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Aims: The aim of this study was to evaluate isometric muscle contraction (handgrip) changes on key elements of cardiac afterload, before and after raloxifene administration in postmenopausal women., Methods/results: 12 postmenopausal and 12 fertile women were studied. Postmenopausal women underwent raloxifene administration (60 mg/day for 30 days). We evaluated vascular reactivity in superficial palmar arterial arch during handgrip in postmenopausal women before and after (M+R) drug administration, and in controls. Blood flow was higher after raloxifene administration (p<0.05). Mean arterial pressure (MAP)/mean arterial flow (Fmed) and arterial pulse pressure (APP)/systolic maximum arterial flow (Fmax syst) were lower after raloxifene administration (p<0.001). Systolic blood pressure (SBP)/R-R ratio was higher in postmenopausal women than in the controls and M+R (p<0.01). End-handgrip systolic and diastolic blood pressure were higher in patients before raloxifene administration than in controls (p<0.001); diastolic and mean arterial pressure reduced after raloxifene administration (p<0.001). End-effort APP/Fmax syst-ratio before treatment was higher than baseline (p<0.05). Controls and no-treated patients showed a MAP/Fmed ratio at end-handgrip higher than M+R group and rest (p<0.05). Handgrip reduced R-R interval and increased SBP/R-R ratio were shown in all groups (p<0.05)., Conclusions: Raloxifene reduced the vascular effects of isometric muscle contraction by modulating the vasomotor tone of peripheral vessels in relation to exercise., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Purpose: Most patients with heart failure are elderly with multiple coexisting diseases and heart failure is the most common discharge diagnosis in elderly hospitalized patients. Despite major advances in the pharmacotherapy of heart failure, hospitalization rates remain high, owing in large part to a multitude of psychosocial, behavioral, and financial factors that serve as barriers to effective compliance with prescribed treatment. In the last decade, several models have been proposed in order to optimise the long-term management of elderly patients with heart failure., Design: A review of most significant and recent models available was performed., Results: Several studies have documented the efficacy of specialized multidisciplinary heart failure disease management programs in terms of reducing hospital utilization, improving quality of life, functional capacity, patient satisfaction, compliance with diet and medications and decreasing cost of care., Conclusions: At present, the greatest challenge in managing elderly heart failure patients is to more effectively implement proven treatments and disease management systems.

Background: Cardiovascular disease remains the main cause of death and morbidity in the industrialized world. Atherosclerosis is a slowly progressive disease; coronary artery disease may be the first presentation of a systemic pathology. The association between coronary artery disease and peripheral vascular disease has often been confirmed by multicenter trials; nevertheless it still remains a subject of debate., Methods: In order to assess the incidence of coronary artery disease and the degree of associated vascular lesions, between January 1997 and September 1999, in the Department of Cardiothoracic Surgery of the Second University of Naples (Italy), all candidates to coronary artery bypass grafting (CABG) were submitted to routine preoperative echo color Doppler study of the carotid vessels, abdominal aorta and iliac-femoral arteries. The correlation between the echo color Doppler findings, the angiographic patterns of coronary lesions and atherosclerotic risk factors was analyzed in all cases., Results: Among 540 patients undergoing CABG, 418 (77.4%) had carotid disease, with a stenosis > 70% in 62 (11.3%). Forty-nine (79%) patients had asymptomatic severe carotid disease. A significant correlation between the severity of coronary disease and the incidence of severe carotid disease was found (p = 0.02). An abdominal aortic dilation was found in 37 cases (6.7%). Its diameter exceeded 35 mm in 14 patients (2.5%) and in 8 it was associated with triple vessel coronary disease. Atherosclerotic lesions of the iliac-femoro-popliteal axis were found in 394 (72.9%) patients and strongly correlated with the severity of coronary artery disease (p = 0.02); lesions were hemodynamically significant in 91 (16.8%) cases., Conclusions: Our study emphasizes the association between coronary artery disease and vascular disease. Non-invasive complete arterial investigation should be routinely performed in patients undergoing CABG.

Despite the importance of beta-blockers for secondary prevention after acute myocardial infarction, several studies suggested that they are substantially underutilized, particularly in elderly patients. Actually no randomized clinical trial including elderly patients with heart failure treated with beta-blockers is reported in the literature. However, previous studies showed that beta-blocker therapy was associated with a reduction in total cardiac mortality (-40%) of elderly patients with acute myocardial infarction without left ventricular dysfunction. Furthermore, a meta-analysis of five trials including 1729 patients aged > 60 years with heart failure evidenced a non-significant trend versus total mortality reduction in patients receiving beta-blockers (odds ratio 0.68, 95% confidence interval 0.51-0.93, p = 0.4).