Thursday, February 28, 2008

Medwire -

Meta-analysis shows PCI beats medical therapy for late reperfusion
28 February 2008
Patients who undergo percutaneous coronary intervention more than 12 hours after suffering an acute myocardial infarction have improved cardiac function and survival compared with those who receive medical management, a meta-analysis indicates.

Chest pain causes sustained psychological distress
28 February 2008
Chest pain causes significant anxiety and depression even after people have been told that is not due to cardiovascular disease, say UK researchers.

Eye disease more than doubles MI risk
28 February 2008
The progressive eye disease age-related macular degeneration doubles the risk for death due to cardiovascular disease, reveals a study from Australia.

Tuesday, February 26, 2008

Top 10 Articles on Medscape

Top 10 Most Read Articles by Cardiologists:

A 57-Year-Old Asymptomatic Male Presents for Evaluation of an Abnormal ECG Obtained During a Physical CMEThe patient presents with an abnormal ECG. Is there cause for concern?

ENHANCE Saga Continues: Experts Dispute Ezetimibe's Future and "Weight" of Imaging Studies

Questioning the Importance of LDL Cholesterol: The ENHANCE Fallout

Atrial Fibrillation: Diagnosis and Management

Nebivolol Approved in US CME

Abnormal ECG Patterns in Athletes: An Initial Expression of Underlying Cardiomyopathy?

ENHANCE Results Yield Disappointment for Ezetimibe

Staying Active and Drinking Moderately Is Key to a Long Life CME

Meta-Analysis Shows Statins Reduce All-Cause Mortality 22% in Elderly CHD Patients


Folic Acid -- Finally Some Good News: A Best Evidence Review CME/CE

HF burden increasing in USA

By Caroline Price
26 February 2008
Arch Intern Med 2008; 168: 418-424

MedWire News: The prevalence of heart failure (HF) has increased recently in the USA, despite a decline in its incidence, study findings indicate.

They show that the incidence of HF fell overall among both men and women from 1994 to 2003, but, owing to improved survival rates, the number of people living with HF increased during this period.

Lesley Curtis (Duke University School of Medicine, Durham, North Carolina) and colleagues studied a nationally representative 5% sample of Medicare beneficiaries, of whom 622,786 were diagnosed with HF between 1994 and 2003.

"Estimates of the incidence and prevalence of HF in elderly persons translate directly into projections of resource use for the Medicare program, so accurate estimates are essential," they note.

The researchers report in the Archives of Internal Medicine that the incidence of HF declined slightly from 32 per 1000 person-years in 1994 to 29 per 1000 person-years in 2003 (p<0.01).

The incidence actually increased over this time in patients aged 65-69 years, but this was offset by the decline among patients aged 75 years or over.

Meanwhile, the prevalence of HF increased steadily from around 140,000 in 1994 to 200,000 in 2003. These numbers equated to rates of around 90 and 121 per 1000 beneficiaries, respectively. Each yearly increase in the prevalence rate was significant (p<0.01) for the whole group and in both men and women.

The increase in prevalence reflected improved survival rates. Between 1994 and 2003, both unadjusted and risk-adjusted mortality declined slightly. Risk-adjusted 30-day mortality decreased by over 5%, from 13.0% to 12.6% in men and from 11.5% to 10.8% for women. There was a 5% decrease in 1-year mortality, from 28.9% to 27.5% overall. And 5-year mortality fell by 3%, from 67.5% to 64.9% in men and from 61.7% to 60.2% in women.

Closer inspection showed that the rate of increase in prevalence slowed over time, growing from 90 per 1000 beneficiaries in 1994 to 121 per 1000 in 2000, after which it remained at around 120 per 1000 up to 2003. This reflected declines in incidence and relatively steady mortality rates, the authors note.

They conclude: "Identifying optimal strategies for the treatment and management of HF will become increasingly important as the size of the Medicare population grows."
Curtis commented: "From all indications, HF will continue to be a major public health burden, consuming billions of dollars each year."

Free abstract

Friday, February 22, 2008

Only One-Third of Adults Know Heart Attack Signs

Only about one-third of U.S. adults are aware of the five major warning signs of heart attacks, according to a CDC survey in MMWR.

The telephone survey of 72,000 people, conducted in 2005, found that, nationally:

48% recognize pain or discomfort in the jaw, neck, or back as a warning sign;
62%, feeling weak, lightheaded, or faint;
85%, pain or discomfort in the arms or shoulder;
92%, chest pain or discomfort;
93%, shortness of breath.

The numbers were even lower among non-Hispanic blacks and Hispanics, men, and those with less than a high school education.

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Only One-Third of Adults Know Heart Attack Signs
Only about one-third of U.S. adults are aware of the five major warning signs of heart attacks, according to a CDC survey in MMWR.
The telephone survey of 72,000 people, conducted in 2005, found that, nationally:

48% recognize pain or discomfort in the jaw, neck, or back as a warning sign;
62%, feeling weak, lightheaded, or faint;
85%, pain or discomfort in the arms or shoulder;
92%, chest pain or discomfort;
93%, shortness of breath.

The numbers were even lower among non-Hispanic blacks and Hispanics, men, and those with less than a high school education.

In addition, 86% said they would dial 911 if they thought someone was having a heart attack or stroke.

Thursday, February 21, 2008

Cardiac Surgery Drug Proven To Increases Death Rate

21 Feb 2008

The largest study to date of a controversial cardiac surgery drug shows it increases death rates and damages kidney function, according Duke University Medical Center researchers. Aprotinin, a drug used to limit bleeding, was temporarily suspended from marketing in the U.S. in November 2007 after a small Canadian study was stopped because similar findings were discovered. The drug, Trasylol, is manufactured by Baylor AG. "We're not surprised by the results," says Dr. Andrew Shaw, an associate professor in Duke Medicine's department of anesthesiology and the lead author of the paper which appears in the February 21 edition of the New England Journal of Medicine. "It's what we expected to find." The Duke study is significant because "it is more than twice the size of the next largest study of aprotinin," says Shaw. The prospective data was collected between 1996 and 2005. "Unlike the highly selected nature of randomized trial populations, our data represent the every day cardiac bypass surgery patient population. The data were collected at a time when aprotinin was thought to be safe."

The Duke team started analyzing its database of patients after a 2006 NEJM study reported aprotinin use may increase the risk of heart attack, stroke and serious kidney injury. "We were looking for an association between exposure to the drug and subsequent adverse outcomes," Shaw says. "We found an increased incidence of death in patients who received aprotinin. That higher death rate seemed to persist even when we were able to control for the differences seen between the patient groups." Shaw and his Duke colleagues also linked aprotinin to impaired kidney function. "Kidney function is measured by serum creatinine levels which indicate how well the blood is filtering waste products," he says.

The study found aprotinin use increased serum creatinine levels, but they did not report an increase in patients needing dialysis. Shaw believes "that's because we probably didn't have enough patients who needed dialysis in our study to detect a significant statistical difference, although the incidence was numerically higher." Of the 10,275 patients studied, 1343 patients (13.2%) received aprotinin, 6776 patients (66.8%) received aminocaproic acid (another drug used to limit bleeding) and 2029 patients (20.0%) received no therapy. All patients underwent coronary-artery bypass surgery (CABG), and 1181 of them also underwent valve surgery.

Patients who received either aminocaproic acid or no therapy did not have high rates of death or poor kidney function seen in the aprotinin group. After gaining FDA approval in 1993, aprotinin was used routinely during cardiac surgery, particularly on high-risk patients, to reduce bleeding and the need for blood transfusion. According to previously published research, patients undergoing cardiac surgery receive approximately one fifth of all the red cell transfusions in the U.S., and each unit transfused is known to increase the risk of infection. Shaw says this study does not rule out the possibility that the increased death rate was due to high-risk, sicker patients receiving the drug. "You would expect sicker patients would be more likely to die," he said. "The unanswered question is, 'are there differences between the patient groups that we were unable to detect that led to the increased death rate, or is the death rate due to exposure to the drug?' "Our study doesn't answer that question nor was it designed to," he says. "But it does further raise the question of the safety of aprotinin. And, on a broader scale, it highlights the importance of post-marketing observational studies of drugs that are widely used."

Article adapted by Medical News Today from original press release.

Wednesday, February 20, 2008

Patients Less Likely to Survive In-Hospital Cardiac Arrests on Nights, Weekends

Cardiac arrest during the night or on weekends places hospital patients at higher risk for death and complications, a JAMA article reports.

Using national registry data on nearly 87,000 adult cardiac arrests occurring between 2000 and 2007, researchers characterized the events by time-of-day and day-of-week. When compared with arrests that occurred during the day or evening hours, nighttime events (11 p.m. to 7 a.m.) showed significantly lower rates of survival to discharge, return of spontaneous circulation for more than 20 minutes, survival at 24 hours, and favorable neurologic outcome.

Rates on weekends were similar to those on weekday nights.

The authors write that, in searching for causes, "it is reasonable to focus on the potential for decreased physical and psychological performance on the part of the health care worker, different staffing patterns, and less patient surveillance during nights and weekends."

JAMA article (Free abstract; full text requires subscription)

Associated Press story (Free)

Related Journal Watch link(s):

Journal Watch Cardiology summary (Free)

Tuesday, February 19, 2008

Chances Of Survival Depends On What Time Cardiac Arrest Occurs

Medical News Today - 19 Feb 2008

If you are in the hospital and have cardiac arrest at night or on the weekend, you have a significantly lower chance of survival to discharge than if you had the arrest during day or evening times on weekdays, according to Mary Ann Peberdy of Virginia Commonwealth University in Richmond, VA and colleagues. The results of their study are published in The Journal of the American Medical Association (JAMA).

The researchers suggest that patient, hospital, staffing, and response factors could come together to reduce the effectiveness of detecting and treating cardiac arrests at night. The findings are essential to inform decisions regarding hospital staffing, training, care delivery processes, and equipment - especially if in-hospital cardiac arrests are more frequent or survival is less likely on nights and weekends.

The study data consisted of 86,748 adult, in-hospital cardiac arrest events occurring at 507 medical/surgical hospitals from January 2000 to February 2007.

All of the hospitals participate in the American Heart Association's National Registry of Cardiopulmonary Resuscitation. Peberdy and colleagues evaluated survival rates for adults with in-hospital cardiac arrest by time of day and day of week. They examined survival from cardiac arrest using the following definitions:

Day/evening is 7:00 a.m. to 10:59 p.m.
Night is 11:00 p.m. to 6:59 a.m.
Weekend is 11:00 p.m. on Friday to 6:59 a.m. on Monday

There were 58,593 in-hospital cardiac arrest events that occurred during day/evening hours (15,110 on weekends) and 28,155 cases during night hours (7,790 on weekends).Key findings include that compared to day/evening cardiac arrest events:

Rates of survival to discharge were lower at night, 14.7% vs. 19.8%,
Rates of return of spontaneous circulation for longer than 20 minutes were lower at night, 44.7% vs. 51.1%,
Rates of survival at 24 hours were lower at night, 28.9% vs. 35.4%,
Rates of favorable neurological outcomes were lower at night, 11.0% vs. 15.2%,

There was only a slight difference between survival to discharge at night during the week (14.6%) and during weekends (14.8%). However, the rate of survival during day/evening weekdays was higher than on weekends (20.6% vs. 17.4%).

The researchers write, "The principal finding of this study was that survival to discharge following in-hospital cardiac arrest was lower [when the arrest occurred] during nights and weekends compared with day/evening times on weekdays, even after accounting for many potentially confounding patient, arrest event, and hospital factors.".

"The mechanism for the decreased survival during the night is likely multifactorial, potentially including biological differences in patients as well as health care staff and hospital staffing and operational factors.

These data suggest the need to focus on night and weekend hospitalwide resuscitation system processes of care that can potentially improve patient safety and survival following cardiac arrest," conclude the authors.

Click Here to View JAMA website

Monday, February 18, 2008

(ACC/AHA) scientific statement on clinical performance measures for adults with atrial fibrillation (AF) or atrial flutter (AFl).

Citation: J Am Coll Cardiol. 2008;51:865-884.

Author(s): Estes NA, Halperin JL, Calkins H, et al.

Perspective: The following are 10 points to remember from this American College of Cardiology/American Heart Association (ACC/AHA) scientific statement on clinical performance measures for adults with atrial fibrillation (AF) or atrial flutter (AFl).

1. Antithrombotic therapy is indicated for all patients with AF except those with lone AF or contraindications.

2. Assessment of thromboembolic risk factors should include prior stroke/transient ischemic attack (TIA), age ≥75 years, hypertension, diabetes, and heart failure or left ventricular (LV) systolic dysfunction.

3. Prior stroke/TIA is the strongest risk factor and is an indication for anticoagulation with warfarin.

4. Rheumatic mitral stenosis also is a strong risk factor for stroke and is an indication for warfarin even if no other risk factors are present.

5. Warfarin also is indicated for patients with >1 moderate risk factor (age ≥75 years, hypertension, diabetes, and heart failure/LV systolic dysfunction.

6. Aspirin may be used for stroke prevention in patients without any risk factors.

7. Antithrombotic therapy (warfarin or aspirin) should be used on an individualized basis in patients with one moderate risk factor.

8. The international normalized ratio (INR) initially should be measured at least once per week and then once per month after a stable degree of anticoagulation when an INR of 2-3 is achieved.

9. When aspirin is used for stroke prevention, the daily dose should be 81-325 mg/day.

10. Patients with AFl should receive antithrombotic therapy in the same fashion as patients with AF. Fred Morady, M.D., F.A.C.C.

Statins Found to Reduce Risk of Recurrent Atrial Fibrillation

TOURS, France, Feb. 18 -- Statin therapy significantly reduces the risk of atrial fibrillation in patients with a history of the condition and other high-risk groups, a meta-analysis has suggested.

Overall, statins reduced the odds ratio for atrial fibrillation by more than 60% compared with patients who did not receive the drugs, Laurent Fauchier, M.D., Ph.D., of Trousseau University Hospital Center, and colleagues reported in the Feb. 26 issue of the Journal of the American College of Cardiology.

Statins appeared to exert a greater impact in secondary prevention of atrial fibrillation rather than new-onset or postoperative atrial fibrillation.

"These results provide some evidence of the benefit of statins beyond their lipid-lowering activity," the authors concluded. "However, large-scale, prospective, randomized clinical trials are still needed to establish whether statins bring a similar benefit and are an appropriate therapeutic option in all subgroups of patients for the management of atrial fibrillation."

Observational studies have provided evidence of a protective effect of statins against atrial fibrillation. However, data were insufficient to provide a basis for recommending statin therapy to prevent the arrhythmia.

In an attempt to bring the potential atrial fibrillation benefit into sharper focus, Dr. Fauchier and colleagues searched for all randomized controlled trials of statins published from January 1980 through June 2007. They identified six trials involving 3,557 patients given statins versus placebo or a control therapy for treatment or prevention of atrial fibrillation.

Three studies examined the use of statins in patients with a history of paroxysmal atrial fibrillation or who were undergoing cardioversion for persistent atrial fibrillation. The remaining three trials evaluated statins in patients undergoing cardiac surgery or after acute coronary syndrome.

Overall, statin therapy was associated with a 61% decrease in the risk of atrial fibrillation (OR 0.39, 95% CI 0.18 to 0.85, P=0.02). Separate analyses suggested a more marked effect in the setting of secondary prevention (OR 0.33, 95% CI 0.10 to 1.03, P=0.06) than for new-onset or postoperative atrial fibrillation (OR 0.60, 95% CI 0.27 to 1.37, P=0.23).

The authors acknowledged they were unable to evaluate the possible impact of statin dose or the degree of LDL-lowering on arrhythmic events. They also noted that atrial fibrillation might arise from different factors in different patient subgroups, potentially making certain patients more responsive to an intervention compared with others.

Despite those limitations, Dr. Fauchier and colleagues concluded, "Use of statins was significantly associated with a decreased risk of incidence or recurrence of AF inpatients in sinus rhythm with a history of previous AF or undergoing cardiac surgery or after acute coronary syndrome."

The authors reported no disclosures.

Primary source: Journal of the American College of CardiologySource reference:Fauchier L, et al "Antiarrhythmic effect of statin therapy and atrial fibrillation: a meta-analysis of randomized controlled trials" J Am Coll Cardiol 2008; 51: DOI:10.1016/j.jacc.2007.09.063.

Restricted clopidogrel access linked to increased mortality after PCI

18 February 2008

Medical insurance restricting access to clopidogrel can delay or stop patients receiving treatment with the drug after percutaneous coronary intervention with stenting, which in turn may increase their risk for dying, a Canadian study suggests.

Medwire News: Restricted clopidogrel access linked to increased mortality after PCI

Saturday, February 16, 2008

Systematic Review: Comparing Routine and Selective Invasive Strategies for the Acute Coronary Syndrome

Rehan Qayyum, MD; M. Rizwan Khalid, MD; Jurga Adomaityte, MD; Stylianos P. Papadakos, MD; and Frank C. Messineo, MD

Annals of Internal Medicine
5 February 2008 Volume 148 Issue 3 Pages 186-196

Background: Patients with non–ST-segment elevation acute coronary syndrome (ACS) are managed with either a routine invasive strategy, in which all patients receive coronary angiography, or a selective invasive strategy, in which only patients with refractory or inducible ischemia receive coronary angiography.

Purpose: To evaluate whether a routine invasive strategy improves cardiovascular outcomes more than a selective invasive strategy in patients with non–ST-segment elevation ACS.

Data Sources: English-language publications in PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials from 1966 to 18 September 2007.

Study Selection: Two investigators independently reviewed searches and selected trials that compared death or myocardial infarction outcomes among adults with non–ST-segment elevation ACS by randomly assigning patients to either a routine invasive strategy or a selective invasive strategy.

Data Extraction: Three investigators independently abstracted data from trial reports by using standardized forms.

Data Synthesis: 10 trials with a total of 10 648 patients (mean age, 62 years; 71% male; median follow-up, 16.5 months) were found. Trial participants had typical symptoms of unstable angina and frequently had a positive electrocardiogram or marker evidence of myocardial ischemia. Of the 5330 participants assigned to the routine invasive strategy group, 847 had the composite outcome of death or nonfatal myocardial infarction, compared with 928 of 5318 participants assigned to the selective invasive strategy group (relative risk, 0.90 [95% CI, 0.74 to 1.08]). Four hundred thirty-eight patients in the routine invasive strategy group and 463 in the selective invasive strategy group died (relative risk, 0.95 [CI, 0.80 to 1.14]). Four hundred ninety and 569 nonfatal myocardial infarctions, respectively, occurred in the 2 groups (relative risk, 0.86 [CI, 0.68 to 1.08]).

Limitations: Methodology, protocols, and outcome definitions differed substantially among the trials. The lower bound of the CI for the pooled results did not rule out the superiority of the routine invasive strategy.

Conclusion: Available trial evidence is heterogeneous and insufficient for comparing routine and selective invasive strategies. Therefore, in patients with non–ST-segment elevation ACS a routine invasive strategy cannot be proven to reduce deaths or nonfatal myocardial infarction.

Friday, February 15, 2008

Women less likely to receive optimum heart failure care than men

Women less likely to receive optimum heart failure care than men

Women with heart failure are less likely to undergo assessment of left ventricular function and be treated with evidence-based drugs than their male counterparts, European investigators have discovered.

Heart 2008; 94: e10

One alcoholic drink relaxes but two stress circulation

One alcoholic drink relaxes but two stress circulation

One drink of alcohol results in vasodilation and reduces cardiac output, but a second cancels out these beneficial effects, increasing the heart rate, cardiac output, and sympathetic nervous activity, a Canadian study reveals.

Am J Physiol Heart Circ Physiol 2008; 294: H605-H612

Aircraft Noise Raises Blood Pressure Even While People Are Sleeping, Says Study

ScienceDaily (Feb. 13, 2008) —

Night-time noise from aircraft or traffic can increase a person's blood pressure even if it does not wake them, according to a new study published in the European Heart Journal. Scientists from Imperial College London and other European institutions monitored 140 sleeping volunteers in their homes near London Heathrow and three other major European airports.


Thursday, February 14, 2008

Effect of Moderate or Intensive Disease Management Program on Outcome in Patients With Heart Failure

Effect of Moderate or Intensive Disease Management Program on Outcome in Patients With Heart Failure

Coordinating Study Evaluating Outcomes of Advising and Counseling in Heart Failure (COACH)

Arch Intern Med. 2008;168(3):316-324.


Heart failure (HF) disease management programs are widely implemented, but data about their effect on outcome have been inconsistent.

Methods The Coordinating Study Evaluating Outcomes of Advising and Counseling in Heart Failure (COACH) was a multicenter, randomized, controlled trial in which 1023 patients were enrolled after hospitalization because of HF. Patients were assigned to 1 of 3 groups: a control group (follow-up by a cardiologist) and 2 intervention groups with additional basic or intensive support by a nurse specializing in management of patients with HF. Patients were studied for 18 months. Primary end points were time to death or rehospitalization because of HF and the number of days lost to death or hospitalization.

Results Mean patient age was 71 years; 38% were women; and 50% of patients had mild HF and 50% had moderate to severe HF. During the study, 411 patients (40%) were readmitted because of HF or died from any cause: 42% in the control group, and 41% and 38% in the basic and intensive support groups, respectively (hazard ratio, 0.96 and 0.93, respectively; P = .73 and P = .52, respectively). The number of days lost to death or hospitalization was 39 960 in the control group, 33 731 days for the basic intervention group (P = .81), and 34 268 for the intensive support group (P = .49). All-cause mortality occurred in 29% of patients in the control group, and there was a trend toward lower mortality in the intervention groups combined (hazard ratio, 0.85; 95% confidence interval, 0.66-1.08; P = .18). There were slightly more hospitalizations in the 2 intervention groups (basic intervention group, P = .89; and intensive support group, P = .60).

Conclusions Neither moderate nor intensive disease management by a nurse specializing in management of patients with HF reduced the combined end points of death and hospitalization because of HF compared with standard follow-up. There was a nonsignificant, potentially relevant reduction in mortality, accompanied by a slight increase in the number of short hospitalizations in both intervention groups.

Wednesday, February 13, 2008

Do Statins Dull the Minds of Some Patients?

Wall Street Journal

February 12, 2008, 8:51 am

Posted by Jacob Goldstein

Here’s what the vice chairman of medicine at New York Presbyterian Hospital says about the effects of Lipitor on the cognitive function of some women: “This drug makes women stupid.”

Pfizer, which sells the cholesterol drug, says the pill has been tested in 400 clinical trials and racked up 145 million patient years of experience. The extensive data “do not establish a casual link between Lipitor and memory loss,” Pfizer says

And, as the WSJ’s Melinda Beck notes in today’s Health Journal column, the patient information sheet for the drug does not list cognitive issues such as memory loss or fuzzy thinking among the drug’s possible side effects. But the article also notes that anecdotal reports of a connection between statins and mental problems in some patients have been “rampant for years.”

The problem with anecdotal evidence, of course, is that it could always be coincidence masquerading as causality — the patients might have had memory problems even if they weren’t on the drug. And most cardiologists say the benefits of statins far outweigh any risks.

In any case, a clearer picture may be forthcoming: Researchers at the University of California at San Diego will soon complete a randomized controlled trial examining the effects of statins on thinking, mood, behavior and quality of life.

Tuesday, February 12, 2008

Risk For Heart Disease Elevated By Combined Hostility And Depression

12 Feb 2008

Researchers led by Jesse Stewart, Ph.D., assistant professor of psychology at Indiana University-Purdue University Indianapolis, report that hostility and depression appear to act together in a complex way to elevate inflammatory proteins in the human body, possibly putting hostility plus depression on the list of risk factors for heart disease along with high blood pressure, elevated cholesterol, and smoking.

The findings, that hostility enhances inflammatory processes relevant to heart disease only in the presence of depressive symptoms, are published in the February-March 2008 issue of Psychosomatic Medicine.

Dr. Stewart and colleagues examined associations of depressive symptoms and hostility with blood levels of two inflammatory proteins, interleukin-6 and C-reactive protein, that are predictive of future heart disease.

Participants in the study were 316 healthy men and women aged 50-70. Previous studies have found depression to be associated with raised inflammatory protein levels.

Other studies have confirmed links between hostility and inflammatory proteins that are predictive of heart disease.

But this study is the first to find that, among older adults, the relationship between hostility and these inflammatory proteins depends on the level of depression.

"In our study, we looked at depression and hostility simultaneously, and we found that the relationship of these negative emotions to inflammatory markers is more complex and much stronger than depression or hostility individually," said Dr. Stewart, who notes that depression and hostility tend to co-occur within individuals.

Psychological risk factors for heart disease merit further study.

According to Dr. Stewart, the strength of the association of psychological factors with future heart disease is similar to that of traditional risk factors like smoking, high blood pressure, and elevated cholesterol.

"There are of course mental health reasons to treat depression and hostility. Now we know there is a physical health reason - the link to cardiovascular diseases," said Dr. Stewart, a clinical health psychologist at IUPUI's School of Science, is an IU Center for Aging Research affiliated scientist.

Article adapted by Medical News Today from original press release.

Recent Trends in the Prevalence of Coronary Disease - A Population-Based Autopsy Study of Nonnatural Deaths

Arch Intern Med. 2008;168(3):264-270.

Peter N. Nemetz, PhD; Véronique L. Roger, MD, MPH; Jeanine E. Ransom, BS; Kent R. Bailey, PhD; William D. Edwards, MD; Cynthia L. Leibson, PhD

Background Despite increases in obesity and diabetes mellitus, mortality caused by coronary disease continues to decline. Recent trends in coronary disease prevalence are unknown.

Methods There were 3237 deaths among Olmsted County, Minnesota, residents aged 16 through 64 years during the 1981-2004 period. Of the 515 due to accident, suicide, homicide, or a manner that could not be determined, 425 individuals (82%) had coronary anatomy graded. Pathology reports were reviewed for the grade of coronary disease (range, 0-5) assigned each of 4 arteries: left anterior descending (LAD), left circumflex (LCx), right coronary artery (RCA), and left main artery (LMA). High-grade disease was defined as more than a 75% reduction in cross-sectional luminal area (grade 4) in any of LAD, LCx, or RCA or more than 50% reduction (grade 3) in LMA. Evidence of any disease was defined as a grade higher than 0 in any artery. Calendar-year trends were analyzed as linear and nonlinear functions.

Results Over the full period (1981-2004), 8.2% of the 425 individuals had high-grade disease, and 83% had evidence of any disease. Age- and sex-adjusted regression analyses revealed temporal declines over the full period (1981-2004) for high-grade disease, any disease, and grade of coronary disease. Declines in the grade of coronary disease ended after 1995 (P .01 for every artery) and possibly reversed after 2000 (P = .06 for LCx).

Conclusions Declines in coronary disease prevalence overall (during 1981-2004) reinforce arguments that any increased prevalence resulting from improved survival among persons with disease was offset by reductions in disease incidence. Study findings suggest that declines in coronary disease prevalence have ended. The question of whether recent trends are attributable to increasing obesity and diabetes mellitus awaits further investigation.

Poor BP Control Tied to Medication Nonadherence & Therapy Intensification

Physician's First Watch for February 12, 2008
David G. Fairchild, MD, MPH, Editor-in-Chief

Poor BP Control Tied to Medication Nonadherence & Therapy Intensification

Medication nonadherence explains why some patients with coronary artery disease have difficulty controlling their hypertension despite more intensive therapy, reports Archives of Internal Medicine.

In a retrospective study, over 10,000 patients with coronary disease were followed for a median of 4.6 years within a managed care organization.

After multivariable adjustment, the 5% of patients who had uncontrolled BP were more likely to have medication nonadherence (prescription fill rate <80%) and to have had increases in the dosage or number of antihypertensive drugs (respective odds ratios, 1.73 and 1.31), compared with patients who lowered their blood pressure.

Noting the cohort's "remarkably low" rate of uncontrolled hypertension, an editorialist points out that clinicians were aided by "a clinical pharmacy specialist-managed, physician-monitored disease management service." He writes: "The key to effective blood pressure control appears to have more to do with patient and physician information exchange (or lack thereof) than with biology or drug failure."

Archives of Internal Medicine article (Free abstract; full text requires subscription)
Archives of Internal Medicine editorial (Subscription required)Related Journal Watch link(s):
Journal Watch Cardiology summary (Free)

Factors Favoring Longevity; Disability at 100

Physician's First Watch for February 12, 2008

David G. Fairchild, MD, MPH, Editor-in-Chief

Factors Favoring Longevity; Disability at 100

Exceptional longevity is neither so elusive nor as disabling as was once thought, according to two studies in Archives of Internal Medicine.

Researchers in the first study examined the factors associated with living to age 90 and beyond in a cohort of the Physicians' Health Study followed for some 25 years. Among men born before 1916, the presence of one of five risk factors at age 70 reduced the adjusted odds of survival to age 90. The risk factors (and their associated hazard ratios for dying before 90) were smoking (
2.10), diabetes (1.86), obesity (1.44), and hypertension (1.28). Regular exercise conferred a 30% lower mortality risk.

In the second study, researchers studied disease and disability among centenarians and found that about a third had suffered from a disabling condition like COPD, diabetes, or dementia for over 15 years and that most required either minimal or no assistance in their daily lives.

An editorialist offers wryly that, although the successfully aged may have undefined reserves, "an alternative explanation might be that their primary care physicians aggressively treated their chronic illnesses rather than assume ageist nihilism about treating the oldest old."

Archives of Internal Medicine article on longevity in men (Free abstract; full text requires subscription)
Archives of Internal Medicine article on longevity and disability (Free abstract; full text requires subscription)
Archives of Internal Medicine editorial (Subscription required)

Monday, February 11, 2008

Women less well managed than men with hypertension

Women less well managed than men with hypertension

By Caroline Price

11 February 2008

Hypertension 2008; Advance online publication

MedWire News: Two studies published in the journal Hypertension reveal gender disparities in the cardiovascular disease (CVD) management of patients with hypertension in the USA.

Indeed, one study found that women were significantly less likely than men to have their hypertension under control, as well as being less likely to receive CVD secondary prevention medications. In the second study, blood pressure (BP) control was not significantly inferior in women compared with men, but women had a higher prevalence of other concomitant CVD risk factors.

The studies are published in advance online to be included in a special edition of the journal highlighting women's unique risks for, and specific challenges in managing, hypertension.

Salomeh Keyhani (Mount Sinai School of Medicine, New York, USA) and colleagues examined data from the 2005 US National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey, which included a total of 12,064 patient visits with a primary care provider, 7786 for women and 4278 for men.

Among patients with hypertension, women were significantly less likely than men to meet BP goal levels, at 54.0% versus 58.7% (p<0.01). This relationship was also seen among older patients aged 65 to 80 years, at corresponding rates of 53.4% versus 63.2% (p<0.005). The lower rate of hypertension control among women compared with men in this age group persisted in multivariable models, at an odds ratio (OR) of 0.62.

Women were less likely to receive ACE inhibitors to treat their hypertension than men (20.9% vs 28.7%, p<0.001) and more likely to receive diuretics (20.9% vs 16.9%, p=0.05). However, no associations were found between gender and use of antihypertensive medication or the initiation of a new hypertensive-lowering medication in patients with uncontrolled hypertension.

Meanwhile, among patients with diabetes and hypertension, just 38.4% of women compared with 46.6% of men received an ACE inhibitor or angiotensin receptor blocker (OR=0.71). Women with ischemic heart disease and cerebrovascular disease were also less likely to receive aspirin (OR=0.43) and those with ischemic heart disease less likely to receive a beta blocker (OR=0.60) than men with these conditions.

The authors emphasize that the study "reveals suboptimal treatment for both men and women in a national sample," with less than 60% of all hypertensive patients having controlled BP and fewer than half receiving recommended therapies for chronic conditions. Nevertheless, they conclude that there is a "need for increased awareness of the persistent gender disparities in CVD management."

In the second study, Bernard Cheung (University of Birmingham, UK) and colleagues studied control of BP and the prevalence of five other CVD risk factors among 3475 adults with diagnosed hypertension in the National Health and Nutrition Examination Survey conducted between 1999 and 2004.

The researchers report that the age-adjusted prevalence of uncontrolled BP was not significantly different between men and women, at 50.8% and 55.9%, respectively, and did not change significantly over the study period.

However, central obesity, elevated total cholesterol levels, and low high-density lipoprotein cholesterol levels were all significantly more common among men than women (all p<0.05).

Cheung et al conclude: "Although there is still room for improvement in BP control, our study has highlighted the importance of addressing other concomitant cardiovascular risk factors in women."


Saturday, February 9, 2008

Improving Reperfusion in Patients with Myocardial Infarction

Editorial In New England Journal Of Medicine Written By Nationally Known VCU Cardiologist

Medical News Today

09 Feb 2008

George W. Vetrovec, M.D., chair of cardiology at the Virginia Commonwealth University Medical Center, known nationally for his study and treatment of coronary artery disease, says a new technique for treating blocked coronary arteries shows promise, but is best performed by experienced physicians.

The editorial review, Improving Reperfusion in Patients with Myocardial Infarction, appears in the current issue of the New England Journal of Medicine.

A study - also published in the current issue - investigates a technique for treating patients suffering a myocardial infarction, or heart attack.

The procedure, called a thrombectomy, uses a special aspiration catheter placed at the site of an arterial blockage, or clot, causing the heart attack. Doctors then suction out the thrombus, or blockage, and place a stent to prevent the area from becoming occluded again.

According to Vetrovec, the technique reduces the chance that pieces of the blockage could travel downstream and cause another obstruction - a potential consequence with traditional balloon angioplasty.

Importantly, he adds, beyond the improvement of perfusion, or blood flow restoration, is the fact that clinical outcomes were improved and the improvements correlated with the improved markers of perfusion. Vetrovec is world-renowned for his studies on coronary artery disease.

Article adapted by Medical News Today from original press release.

Friday, February 8, 2008

Aprotinin plus ACE inhibitors during off-pump surgery linked to renal dysfunction

By Sara Carrillo de Albornoz

08 February 2008

The Lancet 2008; 371: 475-482

MedWire News: Patients undergoing off-pump cardiac surgery who are treated with aprotinin and preoperative angiotensin-converting enzyme (ACE) inhibitors are at high risk for postoperative renal dysfunction, UK researchers report in The Lancet.

"We recommend that it might be beneficial for patients to discontinue any use of an ACE inhibitor before undergoing elective off-pump cardiac surgery, particularly patients with a history of renal impairment," say Kai Zacharowski and colleagues from the Bristol Royal Infirmary.

Aprotinin is an antifibrinolytic serine protease inhibitor that reduces peri-operative bleeding and decreases the need for blood transfusion and re-operation in patients undergoing cardiac surgery, but concerns have been raised about its role in renal impairment, the authors comment.

Zacharowski and team examined the association between aprotinin and renal dysfunction in 9012 patients undergoing cardiac surgery, of whom 5434 were operated on-pump and 3672 off-pump.

They separately analyzed the incidence of renal dysfunction in patients treated with aprotinin, tranexamic acid, or no antifibrinolytic therapy in combination with or without pre-operative ACE inhibitors.

After propensity adjustment, only patients undergoing off-pump surgery and treated with both ACE inhibitors and aprotinin were at high risk for postoperative renal dysfunction (odds ratio=2.87, p=0.013).

Among patients undergoing on-pump surgery, aprotinin - with or without ACE inhibitors - did not significantly increase the risk for renal dysfunction.

Zacharowski and co-workers conclude: "Our results have shown that aprotinin seems to be safe during on-pump cardiac surgery.

"However, the combination of aprotinin and ACE inhibitors during off -pump cardiac surgery is associated with a significant risk of postoperative renal dysfunction."

They add: "The international communities of cardiac anesthesia and surgery face controversy regarding the use of aprotinin."


Top 10 news from - January edition

Top 10 news from - January edition


TOP 10 NEWSWeb site:

1 ::::::"ENHANCE results yield disappointment for ezetimibe"

2 ::::::"ENHANCE saga continues: Experts dispute ezetimibe's future and"weight" of imaging studies"

3 ::::::"Questioning the importance of LDL cholesterol: The ENHANCE fallout"

SATELLITE PROGRAM ::::::"Demystifying the rate vs rhythm conundrum: New perspectives on recenttrials and future treatment options"Drs Reiffel, Kowey and Ruskin describe the electrophysiologic andpharmacologic profiles of novel antiarrhythmic agents and their safetyand efficacy relative to conventional agents. CME provider: DiscoveryInstitute of Medical Education. Supported by an educational grant fromAstellas Pharma US, Inc."Improving outcomes with antiplatelet therapy: Practical applicationsfrom new research"The presentations, by a panel of renowned experts in the field, led byDr Eugene Braunwald, will focus on issues and answers surroundingantiplatelet therapy and where research is taking us in terms ofmanaging our patients. Sponsored by The Annenberg Center for HealthSciences at Eisenhower. Supported by an educational grant from DaiichiSankyo, Inc. and Eli Lilly and Company.

4 ::::::"NEJM reviewer under fire for leaking Nissen's rosiglitazone paper toGlaxoSmithKline"

5 ::::::"Role of cholesterol in prevention and mortality benefit of statinsdebated in media"

6 ::::::"Congress investigates Jarvik's Lipitor ads"

7 ::::::"More talent heads to the University of Miami; two fewer EP docs atMass General"

SATELLITE PROGRAM ::::::"DES 2008: New choices, new era"Join Drs Topol and Teirstein as they discuss how the new devices willimpact treatment selection and watch them give their predictions forDES and PCI in 2008. CME provider: Medscape, LLC. This educationalactivity is supported by an unrestricted educational grant fromMedtronic, Inc."Recent clinical trial data on adjunctive pharmacology in ACS patientsundergoing PCI"What is the future of adjunctive pharmacology given the results of theHORIZONS-AMI and TRITON-TIMI 38 trials? Join Drs Deepak Bhatt, LarsWallentin, and Gilles Montalescot as they comment on the optimalpharmacological management of patients undergoing acute PCI. CMEprovider: Medscape, LLC. Supported by an independent educational grantfrom sanofi-aventis and Bristol-Myers Squibb.

8 ::::::"Fewer deaths, MI, with CABG than DES for multivessel disease in NYState"

9 ::::::"Questions arise about the chronology of events in the ENHANCE trial"

10 ::::::"ACE inhibitors or ARBs in hypertension? In chronic kidney disease?"

Thursday, February 7, 2008

ACCORD Trial Researchers Halt Intensive Glucose-Lowering After Increased Deaths

ACCORD Trial Researchers Halt Intensive Glucose-Lowering After Increased Deaths

Researchers exploring the benefits of intensive versus standard glucose-lowering therapy have decided to end the trial's intensive treatment arm after interim analyses found higher mortality there.

The ACCORD researchers randomized 10,250 patients with type 2 diabetes averaging 10 years' duration and at high risk for cardiovascular disease to one of two treatment arms: the standard arm had a hemoglobin A1c target between 7% and 7.9%, and the intensive arm targeted levels under 6%. The trial's data and safety monitoring board recommended ending the intensive arm when it found increased all-cause mortality.

In a Wednesday news conference, researchers said that although the rates of nonfatal cardiovascular events were lower during intensive treatment, "if a heart attack did occur, it was more likely to be fatal." They also said that none of the study drugs used, including rosiglitazone, was conclusively implicated in the increased mortality.

Link: National Institutes of Health press release (Free)

Effect of a Multifactorial Intervention on Mortality in Type 2 Diabetes

Effect of a Multifactorial Intervention on Mortality in Type 2 Diabetes

N Engl J Med 2008 Feb 7; 358:580.

Peter Gæde, M.D., D.M.Sc., Henrik Lund-Andersen, M.D., D.M.Sc., Hans-Henrik Parving, M.D., D.M.Sc., and Oluf Pedersen, M.D., D.M.Sc.



Intensified multifactorial intervention — with tight glucose regulation and the use of renin–angiotensin system blockers, aspirin, and lipid-lowering agents — has been shown to reduce the risk of nonfatal cardiovascular disease among patients with type 2 diabetes mellitus and microalbuminuria. We evaluated whether this approach would have an effect on the rates of death from any cause and from cardiovascular causes.


In the Steno-2 Study, we randomly assigned 160 patients with type 2 diabetes and persistent microalbuminuria to receive either intensive therapy or conventional therapy; the mean treatment period was 7.8 years. Patients were subsequently followed observationally for a mean of 5.5 years, until December 31, 2006. The primary end point at 13.3 years of follow-up was the time to death from any cause.


Twenty-four patients in the intensive-therapy group died, as compared with 40 in the conventional-therapy group (hazard ratio, 0.54; 95% confidence interval [CI], 0.32 to 0.89; P=0.02). Intensive therapy was associated with a lower risk of death from cardiovascular causes (hazard ratio, 0.43; 95% CI, 0.19 to 0.94; P=0.04) and of cardiovascular events (hazard ratio, 0.41; 95% CI, 0.25 to 0.67; P<0.001). One patient in the intensive-therapy group had progression to end-stage renal disease, as compared with six patients in the conventional-therapy group (P=0.04). Fewer patients in the intensive-therapy group required retinal photocoagulation (relative risk, 0.45; 95% CI, 0.23 to 0.86; P=0.02). Few major side effects were reported.


In at-risk patients with type 2 diabetes, intensive intervention with multiple drug combinations and behavior modification had sustained beneficial effects with respect to vascular complications and on rates of death from any cause and from cardiovascular causes.

Wednesday, February 6, 2008

Incidence of Death and Acute Myocardial Infarction Associated With Stopping Clopidogrel After Acute Coronary Syndrome

Incidence of Death and Acute Myocardial Infarction Associated With Stopping Clopidogrel After Acute Coronary Syndrome

P. Michael Ho, MD, PhD; Eric D. Peterson, MD, MPH; Li Wang, MS; David J. Magid, MD, MPH; Stephan D. Fihn, MD, MPH; Greg C. Larsen, MD; Robert A. Jesse, MD, PhD; John S. Rumsfeld, MD, PhD

JAMA. 2008;299(5):532-539.


It is unknown whether patients are at increased short-term risk for adverse events following clopidogrel cessation.


To assess the rates of adverse events after stopping treatment with clopidogrel in a national sample of patients with acute coronary syndrome (ACS).

Design, Setting, and Patients

Retrospective cohort study of 3137 patients with ACS discharged from 127 Veterans Affairs hospitals between October 1, 2003, and March 31, 2005, with posthospital treatment with clopidogrel.

Main Outcome Measure

Rate of all-cause mortality or acute myocardial infarction (AMI) after stopping treatment with clopidogrel.


Mean (SD) follow-up after stopping treatment with clopidogrel was 196 (152) days for medically treated patients with ACS without stents (n = 1568) and 203 (148) days for patients with ACS treated with percutaneous coronary intervention (PCI) (n = 1569). Among medically treated patients, mean (SD) duration of clopidogrel treatment was 302 (151) days and death or AMI occurred in 17.1% (n = 268) of patients, with 60.8% (n = 163) of events occurring during 0 to 90 days, 21.3% (n = 57) during 91 to 180 days, and 9.7% (n = 26) during 181 to 270 days after stopping treatment with clopidogrel. In multivariable analysis including adjustment for duration of clopidogrel treatment, the first 90-day interval after stopping treatment with clopidogrel was associated with a significantly higher risk of adverse events (incidence rate ratio [IRR], 1.98; 95% confidence interval [CI], 1.46-2.69 vs the interval of 91-180 days). Similarly, among PCI-treated patients with ACS, mean (SD) duration of clopidogrel treatment was 278 (169) days and death or AMI occurred in 7.9% (n = 124) of patients, with 58.9% (n = 73) of events occurring during 0 to 90 days, 23.4% (n = 29) during 91 to 180 days, and 6.5% (n = 8) during 181 to 270 days after stopping clopidogrel treatment. In multivariable analysis including adjustment for duration of clopidogrel treatment, the first 90-day interval after stopping clopidogrel treatment was associated with a significantly higher risk of adverse events (IRR, 1.82; 95% CI, 1.17-2.83).



Tuesday, February 5, 2008

Interpreting risks and ratios in therapy trials

Australian Prescriber - Interpreting risks and ratios in therapy trials


To appreciate the significance of clinical trial results, clinicians need to understand the mathematical language used to describe treatment effects. When comparing intervention and control groups in a trial, results may be reported in terms of relative or absolute risk (or probability), or as more statistically sophisticated entities based on odds and hazard ratios. When events in the intervention group are significantly less frequent than in the control group, then relative risk, odds ratio and hazard ratio (and their confidence intervals) will be less than 1.0. If the converse holds true, these values will be greater than 1.0.

Pharmacological interventions for hypertensive emergencies - Cochrane Reviews, 01/24/08

Pharmacological interventions for hypertensive emergencies


MI Perez, VM Musini

Cochrane Database of Systematic Reviews 2008 Issue 1 (Status: New) Copyright © 2008 The Cochrane Collaboration.



Hypertensive emergencies, marked hypertension associated with acute end-organ damage, are life-threatening conditions. Many anti-hypertensive drugs have been used in these clinical settings. The benefits and harms of such treatment and the best first-line treatment are not known.


To answer the following two questions using randomized controlled trials (RCTs):

1) does anti-hypertensive drug therapy as compared to placebo or no treatment affect mortality and morbidity in patients presenting with a hypertensive emergency?

2) Does one first-line antihypertensive drug class as compared to another antihypertensive drug class affect mortality and morbidity in these patients?

Search strategy

Electronic sources: MEDLINE, EMBASE, Cochrane clinical trial register. In addition, we searched for references in review articles and trials. We attempted to contact trialists. Most recent search August 2007.

Selection criteria

All unconfounded, truly randomized trials that compare an antihypertensive drug versus placebo, no treatment, or another antihypertensive drug from a different class in patients presenting with a hypertensive emergency.

Data collection and analysis

Quality of concealment allocation was scored. Data on randomized patients, total serious adverse events, all-cause mortality, non-fatal cardiovascular events, withdrawals due to adverse events, length of follow-up, blood pressure and heart rate were extracted independently and cross checked.

Main results

Fifteen randomized controlled trials (representing 869 patients) met the inclusion criteria.

Two trials included a placebo arm. All studies (except one) were open-label trials. Seven drug classes were evaluated in those trials: nitrates (9 trials), ACE-inhibitors (7), diuretics (3), calcium channel blockers (6), alpha-1 adrenergic antagonists (4), direct vasodilators (2) and dopamine agonists (1).

Mortality event data were reported in 7 trials. No meta-analysis was performed for clinical outcomes, due to insufficient data. The pooled effect of 3 different anti-hypertensive drugs in one placebo-controlled trial showed a statistically significant greater reduction in both systolic [WMD -13, 95%CI -19,-7] and diastolic [WMD -8, 95%CI, -12,-3] blood pressure with antihypertensive therapy.

Authors' conclusions

There is no RCT evidence demonstrating that anti-hypertensive drugs reduce mortality or morbidity in patients with hypertensive emergencies. Furthermore, there is insufficient RCT evidence to determine which drug or drug class is most effective in reducing mortality and morbidity. There were some minor differences in the degree of blood pressure lowering when one class of antihypertensive drug is compared to another. However, the clinical significance is unknown. RCTs are needed to assess different drug classes to determine initial and longer term mortality and morbidity outcomes.

Plain language summary

Hypertensive emergencies occur when high blood pressure is associated with the presence of acute end organ damage, such as heart attack or stroke. There is controversy as to when and which blood pressure drugs to use in these situations. This review looked for all studies where patients were randomized to one or more treatments to measure the effects of such therapies. The questions of the review were to see whether drug treatments affected death or cardiovascular morbidity or whether there were differences between drug treatments. The available evidence was insufficient to answer these questions.

Saturday, February 2, 2008

Diabetes Increases Risk Of Heart Disease Death For Women

Diabetes Increases Risk Of Heart Disease Death For Women

Medical News Today

02 Feb 2008

The word is out: women are at risk for heart disease, just like men. In fact, roughly twice as many women in this country will die of heart disease, stroke, and other cardiovascular diseases than from all forms of cancer combined, including breast cancer, according to the American Heart Association.

Risk factors for heart disease and stroke have long been identified. Several risk factors cannot be controlled by the individual, such as sex, increasing age and a family history of heart disease.

Others can be modified and include:

Smoking-- High blood pressure and cholesterol


Sedentary lifestyle

Body weight

Diabetes continues to be a growing problem in the United States for both men and women. A study published in the December 2007 issue of the European Heart Journal reveals that diabetes is a stronger risk factor for heart disease death in women than in men."The reason for the higher relative risk of coronary heart disease in women with diabetes than in men with diabetes is still unclear," explains Ane Cecilie Dale, M.D., the study's lead researcher and head of the Department of Circulation and Medical Imaging at the Norwegian University of Science and Technology in Trondheim. "But research in this field continues to go on."

According to the U.S. Food and Drug Administration, diabetes affects approximately 8.9 percent of American women. The occurrence of diabetes is significantly higher among African American, Hispanic/Latino, American Indian, and Asian/Pacific Islander women than in white women.

Women with diabetes have a two to four times higher risk of dying from heart disease and stroke compared to women without diabetes, according to data from the American Heart Association. Women with diabetes are often overweight and suffer from high blood pressure, also known as hypertension, and high cholesterol levels, which can add to the risk.

"Women with diabetes need to be aware of the associated risk of heart disease. The most important thing to do for all persons with diabetes to protect themselves from heart disease and other diabetes complications is to have a good glucometabolic control with a blood glucose as near normal as possible," Dale said. "They also need to control other risk factors like hypertension and blood cholesterol levels. In addition it is important to quit smoking, have a healthy diet and practice regularly exercise."

Considering how complex the management of diabetes and heart diseases risks are, women should talk to their health care providers to develop a plan of action.

Without the support of health care professionals, patients can easily feel overwhelmed.

February is American Heart Month.

For tips on reducing your heart disease risk, visit the American Heart Association Web site: http://http:/

For diabetes information, visit the American Diabetes Association:

WomenHeart, the National Coalition for Women with Heart Disease, provides patients with education and grassroots support networks. WomenHeart is online at

Society for Women's Health Research (SWHR)1025 Connecticut Ave. NW, Ste. 701Washington, DC 20036United States

Friday, February 1, 2008

The Association Between Physical Activity in Leisure Time and Leukocyte Telomere Length, January 28, 2008, Cherkas et al. 168 (2): 154

Arch Intern Med -- Abstract: The Association Between Physical Activity in Leisure Time and Leukocyte Telomere Length, January 28, 2008, Cherkas et al. 168 (2): 154

A sedentary lifestyle (in addition to smoking, high body mass index, and low socioeconomic status) has an effect on LTL and may accelerate the aging process. This provides a powerful message that could be used by clinicians to promote the potentially antiaging effect of regular exercise.

The combined influence of leisure-time physical activity and weekly alcohol intake on fatal ischaemic heart disease and all-cause mortality -- Pedersen et al. 29 (2): 204 -- European Heart Journal

The combined influence of leisure-time physical activity and weekly alcohol intake on fatal ischaemic heart disease and all-cause mortality -- Pedersen et al. 29 (2): 204 -- European Heart Journal

Physically active individuals who drink moderately have a lower risk for fatal ischemic heart disease (IHD) and all-cause mortality than those who abstain and are physically inactive, Danish researchers report.

COX-2 inhibitor may disrupt heart rhythm

MedWire News - Cardiology - COX-2 inhibitor may disrupt heart rhythm

Gene Linked To Increased Risk Of Developing Inflammatory Arthritis May Also Increase Patients' Risk Of Dying From Cardiovascular Disease

Gene Linked To Increased Risk Of Developing Inflammatory Arthritis May Also Increase Patients' Risk Of Dying From Cardiovascular Disease

Medical News Today News Article: "Gene Linked To Increased Risk Of Developing Inflammatory Arthritis May Also Increase Patients' Risk Of Dying From Cardiovascular Disease
01 Feb 2008

People with rheumatoid arthritis (RA), an inflammatory autoimmune disease, tend to die younger and, largely from cardiovascular disease (CVD). One explanation for this increasingly recognized fact is that inflammation promotes atherosclerosis. A marker of inflammation, elevation of the C-reactive protein (CRP) level has been shown to predict CVD in the general population. However, other highly inflammatory diseases - Crohn's, for example - do not carry the same high risk of premature death from heart disease.

To identify other possible suspects, researchers in the United Kingdom investigated whether genetic variants linked to the likelihood of developing RA might also make patients more likely to die from CVD. Led by Dr. Tracey M. Farragher at the University of Manchester and funded by the Arthritis Research Campaign (arc), the study focused on two genes - HLA-DRB1and PTPN22 - and their interactions with known RA risk factors. The evidence, presented in the February 2008 issue of Arthritis & Rheumatism (, implicates HLA-DRB1 genotypes, already associated with RA susceptibility and severity, as a predictor of premature death from CVD for inflammatory arthritis patients. For RA patients in particular, having the shared epitope (SE) - a group of HLA-DRB1 alleles with kindred amino acid traits - plus anti-cyclic citrullinated peptide (anti-CCP) antibodies and current smoking is an especially deadly combination."