Japanese patients with end-stage renal disease (ESRD) has not been established. Materials and Methods: Researchers evaluated 42 [29 African-Americans (69%), 11 Caucasians (26%), and 2 other (5%)] male ESRD patients on dialysis for more than 6 months. Pre- and postdialysis, blood pressures and aldosterone and renin concentrations were measured. Transthoracic echocardiography was performed and left ventricular mass (LVM) index was calculated using the Devereaux formula. Medications were reviewed. Results: There were no differences noted in medications prescribed for African-Americans and for Caucasians. Additionally, data from diabetic patients showed no statistically significant correlation between LVM index and any of the variables, including pre- and postdialysis blood pressure, serum potassium, renin, and aldosterone levels, for African-Americans compared to Caucasians. Data from nondiabetic patients showed a positive correlation between LVM and plasma aldosterone concentration in African-Americans (n = 10). Data from nondiabetic Caucasians were disregarded because only one was studied. Conclusion: LVM and aldosterone correlate in African-American males with ESRD on hemodialysis without diabetes. This has important implications for the etiology of, and therapy for LVH in this population. Larger studies are needed to determine whether the same associations exist in females and Caucasians.

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Background: Loop diuretics are recommended by current guidelines for patients with symptomatic heart failure (HF) with NYHA class II-IV. While torsemide's oral bioavailability and half life theoretically render it a more efficacious drug than furosemide, the clinical outcomes of torsemide compared with furosemide in patients with HF remain unclear. Methods: We performed a meta-analysis including all published randomized control trial (RCTs) and observational studies that compared torsemide and furosemide use in chronic HF patients from inception to February 2019. Results: Fifteen studies (eight RCTs and seven observational studies) including 9758 patients were included. Over a weighted mean follow-up duration of 8 §3 months, torsemide was associated with a lower risk of rehospitalization due to HF (8.6% vs. 12.7%, NNT=23) (OR 0.63, 95% CI (0.44, 0.91), p=0.01, I 2 =8%) and cardiac mortality (1.6% vs. 4.4%, NNT=37) (OR 0.37, 95% CI (0.20, 0.66), p<0.001, I 2 =0%); and significantly higher improvement in functional status from NYHA class III/IV to I/II (72.5% vs. 58%, NNT=5) (OR 2.34, 95% CI 1.32, 4.15), p=0.004, I 2 =27%) compared with furosemide. There was no difference in all-cause mortality or medication side effects between both diuretics. In sensitivity analysis including RCTs only, improvement in functional status remained significant between torsemide and furosemide groups; however there was no difference in cardiac mortality between the two groups. With subgroup analysis, there was no difference in rehospitalization due to heart failure when analyzing subgroups of RCTs and observational studies individually. Conclusion: Torsemide use improved functional status and reduced rehospitalization due to HF compared with furosemide in chronic HF patients. Torsemide was also associated with reduced cardiac mortality, but this effect requires further study.