Gmail - MedWire Cardiology News - 13 March 2008
Plausible role for CAPON gene in QRT variationResearchers have shown cardiac expression and biologic effects of the CAPON protein, supporting its potential influence on QT interval variation in human populations.http://www.medwire-news.md/38/73666/Cardiology_News/Plausible_role_for_CAPON_gene_in_QRT_variation.html
Implantable pressure monitor fails to reduce HF-related eventsUse of an implantable continuous hemodynamic monitor to guide optimal medical management of patients with heart failure failed to significantly reduce rates of HF-related events, report researchers.http://www.medwire-news.md/38/73667/Cardiology_News/Implantable_pressure_monitor_fails_to_reduce_HF-related_events.html
No evidence of link between bisphosphonates and AF, flutterScientists have found no evidence to suggest that use of bisphosphonates increases the risk for atrial fibrillation and flutter.http://www.medwire-news.md/38/73668/Cardiology_News/No_evidence_of_link_between_bisphosphonates_and_AF,_flutter.html
Thursday, March 13, 2008
Wednesday, March 12, 2008
Migraine Intervention With STARFlex Technology (MIST)
Summary
Posted: 3/10/2008
Writer: Anthony A. Bavry, M.D., M.P.H.
Description
The goal of this trial was to evaluate closure of patent foramen ovale (PFO) compared with a sham procedure in patients with refractory migraine headache.
Hypothesis
Closure of a PFO with the STARFlex device will be more effective in reducing migraine headache.
Drugs/Procedures Used
After general anesthesia, patients underwent transesophageal echocardiography to assess the interatrial septal anatomy. Patients were then randomized to PFO closure (n = 74) or a sham procedure that consisted of a skin incision (n = 73).
Concomitant Medications
Patients received aspirin (300 mg) and clopidogrel (300 mg) 24 hours prior to the procedure and for 90 days after the procedure at a dose of 75 mg daily for both medications. Patients continued any prophylactic medication that they were on at the start of the trial.
Principal Findings
Of the migraine patients referred for potential study enrollment, a right-to-left shunt from a moderate-to-large PFO was documented by transthoracic echocardiography in 38%. Any type of shunt, including atrial septal defect, was present in 60%. The mean number of migraine attacks in the 30 days prior to the procedure was 4.82 in the closure group and 4.51 in the sham group. No PFO was identifiable in 7% of the closure group. Residual moderate-to-large right-to-left shunt was present in four patients at 6 months. There were more serious procedural-related adverse events in the closure group (atrial fibrillation, n = 2; pericardial tamponade, n = 2; retroperitoneal hemorrhage, n = 1; and chest pain, n = 2).
Three patients in each group reported migraine cessation (p = 1.0). Similarly, for closure versus sham, there was no difference in any of the secondary endpoints; frequency of migraine attacks per month (3.23 vs. 3.52, p = 0.14), total MIDAS headache score (17 vs. 18, p = 0.88), or headache days per 3 months (18 vs. 21, p = 0.79).
No difference in treatment effect was noted, regardless of whether a residual shunt was present at follow-up. Two patient outliers accounted for one-third of the study headache burden. When these patients were removed from analysis, there was a reduction of 2.2 headache days per month in the closure group versus 1.3 days per month in the sham group (p = 0.027).
Interpretation
This was the first randomized sham-controlled trial to study the effect of PFO closure in patients with refractory migraine. An important finding was that among migraine patients referred for analysis, some type of right-to-left shunt was documented in 60% (in 38% due to PFO). The primary outcome, cessation of migraine, occurred in three patients in each group. Secondary outcomes such as frequency of migraines and headache scores were also similar between the two groups.When the two patient outliers were excluded from analysis, a difference was noted in the reduction of headache days favoring PFO closure; however, this finding should only be hypothesis generating since it was a post-hoc analysis.
Failure to detect a difference between treatment groups may have been at least partly explained by lack of adequate power. It is unknown if a longer duration of follow-up to allow for more complete healing of the defect would have also been beneficial. Additionally, patients continued prophylactic medications throughout the trial, which may have made it more difficult for the PFO device to show benefit. Additional trials on the topic are forthcoming.
References:
Dowson A, Mullen MJ, Peatfield R, et al. Migraine Intervention With STARFlex Technology (MIST) Trial. A Prospective, Multicenter, Double-Blind, Sham-Controlled Trial to Evaluate the Effectiveness of Patent Foramen Ovale Closure With STARFlex Septal Repair Implant to Resolve Refractory Migraine Headache. Circulation 2008;Mar 3:[Epub ahead of print].
Posted: 3/10/2008
Writer: Anthony A. Bavry, M.D., M.P.H.
Description
The goal of this trial was to evaluate closure of patent foramen ovale (PFO) compared with a sham procedure in patients with refractory migraine headache.
Hypothesis
Closure of a PFO with the STARFlex device will be more effective in reducing migraine headache.
Drugs/Procedures Used
After general anesthesia, patients underwent transesophageal echocardiography to assess the interatrial septal anatomy. Patients were then randomized to PFO closure (n = 74) or a sham procedure that consisted of a skin incision (n = 73).
Concomitant Medications
Patients received aspirin (300 mg) and clopidogrel (300 mg) 24 hours prior to the procedure and for 90 days after the procedure at a dose of 75 mg daily for both medications. Patients continued any prophylactic medication that they were on at the start of the trial.
Principal Findings
Of the migraine patients referred for potential study enrollment, a right-to-left shunt from a moderate-to-large PFO was documented by transthoracic echocardiography in 38%. Any type of shunt, including atrial septal defect, was present in 60%. The mean number of migraine attacks in the 30 days prior to the procedure was 4.82 in the closure group and 4.51 in the sham group. No PFO was identifiable in 7% of the closure group. Residual moderate-to-large right-to-left shunt was present in four patients at 6 months. There were more serious procedural-related adverse events in the closure group (atrial fibrillation, n = 2; pericardial tamponade, n = 2; retroperitoneal hemorrhage, n = 1; and chest pain, n = 2).
Three patients in each group reported migraine cessation (p = 1.0). Similarly, for closure versus sham, there was no difference in any of the secondary endpoints; frequency of migraine attacks per month (3.23 vs. 3.52, p = 0.14), total MIDAS headache score (17 vs. 18, p = 0.88), or headache days per 3 months (18 vs. 21, p = 0.79).
No difference in treatment effect was noted, regardless of whether a residual shunt was present at follow-up. Two patient outliers accounted for one-third of the study headache burden. When these patients were removed from analysis, there was a reduction of 2.2 headache days per month in the closure group versus 1.3 days per month in the sham group (p = 0.027).
Interpretation
This was the first randomized sham-controlled trial to study the effect of PFO closure in patients with refractory migraine. An important finding was that among migraine patients referred for analysis, some type of right-to-left shunt was documented in 60% (in 38% due to PFO). The primary outcome, cessation of migraine, occurred in three patients in each group. Secondary outcomes such as frequency of migraines and headache scores were also similar between the two groups.When the two patient outliers were excluded from analysis, a difference was noted in the reduction of headache days favoring PFO closure; however, this finding should only be hypothesis generating since it was a post-hoc analysis.
Failure to detect a difference between treatment groups may have been at least partly explained by lack of adequate power. It is unknown if a longer duration of follow-up to allow for more complete healing of the defect would have also been beneficial. Additionally, patients continued prophylactic medications throughout the trial, which may have made it more difficult for the PFO device to show benefit. Additional trials on the topic are forthcoming.
References:
Dowson A, Mullen MJ, Peatfield R, et al. Migraine Intervention With STARFlex Technology (MIST) Trial. A Prospective, Multicenter, Double-Blind, Sham-Controlled Trial to Evaluate the Effectiveness of Patent Foramen Ovale Closure With STARFlex Septal Repair Implant to Resolve Refractory Migraine Headache. Circulation 2008;Mar 3:[Epub ahead of print].
Gmail - MedWire Cardiology News - 12 March 2008
Gmail - MedWire Cardiology News - 12 March 2008
Minimally interrupted cardiac resuscitation improves survival after cardiac arrestPatients with out-of-hospital cardiac arrest who receive minimally interrupted cardiac resuscitation are more likely to survive than those receiving the standard emergency medical services protocol, US study findings indicate.http://www.medwire-news.md/38/73627/Cardiology_News/Minimally_interrupted_cardiac_resuscitation_improves_survival_after_cardiac_arrest.html
Acute heart failure patients delay seeking medical careMost patients with acute heart failure delay seeking medical care, researchers highlight.http://www.medwire-news.md/38/73628/Cardiology_News/Acute_heart_failure_patients_delay_seeking_medical_care.html
Follow-up within month of AMI increases patients' medication adherencePatients are more likely to adhere to recommended medications after an acute myocardial infarction if they see a doctor within a month of leaving hospital, research suggests.http://www.medwire-news.md/38/73629/Cardiology_News/Follow-up_within_month_of_AMI_increases_patients_medication_adherence.html
Minimally interrupted cardiac resuscitation improves survival after cardiac arrestPatients with out-of-hospital cardiac arrest who receive minimally interrupted cardiac resuscitation are more likely to survive than those receiving the standard emergency medical services protocol, US study findings indicate.http://www.medwire-news.md/38/73627/Cardiology_News/Minimally_interrupted_cardiac_resuscitation_improves_survival_after_cardiac_arrest.html
Acute heart failure patients delay seeking medical careMost patients with acute heart failure delay seeking medical care, researchers highlight.http://www.medwire-news.md/38/73628/Cardiology_News/Acute_heart_failure_patients_delay_seeking_medical_care.html
Follow-up within month of AMI increases patients' medication adherencePatients are more likely to adhere to recommended medications after an acute myocardial infarction if they see a doctor within a month of leaving hospital, research suggests.http://www.medwire-news.md/38/73629/Cardiology_News/Follow-up_within_month_of_AMI_increases_patients_medication_adherence.html
Gmail - MedWire Cardiology News - 12 March 2008
Gmail - MedWire Cardiology News - 12 March 2008
Minimally interrupted cardiac resuscitation improves survival after cardiac arrestPatients with out-of-hospital cardiac arrest who receive minimally interrupted cardiac resuscitation are more likely to survive than those receiving the standard emergency medical services protocol, US study findings indicate.http://www.medwire-news.md/38/73627/Cardiology_News/Minimally_interrupted_cardiac_resuscitation_improves_survival_after_cardiac_arrest.html
Acute heart failure patients delay seeking medical careMost patients with acute heart failure delay seeking medical care, researchers highlight.http://www.medwire-news.md/38/73628/Cardiology_News/Acute_heart_failure_patients_delay_seeking_medical_care.html
Follow-up within month of AMI increases patients' medication adherencePatients are more likely to adhere to recommended medications after an acute myocardial infarction if they see a doctor within a month of leaving hospital, research suggests.http://www.medwire-news.md/38/73629/Cardiology_News/Follow-up_within_month_of_AMI_increases_patients_medication_adherence.html
Minimally interrupted cardiac resuscitation improves survival after cardiac arrestPatients with out-of-hospital cardiac arrest who receive minimally interrupted cardiac resuscitation are more likely to survive than those receiving the standard emergency medical services protocol, US study findings indicate.http://www.medwire-news.md/38/73627/Cardiology_News/Minimally_interrupted_cardiac_resuscitation_improves_survival_after_cardiac_arrest.html
Acute heart failure patients delay seeking medical careMost patients with acute heart failure delay seeking medical care, researchers highlight.http://www.medwire-news.md/38/73628/Cardiology_News/Acute_heart_failure_patients_delay_seeking_medical_care.html
Follow-up within month of AMI increases patients' medication adherencePatients are more likely to adhere to recommended medications after an acute myocardial infarction if they see a doctor within a month of leaving hospital, research suggests.http://www.medwire-news.md/38/73629/Cardiology_News/Follow-up_within_month_of_AMI_increases_patients_medication_adherence.html
Tuesday, March 11, 2008
What is the relationship between early outpatient follow-up after acute myocardial infarction (AMI) and use of evidence-based therapies?
Title: Association of Early Follow-Up After Acute Myocardial Infarction With Higher Rates of Medication
Date Posted: 3/10/2008
Author(s): Daugherty SL, Ho PM, Spertus JA, et al.
Citation: Arch Intern Med 2008;168:485-491.
Study Question: What is the relationship between early outpatient follow-up after acute myocardial infarction (AMI) and use of evidence-based therapies?
Methods: A total of 1,516 patients hospitalized with AMI participated in the multicenter Prospective Registry Evaluating Outcomes After Myocardial Infarction: Events and Recovery registry. Early follow-up was defined as patient-reported visits with a primary care physician or cardiologist within 1 month after discharge. The primary outcomes were use of aspirin, beta-blockers, angiotensin-converting enzyme inhibitors, and statins in eligible patients at 6 months. Multivariable analyses assessed the association between early follow-up and medication use at 6 months, adjusting for patient and clinical characteristics. Secondary analyses compared medication use at 6 months for patients receiving collaborative follow-up from a single provider versus those receiving follow-up from both provider types.
Results: Among the cohort, 34% reported no outpatient follow-up during the month following discharge. Rates of medication prescription among appropriate candidates were similar at hospital discharge for both follow-up groups. Compared with those not receiving early follow-up, those receiving early follow-up were more likely to be prescribed beta-blockers (80.1% vs. 71.3%; p = 0.001), aspirin (82.9% vs. 77.1%; p = 0.01), or statins (75.9% vs. 68.6%; p = 0.005) at 6 months. In multivariable analyses, a persistent relationship remained between early follow-up and beta-blocker use (risk ratio [RR], 1.08; 95% confidence interval [CI], 1.02-1.15). In secondary analyses, statin use was higher in patients receiving collaborative follow-up (RR, 1.11; 95% CI, 1.01-1.22).
Conclusions: Early outpatient follow-up and collaborative follow-up after AMI are associated with higher rates of evidence-based medication use. Although further studies should assess whether this relationship is causal, these results support current guideline recommendations for follow-up after AMI.
Perspective: This prospective observational study demonstrated a modest advantage of early follow-up post-MI, but which could infer a significant clinical outcome benefit. I suspect it underestimates the value of the cardiologist assessment and opportunity for referral to cardiac rehabilitation, smoking cessation, and education. Our experience is that early follow-up by a nurse practitioner can be effective as well. Melvyn Rubenfire, M.D., F.A.C.C.
Date Posted: 3/10/2008
Author(s): Daugherty SL, Ho PM, Spertus JA, et al.
Citation: Arch Intern Med 2008;168:485-491.
Study Question: What is the relationship between early outpatient follow-up after acute myocardial infarction (AMI) and use of evidence-based therapies?
Methods: A total of 1,516 patients hospitalized with AMI participated in the multicenter Prospective Registry Evaluating Outcomes After Myocardial Infarction: Events and Recovery registry. Early follow-up was defined as patient-reported visits with a primary care physician or cardiologist within 1 month after discharge. The primary outcomes were use of aspirin, beta-blockers, angiotensin-converting enzyme inhibitors, and statins in eligible patients at 6 months. Multivariable analyses assessed the association between early follow-up and medication use at 6 months, adjusting for patient and clinical characteristics. Secondary analyses compared medication use at 6 months for patients receiving collaborative follow-up from a single provider versus those receiving follow-up from both provider types.
Results: Among the cohort, 34% reported no outpatient follow-up during the month following discharge. Rates of medication prescription among appropriate candidates were similar at hospital discharge for both follow-up groups. Compared with those not receiving early follow-up, those receiving early follow-up were more likely to be prescribed beta-blockers (80.1% vs. 71.3%; p = 0.001), aspirin (82.9% vs. 77.1%; p = 0.01), or statins (75.9% vs. 68.6%; p = 0.005) at 6 months. In multivariable analyses, a persistent relationship remained between early follow-up and beta-blocker use (risk ratio [RR], 1.08; 95% confidence interval [CI], 1.02-1.15). In secondary analyses, statin use was higher in patients receiving collaborative follow-up (RR, 1.11; 95% CI, 1.01-1.22).
Conclusions: Early outpatient follow-up and collaborative follow-up after AMI are associated with higher rates of evidence-based medication use. Although further studies should assess whether this relationship is causal, these results support current guideline recommendations for follow-up after AMI.
Perspective: This prospective observational study demonstrated a modest advantage of early follow-up post-MI, but which could infer a significant clinical outcome benefit. I suspect it underestimates the value of the cardiologist assessment and opportunity for referral to cardiac rehabilitation, smoking cessation, and education. Our experience is that early follow-up by a nurse practitioner can be effective as well. Melvyn Rubenfire, M.D., F.A.C.C.
Monday, March 10, 2008
Gmail - MedWire Cardiology News - 10 March 2008
Gmail - MedWire Cardiology News - 10 March 2008
CRT reverses dyssynchrony-induced molecular cardiac abnormalitiesCardiac resynchronization therapy reverses molecular stress response and cell survival abnormalities that accompany cardiac dyssynchrony, preliminary study findings indicate.http://www.medwire-news.md/38/73566/Cardiology_News/CRT_reverses_dyssynchrony-induced_molecular_cardiac_abnormalities_.html
Starting to drink alcohol in middle age has heart benefitsPeople who begin drinking moderate amounts of alcohol in middle age have lower rates of cardiovascular disease morbidity than nondrinkers who continue to abstain from drinking alcohol, findings from the ARIC study show.http://www.medwire-news.md/38/73567/Cardiology_News/Starting_to_drink_alcohol_in_middle
_age_has_heart_benefits.html
Cardiovascular risk lowered by anti-rheumatic drugsThe risk for a patient with rheumatoid arthritis experiencing a major cardiovascular event can be significantly lowered with appropriate risk factor management and treatment with disease-modifying anti-rheumatic drugs, say researchers.http://www.medwire-news.md/38/73568/Cardiology_News/Cardiovascular_risk_lowered_by_anti-rheumatic_drugs.html
CRT reverses dyssynchrony-induced molecular cardiac abnormalitiesCardiac resynchronization therapy reverses molecular stress response and cell survival abnormalities that accompany cardiac dyssynchrony, preliminary study findings indicate.http://www.medwire-news.md/38/73566/Cardiology_News/CRT_reverses_dyssynchrony-induced_molecular_cardiac_abnormalities_.html
Starting to drink alcohol in middle age has heart benefitsPeople who begin drinking moderate amounts of alcohol in middle age have lower rates of cardiovascular disease morbidity than nondrinkers who continue to abstain from drinking alcohol, findings from the ARIC study show.http://www.medwire-news.md/38/73567/Cardiology_News/Starting_to_drink_alcohol_in_middle
_age_has_heart_benefits.html
Cardiovascular risk lowered by anti-rheumatic drugsThe risk for a patient with rheumatoid arthritis experiencing a major cardiovascular event can be significantly lowered with appropriate risk factor management and treatment with disease-modifying anti-rheumatic drugs, say researchers.http://www.medwire-news.md/38/73568/Cardiology_News/Cardiovascular_risk_lowered_by_anti-rheumatic_drugs.html
Sunday, March 9, 2008
Myoblast Autologous Grafting in Ischemic Cardiomyopathy (MAGIC)
Myoblast Autologous Grafting in Ischemic Cardiomyopathy (MAGIC)
Interpretation
The results of this small, but first-of-its-kind clinical trial indicate that there was no additional benefit of autologous skeletal myoblasts in improving regional or global LV function in patients with severe ischemic cardiomyopathy, compared with CABG alone.
This was despite the fact that the highest dose of myoblasts was associated with a significant antiremodeling effect at 6 months, as evidenced by a reduction in both LVEDV and LVESV, when compared with placebo.
There was no increase in the incidence of MACE or arrhythmias with myoblast injections, although there was a nonsignificant doubling of arrhythmias in the myoblast groups.
Although this was a negative study, cardiac cell therapy is a fascinating, and rapidly evolving field. It is left to be seen if future clinical trials, with optimization of the best cells, their method of harvesting and delivery, and their functional integration in the myocardium, will be able to demonstrate improved patient outcomes in the days ahead.
Interpretation
The results of this small, but first-of-its-kind clinical trial indicate that there was no additional benefit of autologous skeletal myoblasts in improving regional or global LV function in patients with severe ischemic cardiomyopathy, compared with CABG alone.
This was despite the fact that the highest dose of myoblasts was associated with a significant antiremodeling effect at 6 months, as evidenced by a reduction in both LVEDV and LVESV, when compared with placebo.
There was no increase in the incidence of MACE or arrhythmias with myoblast injections, although there was a nonsignificant doubling of arrhythmias in the myoblast groups.
Although this was a negative study, cardiac cell therapy is a fascinating, and rapidly evolving field. It is left to be seen if future clinical trials, with optimization of the best cells, their method of harvesting and delivery, and their functional integration in the myocardium, will be able to demonstrate improved patient outcomes in the days ahead.
Friday, March 7, 2008
Angiotensin II Vaccine Lowers Blood Pressure
Physician's First Watch for March 7, 2008David G. Fairchild, MD, MPH, Editor-in-Chief
A vaccine against angiotensin II lowers blood pressure, reports Lancet.
In a phase II (safety and efficacy) study sponsored by the developer, European researchers randomized 72 patients with mild-to-moderate hypertension to one of two doses of vaccine (100 or 300 μg) or to placebo. The vaccine consists of virus-like particles linked to angiotensin II; injections were given at weeks 0, 4, and 12.
By week 14, about 20% of vaccine recipients had experienced transient flu-like symptoms, and all had antibodies against angiotensin II. Those who received the 300-μg regimen had significant drops in mean BP compared with placebo recipients, especially early in the morning (–25 mm Hg systolic, –13 mm Hg diastolic).
Commentators wonder about the hazards of a treatment whose effects are not immediately reversible (the antibody's half-life after the third injection was 17 weeks). However, they find the exploratory trial "promising."
Lancet abstract (Free abstract; full text requires subscription)
Lancet comment (Subscription required
A vaccine against angiotensin II lowers blood pressure, reports Lancet.
In a phase II (safety and efficacy) study sponsored by the developer, European researchers randomized 72 patients with mild-to-moderate hypertension to one of two doses of vaccine (100 or 300 μg) or to placebo. The vaccine consists of virus-like particles linked to angiotensin II; injections were given at weeks 0, 4, and 12.
By week 14, about 20% of vaccine recipients had experienced transient flu-like symptoms, and all had antibodies against angiotensin II. Those who received the 300-μg regimen had significant drops in mean BP compared with placebo recipients, especially early in the morning (–25 mm Hg systolic, –13 mm Hg diastolic).
Commentators wonder about the hazards of a treatment whose effects are not immediately reversible (the antibody's half-life after the third injection was 17 weeks). However, they find the exploratory trial "promising."
Lancet abstract (Free abstract; full text requires subscription)
Lancet comment (Subscription required
Thursday, March 6, 2008
Case Studies IncorporatingACC/AHA Practice Guidelines
Perioperative Guidelines Case Studies
Case Studies IncorporatingACC/AHA Practice Guidelines
Cardiosource
Case Studies IncorporatingACC/AHA Practice Guidelines
Cardiosource
Wednesday, March 5, 2008
Sunday, March 2, 2008
Loud Snoring Associated With Higher Stroke And Heart Disease Risk
01 Mar 2008
If you are a loud snorer there is a good chance your risk of stroke and heart disease is higher compared to people who do not snore, say Hungarian scientists after a new study on 12,643 participants.
You can read about this in the journal Sleep.
The authors explain that everybody snores to some extent at some period in their lives.
Estimates indicate that approximately 40% of men and 24% of women snore regularly.
Although previous studies had indicated there may be a link between habitual snoring and stroke and heart attack risk, this one has more compelling evidence.
The scientists interviewed 12,643 people at home about their snoring - they The represented 0.16% of the Hungarian population over the age of 18 years according to age, sex, and 150 sub-regions of the country.
The scientists report that, according to their study, 37% of men and 21% of women reported loud snoring with breathing pauses. 26% of the respondents reported having hypertension (high blood pressure), 3% had had myocardial infarction and 4% a stroke.
They found that a loud snorer has a 67% higher risk of having a stroke compared to people who do not snore, the risk of heart attack is 34% higher for loud snorers. It seems that quiet snorers do not run a higher risk of heart disease and/or stroke compared to people who do not snore, the scientists said.
The authors concluded "Snoring is frequent in the Hungarian adult population, and loud snoring with breathing pauses, in contrast with quiet snoring, is associated with an increased risk of cardiovascular disease and increased health-care utilization."
"Cardiovascular Disease and Health-Care Utilization in Snorers: a Population Survey"
Andrea Dunai, MD, Andras P. Keszei, MD, PhD, Maria S. Kopp, MD,PhD, Colin M. Shapiro, MBBCh, PhD, FRCPC, Istvan Mucsi, MD, PhD, Marta Novak, MD, PhD
SLEEP Volume 31, Issue 03, Pages 411-416
Click here to view abstract online
If you are a loud snorer there is a good chance your risk of stroke and heart disease is higher compared to people who do not snore, say Hungarian scientists after a new study on 12,643 participants.
You can read about this in the journal Sleep.
The authors explain that everybody snores to some extent at some period in their lives.
Estimates indicate that approximately 40% of men and 24% of women snore regularly.
Although previous studies had indicated there may be a link between habitual snoring and stroke and heart attack risk, this one has more compelling evidence.
The scientists interviewed 12,643 people at home about their snoring - they The represented 0.16% of the Hungarian population over the age of 18 years according to age, sex, and 150 sub-regions of the country.
The scientists report that, according to their study, 37% of men and 21% of women reported loud snoring with breathing pauses. 26% of the respondents reported having hypertension (high blood pressure), 3% had had myocardial infarction and 4% a stroke.
They found that a loud snorer has a 67% higher risk of having a stroke compared to people who do not snore, the risk of heart attack is 34% higher for loud snorers. It seems that quiet snorers do not run a higher risk of heart disease and/or stroke compared to people who do not snore, the scientists said.
The authors concluded "Snoring is frequent in the Hungarian adult population, and loud snoring with breathing pauses, in contrast with quiet snoring, is associated with an increased risk of cardiovascular disease and increased health-care utilization."
"Cardiovascular Disease and Health-Care Utilization in Snorers: a Population Survey"
Andrea Dunai, MD, Andras P. Keszei, MD, PhD, Maria S. Kopp, MD,PhD, Colin M. Shapiro, MBBCh, PhD, FRCPC, Istvan Mucsi, MD, PhD, Marta Novak, MD, PhD
SLEEP Volume 31, Issue 03, Pages 411-416
Click here to view abstract online
Saturday, March 1, 2008
Medwire - 29.02.08
Minority of CHD patients do recommended exercise
29 February 2008
Study findings reveal that patients with coronary heart disease often do not comply with physical activity recommendations, and are less likely to do so than individuals without CHD.
Information, reassurance, and support aid post-CABG recovery
29 February 2008
The results of a small, qualitative UK survey show that patients undergoing coronary bypass grafting surgery who may feel anxious or depressed about their recovery can be helped if they remain optimistic and are given information, reassurance, and support from the healthcare team and their social network.
Persistent hyperglycemia in AMI predicts in-hospital mortality
29 February 2008
Persistent hyperglycemia determined by multiple glucose assessments during hospitalization for acute myocardial infarction better predicts mortality than hyperglycemia on admission, research shows.
29 February 2008
Study findings reveal that patients with coronary heart disease often do not comply with physical activity recommendations, and are less likely to do so than individuals without CHD.
Information, reassurance, and support aid post-CABG recovery
29 February 2008
The results of a small, qualitative UK survey show that patients undergoing coronary bypass grafting surgery who may feel anxious or depressed about their recovery can be helped if they remain optimistic and are given information, reassurance, and support from the healthcare team and their social network.
Persistent hyperglycemia in AMI predicts in-hospital mortality
29 February 2008
Persistent hyperglycemia determined by multiple glucose assessments during hospitalization for acute myocardial infarction better predicts mortality than hyperglycemia on admission, research shows.
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.
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:
1.
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?
2.
ENHANCE Saga Continues: Experts Dispute Ezetimibe's Future and "Weight" of Imaging Studies
3.
Questioning the Importance of LDL Cholesterol: The ENHANCE Fallout
4.
Atrial Fibrillation: Diagnosis and Management
CME
5.
Nebivolol Approved in US CME
6.
Abnormal ECG Patterns in Athletes: An Initial Expression of Underlying Cardiomyopathy?
7.
ENHANCE Results Yield Disappointment for Ezetimibe
8.
Staying Active and Drinking Moderately Is Key to a Long Life CME
9.
Meta-Analysis Shows Statins Reduce All-Cause Mortality 22% in Elderly CHD Patients
10.
Folic Acid -- Finally Some Good News: A Best Evidence Review CME/CE
1.
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?
2.
ENHANCE Saga Continues: Experts Dispute Ezetimibe's Future and "Weight" of Imaging Studies
3.
Questioning the Importance of LDL Cholesterol: The ENHANCE Fallout
4.
Atrial Fibrillation: Diagnosis and Management
CME
5.
Nebivolol Approved in US CME
6.
Abnormal ECG Patterns in Athletes: An Initial Expression of Underlying Cardiomyopathy?
7.
ENHANCE Results Yield Disappointment for Ezetimibe
8.
Staying Active and Drinking Moderately Is Key to a Long Life CME
9.
Meta-Analysis Shows Statins Reduce All-Cause Mortality 22% in Elderly CHD Patients
10.
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
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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Physician's First Watch for February 22, 2008
David G. Fairchild, MD, MPH, Editor-in-Chief
Only One-Third of Adults Know Heart Attack Signs
Google Prototyping Personal Health Records
Early Immunosuppression Better Than Conventional Therapy in Crohn Disease
Antioxidants, Folate of No Developmental Benefit to Infants with Down Syndrome
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.
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.
To ensure you receive Physician's First Watch, add FirstWatch@jwatch.org to your address book.
Forward Sign Up
My Alerts About Physician's First Watch Editorial Board
Advertisement*
Physician's First Watch for February 22, 2008
David G. Fairchild, MD, MPH, Editor-in-Chief
Only One-Third of Adults Know Heart Attack Signs
Google Prototyping Personal Health Records
Early Immunosuppression Better Than Conventional Therapy in Crohn Disease
Antioxidants, Folate of No Developmental Benefit to Infants with Down Syndrome
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.
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)
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
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.
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.
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
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.
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
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.
Link http://www.sciencedaily.com/releases/2008/02/080213090530.htm
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.
Link http://www.sciencedaily.com/releases/2008/02/080213090530.htm
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.
ABSTRACT
Background: 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.
Coordinating Study Evaluating Outcomes of Advising and Counseling in Heart Failure (COACH)
Arch Intern Med. 2008;168(3):316-324.
ABSTRACT
Background: 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.
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.
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.
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)
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)
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."
Journal
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."
Journal
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.
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."
Journal
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."
Journal
Top 10 news from theheart.org - January edition
Top 10 news from theheart.org - January edition
THEHEART.ORG - From WebMD
TOP 10 NEWSWeb site: http://email.theheart.org/cgi-bin1/DM/z/eBhPV0UALTw0V110HJsB0El##pubdate##
1 ::::::"ENHANCE results yield disappointment for ezetimibe"http://email.theheart.org/cgi-bin1/DM/z/eBhPV0UALTw0V110JEj40EL
2 ::::::"ENHANCE saga continues: Experts dispute ezetimibe's future and"weight" of imaging studies"http://email.theheart.org/cgi-bin1/DM/z/eBhPV0UALTw0V110JEj50EM
3 ::::::"Questioning the importance of LDL cholesterol: The ENHANCE fallout"http://email.theheart.org/cgi-bin1/DM/z/eBhPV0UALTw0V110JEj60EN
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.
http://email.theheart.org/cgi-bin1/DM/z/eBhPV0UALTw0V110JEj70EO"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.http://email.theheart.org/cgi-bin1/DM/z/eBhPV0UALTw0V110JEj80EP
4 ::::::"NEJM reviewer under fire for leaking Nissen's rosiglitazone paper toGlaxoSmithKline"http://email.theheart.org/cgi-bin1/DM/z/eBhPV0UALTw0V110JEkA0EZ
5 ::::::"Role of cholesterol in prevention and mortality benefit of statinsdebated in media"http://email.theheart.org/cgi-bin1/DM/z/eBhPV0UALTw0V110JEkB0Ea
6 ::::::"Congress investigates Jarvik's Lipitor ads"http://email.theheart.org/cgi
-bin1/DM/z/eBhPV0UALTw0V110JEkC0Eb
7 ::::::"More talent heads to the University of Miami; two fewer EP docs atMass General"http://email.theheart.org/cgi-bin1/DM/z/eBhPV0UALTw0V110JEkD0Ec
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.http://email.theheart.org/cgi-bin1/DM/z/eBhPV0UALTw0V110JEkE0Ed"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.http://email.theheart.org/cgi-bin1/DM/z/eBhPV0UALTw0V110JEkF0Ee
8 ::::::"Fewer deaths, MI, with CABG than DES for multivessel disease in NYState"
http://email.theheart.org/cgi-bin1/DM/z/eBhPV0UALTw0V110JEkG0Ef
9 ::::::"Questions arise about the chronology of events in the ENHANCE trial"http://email.theheart.org/cgi-bin1/DM/z/eBhPV0UALTw0V110JEkH0Eg
10 ::::::"ACE inhibitors or ARBs in hypertension? In chronic kidney disease?"http://email.theheart.org/cgi-bin1/DM/z/eBhPV0UALTw0V110JEkI0Eh
THEHEART.ORG - From WebMD
TOP 10 NEWSWeb site: http://email.theheart.org/cgi-bin1/DM/z/eBhPV0UALTw0V110HJsB0El##pubdate##
1 ::::::"ENHANCE results yield disappointment for ezetimibe"http://email.theheart.org/cgi-bin1/DM/z/eBhPV0UALTw0V110JEj40EL
2 ::::::"ENHANCE saga continues: Experts dispute ezetimibe's future and"weight" of imaging studies"http://email.theheart.org/cgi-bin1/DM/z/eBhPV0UALTw0V110JEj50EM
3 ::::::"Questioning the importance of LDL cholesterol: The ENHANCE fallout"http://email.theheart.org/cgi-bin1/DM/z/eBhPV0UALTw0V110JEj60EN
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.
http://email.theheart.org/cgi-bin1/DM/z/eBhPV0UALTw0V110JEj70EO"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.http://email.theheart.org/cgi-bin1/DM/z/eBhPV0UALTw0V110JEj80EP
4 ::::::"NEJM reviewer under fire for leaking Nissen's rosiglitazone paper toGlaxoSmithKline"http://email.theheart.org/cgi-bin1/DM/z/eBhPV0UALTw0V110JEkA0EZ
5 ::::::"Role of cholesterol in prevention and mortality benefit of statinsdebated in media"http://email.theheart.org/cgi-bin1/DM/z/eBhPV0UALTw0V110JEkB0Ea
6 ::::::"Congress investigates Jarvik's Lipitor ads"http://email.theheart.org/cgi
-bin1/DM/z/eBhPV0UALTw0V110JEkC0Eb
7 ::::::"More talent heads to the University of Miami; two fewer EP docs atMass General"http://email.theheart.org/cgi-bin1/DM/z/eBhPV0UALTw0V110JEkD0Ec
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.http://email.theheart.org/cgi-bin1/DM/z/eBhPV0UALTw0V110JEkE0Ed"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.http://email.theheart.org/cgi-bin1/DM/z/eBhPV0UALTw0V110JEkF0Ee
8 ::::::"Fewer deaths, MI, with CABG than DES for multivessel disease in NYState"
http://email.theheart.org/cgi-bin1/DM/z/eBhPV0UALTw0V110JEkG0Ef
9 ::::::"Questions arise about the chronology of events in the ENHANCE trial"http://email.theheart.org/cgi-bin1/DM/z/eBhPV0UALTw0V110JEkH0Eg
10 ::::::"ACE inhibitors or ARBs in hypertension? In chronic kidney disease?"http://email.theheart.org/cgi-bin1/DM/z/eBhPV0UALTw0V110JEkI0Eh
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)
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.
ABSTRACT
Background
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.
Methods
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.
Results
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.
Conclusions
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.
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.
ABSTRACT
Background
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.
Methods
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.
Results
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.
Conclusions
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.
Context
It is unknown whether patients are at increased short-term risk for adverse events following clopidogrel cessation.
Objective
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.
Results
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).
Conclusions
'
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.
Context
It is unknown whether patients are at increased short-term risk for adverse events following clopidogrel cessation.
Objective
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.
Results
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).
Conclusions
'
Tuesday, February 5, 2008
Interpreting risks and ratios in therapy trials
Australian Prescriber - Interpreting risks and ratios in therapy trials
Summary
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.
Summary
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
Review
MI Perez, VM Musini
Cochrane Database of Systematic Reviews 2008 Issue 1 (Status: New) Copyright © 2008 The Cochrane Collaboration.
Abstract
Background
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.
Objectives
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.
Review
MI Perez, VM Musini
Cochrane Database of Systematic Reviews 2008 Issue 1 (Status: New) Copyright © 2008 The Cochrane Collaboration.
Abstract
Background
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.
Objectives
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
Diabetes
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:/www.heart.org.
For diabetes information, visit the American Diabetes Association: http://www.diabetes.org.
WomenHeart, the National Coalition for Women with Heart Disease, provides patients with education and grassroots support networks. WomenHeart is online at http://www.womenshealthresearch.org.S
Society for Women's Health Research (SWHR)1025 Connecticut Ave. NW, Ste. 701Washington, DC 20036United Stateshttp://www.womenshealthresearch.org
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
Diabetes
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:/www.heart.org.
For diabetes information, visit the American Diabetes Association: http://www.diabetes.org.
WomenHeart, the National Coalition for Women with Heart Disease, provides patients with education and grassroots support networks. WomenHeart is online at http://www.womenshealthresearch.org.S
Society for Women's Health Research (SWHR)1025 Connecticut Ave. NW, Ste. 701Washington, DC 20036United Stateshttp://www.womenshealthresearch.org
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