European Journal of Preventive Cardiology

Heartscore is not well validated for individuals less than 40 years of age. In the latest guidelines a relative risk chart is provided with the proposal to be used for young adults aged less than 60 years instead of projecting risk at the age of 60 years. Moreover, coronary artery disease is insidiously manifested in younger patients.

Cross-sectional study.

Two hundred and two young Greeks of age less than 40 years and 232 middle-aged adults aged 40–60 years without clinically overt cardiovascular disease or diabetes were consecutively recruited. Flow-mediated dilatation of the brachial artery, carotid, and femoral intima media thickness (IMT), carotid-radial and carotid-femoral pulse wave velocity (PWV) were measured in all individuals in one session. The European Society of Cardiology online Heartscore calculator was used for mortality risk (MR) 60 and Systematic Coronary Risk Evaluation risk charts for relative risk (RR) computation.

MR60 in the younger significantly correlated with all measured vascular markers whereas RR significantly correlated with carotid IMT. By multivariate regression analysis, MR60 was a stronger identifier than RR for PWV, mean carotid and femoral IMT in both groups. Young adults (<40 years) with a high MR60 (>5%) had significantly higher carotid-radial PWV, carotid and femoral IMT whereas those with a high RR (>3rd tertile) had significantly higher carotid IMT.

MR60 was a stronger identifier of most of the measured markers of early atherosclerosis as compared with RR. These data support Heartscore as a prognostic tool in terms of primary prevention for participants younger than 40 years old. Eur J Cardiovasc Prev Rehabil 15:619–624 © 2008 The European Society of Cardiology

Abdominal obesity is an important risk factor for coronary artery disease (CAD). The extent to which tobacco exposure influences the effect of abdominal adiposity on CAD incidence remains uncertain. Therefore, the goal of this study was to assess the effects of tobacco exposure on CAD risk associated with abdominal obesity.

A cohort of 9763 men, aged 50–59 years, without known CAD was followed 10 years for CAD events. Risk factors were recorded using a questionnaire, a clinical examination, including waist circumference (WC) and waist-to-hip ratio (WHR) and biological measurements. Cox regression was used for statistical analyses.

During follow-up, there were 659 incident CAD events. BMI, WC, WHR, blood pressure, cholesterol, high-density lipid cholesterol and triglycerides, physical activity and alcohol intake varied across smoking exposure categories. The incidence of CAD increased across tertiles of waist circumference in never (5.1, 6.1 and 7.2 CAD events/1000 in first, second and third tertiles of WC distribution, respectively), former (6.6, 7.8 and 9.3 events/1000, across tertiles) and current smokers (9.4, 11 and 13.1 events/1000, across tertiles). After adjusting for age, centre, educational level, alcohol intake and physical activity, the relative risk of CAD was 1.28 (1.08–1.51) for 1 standard deviation increase of WC in never smokers, 1.23 (1.08–1.38) in former smokers and 1.14 (1.00–1.29) in current smokers. Similar results were observed for WHR. No evidence for heterogeneity among tobacco exposure strata for both WC and WHR was observed.

In conclusion, the relative risk of CAD associated with abdominal obesity is homogeneous in never, former and current smokers. Therefore, smokers with abdominal obesity are at high absolute risk of CAD. Eur J Cardiovasc Prev Rehabil 15:625–630 © 2008 The European Society of Cardiology

We identify determinants of plasma interleukin-6 (IL-6) levels in a multicenter panel study of myocardial infarction (Ml) survivors, using repeated measurements to evaluate both baseline and time-varying factors.

Survivors of Ml (N=1003) recruited in six European cities had repeated measurements (median: 6/patient) of IL-6. At baseline, participants’ behaviour and medical histories were determined by interview, and blood pressure, anthropometry, cholesterol and N-terminal B-type natriuretic peptide (NT-proBNP) were measured. Short-term exposures and medication intake were recorded at each visit. Generalized additive mixed models were used to analyze associations of IL-6 with baseline and time-varying risk factors, taking into account repeated measurements.

Age, hour of blood withdrawal, body mass index, pack-years of smoking, NT-proBNP, systolic blood pressure, high-density lipoprotein cholesterol, persistent cough/phlegm and statin use were significantly and independently associated with IL-6 after adjustment for city, recurrent Ml, baseline alcohol intake, current active smoking, tea consumption and extreme anger or stress.

Among Ml survivors, IL-6 levels are associated with many traditional cardiovascular risk factors. Patients with elevated NT-proBNP, respiratory symptoms or obesity had higher IL-6 concentrations and may potentially be at greater risk for coronary artery disease progression. Eur J Cardiovasc Prev Rehabil 15:631–638 © 2008 The European Society of Cardiology

Patients with established coronary heart disease (CHD) are encouraged to be physically active to prevent disease progression and to prolong life. The amount and intensity of exercise required for risk reduction in patients with CHD is not yet fully resolved.

Population-based prospective cohort study with 18 years of follow-up.

A linkage between a Norwegian population-based study (Nord-Trøndelag health study) and the Cause of Death Registry at Statistics Norway. Exercise amount and intensity were measured at baseline (1984–1986) in 2137 men and 1367 women with CHD.

During 18 years of follow-up, 1741 (81.6%) men and 1100 (80.5%) women died. Compared with the reference category (no activity), one weekly exercise session was associated with a lower all-cause mortality, both in men (relative risk 0.80, 95% confidence interval 0.68–0.94) and women (relative risk 0.68, 95% confidence interval 0.55–0.83). This inverse association became stronger with increasing frequency (P ≤ 0.001 for men and women). Those who reported moderate or high-intensity exercise had a somewhat lower risk of death than those who exercised with low intensity.

Exercise training reduced all-cause and cardiovascular mortality in men and women with CHD. This study adds significantly to the sparse literature regarding prospective data on physical activity, exercise intensity and mortality in CHD patients. Eur J Cardiovasc Prev Rehabil 15:639–645 © 2008 The European Society of Cardiology

Nicotine replacement therapy (NRT) has been shown to increase 12-month abstinence rates by as much as 50% when compared with placebo; however, NRT seems to be underutilized in the acute cardiac setting. This study explores the attitudes and beliefs of healthcare professionals regarding the use of NRT in acute cardiac inpatients, in an effort to identify and expose barriers that may impede the use of this drug in the acute cardiac care environment.

Framework analysis formed the methodological foundation of the study and provided the structure for analysis of data generated via qualitative, semistructured one-on-one interviews. A purposive sample of healthcare professionals practicing in the acute cardiac care setting informed the study.

Although health care professionals expressed strong views regarding the benefits of implementing NRT as a smoking cessation intervention, barriers were identified that hinder its use. Financial implications, lack of knowledge and safety issues all contributed to the institutional justification for rejecting hospital-based NRT as a secondary prevention intervention in the acute cardiac setting.

To proactively reduce the incidence of secondary cardiac events, education of healthcare professionals concerning tobacco addiction and available cessation treatments in the acute cardiac patient is paramount Nicotine replacement products require further investigation to ascertain their safety and financial viability in the acute cardiac setting. Findings may support the implementation of NRT in the inpatient cardiac setting, and ultimately help curb the incidence of smoking-related mortality owing to secondary cardiac events. Eur J Cardiovasc Prev Rehabil 15:646–650 © 2008 The European Society of Cardiology

Heartwatch, a secondary prevention programme in primary care was initiated in 2003, based on the second European Joint Task Force recommendations for secondary prevention of coronary heart disease (CHD). The aim was to examine the effect of the first 2 years of the Heartwatch programme on cardiovascular risk factors and treatments.

Prospective cohort study of patients with established CHD enrolled into the Heartwatch programme.

Four hundred and seventy (20%) general practitioners nationwide participated in the programme, recruiting 11542 patients with established CHD (earlier myocardial infarction, coronary intervention or coronary artery bypass surgery). Clinical data were electronically transferred by each general practitioner to a central database. Comparison of changes in risk factors and treatments at 1-year and 2-year follow-up from baseline were made using paired t-test for continuous and McNemar's test for categorical data.

Statistically significant changes in systolic blood pressure, diastolic blood pressure, total and low-density lipoprotien cholesterol and smoking status at 1 and 2 years (P < 0.0001) were observed. Little or no improvements were shown for exercise, BMI or waist circumference. Increases in the prescribing of statins, angiotensin-converting enzyme inhibitors and β-blockers over the course of the study were observed.

The Heartwatch programme has demonstrated significant improvements in the main risk factors and treatments for CHD. More effective interventions are required to reduce BMI, waist circumference and physical inactivity in this population. The increases in treatment uptake are approaching the optimal levels in this population. Eur J Cardiovasc Prev Rehabil 15:651–656 © 2008 The European Society of Cardiology

This study aims to compare various family history profiles as predictors of diabetes in a community-based prospective cohort because few prospective studies have examined the association of family history with diabetes risk in ethnic Chinese populations.

Among 2960 participants free from baseline diabetes through the Chin-Shan Community Cardiovascular Cohort Study, there were 548 cases that developed diabetes after a median 9 years of follow-up.

After multivariate adjustment, sibling history was associated with diabetes [Relative risk (RR): 2.08, 95% confidence interval (CI): 1.42–3.06, P = 0.0002]. Both maternal and paternal histories had similar effects (RR: 1.62, 95% CI: 1.04–2.51 for paternal history, RR: 1.36, 95% CI: 0.98–1.89 for maternal history). Obese participants with sibling history increased the risk of diabetes by 4.6-fold (RR: 4.61, 95% CI: 2.93–7.26), compared with those with neither obesity nor family history.

The findings support the hypothesis that sibling history is more important than parental history for diabetes risk. Eur J Cardiovasc Prev Rehabil 15:657–662 © 2008 The European Society of Cardiology

Many studies examining stroke risk factors have focused on men and younger age groups. We examined stroke risk factors over a wide age range including elderly and women in a British population.

We examined the prospective relationship between known risk factors for stroke and stroke incidence in 22516 men and women aged 40–79 years without stroke at baseline in the years 1993–1997 participating in the European Prospective Investigation into Cancer-Norfolk.

During a total of 214542 person-years of follow-up, 507 incident strokes occurred (fatal = 162). Stroke risk increased with increasing age [relative risk (RR) 1.65, 95% confidence interval: 1.54, 1.75 per increase in 5 years]. Our results confirm the importance of modifiable risk factors for stroke in men and women, in particular, blood pressure and smoking. Higher systolic blood pressure of 10 mmHg was associated with RR of 1.19 (1.13, 1.24) and current smokers had RR of 1.70 (1.29, 2.23) compared with never smokers independent of age, sex, body mass index, cholesterol, triglycerides and diabetes. Having a systolic blood pressure greater than 140 mmHg compared with less than 140 mmHg was equivalent to being 6 years older and current smoking compared with nonsmoking equivalent to being 5 years older and diabetes 5 years older in terms of stroke risk.

Classical modifiable stroke risk factors, blood pressure and smoking, may have a substantial impact on the age-related increase in stroke risk in men and women. Eur J Cardiovasc Prev Rehabil 15:663–669 © 2008 The European Society of Cardiology

To examine cardiovascular mortality of African migrants in Portugal in relation to socio-economic status.

Data from death registrations, 1998–2002, and the 2001 Census were used to derive standardized death rates by country of birth and occupational class/marital status.

Compared with native Portuguese, African migrants had higher mortality for all causes, circulatory disease, coronary heart disease and stroke. There was considerable heterogeneity among Africans with Cape Verdeans having higher mortality than Angolans or Mozambiquans. Class differences in mortality were generally greater for African than for Portuguese men. Although the coronary heart disease mortality rate among Africans in a manual class was twice that of those in a nonmanual class, there was no class difference for Portuguese men. Marital status was associated with 2–3-fold differences in mortality rates in both Africans and Portuguese. A larger proportion of Africans were not married which accounted for some of the excess mortality.

Adverse cardiovascular mortality experience of African migrants is associated with socio-environmental factors. Investigating how best to achieve risk reduction in Africans should be a public health priority in Portugal. Eur J Cardiovasc Prev Rehabil 15:670–676 © 2008 The European Society of Cardiology

Conduit arteries respond to increases in flow by dilating, which is mediated by endothelium-derived nitric oxide. The significance of the interaction between microcirculation and macrocirculation in the flow-mediated dilation (FMD) is poorly understood.

We hypothesize that baseline conduit artery vasomotor tone (CAVT) and resting microvascular resistance (MVR) predict FMD.

We investigated resting diameter and FMD of the brachial artery using high-resolution ultrasound and forearm blood flow with plethysmography in 60 healthy individuals. CAVT was calculated as change of the arterial diameter from baseline to maximal dilation expressed as percentage of the maximum dilation. Resting MVR was determined as quotient of mean arterial blood pressure and forearm blood flow.

Mean FMD was 10.7 ± 2.0%, indicating normal endothelial function. The extent of brachial artery FMD was not only related to baseline CAVT (r = 0.70, P < 0.01), but inversely to resting MVR (r = –0.69, P < 0.01). Moreover, in a simple regression analysis, baseline CAVT was inversely related to resting MVR (r = −0.82, P < 0.01). In a multivariate linear regression analysis, baseline CAVT and MVR were identified as independent predictors of brachial artery FMD.

Our data imply a close interaction of resting microvascular resistance and baseline CAVT modulating flow-mediated conduit artery dilation. Eur J Cardiovasc Prev Rehabil 15:677–682 © 2008 The European Society of Cardiology

Hypertension has been reported to be a major problem of the blacks. There is a paucity of studies, however, on community-based surveys on the prevalence and pattern of hypertension in Nigeria in the recent time. This study sought to investigate the prevalence and pattern of hypertension in the adult population living in the ancient semiurban community of Ile-Ife, southwest Nigeria.

Two thousand and ninety-seven adults of above 20 years of age were recruited into the door-to-door survey through a multistage cluster sampling technique. Diagnosis of hypertension was based on blood pressure (BP) threshold of 160/95 mmHg and the World Health Organization/International Society of Hypertension guidelines (Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure guidelines) definitions. Resting blood pressure was taken using electronic sphygmomanometer.

The mean age and BP of the participants were aged 44.2 ± 11.6 years and 127/77 mmHg, respectively. The participants (36.6%) had a BP of greater than or equal to 140/90 mmHg whereas 13.3% had BP of greater than or equal to 160/95 mmHg. 22.1% had isolated systolic hypertension whereas 14.5% had isolated diastolic hypertension using the BP of greater than or equal to 140/90 mmHg cut off-point. Using the BP of greater than or equal to 160/95 mmHg, isolated systolic hypertension and isolated diastolic hypertension were 6.63%, respectively. A male-to-female ratio of 1.7:1 and 1:5 was observed for BP greater than or equal to 140/90 mmHg and BP greater than or equal to 160/95 mmHg, respectively. Hypertension prevalence increased across age gradient from young to old adults.

The prevalence estimates of hypertension obtained in this study was higher than those found in most earlier studies from Nigeria, other West Africa nations and for African–Americans. Eur J Cardiovasc Prev Rehabil 15:683–687 © 2008 The European Society of Cardiology

Exertional oscillatory ventilation (EOV) in heart failure may potentiate the negative effects of low cardiac output and high ventilation on exercise performance. We hypothesized that the presence of EOV might, per se, influence exercise capacity as evaluated by maximal cardiopulmonary exercise test.

We identified 78 severe chronic heart failure patient pairs with and without EOV. Patients were matched for sex, age and peak oxygen consumption (VO₂). Patients with EOV showed, for the same peak VO₂, a lower workload (WL) at peak (ΔWatts = 5.8 ± 23.0, P = 0.027), a less efficient ventilation (higher V _E/VCO₂ slope: 38.0 ± 8.3 vs. 32.8 ± 6.3, P < 0.001), lower peak exercise tidal volume (1.49 ± 0.36 L vs. 1.61 ± 0.46 L, P = 0.015) and higher peak respiratory rate (34 ± 7/min vs. 31 ± 6/min, P = 0.002). In 33 patients, EOV disappeared during exercise, whereas in 45 patients EOV persisted. Fifty percent of EOV disappearing patients had an increase in the VO₂/WL relationship after EOV regression, consistent with a more efficient oxygen delivery to muscles. No cardiopulmonary exercise test parameter was associated with the different behaviour of VO₂/WL.

The presence of EOV negatively influences exercise performance of chronic heart failure patients likely because of an increased cost of breathing. EOV disappearance during exercise is associated with a more efficient oxygen delivery in several cases. Eur J Cardiovasc Prev Rehabil 15:688–692 © 2008 The European Society of Cardiology

There is limited information about whether a diagnosis of metabolic syndrome (MS) predicts peripheral arterial disease independently of diabetes. This study assessed whether MS adds prognostic information beyond that relating to diabetes in the identification of a low ankle–brachial index (ABI).

Cross-sectional population-based study of people aged 50–75 years.

Eight hundred and fifty-eight participants were randomly selected. The likelihood of low ABI (< 0.90) was calculated according to MS status before and after excluding diabetes. The National Cholesterol Education Panel and the International Diabetes Federation (IDF) definitions of MS were used.

The prevalence of National Cholesterol Education Panel-defined and IDF-defined MS, and low ABI was 57.8, 61.1 and 7.5%, respectively. When there were participants with three or more criteria for MS, participants with only three criteria, and participants with four or five criteria were compared with participants without MS, the odds ratio for low ABI was 1.89 (95% confidence interval, 1.08–3.30), 1.34 (0.70–2.60) and 2.70 (1.45–5.03), respectively. The association of MS and low ABI lost statistical significance after excluding diabetes. No difference was observed using the IDF definition of MS. Conclusion Screening of participants with MS does not improve the identification of abnormal ABI provided by diabetes. Eur J Cardiovasc Prev Rehabil 15:693–697 © 2008 The European Society of Cardiology

The reasons for greater premature withdrawal from cardiac rehabilitation programmes (CRP) in women compared with men and differences in baseline predictors of withdrawal have not been extensively studied.

Reasons for withdrawal from a 12-month CRP in 1089 women and 4833 men were ascertained by interview. Regression analysis was used to determine demographic and baseline medical conditions that predicted noncompletion.

Noncompletion was higher in women than men (35 vs. 29%, P < 0.001), however, multivariate regression revealed that sex was not the main driver of withdrawal but rather, other factors common to women at entry to CR could predict noncompletion (i.e. not being married, being obese, lower peak oxygen uptake, not having earlier coronary artery bypass graft surgery, being on antidepressant medication and not on lipid lowering or β-blockade medication). By interview, a greater proportion of women than men withdrew for medical issues (P < 0.001), specifically musculoskeletal conditions (P = 0.002) and multiple medical problems (P = 0.02). A greater proportion of women withdrew for transportation (P < 0.001) and family issues (P = 0.009), whereas work issues affected men more than women (P = 0.009), as did lack of interest (P = 0.009). Women were more likely to withdraw than men regardless of age (P < 0.05).

Women were significantly more likely to withdraw from CRP than men because of greater medical problems, specifically musculoskeletal and multiple medical reasons. Lack of interest and work obligations were greater barriers for men while transportation and family obligations more often affected women. Difference in withdrawal can be explained by the profile of women rather than by sex independently. Eur J Cardiovasc Prev Rehabil 15:698703 © 2008 The European Society of Cardiology

To study whether symptoms of depression and anxiety would affect changes in exercise capacity and body mass index (BMI) during rehabilitation.

Comprehensive cardiac outpatient rehabilitation intervention program.

We investigated exercise capacity, BMI, and symptoms of depression and anxiety before and after cardiac rehabilitation in 114 patients with coronary artery disease. The Hospital Anxiety and Depression Scale (HADS) was applied to assess symptoms of depression (HADS-D) and anxiety (HADS-A).

Exercise capacity increased (127 ± 47 vs. 144 ± 51 watts, P < 0.001) and symptoms of depression (4.0 ± 3.6 vs. 2.7 ± 2.7, P < 0.001) and anxiety (5.4 ± 4.4 vs. 4.1 ± 3.6, P < 0.001) decreased with the program, whereas BMI did not change. After controlling for covariates, HADS-D (r = −0.19, P = 0.47) and HADS-A (r = 0.17, P < 0.09) correlated with change in exercise capacity. Change in HADS-A also correlated with that in exercise capacity (r = 0.18, P < 0.06). Changes in depression and anxiety were not significantly related to those in BMI.

Symptoms of depression and anxiety affected change in exercise capacity during cardiac rehabilitation. Depressive symptoms may impair improvement in exercise capacity, thereby mitigating the cardiovascular benefit achieved by cardiac rehabilitation programs. Eur J Cardiovasc Prev Rehabil 15:704–708 © 2008 The European Society of Cardiology

Short-term (within 6 weeks follow-up) clinical studies indicate that implantation of bone marrow cells (BMCs) into ischemic limbs may improve peripheral ischemia. Here, the long-term safety and feasibility of intraarterial autologous BMCs with oral treatment with antioxidants and L-arginine were investigated in patients with critical ischemia on account of advanced atherosclerotic peripheral arterial disease (PAD).

Eighteen patients with PAD (advanced III/IV Fontaine stages) were enrolled in this study (NCT00306085). An additional group of 18 patients taking maximal drug therapy that refused BMC therapy served as control. The BMC-treated group received two doses of BMCs in the leg arteries (time 0 and 45 days). After 30 days from the first BMC dose, patients received daily antioxidants, and l-arginine. Therapeutic neoangiogenesis was estimated by angiography and laser Doppler capillaroscopy.

Ankle brachial index improvement (ΔABI: >0.1) was seen in 10 patients at 3 months and in 12 patients at 12–18 months. Ischemic ulcers improved in 13 patients (after 6–12 months). Although two patients underwent amputation, the mean maximum walking distance significantly increased at 3 months and was sustained up to 18 months. Among conservative patients, 10 underwent amputation in comparison with two BMC-treated patients (55.6 vs. 13.3%; P = 0.014).

This small study shows that intraarterial autologous BMC and antioxidants and l-arginine therapy is safe and effective in patients with advanced atherosclerotic PAD with positive effects until 18 months. Eur J Cardiovasc Prev Rehabil 15:709–718 © 2008 The European Society of Cardiology

The aim was to investigate whether multivariate coefficients of serum cholesterol in the prediction of coronary heart disease (CHD) deaths were similar across different cultures in a long-term follow-up.

Thirteen cohorts for a total of 10157 men aged 40–59 years at entry, enrolled in seven countries (USA, Finland, the Netherlands, Italy, Serbia, Greece, Japan) were repeatedly examined and followed up for 40 years.

Serum cholesterol measured at baseline, and then on repeated occasions, was studied, using multivariate models, in relation with the occurrence of CHD deaths during a 40-year follow-up.

Homogeneity of multivariate serum cholesterol coefficients was found considering cholesterol levels at baseline, as average of up to three measurements during the first 10 years, as average of up to six measurements in 35 years, using the time-dependent technique with up to three measurements in 10 years, and with up to six measurement in 35 years.

The strength of the association between serum cholesterol and CHD death seems homogeneous across different cultures characterized by different levels of serum cholesterol and different absolute risk of CHD death. Eur J Cardiovasc Prev Rehabil 15:719–725 © 2008 The European Society of Cardiology

Atrial fibrillation (AF) is the most common arrhythmia associated with coronary artery surgery and is an important factor contributing to postoperative morbidity and mortality. Recently, there is growing evidence that dysregulation of the oxidant-antioxidant balance, inflammatory factors and discordant alteration of energy metabolites may play a significant role in its pathogenesis.

We evaluated the link between postoperative atrial fibrillation with inflammatory factors and oxidative stress.

We searched all databases in Medline, Pubmed, ISI, the Cochrane database, and Embase. We identified more than 100 trials, multiple meta-analyses, and three sets of practice guidelines for the prevention of PAF in cardiac surgery.

Mechanisms of postoperative AF are likely to be multifactorial and are influenced by preoperative, intraoperative and postoperative factors including a genetic basis. Electrical remodelling is thought to be related to the generation of reactive oxidant species and inflammatory factors during the ischemia-reperfusion phase of cardiac surgery. Nicotinamide adenine dinucleotide phosphate (NADPH) oxidase was found to be the primary source of superoxide within the human atrial myocardium (in patients in sinus rhythm and in those with AF) and linked with paroxysmal and chronic AF. Reactive oxidant species cause lipid peroxidation, breakdown of cell membrane, decreased mitochondrial function, calcium overload and apoptosis. This affect was shown to be reversed by exogenous nitric oxide/donors (sodium nitroprusside). Inflammatory factors such as the rise in white blood cell count, C-reactive proteins were implicated in the pathogenesis of AF. In contrast, new evidence identifies statins as having both antioxidant and anti-inflammatory properties and that their use reduces the incidence of postoperative AF (57% in the control vs. 35% in the atorvastatin group). Other antiinflammatory strategies include steroids with one study showing postoperative AF occurred in 21% in the steroid group compared with 51% in the placebo group although their use resulted in an increase in other complications. The mainstay of therapy however, remains to be beta-blockers alone which impart a modest influence on overall rates of AF with a reduction from 33.7 to 16.9% (OR: 0.37, 95% CI: 0.29–0.48). Angiotensin converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers has been shown in one study to reduce the risk of developing new-onset AF by nearly 50%, although this has not been adequately evaluated in cardiac surgery.

Inflammatory factors and oxidative stress play a major role in the pathogenesis of postoperative AF. This review provides an analysis of current evidence in support of efforts directed at antiinflammatory and antioxidant agents as interventions. Eur J Cardiovasc Prev Rehabil 15:735–741 © 2008 The European Society of Cardiology