Heart Smart Advice

Technique to Stimulate Heart Cells May Lead to Light-Controlled Pacemakers

2011-08-12T16:44:00.002-05:00

A new technique that stimulates heart muscle cells with low-energy light raises the possibility of a future light-controlled pacemaker, researchers reported in Circulation: Arrhythmia & Electrophysiology, a journal of the American Heart Association.

"Electronic cardiac pacemakers and defibrillators are well established and successful technologies, but they are not without problems, including the breakage of metal leads, limited battery life and interference from strong magnetic fields," said Emilia Entcheva, Ph.D., senior author of the study and associate professor of biomedical engineering at Stony Brook University in Stony Brook, New York. "Eventually, optical stimulation may overcome some of these problems and offer a new way of controlling heart function."

The research is part of a new field called optogenetics that introduces light-sensitive proteins into "excitable" cells, making it possible to control specific activities within cells. Excitable cells can actively generate electrical signals such as nerve cells and muscle cells.

The main appeal of control by light is the unprecedented ability to remotely, without contact, turn on/off a single cell or a cell type, not possible by electrical or other means of stimulation.

Several years ago, investigators discovered that brain cells could be stimulated using light if they were genetically altered to produce a light-sensitive protein called channelrhodopsin 2 (ChR2).

In the new study, researchers created cells expressing the ChR2 protein and coupled them with heart muscle cells from animals, creating heart tissue stimulated by light. They found light-triggered heart muscle contractions and electrical waves were indistinguishable from electrically-triggered waves.

Rather than directly modifying heart cells, the researchers coupled donor cells optimized for light responsiveness with the heart cells. The new technique uses much lower energy than in prior studies and doesn't require the use of viruses or the introduction of genes from other organisms into heart cells. Instead, cells from a person's bone marrow or skin can be cultured and modified to respond to light, reducing the possibility that the immune system will reject the light-sensitive cells.

"Our method of non-viral cell delivery may overcome some hurdles toward potential clinical use by harvesting cells from the patient, making them light-responsive and using them as donor cells in the same patient," Entcheva said.

The approach may someday improve pacemakers and defibrillators. Instead of metal leads, a light-controlled pacemaker would use biocompatible, flexible plastic optic fibers.

In preliminary calculations, a light-based system might require only one-tenth the energy, meaning that a battery could last 50 years rather than five. The more immediate application of the technique will likely be to aid heart research.

"Optical stimulation is a great tool to selectively probe and control different parts of the electrical circuitry of the heart to better understand where the vulnerable sites are or what gives rise to lethal arrhythmias," Entcheva said.

The technique might also be used to test new drugs for possible cardiac side effects.

Co-authors are: Zhiheng Jia, M.S.; Virginijus Valiunas, Ph.D.; Zongju Lu, Ph.D.; Harold Bien, M.D., Ph.D.; Huilin Liu, M.S.; Hong-Zhang Wang, Ph.D.; Barbara Rosati, Ph.D.; Peter R. Brink, Ph.D.; and Ira S. Cohen, M.D., Ph.D. Author disclosures and sources of funding are on the manuscript.

The above story is reprinted (with editorial adaptations by Heart Smart Advice staff) from materials provided by American Heart Association.

Why the Human Heart Can't Regenerate Itself

2011-08-12T16:41:00.001-05:00

Stem cell researchers at UCLA have uncovered for the first time why adult human cardiac myocytes have lost their ability to proliferate, perhaps explaining why the human heart has little regenerative capacity.

The study, done in cell lines and mice, may lead to methods of reprogramming a patient's own cardiac myocytes within the heart itself to create new muscle to repair damage, said Dr. Robb MacLellan, a researcher with the Eli and Edythe Broad Center of Regenerative Medicine and Stem Cell Research at UCLA and senior author of the study.

Unlike newts and salamanders, human adults cannot spontaneously regrow damaged organs such as the heart. However, recent research suggests that mammals do have the ability to regenerate the heart for a very brief period, about the first week of life. But that ability is quickly lost. But if we had it once, MacLellan said, maybe it is possible to regain that ability.

Published in the Aug. 8 issue of the peer-reviewed Journal of Cell Biology, MacLellan's study suggests it might be possible to turn back the cellular clock to a time when cardiac myocytes had the ability to proliferate and re-grow heart muscle.

"These salamanders and other lower organisms have the ability to de-differentiate cardiac myocytes, or take them back to an earlier, more primitive state, which allows them to re-enter the cell cycle, creating new heart muscle," said MacLellan, who also is an associate professor of cardiology and physiology. "In mammals, we've lost that potential. If we knew how to restore that, or knew the reason why adult myocytes can't do it, we could try to figure out a way to use nature's methods to regenerate the heart."

During human development, cardiac myocytes are made by progenitor stem cells and proliferate to form the heart. Once the heart is formed, the myocytes transform from immature cells into mature cells that cannot proliferate. That's not so for newts and salamanders, whose cardiac myocytes can go back and forth between immature, or primitive, states to proliferate and repair damage and then revert back into mature cells once the damage is repaired.

MacLellan believes the reason adult human cardiac myocytes can't do this is quite simple -- when the myocytes are in a more primitive state, they are not as good at contracting, which is vital for proper heart function. Because humans are much larger than newts and salamanders, we needed more heart contraction to maintain optimum blood pressure and circulation.

"The way we evolved, in order to maintain blood pressure and flow we had to give up the ability to regenerate the heart muscle," MacLellan said. "The up side is we got more efficient cardiac myocytes and better hearts. But it was a trade-off."

MacLellan said that by temporarily knocking down the proteins that block the cell cycle mechanism, it may be possible to get adult cardiac myocytes to re-enter the cell cycle and revert to a state where they can again proliferate. These therapies would need to be reversible so that the effects of the protein manipulation eventually wear off once the damage is repaired. Then myocytes would become mature again and aid in contracting the regenerated heart muscle. MacLellan currently is looking into using nanoparticles to deliver small interfering RNA to the heart to knock out the proteins that are keeping the myocytes mature.

When a heart attack occurs, oxygen is cut off to part of the heart, causing the cardiac myocytes to die and resulting in scar tissue. It's easy to locate the damaged area of the heart, and if a way could be developed to reprogram a patient's own myocytes, the protein manipulation system could be injected into the damaged area, reverting the myocytes to their primitive state and replacing the dead muscle with new, living muscle, MacLellan said.

"People have been talking about the regenerative potential of these lower organisms for a long time and why this does not occur in humans" MacLellan said. "This is the first paper that provided a rationale and mechanism for why this happens."

There has been much talk of using human embryonic stem cells or reprogrammed induced pluripotent stem cells to regenerate the heart. However, it's unknown how much regeneration is possible and how much benefit would come from it.

"From my point of view, this is a potential mechanism to regenerate heart muscle without having to harvest or expand stem cells," MacLellan said. "Each person would be their own source for cells for regeneration."

The five-year study was funded by the National Institutes of Health.

The above story is reprinted (with editorial adaptations by Heart Smart Advice staff) from materials provided by University of California - Los Angeles Health Sciences, via EurekAlert!, a service of AAAS.

No Proof Fibrate Drugs Reduce Heart Risk in Diabetes Patients On Statins, Experts Say

2011-08-12T16:39:00.002-05:00

Type 2 diabetes patients, who face higher risk of cardiovascular disease, often take a combination of medications designed to lower their LDL or "bad" cholesterol and triglyceride levels while raising their HDL or "good" cholesterol because doctors long have thought that taken together, the drugs offer protection from heart attacks and improve survival.

But in a commentary in the current New England Journal of Medicine, a trio of doctors who served on a recent Food and Drug Administration panel that evaluated the drugs' effectiveness says the commonly prescribed medications have not been proven successful at preventing heart attacks in Type 2 diabetes patients with elevated cholesterol.

The drugs, called fibrates, seek to lower blood triglyceride levels and raise the amount of HDL cholesterol. They often are prescribed to diabetes patients as an add-on to statins, drugs that lower LDL cholesterol. Annual sales in the U.S. for the three fibrates now approved by the FDA -- gemfibrozil (Lopid), fenofibrate (Tricor) and fenofibric acid (Trilipix) -- amount to billions of dollars.

"There have been few studies regarding the clinical outcome efficacy of fibrates," said Sanjay Kaul, MD, a commentary author and director of the Cardiology Fellowship Training Program at the Cedars-Sinai Heart Institute. "Thousands and thousands of Americans take fibrates every day but so far, there are no long-term studies showing that fibrates lower cardiovascular risk or improve survival among diabetes patients who are also on statins."

The commentary calls for more studies. Meantime, the authors suggest that doctors prescribe the statin-fibrate combination only to diabetic patients at high risk for a heart attack and only after optimal control of LDL cholesterol has been achieved with statin treatment.

The above story is reprinted (with editorial adaptations by Heart Smart Advice staff) from materials provided by Cedars-Sinai Medical Center, via EurekAlert!, a service of AAAS.

How Estrogen Could Help Protect Women from Cardiovascular Disease

2011-08-12T16:36:00.002-05:00

The sex hormone estrogen could help protect women from cardiovascular disease by keeping the body's immune system in check, new research from Queen Mary, University of London has revealed.

The study has shown that the female sex hormone works on white blood cells to stop them from sticking to the insides of blood vessels, a process which can lead to dangerous blockages.

The results could help explain why cardiovascular disease rates tend to be higher in men and why they soar in women after the menopause.

The researchers compared white blood cells from men and pre-menopausal women blood donors. They found that cells from premenopausal women have much higher levels of protein called annexin-A1 on the surface of their white blood cells.

The scientists also found that annexin-A1 and estrogen levels were strongly linked throughout the menstrual cycle.

White blood cells play a vital role in protecting the body from infections. When they are activated they stick to the walls of blood vessels. This process normally helps the cells to tackle infection but if it happens too much, it can lead to blood vessel damage, which in turn can lead to cardiovascular disease. However, when annexin-A1 is on the surface of these white blood cells, it prevents them from sticking to the blood vessel wall.

The new research shows that estrogen can move annexin-A1 from inside the white blood cell, where it is normally stored, to the surface of the cells, thereby preventing the cells from sticking to blood vessel walls and causing vascular damage. This may have important implications in cardiovascular disease.

Dr Suchita Nadkarni from the William Harvey Research Institute, Queen Mary, University of London, who led the research, said: "We've known for a long time that estrogen protects pre-menopausal women from heart disease, but we don't know exactly why. This study brings us a step closer to understanding how natural estrogen might help protect our blood vessels.

"We've shown a clear relationship between estrogen levels and the behaviour of these white blood cells. Our results suggest that estrogen helps maintain the delicate balance between fighting infections, and protecting arteries from damage that can lead to cardiovascular disease.

"Understanding how the body fights heart disease naturally is vital for developing new treatments."

The study was co-funded by the British Heart Foundation, the Wellcome Trust and the National Institutes of Health Research (NIHR).

The above story is reprinted (with editorial adaptations by Heart Smart Advice staff) from materials provided by Queen Mary, University of London, via EurekAlert!, a service of AAAS.

Depression Linked to Increased Risk of Stroke in Women

2011-08-12T16:34:00.001-05:00

Depressed women may face an increased risk of stroke, according to new research reported in Stroke: Journal of the American Heart Association.

In six years of follow-up of women in the Nurses' Health Study, researchers found that a history of depression was associated with a 29 percent increased risk of total stroke -- even after considering other stroke risk factors. Women who used anti-depressant medication -- particularly selective serotonin reuptake inhibitors -- had a 39 percent increased risk of stroke. Examples of these drugs are Prozac, Zoloft, and Celexa.

Anti-depressant medication use may be an indicator of depression severity, said Kathryn Rexrode, M.D., the study's senior author and Associate Physician at Brigham and Women's Hospital in Boston, Mass. "I don't think the medications themselves are the primary cause of the risk. This study does not suggest that people should stop their medications to reduce the risk of stroke."

Researchers followed 80,574 women 54 to 79 years old in the Nurses' Health Study from 2000-06 without a prior history of stroke. They assessed depressive symptoms multiple times with a Mental Health Index. Anti-depressant use was reported every two years beginning in 1996, and physicians diagnosed depression beginning in 2000.

Depression was defined as currently reporting or having a history of depression.

The reported prevalence of depression at baseline in the women was 22 percent, and 1,033 stroke cases were documented during six years of follow-up.

Compared to women without a history of depression, depressed women were more likely to be single, smokers and less physically active. They were also slightly younger, had a higher body mass index and more coexisting conditions such as high blood pressure, heart disease and diabetes.

"Depression can prevent individuals from controlling other medical problems such as diabetes and hypertension, from taking medications regularly or pursuing other healthy lifestyle measures such as exercise," said Rexrode, who is also Assistant Professor of Medicine at Harvard Medical School. "All these factors could contribute to increased risk."

Depression may be associated with an increased risk of stroke through a variety of mechanisms. It may be linked to inflammation, which increases the risk of stroke as well as other conditions or underlying vascular disease in the brain, said An Pan, Ph.D., lead author of the study and a research scientist at the Harvard School of Public Health. "Regardless of the mechanism, recognizing that depressed individuals may be at a higher risk of stroke may help the physician focus on not only treating the depression, but treating stroke risk factors such as hypertension, diabetes and elevated cholesterol as well as addressing lifestyle behaviors such as smoking and exercise."

Among limitations of the study, the participants were predominantly white registered nurses, it excluded women without detailed information on depression measures and the participants with onset of stroke at a young age.

"We cannot infer cause or fully exclude the possibility that the results could be explained by other unmeasured unknown factors," Pan said. "Although the underlying mechanisms remain unclear, recognizing that depressed women may be at a higher risk of stroke merits additional research into preventive strategies in this group."

Other co-authors are Olivia I. Okereke, M.D.; Qi Sun, M.D., Sc.D.; Giancarlo Logroscino, M.D., Ph.D.; JoAnn E. Manson, M.D.; Walter C.Willett, M.D.; Alberto Ascherio, M.D.; and Frank B. Hu, M.D., Ph.D. Author disclosures are on the manuscript.

The National Institutes of Health/National Heart, Blood, Lung Institute funded the study.

The above story is reprinted (with editorial adaptations by Heart Smart Advice staff) from materials provided by American Heart Association, via EurekAlert!, a service of AAAS.

Lasers Stimulate Stem Cells and Reduce Heart Scarring After Heart Attack, Study Suggests

2011-08-12T16:31:00.002-05:00

After a heart attack or stroke, heart scarring can lead to dangerously paper-thin heart walls and a decreased ability to pump blood through the body. Although the heart is unable to completely heal itself, a new treatment developed at Tel Aviv University uses laser-treated bone marrow stem cells to help restore heart function and health.

Combining the therapeutic benefits of low-level lasers -- a process called "shining" -- and bone marrow stem cells, Prof. Uri Oron of the Department of Zoology at TAU's George S. Wise Faculty of Life Sciences has developed an effective, non-invasive procedure that significantly reduces heart scarring after an ischemic event, in which the heart is injured by a lack of blood supply. When the laser is applied to these cells a few hours after a heart attack, scarring can be reduced by up to 80 percent.

Prof. Oron's innovative method, which was recently reported in the journal Lasers in Surgery and Medicine, is ready for clinical trial.

Sending an SOS signal into the bone marrow

Though the heart is known to contain some stem cells, they have a very limited ability to repair damage caused by a heart attack, says Prof. Oron, and researchers have had to look elsewhere. One of the first efforts to use stem cells to reduce heart scarring involved harvesting them from the bone marrow and inserting them back into the heart muscle, close to the heart's blood supply, but this had limited success.

Prof. Oron, who has long used low level lasers to stimulate stem cells to encourage cell survival and the formation of blood vessels after a heart attack, was inspired to test how laser treatments could also work to heal the heart. He and his fellow researchers tried different methods, including treating the heart directly with low level lasers during surgery, and "shining" harvested stem cells before injecting them back into the body.

But he was determined to find a simpler method. After a low-level laser was "shined" into a person's bone marrow -- an area rich in stem cells -- the stem cells took to the blood stream, moving through the body and responding to the heart's signals of distress and harm, Prof. Oron discovered. Once in the heart, the stem cells used their healing qualities to reduce scarring and stimulate the growth of new arteries, leading to a healthier blood flow.

To determine the success of this method, Prof. Oron performed the therapy on an animal model. Following the flow of bone marrow stem cells through the use of a fluorescent marker, the researchers saw an increase in stem cell population within the heart, specifically in the injured regions of the heart. The test group that received the shining treatment showed a vastly higher concentration of cells in the injured organ than those who had not been treated with the lasers.

In the longer run, Prof. Oron sees this as a way to make cell therapy simpler. Without the need to remove the stem cells from the body, this treatment stimulates a whole variety of stem cells to help heal the body -- a "cocktail" ultimately more efficient than single-cell type treatments. This could prove to be beneficial to the repair of other human organs such as the kidney or the liver, he notes.

A safe and painless procedure

Although stem cells naturally heed the call to heal throughout the body, says Prof. Oron, their success tends to be limited without this laser treatment. But with treatment, the cells' effectiveness become much more highly enhanced.

"After we stimulate the cells with the laser and enhance their proliferation in the bone marrow, it's likely that more cells will migrate into the bloodstream. The cells that eventually reach the heart secrete growth factors to a higher extent, and new blood vessel formation is encouraged," Prof. Oron theorizes.

Through these animal models, Prof. Oron's non-invasive procedure has been proven safer and quicker than other options. He says that his team, including TAU's Dr. Hana Tuby and Lidya Maltz, has also done a series of safety studies to rule out the possibility that the stimulation of the stem cells by laser could encourage the growth of abnormal tissues. Under the specific and low doses of energy applied in this technique, no such dangers were found.

The above story is reprinted (with editorial adaptations by Heart Smart Advice staff) from materials provided by American Friends of Tel Aviv University, via EurekAlert!, a service of AAAS.

Simple Surgical Procedure May Help Prevent Heart Damage in Children

2011-05-18T22:10:00.000-05:00

Removing enlarged tonsils and adenoids may help prevent high blood pressure and heart damage in children who suffer from obstructive sleep apnea (OSA), according to a study conducted at Cincinnati Children's Hospital Medical Center. In some children with OSA, adenotonsillectomy can result in significantly lower blood pressure within 24 months of the procedure.

The results were presented at the ATS 2011 International Conference in Denver.

Children with enlarged tonsils and adenoids are particularly prone to developing OSA, said study lead author Lisa Burns, MD, (Pulmonary Fellow at Cincinnati Children's Hospital Medical Center). And, in children and adults, OSA has been linked with elevations in both daytime and nighttime blood pressure. OSA can also interfere with the normal "dip" in blood pressure levels that occur during sleep. Persistent elevations in blood pressure can result in organ damage, including heart damage.

"Our study emphasizes the importance of treating severe sleep apnea in order to prevent persistent elevation in blood pressure and end-organ damage," Dr. Burns said. "We also show that during sleep, diastolic blood pressure, the measurement of your blood pressure when the heart is relaxing, is more sensitive to the effects of sleep apnea than other measures of blood pressure."

Dr. Burns and colleagues evaluated 115 children between the ages of 7 and 13 years, including 28 patients with mild OSA, 27 with severe OSA and 60 healthy controls. The subjects were evaluated for level of OSA using polysomnography, a diagnostic test used to measure breathing during periods of sleep. All OSA subjects had enlarged adenoids and tonsils and underwent adenotonsillectomy. Blood pressure, rest and activity levels, and heart size were measured at the beginning of the study and during follow-up at 12 to 24 months.

At follow-up, researchers found blood pressure levels during sleep decreased following adenotonsillectomy when compared with measurements at baseline. The procedure also restored the normal nighttime "dip" in blood pressure relative to daytime blood pressure, Dr. Burns said.

In addition, in a subset of children with moderate to severe sleep apnea, there was a decrease in heart size after adenotonsillectomy.

Dr. Burns said the results are similar to those obtained from studies of adults with OSA.

"We expected to see changes based on what we know about adults with sleep apnea and its effect on blood pressure," she said. "We know that children with sleep apnea tend to have higher blood pressures than children without sleep apnea, even if these elevations still fall within a normal range. However this is the first study to evaluate how treatment of sleep apnea impacts blood pressure and heart size in a pediatric population who are free from other diseases, which may also contribute to elevations in blood pressure.

Treating OSA in childhood is especially critical, Dr. Burns noted.

"Children who have elevated blood pressure throughout childhood will often go on to develop high blood pressure in adulthood," she said. "Adults with high blood pressure are at risk for other cardiovascular diseases, such as heart attacks, stroke, and heart failure. By identifying and treating elevations in blood pressure at an earlier age through treatment of OSA, we hope to prevent development of cardiovascular disease in childhood and later in life."

Future studies should investigate the mechanisms leading to blood pressure changes with sleep apnea, she added.

Story Source: The above story is reprinted (with editorial adaptations by the Heart Smart Advice staff) from materials provided by American Thoracic Society, via EurekAlert!, a service of AAAS.

Novel Gene Linked to Aging Hearts

2011-05-18T22:04:00.000-05:00

Researchers at the University of Ottawa Heart Institute (UOHI) have identified a novel gene in the nucleus of muscle and brain cells that affects heart development and the aging process. Their investigation brings the promise of new treatments for an old, failing heart.

"We know that aging is the greatest predictor of cardiovascular disease and heart failure. So we have been working backward in time, looking at the fetal heart to understand changes in the process as it ages, grows frail and fails," said molecular biologist Patrick Burgon, PhD.

A research team led by Burgon discovered the gene in the cell's nucleus -- the site where hereditary information or DNA is housed -- suggesting that it may control the behavior of other genes important in heart development.

The researchers, who focus on the fetal heart as it grows into an adult heart, named the gene MLIP for Muscle enriched A-type Lamin Interacting Protein. Mutations in the Lamin gene family are associated with muscular dystrophy and other degenerative heart muscle diseases.

Their findings have been reported electronically in the Journal of Biological Chemistry and are scheduled for formal publication in June. Researchers now will investigate how animal models respond when the MLIP gene is removed to gain greater knowledge into its function.

"Greater knowledge of this gene and how it works will help us understand loss of cardiac function. Our research opens up new avenues relevant to the characteristics of cardiac development," said Burgon.

At the Heart Institute, studies to identify complex cardiovascular mechanisms are part of a world-wide effort among a core of leading scientific organizations. The Heart Institute collaborates with an international consortium that has already discovered 13 new genes that increase the risk of coronary artery disease (CAD).

Heart Institute researchers previously identified gene 9p21 -- the first genetic risk factor recognized for heart disease and the first major new cardiovascular risk factor since the discovery of cholesterol. The Institute has also located a variety of other genes influencing diseases such as atrial fibrillation and biological processes such as obesity.

Research by Burgon's group was funded by the Heart institute and Canadian Institutes of Health Research.

Story Source:The above story is reprinted (with editorial adaptations by the Heart Smart Advice staff) from materials provided by University of Ottawa Heart Institute.

Heart Drugs Ineffective in Treating Pulmonary Arterial Hypertension, Study Finds

2011-05-18T22:02:00.000-05:00

Despite their beneficial effects in treating heart disease, neither aspirin nor simvastatin appear to offer benefit to patients suffering from pulmonary artery hypertension (PAH), according to a National Institutes of Health (NIH)-funded study conducted at four U.S. medical centers. This was the first NIH-funded randomized clinical trial (RCT) in PAH.

The results of the study were presented at the ATS 2011 International Conference in Denver.

PAH is a progressive, incurable disease characterized by increased blood pressure in the arteries of the lungs, which causes shortness of breath, dizziness and fatigue, and can lead to heart failure and death. PAH can occur on its own or be associated with other conditions, such as connective tissue diseases and congenital heart disease.

Although both aspirin and simvastatin are effective in many types of cardiovascular disease, these drugs have not been well-studied in the treatment of PAH, said Steven Kawut, MD, MS lead author and associate professor of medicine and epidemiology at the University of Pennsylvania School of Medicine. The study was designed to determine if the drugs could be effective in the treatment of patients with PAH.

"Surprisingly, we found no evidence that aspirin or simvastatin had beneficial clinical effects in this population, and the study was terminated early by the National Heart Lung and Blood Institute upon the recommendation of the Data and Safety Monitoring Board (DSMB)," said Dr. Kawut, who is also director of the university's Pulmonary Vascular Disease Program. "The results of this study do not support the routine treatment of PAH with these medications."

Researchers enrolled 65 patients in this placebo-controlled trial and randomized them into four groups: one in which patients received aspirin, one in which patients received simvastatin, one in which patients received both drugs, and one in which patients received neither drug. The main outcome, six-minute walk distance (6MWD) (a measure of how far a person can walk in six minutes), tended to be lower in the group taking simvastatin at six months. Based on these early results, the DSMB recommended stopping the study since there was a low probability of demonstrating a beneficial effect of simvastatin even if the study enrolled the planned number of subjects (92). There was no significant difference in the 6MWD between the group taking aspirin and the group taking placebo.

"Multiple animal studies have suggested that simvastatin would be effective in PAH, and aspirin has biologic effects which would be expected to benefit PAH patients," Dr. Kawut said. "This study demonstrates that federally-funded, investigator-initiated RCTs in PAH and other pulmonary vascular diseases are feasible. The findings show the importance of subjecting traditional cardiovascular therapies and drugs which appear effective in the laboratory to placebo-controlled RCTs in humans before recommending their use."

"Aspirin and simvastatin may be prescribed for usual clinical indications in patients with PAH, but should not be administered specifically to treat PAH," he added.

Story Source: The above story is reprinted (with editorial adaptations by the Heart Smart Advice staff) from materials provided by American Thoracic Society, via EurekAlert!, a service of AAAS.

Simple Fitness Test Could Predict Long-Term Risk for Heart Attack, Stroke in Middle-Aged People

2011-05-18T21:59:00.002-05:00

If you're middle-aged, the answer could provide a strong predictor of your risk of heart attack or stroke over the next decade or more.

In two separate studies, UT Southwestern Medical Center researchers have found that how fast a middle-age person can run a mile can help predict the risk of dying of heart attack or stroke decades later for men and could be an early indicator of cardiovascular disease for women.

In one recent study in the Journal of the American College of Cardiology, researchers analyzed the heart disease risk of 45-, 55- and 65-year-old men based on their fitness level and traditional risk factors, such as age, systolic blood pressure, diabetes, total cholesterol and smoking habits. The scientists found that low levels of midlife fitness are associated with marked differences in the lifetime risk for cardiovascular disease.

For example, a 55-year-old man who needs 15 minutes to run a mile has a 30 percent lifetime risk of developing heart disease. In contrast, a 55-year-old who can run a mile in eight minutes has a lifetime risk of less than 10 percent.

"Heart disease tends to cluster at older ages, but if you want to prevent it, our research suggests that the prescription for prevention needs to occur earlier -- when a person is in his 40s and 50s," said Dr. Jarett Berry, assistant professor of internal medicine and a corresponding author on both studies.

Researchers in this study found that a higher fitness level lowered the lifetime risk of heart disease even in people with other risk factors.

In a separate study in Circulation, UT Southwestern researchers found that the same treadmill test predicts how likely a person is to die of heart disease or stroke more accurately than assessing the risk using only typical prediction tools such as blood pressure and cholesterol levels.

Heart disease is a leading killer in industrialized nations and the No. 1 killer of women in the U.S. Women younger than 50 are particularly difficult to assess for long-term cardiovascular risk.

"Nearly all women under 50 years of age are at low risk for heart disease," Dr. Berry said. "However, as women get older, their risk increases dramatically. In our study, we found that low levels of fitness were particularly helpful in identifying women at risk for heart disease over the long term."

For decades, scientists have tried to improve their ability to determine which patients are at highest cardiovascular disease risk. Blood-based and imaging techniques have been used to try to improve risk prediction, but fitness has not been examined until now, Dr. Berry said.

For both studies, researchers collected information from thousands of participants who underwent a comprehensive clinical exam and a treadmill exercise test at the Cooper Clinic in Dallas between 1970 and 2006.

In the JACC study, researchers evaluated more than 11,000 men tested before 1990 -- women were excluded because of the low number of participants and cardiovascular death rates -- and found 1,106 who died of heart attack or stroke during the study period. They measured participant fitness levels and traditional risk factors for heart disease. Within each age group, higher levels of fitness were associated with lower levels of traditional risk factors.

For the Circulation study, researchers examined more than 66,000 participants without cardiovascular disease, ages 20 to 90. They were then followed until death or the end of the study period; follow-up lasted up to 36 years. There were 1,621 cardiovascular deaths during the study. The researchers found that by adding fitness to the traditional risk factors, they significantly improved their ability to classify participants' short-term (10 years) and long-term (25 years) risk.

Researchers next will try to extend the JACC investigation parameters to women.

Other UT Southwestern researchers involved in the Circulation study were Dr. Sachin Gupta, a postdoctoral trainee in internal medicine and lead author; Dr. Anand Rohatgi, assistant professor of internal medicine; Colby Ayers, faculty associate in internal medicine; Dr. Amit Khera, assistant professor of internal medicine; Dr. Mark Drazner, professor of internal medicine and medical director of the Heart Failure, Left Ventricular Assist Devices and Cardiac Transplant Program; and Dr. James de Lemos, associate professor of internal medicine. Researchers from the Cooper Clinic in Dallas and Stanford University also participated in the research.

Other UT Southwestern researchers involved in the JACC study were Drs. Susan Lakoski, assistant professor of internal medicine; and Drs. de Lemos, Gupta, Khera and Rohatgi. Researchers from the Cooper Clinic, Stanford and Northwestern universities also participated.

The National Institutes of Health and the American Heart Association funded the studies.

Story Source: The above story is reprinted (with editorial adaptations by the Heart Smart Advice staff) from materials provided by UT Southwestern Medical Center.

Increases in Peripheral Arterial Disease Revascularization Correlates With Screening Growth

2011-05-07T04:40:00.002-05:00

Peripheral arterial disease (PAD) is an indicator for coronary and carotid arterial disease and carries inherent risks of claudication and amputation. PAD screening has increased dramatically, particularly among cardiologists, while vascular surgery has demonstrated the greatest growth in revascularization procedures treating PAD, according to research being presented at the 2011 American Roentgen Ray Society's annual meeting.

The study was performed at Rhode Island Hospital in Providence, RI. CPT codes were extracted for lower extremity vascular noninvasive physiologic studies and for peripheral arterial stent placement and transluminal angioplasty. Six years of data were examined from the Centers for Medicare and Medicaid Services Physician/Supplier Procedure Summary Master files over an eight year span from 2000 -- 2007.

Regarding non-invasive physiologic testing, cardiology has demonstrated nearly twice the compounded annual growth rate of vascular surgery and radiology. However, in endovascular therapy for PAD, vascular surgery has shown the greatest increase, with compounded growth rates more than twice that of cardiology. In contrast, radiology has experienced a net decline in endovascular PAD therapy.

"There has been a marked increase in volume of non-invasive physiologic testing, particularly within cardiology, a self-referring specialty, and this has been associated with tremendous growth in endovascular therapy for peripheral arterial disease," said Tyler Harris, MD, lead author of the study.

"Prior work has shown the majority of peripheral arterial stenting and angioplasty is performed for patients with intermittent claudication, particularly when performed by cardiologists," said Harris.

"However, non-invasive therapies such as supervised exercise programs have shown equivalent outcomes versus stenting and angioplasty in this population across multiple trials. Additionally, this growth has occurred in the absence of any major advance in the understanding of morbidity and mortality of peripheral arterial disease," he said.

Story Source: The above story is reprinted (with editorial adaptations by the Heart Smart Advice staff) from materials provided by American Roentgen Ray Society, via EurekAlert!, a service of AAAS.

Animal Studies Reveal New Route to Treating Heart Disease

2011-05-07T04:37:00.001-05:00

Scientists at Johns Hopkins have shown in laboratory experiments in mice that blocking the action of a signaling protein deep inside the heart's muscle cells blunts the most serious ill effects of high blood pressure on the heart. These include heart muscle enlargement, scar tissue formation and loss of blood vessel growth.

Specifically, the Johns Hopkins team found that their intervention halted transforming growth factor beta (TGF-beta) secretion at a precise location called cell receptor type 2 in cardiac muscle cells. Blocking its action in this cell type forestalled pathways for hypertrophy, fibrosis, and angiogenesis by stopping the unbridled TGF-beta signaling, which is typically observed in heart failure, in all other non-muscle types of cells in blood vessels and fibrous tissue. However, blocking TGF-beta signaling in non-muscle cells did not stop disease progression.

In several dozen different experiments, using genetically altered mice or chemicals to selectively block different TGF-beta pathways, researchers were able to pinpoint where the signaling protein had its greatest impact on heart function and determine how its unimpeded activity promoted heart disease.

"Now that we know about the pivotal and specific bad roles played by TGF-beta in a common form of heart disease, we can try to mimic our lab experiments to develop cell-specific drug therapies that stop the chain reactions in the heart muscle at the TGF-beta type 2 cell receptor location," says senior study investigator and cardiologist, David Kass, M.D. Kass is a professor at the Johns Hopkins University School of Medicine and its Heart and Vascular Institute.

The Kass team study, to be published in the June edition of the Journal of Clinical Investigation, is believed to show the first evidence of how TGF-beta is stimulated differently by various cell types in the heart and which resulting pathways promote heart failure, the most common kind of heart disease. Nearly 6 million Americans are estimated to have the condition.

Kass says previous research showed TGF-beta played a mixed role in various heart diseases, reducing arterial inflammation in some while harming valve and blood vessel function in others, such as people with Marfan syndrome. Until now, however, no explanation existed as to why any of these differences occurred, which cells controlled the TGF-beta signal, and which enzymes are stimulated as a result.

In the new study, researchers also found that in mice with hypertension-induced disease, blocking TGF-beta type 2 cell receptor stopped activities of another kind of regulating protein, called TGF-beta activated kinase (TAK-1). Its activation appears to play a key role in heart enlargement and in secreting proteins tied to scarring, as well as others tied to blood vessel formation.

Researchers began the study with injections of TGF-beta neutralizing antibodies to see if they could rein in heart-failing TGF-beta signaling. But the disease got worse in mice whose hearts had induced high blood pressure, and TGF-beta signaling persisted inside the muscle cells even though it was suppressed in other cells in the heart. The action of two other kinds of proteins closely tied to TGF-beta was similarly split, with the activity of Smad proteins suppressed only outside muscle cells, while TAK-1 production continued. This led Kass and his team to investigate what was happening differently inside muscle cells.

Subsequent testing in mice selectively bred to lack either one of the two TGF-beta receptors in the muscle cells revealed that blocking only the TGF-beta type 2 cell receptor shut down both Smad and TAK-1 activity, stalling enlargement and scarring. Blocking only the TGF-beta type 1 receptor, however, failed to block TAK-1 activity, and disease-accelerating TGF-beta signaling persisted in non-muscle heart cells.

Researchers plan further tests in animals of chemicals that block TAK-1 as potential treatments for heart failure or other kinds of heart disease.Funding for the study, which took three years to complete, was provided by the National Institutes of Health, with additional support from the American Heart Association, the Japan Heart Foundation, the Peter Belfer Laboratory Foundation, and the Fondation Leducq.

Story Source: The above story is reprinted (with editorial adaptations by the Heart Smart Advice staff) from materials provided by Johns Hopkins Medical Institutions, via EurekAlert!, a service of AAAS.

Rate of Coronary Artery Bypass Graft Surgeries Decreases Substantially

2011-05-07T04:34:00.002-05:00

Between 2001 and 2008, the annual rate of coronary artery bypass graft surgeries performed in the United States decreased by more than 30 percent, but rates of percutaneous coronary interventions (PCI; procedures such as balloon angioplasty or stent placement used to open narrowed coronary arteries) did not change significantly, according to a study in the May 4 issue of JAMA.

"Coronary revascularization, comprising coronary artery bypass graft (CABG) surgery and PCI, is among the most common major medical procedures provided by the U.S. health care system, with more than 1 million procedures performed annually," according to background information in the article. Several innovations in coronary revascularization, such as drug-eluting stents (DES) and minimally invasive CABG surgery have been adopted widely in the past decade, with the promise of improved clinical outcomes compared with older revascularization technologies and techniques. "During this period of technological innovation, new published evidence, and updated guidelines, it is not well known whether or how the volume of coronary revascularization and its constituent types changed in the United States. Substantial changes in the overall volume of revascularizations or the relative use of CABG surgery vs. PCI would have important ramifications on clinical outcomes, health care costs, and the future organization and delivery of hospital-based cardiovascular care."

Andrew J. Epstein, Ph.D., of the Philadelphia Veterans Affairs Medical Center and University of Pennsylvania, Philadelphia, and colleagues conducted a study using a representative national sample of hospitalization claims to estimate trends in the annual volume of coronary revascularization procedures. The study included data on patients undergoing CABG surgery or PCIs between 2001 and 2008 at U.S. hospitals in the Healthcare Cost and Utilization Project's Nationwide Inpatient Sample, which reports inpatient coronary revascularizations. These data were supplemented by Medicare outpatient hospital claims.

The researchers found that there was a 15 percent decrease in the annual rate of coronary revascularizations from 2001-2002 to 2007-2008. There was a substantial decrease in the rate of CABG surgery, with approximately one-third fewer CABG surgeries being performed in 2008 compared with 2001. The annual CABG surgery rate decreased steadily from 1,742 CABG surgeries per million adults per year in 2001-2002 to 1,081 CABG surgeries per million adults per year in 2007-2008, but PCI rates did not significantly change (3,827 PCI per million adults per year in 2001-2002 vs. 3,667 PCI per million adults per year in 2007-2008).

"Between 2001 and 2008, the number of hospitals in the Nationwide Inpatient Sample providing CABG surgery increased by 12 percent, and the number of PCI hospitals increased by 26 percent. The median (midpoint) CABG surgery caseload per hospital decreased by 28 percent and the number of CABG surgery hospitals providing fewer than 100 CABG surgeries per year increased from 23 (11 percent) in 2001 to 62 (26 percent) in 2008," the authors write.

The researchers write that the findings of this study "suggest the possibility that several thousand patients who underwent PCI in 2008 would have undergone CABG surgery had patterns of care not changed markedly between 2001 and 2008. Our data imply a sizeable shift in cardiovascular clinical practice patterns away from surgical treatment toward percutaneous, catheter-based interventions."

"In conclusion, although the total rate of U.S. coronary revascularization decreased modestly between 2001 and 2008, there was a substantial decrease in the CABG surgery rate. Between 2001 and 2008, the rate of PCI did not significantly change; however, there were continual changes in the frequency of stent types used for PCI."

Story Source: The above story is reprinted (with editorial adaptations by the Heart Smart Advice staff) from materials provided by JAMA and Archives Journals.

'Bad' Cholesterol Not as Bad as People Think, Study Shows

2011-05-07T04:31:00.001-05:00

The so-called "bad cholesterol" -- low-density lipoprotein commonly called LDL -- may not be so bad after all, shows a Texas A&M University study that casts new light on the cholesterol debate, particularly among adults who exercise.

Steve Riechman, a researcher in the Department of Health and Kinesiology, says the study reveals that LDL is not the evil Darth Vader of health it has been made out to be in recent years and that new attitudes need to be adopted in regards to the substance. His work, with help from colleagues from the University of Pittsburgh, Kent State University, the Johns Hopkins Weight Management Center and the Northern Ontario School of Medicine, is published in the Journal of Gerontology.

Riechman and colleagues examined 52 adults from ages to 60 to 69 who were in generally good health but not physically active, and none of them were participating in a training program. The study showed that after fairly vigorous workouts, participants who had gained the most muscle mass also had the highest levels of LDL (bad) cholesterol, "a very unexpected result and one that surprised us.

"It shows that you do need a certain amount of LDL to gain more muscle mass. There's no doubt you need both -- the LDL and the HDL -- and the truth is, it (cholesterol) is all good. You simply can't remove all the 'bad' cholesterol from your body without serious problems occurring.

Cholesterol is found in all humans and is a type of fat around the body. A person's total cholesterol level comprises LDL (low-density lipoprotein) and HDL (high-density lipoprotein) cholesterol.

LDL is almost always referred to as the "bad" cholesterol because it tends to build up in the walls of arteries, causing a slowing of the blood flow which often leads to heart disease and heart attacks.

HDL, usually called the "good cholesterol," often helps remove cholesterol from arteries.

"But here is where people tend to get things wrong," Riechman says.

"LDL serves a very useful purpose. It acts as a warning sign that something is wrong and it signals the body to these warning signs. It does its job the way it is supposed to.

"People often say, 'I want to get rid of all my bad (LDL) cholesterol,' but the fact is, if you did so, you would die," the Texas A&M professor adds. "Everyone needs a certain amount of both LDL and HDL in their bodies. We need to change this idea of LDL always being the evil thing -- we all need it, and we need it to do its job."

According to the American Heart Association, about 36 million American adults have high cholesterol levels.

"Our tissues need cholesterol, and LDL delivers it," he notes. "HDL, the good cholesterol, cleans up after the repair is done. And the more LDL you have in your blood, the better you are able to build muscle during resistance training."

Riechman says the study could be helpful in looking at a condition called sarcopenia, which is muscle loss due to aging. Previous studies show muscle is usually lost at a rate of 5 percent per decade after the age of 40, a huge concern since muscle mass is the major determinant of physical strength. After the age of 60, the prevalence of moderate to severe sarcopenia is found in about 65 percent of all men and about 30 percent of all women, and it accounts for more than $18 billion of health care costs in the United States.

"The bottom line is that LDL -- the bad cholesterol -- serves as a reminder that something is wrong and we need to find out what it is," Riechman says.

"It gives us warning signs. Is smoking the problem, is it diet, is it lack of exercise that a person's cholesterol is too high? It plays a very useful role, does the job it was intended to do, and we need to back off by always calling it 'bad' cholesterol because it is not totally bad."

Story Source: The above story is reprinted (with editorial adaptations by Heart Smart Advice staff) from materials provided by Texas A&M University.

Age Alone Should Be Used to Screen for Heart Attacks and Strokes, Say Experts

2011-05-07T04:29:00.001-05:00

Using age alone to identify those at risk of heart disease or stroke could replace current screening methods without diminishing effectiveness, according to a groundbreaking study published in the open access journal PLoS ONE.

Existing screening methods which include measuring cholesterol and blood pressure are expensive and time consuming. The authors of the new study from Barts and The London Medical School say that this finding could save thousands of lives by making it easier for more people to have access to preventive treatment.

The new study compared screening using age alone with screening using age and multiple risk factors, measured via blood tests and medical examination. The authors used existing data to estimate the effects of the two screening approaches on a modelled population of 500,000 people.

Age screening alone using a cut off of 55 years had an 84 per cent detection rate and a 24 per cent false-positive rate. This is equivalent to correctly identifying 84 per cent of all the people in a population who will have a stroke or heart attack, while incorrectly identifying 24 per cent who will not. Current screening methods can achieve the same 84 per cent detection rate with a false-positive rate that is only slightly less -- 21 per cent.

Professor Sir Nicholas Wald is lead author and Director of the Wolfson Institute at Barts and The London School of Medicine and Dentistry, part of Queen Mary, University of London. He said: "This study shows that age screening for future cardiovascular disease is simpler than current assessments, with a similar screening performance and cost effectiveness. It also avoids the need for blood tests and medical examinations.

With age screening all individuals above a specified age would be offered preventive treatment. Everyone would benefit because, for blood pressure and cholesterol, the lower the better. The policy of selecting people above a certain age is, in effect, selecting people at high risk. It recognises that age is by far the most important determinant of that risk with other factors adding little extra prognostic information.

"Prevention is better than measurement," Professor Wald added. "Identifying people at high risk of cardiovascular disease needs to be greatly simplified, enabling people to obtain easy access to preventive treatment from nurses and pharmacists as well as from doctors.

"Offering appropriate preventive treatment to everyone aged 55 and over in England and Wales could prevent over 100,000 heart attacks and strokes every year."

Story Source:

The above story is reprinted (with editorial adaptations by Heart Smart Advice staff) from materials provided by Queen Mary, University of London, via EurekAlert!, a service of AAAS.

Exercise Protects the Heart Via Nitric Oxide, Researchers Discover

2011-05-07T04:26:00.002-05:00

Exercise both reduces the risk of a heart attack and protects the heart from injury if a heart attack does occur. For years, doctors have been trying to dissect how this second benefit of exercise works, with the aim of finding ways to protect the heart after a heart attack.

Researchers at Emory University School of Medicine have identified the ability of the heart to produce and store nitric oxide as an important way exercise protects the heart from injury.

Nitric oxide, a short-lived gas generated within the body, turns on chemical pathways that relax blood vessels to increase blood flow and activate survival pathways. Both the chemical nitrite and nitrosothiols, where nitric oxide is attached to proteins via sulfur, appear to act as convertible reservoirs for nitric oxide in situations where the body needs it, such as a lack of blood flow or oxygen.

The Emory team's results, published online in the journal Circulation Research, strengthen the case for nitrite and nitrosothiols as possible protectants from the damage of a heart attack.

The first author is John Calvert, PhD, assistant professor of surgery at Emory University School of Medicine. The senior author is David Lefer, PhD, professor of surgery at Emory University School of Medicine and director of the Cardiothoracic Research Laboratory at Emory University Hospital Midtown. Collaborators included scientists at University of Colorado, Boulder, and Johns Hopkins University.

"Our study provides new evidence that nitric oxide generated during physical exercise is actually stored in the bloodstream and heart in the form of nitrite and nitrosothiols. These more stable nitric oxide intermediates appear to be critical for the cardioprotection against a subsequent heart attack," Lefer says.

Timing is key -- the benefits of exercise don't last In experiments with mice, the researchers showed that four weeks of being able to run on a wheel protected them from having a coronary artery was blocked; the amount of heart muscle damaged by the blockage was less after the exercise period. Importantly, the mice are still protected a week after the wheel is taken away.

The researchers found that voluntary exercise boosted levels of an enzyme that produces nitric oxide (eNOS, endothelial nitric oxide synthase). Moreover, the levels of eNOS in heart tissue, and nitrite and nitrosothiols in the blood as well as heart tissue, stayed high for a week after exercise ceased, unlike other heart enzymes stimulated by exercise. The protective effects of exercise did not extend beyond four weeks after the exercise period was over, when nitrite and nitrosothiols in the heart returned to baseline.

In mice that lack the eNOS enzyme, exercise did not protect the heart from a coronary blockage, although these mice appeared to lack the ability to exercise as much as normal mice.

Another molecule that appears to be important for the benefits of exercise is the beta-3-adrenergic receptor, which allows cells to respond to the hormones epinephrine and norepinephrine. All of the beneficial effects of voluntary exercise are lost in mice that are deficient in this receptor. One of the effects of stimulating the receptor appears to be activating eNOS. Additional animal studies are currently underway in Lefer's lab to determine the potential benefit of beta-3-adrenergic receptor activating drugs following a heart attack.

The research was supported by the American Diabetes Association, the National Institutes of Health and the Carlyle Fraser Heart Center of Emory University Hospital Midtown.

Story Source: The above story is reprinted (with editorial adaptations by Heart Smart Advice staff) from materials provided by Emory University.

New Guidelines for Cardiovascular Genetic Testing

2011-05-07T04:24:00.000-05:00

An international panel of experts from The Heart Rhythm Society and the European Heart Rhythm Association issued new guideline recommendations for all health care professionals about cardiovascular genetic testing at the Heart Rhythm Society's 32nd Annual Scientific Sessions.

Silvia G. Priori, MD, PhD, a leader in the field of inherited cardiovascular diseases and director of the Cardiovascular Genetics Program at NYU Langone Medical Center, was co-lead author of the HRS/EHRA Expert Consensus Statement on the State of Genetic Testing for the Channelopathies and Cardiomyopathies. The complete guidelines will be published in the August 2011 issue of the HeartRhythm Journal and Europace.

The new overarching recommendations about cardiac genetic testing include:

•Genetic counseling is recommended for all patients and relatives with the familial heart diseases detailed in the document and should include discussion of the risks, benefits and options available for clinical testing and/or genetic testing.
•Treatment decisions should not rely solely on his/her genetic test result but should be based on an individuals' comprehensive clinical evaluation.
•It can be useful for pre-genetic test counseling, genetic testing, and the interpretation of genetic test results to be performed in centers experienced in the genetic evaluation and family-based management of the heritable arrhythmia syndromes and cardiomyopathies described in the document.
The goal of the authors was to evaluate the role of genetic testing and ensure that all physicians have the latest knowledge about the potentially life-saving screening for patients with cardiac conditions that may predispose them to sudden cardiac death and other genetic heart diseases.

The recommendations focus on genetic testing for 13 inherited cardiac conditions including: Long QT Syndrome, Catecholaminergic Polymorphic Ventricular Tachycardia, Brugada Syndrome, Progressive Cardiac Conduction Disease, Short QT Syndrome, Atrial Fibrillation, Hypertrophic Cardiomyopathy, Arrhythmogenic Cardiomyopathy/Arrhythmogenic Right Ventricular Cardiomyopathy, Dilated Cardiomyopathy, Left Ventricular Noncompaction and Restrictive Cardiomyopathy. In addition, the statement includes guidance on the use of genetic testing for out-of-hospital cardiac arrest survivors and post-mortem testing in sudden death cases.

"Genetic testing cannot be viewed as a one-size fits all solution, but should be considered for each disease state," said Dr. Priori, who is also director of Molecular Cardiology and Electrophysiology Laboratories at Fondazione Salvatore Maugeri University in Pavia, Italy. "The recommendations outlined in this document can and should be used as guidance on how each potential disease is evaluated with respect to genetic testing, keeping in mind that each patient is different."

Story Source: The above story is reprinted (with editorial adaptations by Heart Smart Advice staff) from materials provided by NYU Langone Medical Center / New York University School of Medicine, via EurekAlert!, a service of AAAS.

Antidepressants Linked to Thicker Arteries

2011-04-09T15:48:00.002-05:00

Antidepressant use has been linked to thicker arteries, possibly contributing to the risk of heart disease and stroke, in a study of twin veterans. The data is being presented on April 5 at the American College of Cardiology meeting in New Orleans.

Depression can heighten the risk for heart disease, but the effect of antidepressant use revealed by the study is separate and independent from depression itself, says first author Amit Shah, MD, a cardiology fellow at Emory University School of Medicine. The data suggest that antidepressants may combine with depression for a negative effect on blood vessels, he says. Shah is a researcher working with Viola Vaccarino, MD, PhD, chair of the Department of Epidemiology at Emory's Rollins School of Public Health.

The study included 513 middle-aged male twins who both served in the U.S. military during the Vietnam War. Twins are genetically the same but may be different when it comes to other risk factors such as diet, smoking and exercise, so studying them is a good way to distill out the effects of genetics, Shah says.

Researchers measured carotid intima-media thickness -- the thickness of the lining of the main arteries in the neck -- by ultrasound. Among the 59 pairs of twins where only one brother took antidepressants, the one taking the drugs tended to have higher carotid intima-media thickness (IMT), even when standard heart disease risk factors were taken into account. The effect was seen both in twins with or without a previous heart attack or stroke. A higher level of depressive symptoms was associated with higher IMT only in those taking antidepressants.

"One of the strongest and best-studied factors that thickens someone's arteries is age, and that happens at around 10 microns per year," Shah says. "In our study, users of antidepressants see an average 40 micron increase in IMT, so their carotid arteries are in effect four years older."

Antidepressants' effects on blood vessels may come from changes in serotonin, a chemical that helps some brain cells communicate but also functions outside the brain, Shah says. The most commonly prescribed antidepressants are selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine (Prozac), which increase the level of serotonin in the brain. Other types of antidepressants also affect serotonin levels, and antidepressants can act on other multi-functional brain chemicals such as norepinephrine.

In the study, researchers saw higher carotid IMT in both participants who used SSRIs (60 percent of those who took antidepressants) and those who used other types of antidepressants.

Most of the serotonin in the body is found outside the brain, especially in the intestines, Shah notes. In addition, serotonin is stored by platelets, the cells that promote blood clotting, and is released when they bind to a clot. However, serotonin's effects on blood vessels are complex and act in multiple ways. It can either constrict or relax blood vessels, depending on whether the vessels are damaged or not.

"I think we have to keep an open mind about the effects of antidepressants on neurochemicals like serotonin in places outside the brain, such as the vasculature. The body often compensates over time for drugs' immediate effects," Shah says. "Antidepressants have a clinical benefit that has been established, so nobody taking these medications should stop based only on these results. This isn't the kind of study where we can know cause and effect, let alone mechanism, and we need to see whether this holds up in other population groups."

Story Source: The above story is reprinted (with editorial adaptations by Heart Smart Advice staff) from materials provided by Emory University, via EurekAlert!, a service of AAAS.

Routine Periodic Fasting Is Good for Your Health, and Your Heart, Study Suggests

2011-04-09T15:39:00.000-05:00

Fasting has long been associated with religious rituals, diets, and political protests. Now new evidence from cardiac researchers at the Intermountain Medical Center Heart Institute demonstrates that routine periodic fasting is also good for your health, and your heart.

Research cardiologists at the Intermountain Medical Center Heart Institute are reporting that fasting not only lowers one's risk of coronary artery disease and diabetes, but also causes significant changes in a person's blood cholesterol levels. Both diabetes and elevated cholesterol are known risk factors for coronary heart disease.

The discovery expands upon a 2007 Intermountain Healthcare study that revealed an association between fasting and reduced risk of coronary heart disease, the leading cause of death among men and women in America. In the new research, fasting was also found to reduce other cardiac risk factors, such as triglycerides, weight, and blood sugar levels.

The findings were presented on April 3, at the annual scientific sessions of the American College of Cardiology in New Orleans.

"These new findings demonstrate that our original discovery was not a chance event," says Dr. Benjamin D. Horne, PhD, MPH, director of cardiovascular and genetic epidemiology at the Intermountain Medical Center Heart Institute, and the study's principal investigator. "The confirmation among a new set of patients that fasting is associated with lower risk of these common diseases raises new questions about how fasting itself reduces risk or if it simply indicates a healthy lifestyle."

Unlike the earlier research by the team, this new research recorded reactions in the body's biological mechanisms during the fasting period. The participants' low-density lipoprotein cholesterol (LDL-C, the "bad" cholesterol) and high-density lipoprotein cholesterol (HDL-C, the "good" cholesterol) both increased (by 14 percent and 6 percent, respectively) raising their total cholesterol -- and catching the researchers by surprise.

"Fasting causes hunger or stress. In response, the body releases more cholesterol, allowing it to utilize fat as a source of fuel, instead of glucose. This decreases the number of fat cells in the body," says Dr. Horne. "This is important because the fewer fat cells a body has, the less likely it will experience insulin resistance, or diabetes."

This recent study also confirmed earlier findings about the effects of fasting on human growth hormone (HGH), a metabolic protein. HGH works to protect lean muscle and metabolic balance, a response triggered and accelerated by fasting. During the 24-hour fasting periods, HGH increased an average of 1,300 percent in women, and nearly 2,000 percent in men.

In this most recent trial, researchers conducted two fasting studies of over 200 individuals -- both patients and healthy volunteers -- who were recruited at Intermountain Medical Center. A second 2011 clinical trial followed another 30 patients who drank only water and ate nothing else for 24 hours. They were also monitored while eating a normal diet during an additional 24-hour period. Blood tests and physical measurements were taken from all to evaluate cardiac risk factors, markers of metabolic risk, and other general health parameters.

While the results were surprising to researchers, it's not time to start a fasting diet just yet. It will take more studies like these to fully determine the body's reaction to fasting and its effect on human health. Dr. Horne believes that fasting could one day be prescribed as a treatment for preventing diabetes and coronary heart disease.

To help achieve the goal of expanded research, the Deseret Foundation (which funded the previous fasting studies) recently approved a new grant to evaluate many more metabolic factors in the blood using stored samples from the recent fasting clinical trial. The researchers will also include an additional clinical trial of fasting among patients who have been diagnosed with coronary heart disease.

"We are very grateful for the financial support from the Deseret Foundation. The organization and its donors have made these groundbreaking studies of fasting possible," added Dr. Horne.

Members of the Intermountain Medical Center Heart Institute research team included Dr. Horne, Jeffrey L. Anderson, MD, John F. Carlquist, PhD, J. Brent Muhlestein, MD, Donald L. Lappé, MD, Heidi T. May, PhD, MSPH, Boudi Kfoury, MD, Oxana Galenko, PhD, Amy R. Butler, Dylan P. Nelson, Kimberly D. Brunisholz, Tami L. Bair, and Samin Panahi.

Story Source: The above story is reprinted (with editorial adaptations by Heart Smart Advice staff) from materials provided by Intermountain Medical Center, via EurekAlert!, a service of AAAS.

Vitamin D Levels Linked With Health of Blood Vessels

2011-04-09T15:36:00.001-05:00

A lack of vitamin D, even in generally healthy people, is linked with stiffer arteries and an inability of blood vessels to relax, research from the Emory/Georgia Tech Predictive Health Institute has found.

The results add to evidence that lack of vitamin D can lead to impaired vascular health, contributing to high blood pressure and the risk of cardiovascular disease. Study participants who increased their vitamin D levels were able to improve vascular health and lower their blood pressure.

The data was presented by Ibhar Al Mheid, MD, a cardiovascular researcher at Emory University School of Medicine, at the annual American College of Cardiology meeting in New Orleans. Al Mheid is one of five finalists for the ACC's Young Investigators Award competition in physiology, pharmacology and pathology. He is working with Arshed Quyyumi, MD, professor of medicine and director of the Emory Cardiovascular Research Institute.

The 554 participants in the study were Emory or Georgia Tech employees -average age 47 and generally healthy -- who are taking part in the Center for Health Discovery and Well Being, part of the Emory/Georgia Tech Predictive Health Institute.

The average level of 25-hydroxyvitamin D (a stable form of the vitamin reflecting diet as well as production in the skin) in participants' blood was 31.8 nanograms per milliliter. In this group, 14 percent had 25-hydroxyvitamin D levels considered deficient, or less than 20 nanograms per milliliter, and 33 percent had levels considered insufficient, less than 30 nanograms per milliliter.

The researchers monitored the ability of participants' blood vessels to relax by inflating and then removing a blood pressure cuff on their arms. To allow blood to flow back into the arm, blood vessels must relax and enlarge -- a change that can be measured by ultrasound. The researchers also made other measurements of smaller blood vessels and examined the resistance to blood flow imposed by the arteries.

Even after controlling for factors such as age, weight and cholesterol, people with lower vitamin D levels still had stiffer arteries and impaired vascular function, Al Mheid says.

"We found that people with vitamin D deficiency had vascular dysfunction comparable to those with diabetes or hypertension," he says.

Throughout the body, a layer of endothelial cells lines the blood vessels, controlling whether the blood vessels constrict or relax and helping to prevent clots that lead to strokes and heart attacks.

"There is already a lot known about how vitamin D could be acting here," Al Mheid says. "It could be strengthening endothelial cells and the muscles surrounding the blood vessels. It could also be reducing the level of angiotensin, a hormone that drives increased blood pressure, or regulating inflammation."

Most Americans generally get the majority of their vitamin D from exposure to sunlight or from dietary supplements; fortified foods such as milk or cereals are a minor source. A few foods, such as oily fish, naturally contain substantial amounts of vitamin D.

Participants whose vitamin D levels increased over the next six months, either from dietary supplements or ample sun exposure, tended to improve their measures of vascular health and had lower blood pressure. Forty-two study participants with vitamin D insufficiency whose levels later went back to normal had an average drop in blood pressure of 4.6 millimeters mercury.

"This was an observational study, rather than an interventional one, and it was difficult to tease out how the people who restored their vitamin D levels got there," Al Mheid says. "We are hoping to conduct a study where we have participants take a defined regimen of vitamin D."

"With his findings showing the relationship between vitamin D deficiency and vascular dysfunction, Dr. Mheid has helped advance our understanding of the importance of Vitamin D in preventing a common health problem in aging adults," says Kenneth Brigham, MD, medical director of the Emory/Georgia Tech Center for Health Discovery and Well Being. "Additionally, ongoing health studies based on the Center's collection of health information from participants will yield more discovery as the Center continues to develop."

The Emory-Georgia Tech Predictive Health Institute is a national leader in moving the practice of medicine from a reactive, disease-focused system to a proactive health-focused system. The initiative integrates research, scholarship and education in an innovative effort aimed at revolutionizing care of people to define, preserve and prolong the health of individuals and of society.

Key areas of the Initiative include defining and measuring health using optimal biomarkers of health and understand their interrelationships, determining the best interventions to optimize health throughout an individual's or a population's lifetime.

Story Source: The above story is reprinted (with editorial adaptations by Heart Smart Advice staff) from materials provided by Emory University, via EurekAlert!, a service of AAAS.

Protocol-Driven Heart Attack Care Proves Effective and Contagious

2011-04-09T15:34:00.001-05:00

The implementation of acute heart attack or ST-elevation myocardial infarction (STEMI) guidelines, protocols and standing orders in Minnesota community hospitals without cardiac catheterization labs has dramatically improved since 2003, according to a scientific poster that will be presented at the American College of Cardiology (ACC) Scientific Sessions in New Orleans, April 1-3.

Since the 1990s, the American College Cardiology (ACC)/American Heart Association (AHA) STEMI guidelines recommended that all hospitals develop protocols and standing orders (reperfusion strategy, adjunctive medications, transfer criteria) for STEMI and monitor quality measures (time to treatment and adjunctive medications).

In 2003, a survey of Minnesota hospitals without cardiac catheterization labs found less than 70 percent of hospitals had any protocols and less than 50 percent had a formal quality improvement process and many were "incomplete or inadequate," explained the study's senior author Timothy D. Henry, MD, interventional cardiologist at Minneapolis Heart Institute® at Abbott Northwestern Hospital in Minneapolis and Director of Cardiovascular Research at Minneapolis Heart Institute Foundation. He described the 2003 survey results as "surprising and a major public health problem."

However, those findings stimulated the development of several regional STEMI systems in Minnesota, including the Level 1 Heart Attack Network created by the Minneapolis Heart Institute®. "At this point, almost every hospital in the state belongs to a STEMI network due to their proliferation after 2003," Henry noted.

To compare performance since the 2003 survey results, the researchers mailed the identical survey to emergency department medical directors and nurse managers at all 108 Minnesota hospitals without cardiac catheterization labs in late 2009.

Since 2003, implementation of STEMI guidelines, protocols and standing orders in Minnesota community hospitals without cardiac catheterization labs has "dramatically improved," Henry noted, as more than 90 percent of hospitals have specific STEMI protocols. "These hospitals don't just have general protocols, but we found that they have very specific detailed protocols about medications, when to transfer these patients and what type of reperfusion therapy to use."

Compared with 2003 when 6 percent of these hospitals had protocol-specific indications for transfer to a tertiary hospital, 72 percent of hospitals now have adopted these indications. Also, 66 percent of hospitals have a formal quality improvement process for STEMI patients.

Finally, 91 percent of STEMI patients routinely transferred to a percutaneous coronary intervention (PCI) center, which also is mandated by the guidelines, compared with 59 percent in 2003.

Minnesota has the lowest cardiovascular mortality rate in the United States, and during this time period, that rate declined 50 percent from 2002 to 2009.

"This improvement was stimulated by regional STEMI systems which support the recent class I recommendation for STEMI systems of care in the 2009 focused update of the ACC/AHA guidelines," according to the study authors.

Story Source: The above story is reprinted (with editorial adaptations by Heart Smart Advice staff) from materials provided by Minneapolis Heart Institute Foundation, via EurekAlert!, a service of AAAS.

Severe Psoriasis Linked to Major Adverse Cardiovascular Events

2011-04-09T15:32:00.000-05:00

Psoriasis is a common inflammatory skin disease, and if severe, has been demonstrated to be a risk factor for cardiovascular (CV) disease. However, the degree to which psoriasis is associated with major adverse cardiac events (MACE), such as heart attack, stroke, and cardiovascular death has not been defined. Now, new research from the University of Pennsylvania School of Medicine has revealed an increased incidence of MACE in patients with severe psoriasis.

In a cohort study analyzing data from a general practice research database, Penn researchers reviewed the case histories of over 3,600 patients with severe psoriasis and 14,300 controls. Lead author Nehal N. Mehta, MD, MSCE, Director of Inflammatory Risk in Penn's Preventive Cardiology program, and colleagues found that patients with severe psoriasis have a 53 percent increased incidence of MACE compared to the general population. They also found that having a diagnosed case of severe psoriasis confers an additional ten-year risk of 6 percent on MACE. The study results were reported at the 2011 American College of Cardiology meeting in New Orleans.

Previous work from Dr. Mehta and senior author Joel M. Gelfand, MD, MSCE, from the Department of Dermatology at Penn found that the risk of death from cardiovascular disease increased by 57 percent in patients with severe psoriasis. In addition, the relative risk of death from cardiovascular disease was even higher in younger patients, who were as young as age 40.

Dr. Mehta and colleagues conclude that this new estimate of increased ten-year MACE may warrant more aggressive strategies for treatment of cardiovascular risk factors in patients with psoriasis.

Story Source: The above story is reprinted (with editorial adaptations by Heart Smart Advice staff) from materials provided by University of Pennsylvania School of Medicine.

Alternate Route to Blocked Arteries Safe and Effective for Angioplasty, Study Suggests

2011-04-09T15:29:00.001-05:00

In the future you may hear the doctor say: "Give me your arm and I'll do some heart surgery."

A landmark international study coordinated by the Population Health Research Institute of McMaster University and Hamilton Health Sciences has found accessing blocked arteries through the forearm compared to groin led to fewer vascular complications and similar success rates for angioplasty.

The large, multi-centre randomized trial -- the first of its kind to compare radial access and femoral access -- found that both entry points for angioplasty resulted in similar outcomes, including rates of death, heart attack, stroke or non-bypass-related major bleeding. As well, radial access -- or entry through the forearm -- led to better outcomes in hospitals that conducted a large number of these procedures and in patients suffering heart attacks in which a coronary artery was completely blocked by a blood clot (a condition known as STEMI, or ST-segment elevation myocardial infarction).

Results of the RIVAL (RadIal Vs. femorAL access for coronary angiography or intervention) trial are being presented by Dr. Sanjit Jolly, an interventional cardiologist and assistant professor of medicine in the Michael G. DeGroote School of Medicine, at the annual American College of Cardiology meeting.

The study is also being published simultaneously in The Lancet.

Estimates suggest that more than 10 million coronary angiograms are performed each year worldwide, three million of them in the United States. Entry through the groin, or femoral arterial access, has been the dominant route for coronary angiography and intervention for more than 20 years. It still accounts for approximately 95 per cent of procedures in the United States and 80 per cent of procedures worldwide.

The radial artery, accessed through the wrist, is a superficial and easily compressible site for arterial puncture, and used to avoid femoral bleeding complications. However, there have been concerns that radial access could be associated with reduced angioplasty success rates.

The RIVAL trial, conducted by researchers from 36 countries, was designed to help determine the optimal access site for invasive coronary procedures, such as angioplasty. The study involved 7,021 patients undergoing coronary angiography, with possible angioplasty, who had unstable angina or a heart attack. Patients were randomized to either radial or femoral access for their coronary angiography/intervention.

"Our data suggest that radial compared to femoral access reduces local vascular access site complications with similar angioplasty success rates," said Dr. Jolly, the principal investigator of the RIVAL Trial Group. "However, greater expertise and procedural volume with radial access may improve the results of the radial approach."

The researchers concluded both access sites are safe and effective for conducting invasive coronary procedures in patients with acute coronary syndrome, a spectrum of cardiac conditions ranging from unstable angina to heart attack.

"This is the first multi-centre international trial to address this important question," said Dr. Shamir Mehta, a RIVAL co-investigator, interventional cardiologist, and associate professor of medicine in the Michael G. DeGroote School of Medicine.

"Given the results of previous small trials, we were surprised to not find a difference between the two strategies for the primary outcome. This means either a radial or femoral approach can be used safely and effectively."

The RIVAL study was supported by Sanofi-Aventis, Canadian Network and Centre for Trials Internationally (CANNeCTIN)/Canadian Institutes of Health Research (CIHR) and the Population Health Research Institute but was independently conducted by the Population Health Research Institute along with an international steering committee.

Dr. Salim Yusuf, the RIVAL study chair, is supported by the Heart and Stroke Foundation of Ontario as the Marion W. Burke Chair in Cardiovascular Disease.

Story Source: The above story is reprinted (with editorial adaptations by Heart Smart Advice staff) from materials provided by McMaster University, via EurekAlert!, a service of AAAS.

Key Guideline-Recommended Therapies Improve Survival for Heart Failure Patients

2011-04-09T15:27:00.001-05:00

A UCLA-led study has found that adherence to national guideline-recommended therapies for heart failure in an outpatient practice setting significantly lowered the mortality rate of heart failure patients.

The findings are posted in the April 4 online edition of the journal Circulation.

This is one of the first studies to examine how conformity with current and emerging heart-failure quality measures can impact patient survival and outcomes in the outpatient setting.

A chronic, progressive disease, heart failure impacts millions and results in morbidity, death, the use of significant health care resources, and significant costs. While quality-of-care measures based on national guidelines from the American College of Cardiology and the American Heart Association have been developed, and while prior studies have shown that performance-improvement initiatives substantially improve conformity with these measures, it was unclear if these efforts could improve survival in the real-world clinical practice setting.

"This study establishes a strong process-of-care-clinical outcome link and provides evidence that specific heart failure therapies effectively improve patient survival in an outpatient setting," said the study's first author, Dr. Gregg C. Fonarow, UCLA's Elliot Corday Professor of Cardiovascular Medicine and Science and director of the Ahmanson-UCLA Cardiomyopathy Center at the David Geffen School of Medicine at UCLA. "These results have significant clinical and public health implications in helping track and improve quality of care and heart-failure patient outcomes."

For the study, researchers examined data on 15,177 heart failure patients seen at 167 cardiology practice clinics in the U.S. The data was taken from a national quality improvement program called the Registry to Improve the Use of Evidence-Based Heart Failure Therapies in the Outpatient Setting (IMPROVE HF).

Researchers reviewed medical records at the beginning of the implementation of the IMPROVE program and followed up at 12 and 24 months to assess the relationship between adherence to seven nationally recommended treatment measures and patient outcomes.

The seven measures assessed included:

•Three types of heart failure medications, including beta blockers, aldosterone antagonists, and angiotensin-converting enzyme inhibitors or angiotensin receptor blockers.
•The use of cardiac resynchronization therapy, a device that helps coordinate heart contractions.
•Anticoagulant therapy for atrial fibrillation, to prevent clot formation in patients with an irregular heart beat.
•The use of implantable cardioverter-defibrillator devices, to deliver electrical shocks if potentially fatal heart rhythm abnormalities occur.
•Heart-failure patient education.
At 24 months, 11,621 of the 15,177 patients, or 76.6 percent, had documented follow-up in the medical records. Patients represented a broad range of heart failure needs, with some qualifying for all seven measures and others just one or two.

Researchers found that six out of the seven individual measures were associated with significantly improved patient survival over 24 months. The odds of mortality reduction ranged from 31 percent for anticoagulant therapy to 55 percent for beta blocker use, compared with eligible patients who did not receive these therapies.

In a summary score reflecting adherence to the quality measures, each 10 percent increase in the composite score was associated with 13 percent lower odds of 24-month mortality.

Researchers also looked at an "all or nothing" score that found patients who received all the therapies for which they were eligible had 38 percent lower odds of mortality, compared with patients who did not receive one or more of the therapies for which they were qualified.

Previous research by this team showed how the use of IMPROVE HF, a performance-improvement intervention program, helped increase adherence to these national guideline-related therapies but didn't address the impact on patient outcomes.

The current study provides definitive evidence that complying with measures based on six out of seven of these national guideline therapies is linked to favorable clinical outcomes, with lower mortality over 2 years.

"Adhering to these critical, evidence-based, national guideline-recommended treatments for heart failure truly made an important difference in real-world heart-failure patient survival,"

Fonarow said. "This research puts quality-improvement interventions front and center as an effective means to improve outcomes for outpatients with heart failure."

Fonarow added that the next step is to implement performance-improvement intervention programs in every outpatient practice in which heart failure patients are cared for to further enhance adherence to these recommended therapies and to improve clinical outcomes.

Currently, two guideline-recommended therapies, implantable cardioverter-defibrillator devices and cardiac resynchronization therapy, are not included as national heart-failure performance measures. According to Fonarow, the link to improved survival demonstrated with these two measures suggests these are valid and useful measures of heart failure quality.

The only measure that was not associated with improved 24-month survival was use of aldosterone antagonists. More study will need to address whether this is a useful heart-failure quality measure.

Medtronic Inc., a manufacturer of cardiac resynchronization therapy and implantable defibrillator devices, provided financial and material support for the IMPROVE HF registry. The company had no role or input in the selection of end-points or quality measures used in the study.

Fonarow has received honoraria and consultant fees from Medtronic. Additional author financial disclosures are listed in the study manuscript.

Additional authors included Nancy M. Albert, Ph.D., Cleveland Clinic Foundation; Anne. B. Curtis, University of South Florida College of Medicine; Dr. Mihai Gheorghiade, Northwestern University; Dr. J. Thomas Heywood, Scripps Clinic; Yang Liu, Medtronic Inc.; Dr. Mandeep R. Mehra, University of Maryland; Dr. Christopher M. O'Connor, Duke University Medical Center; Dr. Dwight Reynolds, University of Oklahoma Health Sciences Center; Dr. Mary Norine Walsh, the Care Group, LLC (Indiana); and Dr. Clyde W. Yancy, Baylor University Medical Center.

Story Source: The above story is reprinted (with editorial adaptations by Heart Smart Advice staff) from materials provided by University of California - Los Angeles Health Sciences.

Video Games Effective Treatment for Stroke Patients

2011-04-09T15:23:00.000-05:00

Virtual reality and other video games can significantly improve motor function in stroke patients, according to research from St. Michael's Hospital. Patients who played video games, such as Wii and Playstation, were up to five times more likely to show improvements in arm motor function compared to those who had standard therapy.

"Virtual reality gaming is a promising and potentially useful alternative to enhance motor improvement after stroke," said Dr. Gustavo Saposnik, the lead author of the study and the director of the Stroke Outcomes Research Unit at the hospital. "It provides an affordable, enjoyable and effective alternative to intensify treatment and promote motor recovery after a stroke."

The study, published in the April edition of Stroke: Journal of the American Heart Association, reviewed 12 existing studies that looked at the effects of electronic games on upper arm strength and mobility.

Between 55 and 75 per cent of stroke survivors experience motor problems in their arm. Yet conventional therapy -- physiotherapy and occupational therapy -- provide only "modest and sometimes delayed effects," said Saposnik, also a Heart and Stroke Foundation-funded researcher.

Current research suggests effective therapy needs to be challenging, repetitive, task-specific and novel. Video games apply these concepts, helping the brain to heal through a process called neuroplasticity -- the brain's ability to remodel itself after injury by creating new nerve cell connections.

"Recovery of motor skill depends on neurological recovery, adaptation, and learning new strategies," Saposnik said. "Virtual reality systems drive neuroplasticity and lead to benefits in motor function improvement after stroke."

Most of the studies Saposnik looked at included patients who had mild to moderate strokes. He said further research is needed to determine the effects of video games on treatment for more severe cases.

Story Source: The above story is reprinted (with editorial adaptations by Heart Smart Advice staff) from materials provided by St. Michael's Hospital, via EurekAlert!, a service of AAAS.

Death Rates After Hospitalization Down for Oldest Heart Failure Patients

2011-04-08T16:09:00.001-05:00

Death rates after hospitalization for heart failure have dropped for veterans age 80 and older, but rehospitalizations remain frequent, according to a study in the American Heart Association journal Circulation: Heart Failure.

Results of the study highlight a need to better identify which patients among the oldest are more likely to be rehospitalized not just for heart failure, but for any reason, said Rashmee Shah, M.D., lead author of the study and postdoctoral fellow in the Department of Health Research and Policy at Stanford University School of Medicine in Palo Alto, Calif.

Using Department of Veterans Affairs data, researchers identified 21,397 U.S. veterans age 80 or older who were hospitalized at least once for heart failure from 1999 through 2008. They then compared the heart failure patients' outcomes in different age groups -- 80 to 84, 85 to 89, and 90 or older -- and found that death rates within 30 days of the first recorded hospitalization for heart failure were cut in half from 14 percent to 7 percent, and death rates within a year fell from 48.8 percent to 27.2 percent.

Heart failure patients 90 and older were the most likely to die within a year of the initial hospital admission, researchers said. But 30-day and one-year death rates improved the most in that group -- 11 percent and 26 percent improvements in 30-day and one-year mortality, respectively. With relatively few heart failure patients of that age -- about 8 percent of the total -- it's hard to draw conclusions about the trend, Shah said.

Overall, the drop in death rates might be due to the growing emphasis in recent years on performance measures that promote evidence-based treatment of heart failure.

"There was a lot of room for improvement since so many patients in the oldest age groups were not getting evidence-based heart failure therapies, historically," Shah said.

Though the average age at diagnosis is older than 75, elderly heart failure patients typically are defined as those who are only 65 or older. "Our definition of elderly heart failure patients needs to change," Shah said. "As the population ages, doctors will be treating more heart failure patients in their 80s or older."

In recent years, studies have indicated heart failure that develops late in life often differs from heart failure in younger patients. In most younger patients, the heart typically can't pump well, a condition called heart failure with decreased ejection fraction. In contrast, older patients often have preserved ejection fraction, where the heart seems to be pumping a normal amount of the blood that enters it, but the heart muscle is stiff and isn't relaxing enough to collect blood properly.

The hospital readmission rate for any cause within 30 days of the initial heart failure hospitalization was 17.3 percent, and remained largely unchanged between 1999 and 2008.

Various steps could potentially reduce the risk of short-term readmissions among very elderly heart failure patients, including better patient education, blood testing or other follow-up by a physician shortly after hospital discharge, Shah said.

"The next step would be another investigation to see what's driving the readmissions and test interventions to reduce readmissions among this growing population," Shah said.

The ranks of the oldest Americans are expected to grow dramatically over the next 40 years. The U.S. Census Bureau projects that nearly 21 million Americans will be 85 or older in 2050 -- about 5 percent of the population, compared with about 2 percent today.

Since the current research involved only veterans, the findings don't necessarily apply to broader populations, Shah said. Women, who typically develop heart failure later in life than do men, constituted only 2.6 percent of the study population.

Also, the Department of Veterans Affairs uses electronic health records and integrates all levels of care, including inpatient, outpatient and pharmacy services, so doctors can more easily monitor patients after hospitalization. "When the different aspects of health care provision are integrated, that may help in managing of complex diseases, like heart failure," Shah said.

The researchers also couldn't analyze their results according to patients' race and ethnicity because the information was unavailable for many of the patients.

Co-authors are Vivian Tsai, M.D.; Liviu Klein, M.D., M.S.; and Paul A. Heidenreich, M.D., M.S. Author disclosures and sources of funding are on the manuscript.

The Veteran's Affairs Health Services Research Development Office funded the study.

Story Source: The above story is reprinted (with editorial adaptations by Heart Smart Advice staff) from materials provided by American Heart Association, via EurekAlert!, a service of AAAS.

Sudden Cardiac Death Affects About 1 in 44,000 NCAA Athletes a Year, Study Finds

2011-04-08T16:07:00.001-05:00

About one in 44,000 National Collegiate Athletic Association athletes has sudden cardiac death each year, according to a new study in Circulation: Journal of the American Heart Association.

The death rate -- higher than many estimates for young athletes -- could influence health screening guidelines for youths in organized sports, researchers said.

According to the American Heart Association, athletic training and competition can increase the risk of sudden cardiac death in people with underlying heart disease. Various heart conditions can kill young athletes, including the most common cause -- hypertrophic cardiomyopathy, an abnormal growth of heart muscle fibers.

Estimates of the number of such deaths often have been based on inconsistent data sources such as media reports, said Kimberly Harmon, M.D., study author and clinical professor at the University of Washington in Seattle. Also, some studies lack solid figures on how many young people play sports overall, which also affects risk estimates.

The new study used news reports, insurance claims and data from the NCAA, the governing body for intercollegiate sports in the United States. About 400,000 students, ages 17-23, participate in NCAA sports each year.

Researchers tracked deaths from 2004 through 2008 and identified:

•273 deaths from all causes;
•68 percent of deaths (187 athletes) from non-medical/traumatic causes;
•29 percent (80 athletes) from medical causes; and
•2 percent (6 athletes) from unknown causes.
Of deaths from medical causes, 56 percent (45 athletes) were cardiovascular-related sudden deaths. Of the 36 deaths that occurred during or shortly after exertion, 75 percent (27 athletes) were related to cardiac causes. In all, the study found that one in 43,770 athletes died annually of sudden cardiac death.

Among other findings:

•African-American athletes had a sudden cardiac death rate of one in 17,696, compared with one in 58,653 for Caucasian competitors.
•The risk for males was one in 33,134, compared with one in 76,646 for females.
•Basketball had the highest risk of sudden cardiac death, with a rate of one in 11,394. Swimming had the second-highest risk, followed by lacrosse, football and cross-country track.
•The risk of sudden cardiac death in Division I male basketball athletes was about one in 3,000.
Incidence rates often determine whether screening for young athletes should include an electrocardiogram or echocardiogram, said Harmon, a team physician at the University of Washington. "You have to revisit the whole question of whether a more extensive screening makes sense in light of these new numbers," she said. "The question is: where do you set the risk cutoff -- one in 10,000, or 40,000, or 100,000?"

In a 2007 statement, the American Heart Association recommended that every athlete give a detailed personal and family medical history and have a thorough physical exam before participating in sports. If these items uncover information that raises concern, further testing may be warranted.

The European Society of Cardiology and the International Olympic Committee recommend the addition of electrocardiograms (ECG), a step that the American Heart Association panel considered unwieldy and too costly for large U.S. athlete populations.

"The American Heart Association regards cardiovascular screening for athletes as an important public health issue, for which there are compelling ethical, legal and medical grounds," said Ralph L. Sacco, M.S., M.D., president of the American Heart Association. "We strongly encourage student-athletes and other participants in organized competitive sports to be screened with a careful history, including family history, and thorough physical examination. The American Heart Association also believes healthcare professionals providing the screening should be able to order noninvasive testing when they judge it is needed."

More extensive screening might be practical if targeted at high-risk groups -- for instance, basketball players, Harmon said.

Furthermore, automated external defibrillators, used to revive people whose hearts have stopped, could be placed in venues where the highest-risk sports are played, she said.

Co-authors are: Irfan Asif, M.D.; David Klossner, A.T.C., Ph.D.; and Jonathan A. Drezner, M.D.

Story Source: The above story is reprinted (with editorial adaptations by Heart Smart Advice staff) from materials provided by American Heart Association, via EurekAlert!, a service of AAAS

On-Site Cardiology Team Dramatically Improves Care for Heart Attack Patients

2011-04-08T16:05:00.000-05:00

The availability of an in-house, around-the-clock interventional cardiology team dramatically decreases the time it takes to restore blood flow to heart attack patients, according to data presented this week. These findings were reported by researchers from Loyola University Health System (LUHS) at the American College of Cardiology annual meeting in New Orleans.

In April 2009, Loyola became the first hospital in Illinois to launch a Heart Attack Rapid Response Team (HARRT). This group includes an interventional cardiologist, a nurse and other members of the cardiac catheterization team who are available at the hospital 24 hours a day, seven days a week. Most hospitals do not have such teams on site during nights and weekends.

"Valuable time is lost when nurses, doctors and technicians have to be called in from home," said interventional cardiologist John Lopez, MD, study investigator and HARRT co-director, LUHS. "Our staff is on hand and prepared all of the time to meet patients when they arrive and require immediate care."

A task force of the American College of Cardiology and American Heart Association recommends that patients undergoing heart attacks receive balloon angioplasties as soon as possible or within 90 minutes of arriving at the hospital -- known as the "door-to-balloon" time.

These data revealed Loyola has far exceeded this standard since the HARRT program launched, with a median door-to-balloon time of just 47 minutes. All patients received angioplasties within 90 minutes and 82 percent received them within 60 minutes. These results greatly exceed the national standards and results from the best hospitals in the country.

During a heart attack, a blockage in an artery stops blood flow. Heart muscle begins to die due to lack of blood and oxygen. But a balloon angioplasty, if done in time, can stop a heart attack by restoring blood flow.

"Having a team on site 24/7 is the best way to enhance emergency angioplasty times," said Michelle Fennessy, APN, study investigator, LUHS. "By treating patients quickly, you save more lives and improve their prognosis."

Other study investigators from Loyola included Wojciech Nowak DO, PhD, Fred Leya, MD, Robert S. Dieter, MD, Bruce Lewis, MD, Lowell Steen, MD, Mark E. Cichon, DO, Beatrice Probst, MD, Michael Ryan, MD, Jayson Liu, MD, Catherine Smith, RN, MBA, Michael Jarotkiewicz, MBA, David Wilber, MD, and Brian Nguyen, MD.

Story Source: The above story is reprinted (with editorial adaptations by Heart Smart Advice staff) from materials provided by Loyola University Health System, via EurekAlert!, a service of AAAS.

Body Mass Index in Adolescence Associated With Early Occurrence of Diabetes and Heart Disease

2011-04-08T16:02:00.002-05:00

A new 17 year follow-up study of 37,000 Israeli teenagers found that diabetes risk is mainly associated with increased body mass index (BMI) close to the time of diagnosis at early adulthood, while coronary heart disease risk is associated with elevated BMI both at adolescence and adulthood.

The findings are published in the April 7 issue of the New England Journal of Medicine.

Lead study author, Amir Tirosh, MD PhD, of the Endocrine Division at Brigham and Women's Hospital said, "The study suggests that the obesity problem in children and teens is likely just the tip of an iceberg for increased risk for type 2 diabetes and heart disease in adulthood."

The research team, also including Ben-Gurion Univeristy's Profesors Iris Shai and Assaf Rudich, in Beer-Sheva, Israel, along with researchers from the Israeli Defense Force (IDF) Medical Corps and Tel Hashomer, has followed 37,000 Israeli army career personnel, starting at age 17 years.

Their BMI was recorded at baseline and again every several years. During a mean follow-up period of 17 years, the average BMI of the participants rose at a rate of 0.2-0.3 units per year, mounting to an average weight gain of approximately 30 lbs between ages 17 and 30. During the study period, 1,173 new cases of diabetes and 327 new cases of heart disease were diagnosed.

When controlling for multiple risk factors for both diseases, including age, fasting blood sugar, blood lipids, blood pressure, smoking and family history, the researchers found that at age 17, BMI, even in the currently considered normal range, could predict the occurrence of both diseases. Every rise in 1 unit of BMI was associated with an approximately 10 percent increased risk for type 2 diabetes in early adulthood, and 12 percent increase in the risk for heart disease.

"Previous studies did not unequivocally confirm the association between pre-adulthood BMI and diseases in early adulthood. This study is significant because it demonstrates that the association exists within the currently-considered normal values for BMI, having distinct effect on two diseases occurring in early adulthood and in an age group that is frequently neglected," said Professor Assaf Rudich.

Remarkably, elevated risk at age 17 was significant at a BMI of 23.4 Kg/m2 or higher for diabetes and 20.9 Kg/m2 or higher for heart disease (These values correspond to a weight of 163 lbs or 146 lbs in a 5'10" male teenager, respectively). For diabetes, BMI at age 17 predicted the risk mainly since it is associated with BMI later in life. However, for heart disease, both BMI at adolescence as well as BMI at adulthood independently predicted the risk of the disease.

"It would seem that heart disease has a longer "memory" for BMI than diabetes, and history of a person's BMI should be part of risk assessment," said Profesor Iris Shai. "We do have options, not necessarily pharmacological, to offer patients to decrease their risk for heart disease. Recent intervention trials showed that nutritional habits modification can not only halt the progression of atheorsclerosis, the underlying process of heart disease, but could also reverse it."

Dr. Amir Tirosh adds, "For prevention of early occurrence of heart disease in adulthood it would seem that very early intervention to promote healthy life-style habits is warranted, even during childhood."

Story Source: The above story is reprinted (with editorial adaptations by Heart Smart Advice staff) from materials provided by Brigham and Women's Hospital, via EurekAlert!, a service of AAAS.

Blood Protein Levels May Predict Risk of a Cardiovascular Event

2011-04-08T16:01:00.001-05:00

Increased levels of a protein that helps regulate the body's blood pressure may also predict a major cardiovascular event in high-risk patients, according to a study led by St. Michael's Hospital's cardiovascular surgeon Subodh Verma. Measuring the amount of the protein, known as plasma renin activity (PRA), in the blood stream may give doctors another tool to assess a patient's risk and help prevent a heart attack or stroke.

"Conventional factors like genetics and environment do not always provide a complete patient story and an understanding of cardiovascular risk," says Dr. Subodh Verma, senior author, researcher and cardiovascular surgeon at St. Michael's Hospital. "The plasma renin activity blood marker allows us to identify people at a higher risk and that gives us the opportunity to introduce therapies that would work to lower a patient's PRA levels."

Published in March in the European Heart Journal, the paper was based on 2,913 Canadian HOPE (Heart Outcomes Prevention Evaluation) study patients. Patients in the study had stable chronic vascular disease and/or diabetes and one cardiovascular risk factor.

"This study makes a strong case for further study of PRA and its association with cardiovascular death," explains Dr. Verma. "The next step will be to move into larger trials with PRA therapies and study whether or not this impacts the cardiovascular death rate. This could be a big step forward in our battle against heart disease."

The Heart & Stroke Foundation estimates that heart disease and stroke costs the Canadian economy more than $22.2 billion every year in physician services, hospital costs, lost wages and decreased productivity.

Story Source: The above story is reprinted (with editorial adaptations by Heart Smart Advice staff) from materials provided by St. Michael's Hospital, via EurekAlert!, a service of AAAS.

Physical Activity Decreases Salt's Effect on Blood Pressure, Study Finds

2011-03-29T18:38:00.001-05:00

The more physically active you are, the less your blood pressure rises in response to a high-salt diet, researchers reported at the American Heart Association's Nutrition, Physical Activity and Metabolism/Cardiovascular Disease Epidemiology and Prevention 2011 Scientific Sessions.

"Patients should be advised to increase their physical activity and eat less sodium," said Casey M. Rebholz, M.P.H., lead author of the study and a medical student at the Tulane School of Medicine and doctoral student at the Tulane University School of Public Health & Tropical Medicine in New Orleans. "Restricting sodium is particularly important in lowering blood pressure among more sedentary people."

Investigators compared study participants' blood pressure on two one-week diets, one low in sodium (3,000 mg/day) and the other high in sodium (18,000 mg/day).

The American Heart Association recommends consuming less than 1,500 mg/day of sodium.

If a person's average systolic blood pressure (the top number in the reading, measured when the heart is contracting) increased 5 percent or more from the low-sodium to the high-sodium regimen, the researchers labeled them as high salt-sensitive.

Based on physical activity questionnaires, researchers divided participants into four groups ranging from very active to quite sedentary.

The average increases in systolic blood pressure after switching from low to high sodium, adjusted for age and gender, were:

•5.27 mm Hg in the least active group
•5.07 mm Hg in the next-to-lowest activity group
•4.93 mm Hg in the next to highest activity group
•3.88 mm Hg in the most active group
Compared with the sedentary group, the odds of being salt-sensitive, adjusted for age and gender, fell:

•10 percent in the next-to-lowest activity group
•17 percent in the next-to-highest activity group
•38 percent in the most active group
"In all the analyses we found a dose-response relationship with the more activity, the better," Rebholz said.

The participants were 1,906 Han Chinese adults (average age 38) in the Genetic Epidemiology Network of Salt Sensitivity (GenSalt), a large project to identify genetic and environmental factors contributing to salt sensitivity. Siblings and their parents were invited to become involved in GenSalt if at least one sibling had pre-hypertension (blood pressure between 120/80 and 139/89 mm Hg) or stage-1 hypertension (between 140/90 and 159/99 mm Hg). No one was on blood pressure medication during the study.

The GenSalt project is located in rural China because the homogeneous population makes it more likely that genes influential to blood pressure control will be identified.

"The study needs to be repeated, but I suspect that the relationship between physical activity and salt-sensitivity will apply to other populations," Rebholz said.

Co-authors are: Dongfeng Gu, Ph.D.; Jing Chen, M.D., M.S.; Jian-feng Huang, M.D.; Jie Cao, M.D., M.S.; Ji-chun Chen, M.D., M.S.; Jianxin Li, M.D.; Fanghong Lu, M.D.; Jianjun Mu, M.D.; Jixiang Ma, M.D.; Dongsheng Hu, M.D., M.S.; Xu Ji, M.D.; Lydia A. Bazzano, M.D., Ph.D.; Depei Liu, M.D., Ph.D.; and Jiang He, M.D., Ph.D.

Story Source: The above story is reprinted (with editorial adaptations by Heart Smart Advice staff) from materials provided by American Heart Association, via EurekAlert!, a service of AAAS.

Mini-Stroke Doubles Risk of Heart Attack

2011-03-29T18:36:00.002-05:00

Patients who have suffered a "mini stroke" are at twice the risk of heart attack than the general population, according to research reported in Stroke: Journal of the American Heart Association.

These mini-strokes, called transient-ischemic attacks, or TIAs, occur when a blood clot temporarily blocks a blood vessel to the brain. Although the symptoms are similar to a stroke, a TIA is shorter ─ usually lasting only minutes or a few hours ─ and does not cause long-term disability. A TIA, also called a "warning stroke," signals a high risk of a subsequent, larger stroke.

In this study, the risk of heart attack among TIA patients was about 1 percent per year, double that of people who had never had a TIA. This increased risk persisted for years and was highest among patients under age 60, who were 15 times more likely than non-TIA patients to have a heart attack.

"Physicians and other healthcare providers should be mindful of the increased risk for heart attack after TIA, just as they are about the increased occurrence of stroke," said Robert D. Brown Jr., M.D., M.P.H., principal investigator and chair of the neurology department at the Mayo Clinic in Rochester, Minn. "In the same way that we evaluate the patient to determine the cause of TIA and implement strategies to reduce the occurrence of stroke after a TIA, we should step back and consider whether a stress test or some other screening study for coronary-artery disease should also be performed after a TIA, in an attempt to lessen the occurrence of heart attack."

In the study, the average length of time between a first TIA and a heart attack was five years. Researchers also found that TIA patients who later had a heart attack were three times more likely than those who did not have a heart attack to die during study follow-up.

Factors that independently increased the risk of heart attack after TIA included:

•male gender;
•older age; and
•use of cholesterol-lowering medications (although patients using these drugs may have had more severe heart disease initially).
The study included 456 patients (average age 72, 43 percent men) diagnosed with a TIA between 1985 and 1994. Nearly two-thirds had high blood pressure, more than half smoked, and three-fourths were being treated with medication, such as aspirin, to prevent blood clots. Average follow-up was 10 years.

Investigators used a medical-records database (Rochester Epidemiology Project) to retrospectively identify TIA patients in Rochester, Minn. They then cross-referenced this information with data on heart attacks occurring within this patient group through 2006.

Most heart attacks are caused by coronary-artery disease, which occurs when a blood clot blocks blood and oxygen flow in a blood vessel leading to the heart. Although coronary-artery disease is the primary cause of death among TIA patients, according to the study, limited data exist on the incidence of heart attack after TIA.

"In fact, coronary-artery disease is an even greater cause of death after transient-ischemic attack than stroke is, surprising as that may be," Brown said. "We should use the TIA event not only to provide a warning sign that patients are at heightened risk of stroke, but are also at increased risk of heart attack, an event that will increase their risk of death after the TIA."

Co-authors are Joseph D. Burns, M.D.; Alejandro A. Rabinstein, M.D.; Veronique L. Roger, M.D., M.P.H.; Latha G. Stead, M.D.; Teresa J. H. Christianson, B.S.; and Jill M. Killian, B.S. Author disclosures are on the manuscript.

The Mayo Clinic funded the study. TIA and stroke warning signs are sudden:

•Numbness or weakness of the face, arm or leg, often on only one side of the body
•Confusion and trouble speaking or understanding others
•Difficulty seeing
•Trouble walking, feelings of dizziness and loss of balance or coordination
•Severe headache of unknown cause
The presence of any of these signs warrants a call to 9-1-1 for immediate medical attention.

Story Source: The above story is reprinted (with editorial adaptations by Heart Smart Advice staff) from materials provided by American Heart Association.

Do All Student Athletes Need Heart Screenings?

2011-03-29T18:34:00.001-05:00

Parents may be wondering if enough is being done to identify athletes at risk for dying suddenly. In response, some communities have started programs to perform more extensive heart testing, including electrocardiograms. Yet an American Heart Association task force does not support such community programs due to a lack of evidence that they are able to reduce the number of sudden deaths.

Seemingly every year there are reports of a young, apparently healthy athlete dying on the court or playing field. The sudden death of Wes Leonard, a junior at Fennville High School, who died of cardiac arrest from an enlarged heart on March 3, may have parents and coaches wondering if enough is being done to identify athletes at risk for dying suddenly.

"We would like to develop a better screening program to help prevent sudden cardiac death, but there is not enough rigorous data to support what that should look like," says Sanjaya Gupta, M.D., clinical lecturer in the Division of Electrophysiology at the University of Michigan Health System.

Some communities have begun programs to perform more extensive heart testing, including electrocardiograms and sometimes echocardiograms on students before they compete.

Yet a task force organized by the American Heart Association to evaluate pre-participation screening practices has not supported such community programs due to a lack of evidence that they are able to reduce the number of sudden deaths.

A large trial recently completed in Israel concluded that mandatory ECG testing of athletes prior to sports participation did not reduce the number of deaths from sudden cardiac arrests.

"One of the major obstacles to developing a better screening process is that no one heart test is the best," says Mark Russell, M.D., a pediatric cardiologist at the University of Michigan's C.S. Mott Children's Hospital. "There are a number of different heart conditions that can cause sudden death in a young athlete.

"For some heart conditions, the ECG is the best test. For other heart problems, an echocardiogram is required," Russell says. "Unfortunately, both tests are usually normal in some individuals whose heart problem can only be diagnosed with an exercise stress test."

Furthermore, some conditions such as hypertrophic cardiomyopathy, a thickening of the heart, or dilated cardiomyopathy, the cause of death of the Fennville, Mich. Teen, can develop over time. A single screening may not detect the condition.

As many as 10 million to 12 million young athletes in the United States participate in competitive athletics, identifying which of those athletes is at significant risk of sudden death is a bit like finding a needle in a haystack, doctors say.

How can you responsibly identify the student who is at risk without excluding thousands of other students from participating in sports?

The most important step may be to ensure that the screening process outlined by the AHA is being performed as recommended. The AHA recommendations require that the screening form document 12 specific aspects of the student's personal medical history, his/hers family medical history and a physical exam. If any concerns are identified based on the initial screen, then referral to a cardiologist is recommended.

Unfortunately, until very recently, the pre-participation screening form approved by the state of Michigan only covered five of the 12 topics recommended by the AHA. Russell and other colleagues from U-M were involved in updating the Michigan pre-participation physical form available from the Michigan Department of Community Health. The updated form conforms to the AHA guidelines and will help improve the screening process.

Making sure that all Michigan schools, public and private, use the new forms and that the screenings are performed by physicians familiar with the guidelines is an important next step.

"Simply improving pre-participation screening forms and conducting electrocardiograms on properly selected children and adults may help reduce cardiac deaths," says Sharlene M. Day, M.D., director of the Hypertrophic Cardiomyopathy Clinic at the U-M Cardiovascular Center. "It is also very important for athletes, their families, and their coaches to recognize potential warning signs, like a seizure, passing out, or shortness of breath."

Yet there is still more that can be done to try to reduce the incidence of sudden cardiac death.

U-M experts support having automated external defibrillators available in schools and training coaches and other school personnel on use and maintenance of the devices. Yearly training in basic life support or CPR for coaches and trainers will help them respond as quickly as possible in an emergency.

Emergency response training programs will have the added benefit of not only improving a school's ability to respond to an emergency that occurs on the sports field but to any emergencies that occur on school property. It will also prepare individuals who will take their emergency response skills to their home and to their community.

Story Source: The above story is reprinted (with editorial adaptations by Heart Smart Advice staff) from materials provided by University of Michigan Health System.

Outcomes Improved by Longer Delays Between Heart Attacks and Elective Surgeries, Study Finds

2011-03-29T18:32:00.002-05:00

Before undergoing elective surgery, patients should consider waiting longer after a heart attack than is currently recommended, according to a study scheduled for publication in the May issue of the journal Annals of Surgery.

The American Heart Association and the American College of Cardiology recommend patients wait at least four to six weeks after a heart attack before undergoing elective surgery. This guidance is based on studies conducted in the 1970s and 1980s.

The new study examined surgical outcomes among more than 550,000 California patients over a five-year period (1999-2004) who underwent five common elective surgeries after a heart attack. Researchers found substantially lower death rates and fewer subsequent heart attacks in those who waited eight or more weeks after a heart attack to undergo hip surgery, gallbladder removal, non-traumatic amputation, colon resection or elective abdominal aortic aneurysm repair.

"Despite medical advancements in the treatment of coronary artery disease today, a recent heart attack remains a very important risk factor for patients undergoing surgery," said Christian de Virgilio, MD, the study's corresponding author and a principal investigator at Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center (LA BioMed). "Our study suggests that patients should wait at least eight weeks after a heart attack before undergoing elective surgery. The results of the study also reignite the question of whether, in this high risk group, physicians should consider coronary artery stenting or bypass prior to elective surgery."

Researchers found the risk of subsequent heart attacks and death generally declined the longer the time between a heart attack and elective surgery. For instance, the risk of death for heart attack in patients undergoing hip surgery declined nearly 40 percent when the surgery took place more than six months after the heart attack.

Among patients who underwent hip surgery within 30 days of a heart attack, the study found 13.1 percent died within a month. Among those whose hip surgery occurred six months to one year after a heart attack, researchers found the death rate within a month was 7.9 percent. The risk of a subsequent heart attack went from 38.4 percent for hip surgery performed within a month of a heart attack to 6.2 percent for hip surgery performed six months to a year after a heart attack.

"Our research examined a much wider range of patients and surgeries than in past studies, and it points out the importance of a recent heart attack in determining the timing for elective surgeries," said Dr. de Virgilio.

Story Source: The above story is reprinted (with editorial adaptations by Heart Smart Advice staff) from materials provided by Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center (LA BioMed), via EurekAlert!, a service of AAAS.

Taking Blood Pressure to New Lows -- With Lasting Results

2011-03-29T18:30:00.000-05:00

Interventional radiologists have completed the first human randomized controlled trial of therapeutic renal denervation or RDN -- a procedure that uses a catheter-based probe inserted into the renal artery that emits high-frequency energy to deactivate the nerves near the kidneys (or in the renal artery) that are linked to high blood pressure. The researchers say these results confirm that RDN may be an effective therapy for reducing -- and consistently controlling -- resistant hypertension when current medications have failed.

The results were presented at the Society of Interventional Radiology's 36th Annual Scientific Meeting in Chicago, Ill.

"Renal denervation, a minimally invasive, effective treatment, appears to be safe in the short term with a low incidence of local complications. Its efficacy to lower blood pressure in patients with resistant high blood pressure will be better evaluated with the results of a subsequent trial," said Marc R. Sapoval, M.D., Ph.D., professor of clinical radiology and chair of the cardiovascular radiology department at Hôpital Européen Georges-Pompidou in Paris, France. "After six months, 39 percent of patients receiving the endovascular denervation treatment had reached the recommended blood pressure level and, overall, 50 percent of patients showed a measurable benefit of the intervention," he added.

"It is estimated that one in every four American adults has high blood pressure. High blood pressure increases the risk of heart and/or kidney disease and stroke because it makes the heart work too hard," Sapoval explained. "The renal sympathetic system, which are the small nerves that carry the signal from the brain to the kidney and back from the kidney to the brain, plays an important role in the regulation of blood pressure levels. The disruption of these nerve fibers has a positive effect on blood pressure levels," he continued.

"Given its impact on the central sympathetic drive, endovascular renal denervation may have applicability in additional disease states such as heart failure, cardio-renal syndrome, hepato-renal syndrome, and in the prevention of progression of chronic kidney disease and hypertension in end-stage renal disease -- with the added benefit of helping to raise public awareness on the dramatic burden of this disease," said Sapoval.

This study targeted only patients with resistant essential hypertension, which means that a doctor couldn't find any reason for the condition. Sapoval said the causes of high blood pressure can be wide-ranging, such as a benign tumor in the adrenal gland, stenosis of the renal artery, the taking of certain prescription drugs or other factors. By randomized assignment, 106 adult patients with uncontrolled hypertension received either oral medication or the renal denervation treatment. Six months after the intervention, systolic pressure (the top number in a blood pressure measurement) fell an average of 32 mmHg (millimeters of mercury, the standard for measuring blood pressure) and diastolic pressure (the smaller number in a blood pressure reading) fell an average of 12 mmHg. This initial cohort has been expanded to a multicenter randomized controlled trial at 24 international sites.

Sapoval conceded that this was a small study, that the work still experimental, and that renal denervation should be performed only by interventional radiologists on screened patients in strictly controlled academic and/or research settings. However, he noted that it shows great promise for those suffering from resistant hypertension. Sapoval remarked that the patients had a short hospital stay for safety reasons, but that the treatment might possibly be performed in an outpatient clinic in the future.

While the treatment's efficacy to lower blood pressure in patients with resistant hypertension will be better evaluated with the results of future trials, the interventional radiologist said that some clinical findings (like hypertension in young patients, hypertension after child bearing, etc.) can also be used by doctors to determine if other specific diagnostic tests are needed to rule out potential causes of the hypertension.

Sapoval stated that the trial was funded by the catheter and specific generator manufacturer and that there is a huge need for more research in independent hands. To that end, there will be an upcoming nationwide U.S. Food and Drug Administration trial involving more than 100 U.S.-based interventional radiology teams. He also stressed that the published results need confirmation by follow-up with the succeeding trial's patients after one and two years. Sapoval hopes that new trials, conducted and funded by public entities, such as the National Institutes of Health in the United States; NICE (the National Institute for Clinical Excellence) in the United Kingdom and the Ministry of Health in France, for example, and similar agencies in other countries, will help researchers to move forward and discern which patients would benefit from this technique, possibly in addition to medication.

Story Source: The above story is reprinted (with editorial adaptations by Heart Smart Advice staff) from materials provided by Society of Interventional Radiology, via EurekAlert!, a service of AAAS.

Avoiding Health Risks Could Prevent More Than Half of All Cases of Atrial Fibrillation

2011-03-29T18:28:00.001-05:00

Reducing cardiovascular risk factors like high blood pressure, smoking, diabetes and being overweight could potentially reduce more than half of all cases of atrial fibrillation, according to research reported in Circulation: Journal of the American Heart Association.

More than 2 million Americans live with atrial fibrillation (AF), an irregular heart rhythm that occurs when the heart's two upper chambers beat erratically, causing the chambers to pump blood rapidly, unevenly and inefficiently. Blood can pool and clot in the chambers, increasing the risk of stroke or heart attack. AF affects about 3 percent to 5 percent of people over age 65 and is related to about 15 percent of all strokes.

"We now know that a significant proportion of all cases of atrial fibrillation can be avoided," said Alvaro Alonso, M.D., M.P.H., Ph.D., co-author of the study and assistant professor of epidemiology and community health at the University of Minnesota School of Public Health in Minneapolis. "Ideally, if individuals were able to maintain a normal blood pressure and healthy body weight and didn't smoke, not only would it reduce their risks for other forms of cardiovascular disease, such as heart disease and stroke, but it also would significantly impact the risk of developing atrial fibrillation in later life."

In the study, 57 percent of the AF episodes were linked to specific risk factors, including high blood pressure, smoking, diabetes, overweight and other heart diseases. Of these risks, high blood pressure was the strongest predictor, accounting for more than one-fifth of all cases.

The researchers also identified gender and racial differences in risk factor prevalence, with more than 80 percent of African Americans having one or more risk factors compared to 60 percent of whites. Only about 2 percent of African-American men and African-American women had optimal risk factors versus 3 percent white men and 10 percent of white women with optimal risk.

"A lot of work needs to be done to try to ensure that African-Americans in particular achieve optimal levels of blood pressure and diabetes control," said Rachel R. Huxley, D.Phil., lead author and associate professor of epidemiology and community health at the University of Minnesota School of Public Health.

Only 5 percent of participants overall had optimal levels of risk factors for preventing AF. Slightly more than one-fourth were classified as having a borderline risk factor profile and two-thirds of study participants had elevated risk factor levels. Patients with optimal levels of risk factors had one-third of the risk of developing AF compared with those with an elevated risk factor profile.

During the study, 1,520 episodes of AF occurred.

Population risk estimates showed that having one or more elevated risk factor level could explain 50 percent of AF events. In whites, the risk was 50 percent in women and 38.2 percent in men. In African Americans, the risk of AF associated with having one or more elevated risk factors was 94 percent in women and 91 percent in men.

The study comprised 14,598 participants in the Atherosclerosis Risk in Communities Study (ARIC), a prospective study of heart disease among residents of four communities in North Carolina, Mississippi, Maryland and Minnesota. Their average age was 54 years old, 55 percent were women, 75 percent were white and 25 percent were African-American. The study started in 1987, and follow-up averaged 17 years.

After an initial interview and medical exam, investigators divided participants into one of three groups based on their risk factors for AF: optimal, borderline and elevated. Patients in the optimal-risk group had normal blood pressure and weight, no heart disease or diabetes, and no smoking history.

Patients in the other two groups had increased risks in these categories.

Other co-authors are: Faye L. Lopez, M.P.H.; Aaron R. Folsom, M.D., M.P.H.; Sunil K. Agarwal, M.D., M.P.H., Ph.D.; Laura R. Loehr, M.D., M.S., Ph.D.; Elsayed Z. Soliman, M.D., M.Sc., M.S.; Rich Maclehose, Ph.D.; and Suma Konety, M.D., M.S.

The National Heart, Lung, and Blood Institute and the American Heart Association funded the study.

Story Source: The above story is reprinted (with editorial adaptations by Heart Smart Advice staff) from materials provided by American Heart Association, via EurekAlert!, a service of AAAS.

Study Examines Outcomes of High-Dose Antiplatelet Drug After Stent Placement

2011-03-19T03:09:00.001-05:00

Modifying a patient's dosage of the antiplatelet drug clopidogrel for 6 months depending on the patient's level of platelet reactivity did not result in combined lower rates of nonfatal heart attack, stent thrombosis (clot) and cardiovascular death in patients who had a procedure such as balloon angioplasty and received a drug-releasing coronary stent, according to a study in the March 16 issue of JAMA.

Current guidelines recommend treating patients undergoing percutaneous coronary intervention (PCI; procedure such as balloon angioplasty used to open narrowed coronary arteries) and drug-eluting stent implantation with a combination of aspirin and P2Y12 (compound found on the surface of blood platelet cells and an important regulator in blood clotting) antagonist for at least 1 year. But several studies have suggested that patients with high platelet reactivity during treatment with clopidogrel are at an increased risk of cardiovascular events after PCI. A treatment strategy for this issue has not been well defined, according to background information in the article.

Matthew J. Price, M.D., of Scripps Translational Science Institute, La Jolla, Calif., and colleagues conducted the Gauging Responsiveness with A VerifyNow assay -- Impact on Thrombosis And Safety (GRAVITAS) trial to determine whether high-dose clopidogrel is superior to standard-dose therapy for the prevention of cardiovascular events after PCI in patients with high on-treatment reactivity. The randomized trial included 2,214 patients with high on-treatment reactivity (measured 12 to 24 hours after PCI) with drug-eluting stents at 83 centers in North America between July 2008 and April 2010. Patients received high-dose clopidogrel (600-mg initial dose, 150 mg daily thereafter) or standard-dose clopidogrel (75 mg daily) for 6 months. The primary outcome measured was the 6-month incidence of death from cardiovascular causes, nonfatal heart attack, or stent thrombosis. Safety measurements included severe or moderate bleeding.

The researchers found that the rate of death from cardiovascular causes, nonfatal heart attack, or stent thrombosis was not different with high-dose compared with standard-dose clopidogrel in the patients with high on-treatment reactivity (25 (2.3 percent) vs. 25 [2.3 percent]). In an analysis, the event rates in the 2 groups after 30 days were (20 [1.9 percent] vs. 17 [1.6 percent]), respectively.

The reduction in on-treatment reactivity at 30 days and at 6 months after randomization was significantly greater with high-dose than with standard-dose clopidogrel. High-dose clopidogrel was associated with an absolute 22 percent lower rate of high on-treatment reactivity compared with standard-dose clopidogrel at 30 days and 6 months (40 percent vs. 62 percent; and 36 percent vs. 60 percent, respectively).

Severe or moderate bleeding was not increased with the high-dose regimen.

"In conclusion, high-dose clopidogrel for 6 months in patients with high on-treatment platelet reactivity 12 to 24 hours after PCI with drug-eluting stents did not reduce the rate of death from cardiovascular causes, nonfatal myocardial infarction, or stent thrombosis compared with standard-dose clopidogrel. The results of GRAVITAS do not support a uniform treatment strategy of high-dose clopidogrel in patients with high on-treatment reactivity identified by a single platelet function test after PCI. Alternative treatment strategies incorporating platelet function testing merit further investigation," the authors write.

Editorial: An Initial Experiment With Personalized Antiplatelet Therapy

Paul A. Gurbel, M.D., and Udaya S. Tantry, Ph.D., of the Sinai Hospital of Baltimore, comment on the findings of this study in an accompanying editorial.

"… the GRAVITAS investigators have conducted the largest trial of personalized antiplatelet therapy thus far. The valuable information gained from the GRAVITAS trial can inform future trials. Even though GRAVITAS demonstrated that platelet function testing after drug-eluting stent placement does not improve outcomes if high-dose clopidogrel is used as the remedy, it is hoped that future studies evaluating different platelet function cutpoints and more potent P2Y12 inhibitors will be effective."

Story Source: The above story is reprinted (with editorial adaptations by Heart Smart Advice staff) from materials provided by JAMA and Archives Journals.

Inflammation Behind Heart Valve Disease, Research Suggests

2011-03-19T03:06:00.001-05:00

Research from Karolinska Institutet in Sweden shows that a specific inflammatory factor may be important in the development of the heart valve disease aortic stenosis. The results suggest that anti-inflammatory medication could be a possible new treatment.

Aortic stenosis is the most common heart valve disease, which is caused by calcium deposits and a narrowing of the aortic valve. This is typically seen in the elderly, but can also be caused by a congenital defect. Aortic stenosis is currently treated by surgical replacement of the diseased valve, but research is on-going for identifying medicines which can delay the progress of the disease.

In a new study presented in the journal Circulation, researchers from Karolinska Institutet show that specific pathways of inflammation are important underlying factors in the development of aortic stenosis.

By studying heart valves from patients undergoing surgery for various valve diseases, the researchers have shown that immune cells and a group of inflammatory substances called leukotrienes can be found in calcified heart valves. The most significant inflammation was seen in patients with the narrowest valves on ultrasound examination. The researchers have also shown in cell cultures that leukotrienes stimulate the calcification of heart valve cells.

There are similarities between atherosclerosis (calcification of the arteries) and aortic stenosis. However, lipid-lowering medicines known as statins which are capable of preventing atherosclerosis have proved ineffective in preventing calcification of the aortic valve.

"The results suggest that anti-inflammatory medication could be a future treatment for aortic stenosis, and it would mean a lot to these patients, most of whom are elderly, if we could slow the disease to the extent that they do not need surgery," says associate professor and cardiologist Magnus Bäck, one of the researchers behind the study.

Story Source: The above story is reprinted (with editorial adaptations by Heart Smart Advice staff) from materials provided by Karolinska Institutet.

In Pilot Study, Screening Detects Potentially Serious Heart Conditions in Healthy Children

2011-03-19T03:04:00.001-05:00

A pilot study in healthy children and adolescents shows that it is feasible to screen for undiagnosed heart conditions that increase the risk of sudden cardiac arrest (SCA). Adding a 10-minute electrocardiogram (EKG or ECG) to a history and physical examination identified unsuspected cases of potentially serious heart conditions.

Although more research is needed, the preliminary results suggest that a relatively low-cost screening might help identify children who are at risk for sudden cardiac arrest, possibly preventing childhood death.

"In the United States, the current American Heart Association guidelines recommend screening only competitive athletes, not all children, using history and physical examination alone," said the study leader, Victoria L. Vetter, M.D., M.P.H., a pediatric cardiologist at The Children's Hospital of Philadelphia. She noted that in Italy and Japan, which have compulsory screening of all athletes or schoolchildren, researchers have found that adding an ECG to the history and physical increases the likelihood of detecting children at risk for SCA.

"Our pilot study evaluated the feasibility of adding an ECG to cardiac screening of healthy school-aged children," Vetter added. The Children's Hospital research team published their study on March 15 in the American Heart Journal.

In children, sudden cardiac arrest is caused by structural or electrical abnormalities in the heart that frequently cause no symptoms and may go undiagnosed. It results in an estimated 100 to 1,000 or more annual deaths in childhood in the U.S. The current study evaluated 400 healthy subjects, 5 to 19 years old, recruited from Children's Hospital's Care Network. The researchers screened the subjects using a medical family history questionnaire, a physical examination, an ECG and an echocardiogram.

The study team identified previously undiagnosed cardiac abnormalities in 23 subjects, and hypertension in an additional 20. Ten of the 400 subjects (about 2.5 percent) had potentially serious cardiac conditions. Of those 10 subjects, only one had experienced symptoms, and those had previously been dismissed. None of the 10 subjects had a family history of SCA. "In our study, using ECG outperformed the history and physical examination and found previously unidentified potentially serious abnormalities that would not have been identified by history and physical examination alone," the study authors wrote. The authors added that the children in the screening were not all high school athletes, and most would not have undergone athletic cardiac screening. Regular physical examinations by primary care physicians had not detected the cardiac conditions found in the current study

"Performing the ECG and its interpretation added less than 10 minutes to each subject's total evaluation," said Vetter, added that the ECG machines are portable and relatively inexpensive.

"Our pilot study showed that adding ECG to the currently recommended guideline of history and physical examination is feasible for screening children and adolescents, and offers the potential to identify serious cardiovascular abnormalities," said Vetter. "However, our study was not designed to be generalized to a larger population of children at risk for SCA. Larger, more representative studies must be done, as well as cost-effectiveness research." She added that larger pediatric studies may establish better standards for ECG measurements, and determine how broad ECG-screening of school-aged children could best be implemented.

Story Source: The above story is reprinted (with editorial adaptations by Heart Smart Advice staff) from materials provided by Children's Hospital of Philadelphia.

Altered Gene Protects Some African-Americans from Coronary Artery Disease

2011-03-19T03:02:00.001-05:00

A team of scientists at Johns Hopkins and elsewhere has discovered that a single alteration in the genetic code of about a fourth of African-Americans helps protect them from coronary artery disease, the leading cause of death in Americans of all races.

Researchers found that a single DNA variation -- having at least one so-called guanine nucleotide in a base pair instead of a combination without any guanine -- on a gene already linked to higher risk of coronary disease in other races is linked in blacks to decreased risk. Specifically, the study showed that otherwise healthy African-American men and women with the alternative genetic code had a fivefold reduction in the likelihood that their arteries would narrow or clog.

For African-Americans who inherited two copies of the guanine gene variant, one from each parent, the risk reduction was even more dramatic. They were 10 times less likely to have coronary heart disease, which disproportionately afflicts a greater number of African-Americans than whites or any other ethnic group. Nearly 17 million Americans have an arterial problem plaguing the heart, causing a half-million deaths, annually.

"What we think we have here is the first confirmed hereditary link to cardiovascular disease among African-Americans and it is a protective one," says senior study investigator and health epidemiologist Diane Becker, M.P.H., Sc.D. "This newly found link in African-Americans was not only protective instead of harmful but was also found at a precise location on gene CDKN2B, a gene close to the single base pair modification tied to other increased risk of coronary artery disease in other races."

Becker emphasizes that only an estimated quarter of blacks have the protective CDKN2B code, and only 6 percent have two copies, so "while a lot of African-Americans have this protective genetic modification, most do not." Advance testing for the genetic marker, she says, could ultimately in the future assist physicians in risk-stratifying those without inherited protection so they could be monitored more closely for early signs and symptoms of disease.

The findings are set to appear in the Journal of Human Genetics online Jan. 27.

Becker, a professor at both the Johns Hopkins University School of Medicine and Hopkins' Bloomberg School of Public Health, and a team that included researchers at Duke and Emory universities, also say their results, based on blood analysis from 548 black men and women in the Baltimore region and confirmed in several hundred more in the Atlanta and Durham, N.C., regions, help explain why earlier studies found potentially dangerous genetic connections to this type of heart disease in Caucasians, Hispanics and Asians, but failed to find a negative tie-in to the disease in blacks.

Earlier studies, says Becker, had involved genome-wide reviews in multiracial populations and taken "a needle in the haystack approach" to finding that one change in a string of some 58,000 base pairs, in a chromosomal region known as 9p21. That region, which includes CDKN2B, is associated with higher rates of coronary disease in non-blacks.

The team's latest analysis was successful, she believes, because it had a large and sufficiently broadly based black volunteer population. The study group comprised men and women between the ages of 26 and 60. Investigators also focused on the 9p21 region and a subsection of genetic material within called ANRIL that overlaps and is closely held to CDKN2B, but away from the deleterious genetic variant found earlier.

Johns Hopkins cardiologist Brian Kral, M.D., M.P.H., says the abundance of activity in this particular region of the genome, including CDK2NB and ANRIL, suggests that everyday replication of this zone could play a more fundamental, underlying role in the progression of coronary artery disease in all races.

Kral, an assistant professor at Johns Hopkins and its Heart and Vascular Institute. was co-lead investigator of the latest study, along with Hopkins genetic epidemiologist Rasika Mathias, Sc.D. The team next plans to further investigate the ANRIL subregion of 9p21 to see if any single genetic changes speed up or slow down progression of coronary diseases.

Blood samples for the genetic analysis came from a larger study being led by Becker of some 4,000 people from white and African-American ethnic backgrounds. Called the Genetic Study of Atherosclerosis Risk (GeneSTAR), under way at Johns Hopkins since 1983, it involves participants who were all healthy upon enrollment, with no existing symptoms of heart disease. All were monitored for at least five years with periodic check-ups to see who developed heart disease and who did not. Each had a sibling or a parent who had a history of coronary artery disease or some other symptom of blocked arteries, such as chest pain or shortness of breath. The latest study was based on results collected through 2007, by which time 35 black study participants had suffered some form of heart attack or needed an angioplasty or X-ray scan of the heart's blood vessels to confirm or rule out arterial blockages.

Study funding was provided by the National Heart, Lung and Blood Institute (NHLBI), a member of the National Institutes of Health, and the Johns Hopkins Clinical Research Center.

In addition to Becker, Kral and Mathias, other Hopkins researchers involved in this report are Bhoom Suktitipar, M.D.; Ingo Ruczinski, Ph.D.; Dhananjay "Jay" Vaidya, M.B.B.S., Ph.D.; Lisa Yanek, M.P.H.; and Lewis Becker, M.D. Arshed Quyyumi, M.D.; Riyaz Patel, M.D.; A Maziar Zafari, M.D., Ph.D.; and Viola Vaccarino, M.D., Ph.D., all at Emory University in Atlanta, also contributed to the research. Further study assistance and support was provided from Elizabeth Hauser, Ph.D., and William Kraus, M.D., both at Duke University Medical Center in Durham, N.C.

Story Source: The above story is reprinted (with editorial adaptations by Heart Smart Advice staff) from materials provided by Johns Hopkins Medical Institutions.

Heart Damage Improves, Reverses After Stem Cell Injections in a Preliminary Human Trial

2011-03-19T02:58:00.002-05:00

Researchers have shown for the first time that stem cells injected into enlarged hearts reduced heart size, reduced scar tissue and improved function to injured heart areas, according to a small trial published in Circulation Research: Journal of the American Heart Association.

Researchers said that while this research is in the early stages, the findings are promising for the more than five million Americans who have enlarged hearts due to damage sustained from heart attacks. These patients can suffer premature death, have major disability and experience frequent hospitalizations. Options for treatment are limited to lifelong medications and major medical interventions, such as heart transplantation, according to Joshua M. Hare, M.D., the study's senior author and professor of medicine and director of the Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, University of Miami in Miami, Fla.

Using catheters, researchers injected stem cells derived from the patient's own bone marrow into the hearts of eight men (average age 57) with chronically enlarged, low-functioning hearts.

"The injections first improved function in the damaged area of the heart and then led to a reduction in the size of the heart. This was associated with a reduction in scar size. The effects lasted for a year after the injections, which was the full duration of the study," Hare said.

Specifically, researchers found:

•Heart size decreased an average of 15 percent to 20 percent, which is about three times what is possible with current medical therapies.
•Scar tissue decreased by an average of 18.3 percent.
•And there was dramatic improvement in the function, or contraction, of specific heart areas that were damaged.
"This therapy improved even old cardiac injuries," Hare said. "Some of the patients had damage to their hearts from heart attacks as long as 11 years before treatment."

The researchers had used two different types of bone marrow stem cells in their study -- mononuclear or mesenchymal stem cells. The study lacked the power to determine if one type of cell works better than the other. All patients in the study benefited from the therapy and tolerated the injections with no serious adverse events.

Hare's study assessed the effect of stem cell injections differently from other studies of post-heart attack stem cell treatment. His team measured contractility, scar size and structural changes of the heart.

"Studies of bone marrow cell therapy for ischemic heart disease in animals have shown improved ejection fraction (the amount of blood the heart can pump). However, this measurement has not reliably translated to early phase studies in humans," Hare said. "Ejection fraction may not be the best way to measure the success of stem cell therapy in the human heart."

Hare also said their findings suggest that patients' quality of life could improve as the result of this therapy because the heart is a more normal size and is better functioning. "But, we have yet to prove this clinical benefit -- this is an experimental therapy in phase one studies. These findings support further clinical trials and give us hope that we can help people with enlarged hearts."

Co-authors are Adam R. Williams, M.D.; Barry Trachtenberg, M.D.; Darcy L. Velazquez, R.N., B.S.N.; Ian McNiece, Ph.D.; Peter Altman, Ph.D.; Didier Rouy, M.D., Ph.D.; Adam M. Mendizabal, M.S.; Pradip M. Pattany, Ph.D.; Gustavo A. Lopera, M.D.; Joel Fishman, M.D., Ph.D.; Juan P. Zambrano, M.D. and Alan W. Heldman M.D. Author disclosures are on the manuscript.

The University of Miami Interdisciplinary Stem Cell Institute, BioCardia (makers of the catheter used) and the National Institutes of Health funded the study.

Story Source: The above story is reprinted (with editorial adaptations by Heart Smart Advice staff) from materials provided by American Heart Association.

Stroke Incidence Higher Among Patients With Certain Type of Retinal Vascular Disease

2011-03-19T02:56:00.001-05:00

Patients with a disease known as retinal vein occlusion (RVO) have a significantly higher incidence of stroke when compared with persons who do not have RVO, according to a report in the March issue of Archives of Ophthalmology, one of the JAMA/Archives journals.

"Retinal vein occlusion (RVO) is a retinal vascular disease in which a retinal vein is compressed by an adjacent retinal artery, resulting in blood flow turbulence, thrombus formation, and retinal ischemia," the authors write as background information in the article. "Although RVO is a significant cause of severe visual impairment in adults, it can occur at any age." Older age, diabetes, hypertension and vascular disease are among the risk factors for RVO.

Winifred Werther, Ph.D., then of Genentech Inc., South San Francisco, Calif., now of Vertex Pharmaceuticals, Cambridge, Mass., and colleagues conducted a retrospective cohort study to compare the incidence rates of myocardial infarction (MI, heart attack) and cerebrovascular accident (CVA, stroke) in hospitalized patients with and without retinal vein occlusion. The researchers used a U.S. population-based health care claims database to identify patients with RVO and control patients, matched for age and sex.

Among 4,500 patients with RVO and 13,500 control patients, the researchers found that patients with RVO had an almost two-fold higher incidence of stroke than the age- and sex-matched controls.

"Event rates for CVA were 1.16 and 0.52 per 100 person-years for RVO and controls, respectively," the authors report.

In contrast, event rates for heart attack were similar in the patients with RVO and the control patients.

"Although men and patients younger than 65 years with RVO had a 1.6- and 1.9-fold higher risk of MI, respectively, compared with controls, there were no statistically significant differences in MI rates between patients with RVO and controls when they were stratified by sex or age," the authors write.

They conclude that "these data suggest that physicians and patients should be aware of the possible increased risk of CVA but not of MI in patients with RVO."

Story Source: The above story is reprinted (with editorial adaptations by Heart Smart Advice staff) from materials provided by JAMA and Archives Journals.

Heart and Cardiovascular Disease Deaths Drop Dramatically in Norway

2011-03-19T02:54:00.002-05:00

Life was hard in occupied Norway during WWII, but the occupation had one surprising result: deaths from heart attacks dropped precipitously, because Norwegians ate less fat, smoked less and were more physically active.

Now, in the last half of the 20th century, Norway has seen a similar precipitous drop in heart attack deaths, but this time due to focused prevention programmes and improved treatment, reports a researcher at the Norwegian University of Science and Technology (NTNU).

Writing in the latest issue of the Journal of the Norwegian Medical Association, NTNU Professor Kaare Harald Bønaa notes that the percentage of deaths due to heart disease and cardiovascular disease dropped from 50 per cent in 1975 to 33 per cent in 2009 in Norway, and that deaths from heart attacks alone dropped to levels that were last seen during WWII. Bønaa is a professor of heart and cardiovascular disease epidemiology at NTNU, and is chief physician in charge in intervention cardiology at St Olavs Hospital in Trondheim.

Risk factors down, treatment improved

"Overall, there is solid evidence that the decline in mortality from heart attacks is due to changes in risk factors and treatment," Bønaa writes.

There are many reasons that explain the numbers, Bønaa says. Reductions in cholesterol levels, smoking and high blood pressure can explain between 50 and 75 percent of the reduced mortality, he says. The remainder is explained by better medical treatment, where drugs have had the greatest impact, whether statins, beta blockers or other medicines.

Bønaa believes changes in cholesterol levels and smoking habits have contributed significantly to reducing the Norwegian heart attack epidemic. "From the 1970s, cholesterol levels have been reduced by about 10 percent, while the proportion of smokers has been halved," he says.

More women die

But Bønaa warns that the battle against heart disease has not been won. In one study in Tromsø, in northern Norway, the incidence of a first time heart attack in young- and middle-aged women actually increased over the period from 1974 to 2004, while in the same age groups of men, it decreased.

Another surprising trend in Norway is that more women than men in the 16-74 age group smoke, which has resulted in an increased incidence of lung cancer and COPD in this age group of women, as well as an increase in heart attack risks.

Increases elsewhere, and an aging populace

Elsewhere, lesser developed countries are actually seeing a massive increase in cardiovascular disease, while in Norway, the reduction in risk has leveled off, and 70 percent of the population still has cholesterol levels that are too high.

And, Bønaa adds, as the Norwegian population ages, the medical community must anticipate an increased number of heart attacks in the older segments of the population and an increasing number of patients with chronic heart disease.

Story Source: The above story is reprinted (with editorial adaptations by Heart Smart Advice staff) from materials provided by The Norwegian University of Science and Technology (NTNU).

New Study Adds Weight to Diabetes Drug Link to Heart Problems

2011-03-19T02:52:00.002-05:00

A new study published on the British Medical Journal website adds to mounting evidence that rosiglitazone -- a drug used to treat type 2 diabetes -- is associated with an increased risk of major heart problems.

It finds that rosiglitazone is associated with significantly higher odds of congestive heart failure, heart attack and death compared with a similar drug (pioglitazone).

Rosiglitazone and pioglitazone belong to a class of drugs called thiazolidinediones that help to control blood sugar levels in patients with type 2 diabetes. Both drugs are known to increase the risk of heart failure, but it is unclear whether there are clinically important differences in their cardiac safety.

In 2010, the European Medicines Agency suspended the use of rosiglitazone in Europe, but in the United States it is still available on a restricted basis.

So a team of researchers in the UK and the US set out to compare the cardiovascular effects of the two drugs among patients with type 2 diabetes.

They analysed the results of 16 studies involving 810,000 patients (429,000 on rosiglitazone and 381,000 on pioglitazone). Most patients were aged over 60 years.

Compared with pioglitazone, rosiglitazone was associated with a modest but statistically significant increased risk of heart attack (16%), congestive heart failure (23%), and mortality (14%).

In certain groups of patients with type 2 diabetes, this may lead to 170 excess heart attacks, 649 excess cases of heart failure, and 431 excess deaths for every 100,000 patients who receive rosiglitazone rather than pioglitazone.

Further adjusting the data to minimise bias, did not change the results significantly, suggesting that this is unlikely to be a chance finding, say the authors.

"Our findings have important implications," they write. "Rosiglitazone is still available on a restricted basis in the United States and Canada. However, for patients who need thiazolidinedione treatment, continued use of rosiglitazone may lead to excess heart attacks, heart failure and mortality, compared with pioglitazone."

Given that there are about 3.8 million prescriptions for rosiglitazone dispensed annually in the United States, "the effect on public health may be considerable," they warn.

They also emphasise that both rosiglitazone and pioglitazone have been linked with other important safety concerns, and say that further studies are needed.

In an accompanying editorial, Victor Montori and Nilay Shah from the Mayo Clinic in the US argue that the rosiglitazone story "says much about how healthcare has become less about promoting patients' interests, alleviating illness, promoting function and independence, and curing disease, and much more about promoting other interests, including those of the drug industry."

They believe that regulators, prescribers, and patients all have a role in promoting patient safety and they urge patients to become engaged in decisions about their diabetes treatment.

Story Source: The above story is reprinted (with editorial adaptations by Heart Smart Advice staff) from materials provided by BMJ-British Medical Journal, via EurekAlert!, a service of AAAS.

High Cholesterol and Blood Pressure in Middle Age Tied to Early Memory Problems

2011-03-06T09:50:00.002-05:00

Middle-age men and women who have cardiovascular issues, such as high cholesterol and high blood pressure, may not only be at risk for heart disease, but for an increased risk of developing early cognitive and memory problems as well. That's according to a study released Feb. 21 that will be presented at the American Academy of Neurology's 63rd Annual Meeting in Honolulu April 9 to April 16, 2011.

For the study, 3,486 men and 1,341 women with an average age of 55 underwent cognitive tests three times over 10 years. The tests measured reasoning, memory, fluency and vocabulary. Participants received a Framingham risk score that is used to predict 10-year risk of a cardiovascular event. It is based on age, sex, HDL cholesterol, total cholesterol, systolic blood pressure and whether they smoked or had diabetes.

The study found people who had higher cardiovascular risk were more likely to have lower cognitive function and a faster rate of overall cognitive decline compared to those with the lowest risk of heart disease. A 10-percent higher cardiovascular risk was associated with poorer cognitive test scores in all areas except reasoning for men and fluency for women. For example, a 10 percent higher cardiovascular risk was associated with a 2.8 percent lower score in the test of memory for men and a 7.1 percent lower score in the memory test for women.

Higher cardiovascular risk was also associated with a 10-year faster rate of overall cognitive decline in both men and women compared to those with lower cardiovascular risk.

"Our findings contribute to the mounting evidence for the role of cardiovascular risk factors, such as high cholesterol and blood pressure, contributing to cognitive problems, starting in middle age," said study author Sara Kaffashian, MSc, with INSERM, the French National Institute of Health & Medical Research in Paris. "The study further demonstrates how these heart disease risk factors can contribute to cognitive decline over a 10-year period."

Story Source: The above story is reprinted (with editorial adaptations by Heart Smart Advice staff) from materials provided by American Academy of Neurology.

New Hope for Lowering Cholesterol

2011-03-06T09:47:00.002-05:00

A promising new way to inhibit cholesterol production in the body has been discovered, one that may yield treatments as effective as existing medications but with fewer side-effects.

In a new study published in the journal Cell Metabolism, a team of researchers from the UNSW School of Biotechnology and Biomolecular Sciences -- led by Associate Professor Andrew Brown -- report that an enzyme -- squalene mono-oxygenase (SM) -- plays a previously unrecognized role as a key checkpoint in cholesterol production. The team included doctoral students Saloni Gill and Julian Stevenson, along with research assistant Ika Kristiana.

SM is one of at least 20 enzymes involved in the assembly line when cholesterol is made throughout the body but only one -- HMG-CoA reductase (HMGR) -- is currently targeted by medications to lower cholesterol levels in the blood.

"The class of drugs most commonly used to lower cholesterol -- statins -- are the blockbusters of the pharmaceutical world and work by inhibiting HMGR," says Professor Brown.

"But HMGR is involved very early on in the assembly line, so inhibiting it affects all the other steps down the line -- and other useful products it provides -- and that can give rise in some people to unwanted side-effects, such as muscle pain.

"What's exciting about this previously overlooked SM enzyme is that it acts as a checkpoint much further down the assembly line, which should mean that it can be more specifically targeted at cholesterol production instead and leave the early part of the assembly line undisturbed.

"Cholesterol has developed something of a bad name, so many people don't realize that it is actually essential for a healthy body. It's needed, for example, to make sex hormones and to help build the walls of every single cell in our bodies."

Usually, cholesterol production is very finely controlled through a system of checks and balances. The problem comes when we have a lifestyle (often combined with a genetic predisposition) that results in too much cholesterol being produced and not enough being disposed of. This can overwhelm those controls and result in cardiovascular disease.

Professor Brown likens this process to the water supply to a home: water is essential but careful control is needed for how and where it is delivered and at what rate.

"In effect, statins work like turning down the water supply at the mains," he says. "If new drugs can be developed to inhibit the later control point that we've discovered, this would be like having the ability to slow the flow at a particular tap, leaving the rest of the home unaffected."

As it happens, medications already widely used for treating fungal infections have been shown to work by inhibiting the fungal enzyme equivalent of SM. Anti-cholesterol drugs that target SM for human use still need to be tested.

Story Source: The above story is reprinted (with editorial adaptations by Heart Smart Advice staff) from materials provided by University of New South Wales, via EurekAlert!, a service of AAAS.

Americans fall short of "ideal" heart health

2011-03-05T09:44:00.002-05:00

A new study finds only one out of nearly 2,000 middle-aged Americans hit the mark for ideal heart health as defined by the American Heart Association (AHA).

That entails acing the AHA's seven-item checklist, which includes being physically active, not smoking, having a healthy weight and diet, as well as staying below certain thresholds for cholesterol, blood pressure and blood sugar levels.

Not meeting any one of those goals would be a risk factor for developing heart disease, the leading killer worldwide.

"I was surprised that so few study participants met the AHA's goals, because this was a self-selected group that volunteered to participate in a study focusing on cardiovascular health," including heart attacks and stroke, study author Dr. Steven E. Reis told Reuters Health in an e-mail.

"Heart health may be achieved by changing behaviors, such as becoming a nonsmoker or losing weight," added Reis, a cardiologist at the University of Pittsburgh. "Although this may be very difficult for many individuals to achieve, it is these kinds of changes that can lead to healthy blood pressure, cholesterol and (blood sugar) levels and, in turn, to ideal cardiovascular health."

The AHA released its "Simple 7" (http://www.heart.org/mylifecheck) criteria in January 2010, with the goal of reducing deaths from heart disease by at least 20 percent by 2020.

Today, a third of all U.S. deaths are due to heart disease, so judging from the latest findings it might take a lot of work to reach AHA's goal.

A healthy level of activity means exercising each week, while eating healthily includes getting lots of fish, fruits and vegetables and other foods low in saturated fat, salt and added sugar.

The AHA says total cholesterol should be less than 200 milligrams per deciliter without medical treatment; the top blood pressure (systolic) reading should be less than 120 and the low (diastolic) less than 80; and the fasting blood sugar concentration should be below 100 milligrams per deciliter.

Dr. Reis and his colleagues analyzed data for 1,933 middle-aged men and women in Allegheny County, Pennsylvania, which includes Pittsburgh. Of those, a little less than half were black and two-thirds were women.

Most had been to college and earned at least $40,000 a year.

Heart-healthy lifestyles were uncommon among the volunteers, even when the researchers used more forgiving criteria: Fewer than one in ten people in the study met five or more items on the checklist, and only about two in 10 met four.

Blacks were much less likely than whites to meet the criteria, the researchers report in the journal Circulation.

Bad behaviors abounded. More than 80 percent of study participants were overweight or obese, while 61 percent weren't eating enough heart-healthy foods.

Although nearly a quarter of participants reported getting regular exercise, most either did so sporadically or were inactive.

Meanwhile, almost three-quarters of people in the study had either dangerously high or elevated cholesterol, and 85 percent had elevated or high blood pressure.

So is the AHA's 2020 target woefully unrealistic?

In an editorial accompanying the journal article, Dr. Clyde W. Yancy, past president of the group, said no -- although reaching it may require "a moonshot mentality." Yancy mentioned the better-than-expected achievements of an earlier effort by the AHA to reduce deaths from heart disease by a quarter by 2010. "Clearly, there is much work to be done," Yancy wrote, "but we can and should address this goal with the ingenuity and fervor that previously spurred our success." Reis agreed, noting that "it would be inappropriate to lower the goals just because few individuals meet them." "Rather, our data suggest that we should increase our efforts to assist individuals to achieve heart health," he said.

SOURCE: Circulation, February 14, 2011.

Drug use linked to airplane accidents

2011-03-05T09:39:00.000-05:00

This article has nothing to do with Heart Disease however as a frequent flyer I found it totally shocking!!!

Drug tests of airline personnel are three times more likely to come back positive after a crash or other accident than when testing is done at random times, a government-funded study shows.

"We wanted to see whether drug violations by employees are associated with their risk of being in an aviation accident," Dr. Guohua Li, the lead investigator on the study, told Reuters Health.

"Our answer seems to be a very clear yes."

He emphasized that illicit drug use is still rare among airline employees, and said the industry -- which is considered the pinnacle of safety -- can pat itself on the back.

Drug testing is common across a variety of workplaces in the U.S., but it remains controversial and little is known about its impact on occupational safety.

Li, of Columbia University's Mailman School of Public Health, and his colleagues examined nearly 5,000 drug tests taken from employees after accidents. (An aviation accident is defined as causing severe injuries or more than $50,000 in damage.)

The researchers compared those results to more than a million random drug tests. The tests search for evidence of drugs such as marijuana, cocaine and heroin.

Following accidents, 91 employees -- averaging 18 out of every 1,000 -- tested positive for drug use.

Random testing found just six out of every 1,000 employees tested positive.

"This is a very, very rare occurrence," when compared to other industries such as trucking, where drug use is estimated at 20 to 30 out of every 1,000 employees, Li said.

What's especially encouraging, he added, are the results from the flight crew, including pilots. Drug use among them was even scarcer, with only five out of every 10,000 random tests of crew members returned a positive result.

After accidents, just two out of 436 tests -- or less than five out of every 1,000 -- of flight crew members tested positive for illicit drug use.

The research team's data came from the Federal Aviation Administration (FAA), which mandates random and post-accident testing of crew members, maintenance staff, flight instructors, ground security coordinators, air traffic controllers and other employees for the major airlines, commuter airlines and air taxis.

Their study looked at 10 years of tests, from 1995 to 2005. The job-specific results reflect only the years 2003 to 2005.

The authors say drug violations "play a small role" in aviation accidents, and they attribute roughly one out of every 100 accidents to illicit drug use.

Drug use is known to impair work performance, but Li cautioned not to draw too many conclusions from his study. It shows employees who test positive for drug use are at higher risk of ending up in an accident, but it doesn't prove the drugs themselves are to blame.

Some illicit drugs are detectable days or weeks after use, so a positive test doesn't necessarily mean that the employee used a drug on the day of the accident.

The FAA had little to say about the study, which appears in the journal Addiction. "The FAA does not agree with the authors' conclusions and we believe the study is flawed," a spokesman told Reuters Health in an email. He would not elaborate. The National Transportation Safety Board, which investigates aviation accidents, declined to comment on the study. Li said that he believes the low rates of drug use among aviation employees reflect the success of the aviation industry's random drug testing program. "U.S. airlines have a remarkable safety record, and their robust drug and alcohol testing programs contribute to that record," Victoria Day, a spokesperson for the Air Transport Association of America, which represents the industry, wrote in an email to Reuters Health. The researchers say the data on accidents are too limited to tease apart the roles of different drugs. Marijuana was the most common drug found in random testing, although amphetamines became increasingly common over the years. One emerging problem that current drug testing programs don't address is the abuse of prescription medications, which could have "a significant impairment on safety performance," Li said.

Story Source: The above story is reprinted (with editorial adaptations by Heart Smart Advice staff) from materials provided by http://bit.ly/ehMp7o , Addiction, online February 10, 2011

1 in 5 Patients at California ERs Leaves Without Being Seen

2011-03-05T09:25:00.000-05:00

Upwards of one-fifth of patients who seek care at one of California's hospital emergency departments leave before being seen by anyone, new research reveals.

Rates of "leaves without being seen" varied widely across the state and according to the type of facility in question. And while the study authors said their results can't be extrapolated to the rest of the nation, the trend does seems to be hitting disadvantaged patients the hardest.

"This is concerning to us as both providers and consumers because these are patients who decided they need care, and we're not able to provide service to them," said study author Dr. Renee Y. Hsia, an assistant professor in the department of emergency medicine at the University of California, San Francisco, as well as an attending physician in the emergency department of San Francisco General Hospital.

Her team found the highest degree of unattended, would-be ER patients at teaching hospitals, county-owned hospitals and trauma centers, all of which experienced about double the rate of unseen patients as other facilities.

The problem appears to be worst among the poorest patients and those most likely to lack insurance coverage. "This either means that over-crowding is the problem, or that these patients have a tendency to walk out more than others," Hsia added. "For now this is just a snapshot, and we don't know the underlying factors at work here yet."

Hsia and her colleagues report their findings in the Feb. 22 online issue of the Annals of Emergency Medicine.

According to the U.S. Centers for Disease Control and Prevention, in 2007 (the same year focused on by the study authors) there were nearly 117 million visits to the nation's ERs. Of those, 18 percent of the patients were seen in less than 15 minutes, and more than 12 percent of all visitors ended up being admitted to the hospital.

California accounts for 12 percent of the nation's population and 7 percent of its hospital market, Hsia's team noted. And over the past 15 years, there's been a steady rise in the number of patients who leave an ER without being seen. That trend has been blamed on a variety of factors, including a drop in general access to care and crowding caused by ER closures, often in lower-income communities.

To explore the specific state of affairs in California, the authors analyzed information obtained from the California Office of Statewide Health Planning and Development database. The data covered all 9.2 million emergency department visits that took place at all 262 non-federally run hospitals across the state during 2007.

Patient income, as well as the affluence of the surrounding community, seemed to play a major role in the findings. ERs in poorer communities had higher rates of patient departures than those located in higher income communities, the study found. Specifically, for every increase of $10,000 in average household income, there was an associated drop in the number of patients who went unseen by ER staff.

Communities with worse insurance coverage also experienced higher rates of unseen patients.

The percentage of people who left emergency departments without being attended to ranged from 0 percent to more than 20 percent, depending on the facility, the report found.

While non-profit hospitals had an average unseen patient rate of 2.5 percent, that figure was twice as high at county-owned hospitals. Similarly, teaching hospitals had more than double the rate of non-teaching hospitals (5.1 percent vs. 2.5 percent), while trauma centers had a 3.9 percent rate compared with 2.5 percent at non-trauma centers.

While Hsia emphasized that more work needs to be done to better understand what's driving people to skip the care they initially felt they needed, she characterized the situation as "serious."

"What's important to combat here is the myth that the people who leave an ER aren't that sick to begin with," she stressed. "That's certainly not true. Most people go to the ER only because they have to. Nobody really wants to go. So it's a sad thing when they make that decision to go, and they need care, and they can't get it."

Dr. Marshall Morgan, chief of emergency medicine at the Ronald Reagan UCLA Medical Center in Los Angeles, concurred.

"I think it's a big mistake for people to assume that the people who are leaving the ERs are people who don't have serious problems," he said. "In fact, it's been shown in other research that among the people who are leaving a certain percentage were seriously ill, as witnessed by their having to come back and be admitted within a few days."

"So we're not just talking about the people with sniffles and soar throats and sprained ankles," Morgan noted. "And this is a very big number. And whether it's because of a general increase in overall volume at ERs across the state due to the general economic issues the country faces today, or for some other reason, it's certainly a very big problem." More information There's more statistics on U.S. emergency department visits at the U.S. Centers for Disease Control and Prevention.

Story Source: The above story is reprinted (with editorial adaptations by Heart Smart Advice staff) from materials provided by HealthDay.

Carotid Artery Stenting Shown to Be Cost-Effective Alternative to Endarterectomy

2011-03-05T09:06:00.002-05:00

Researchers determined that carotid artery stenting (CAS) with embolic protection is an economically attractive alternative to endarterectomy (END) for patients at increased surgical risk. The study, based on data from the Stenting and Angioplasty with Protection in Patients at High Risk for Endarterectomy (SAPPHIRE) trial, found that initial procedural cost was higher with CAS, but post-procedure hospital stay was shorter which significantly offset associated costs compared to END. Details of the study -- the first to evaluate the long-term cost-effectiveness of CAS versus END in stroke and heart attack prevention -- are published in the March issue of Catheterization and Cardiovascular Interventions, a peer-reviewed journal of The Society for Cardiovascular Angiography and Interventions (SCAI).

According to the Centers for Disease Control and Prevention (CDC), stroke is the third leading cause of death and the leading cause of serious long-term disability in the U.S. The CDC estimates that stroke cost the U.S. roughly $74 billion in healthcare services, medications, and lost productivity in 2010. Prior studies established carotid END as the standard of care for prevention of stroke in patients with carotid artery stenosis. However, the Food and Drug Administration (FDA) Circulatory System Devices Advisory Panel recently recommended expanding availability of CAS to patients with carotid artery disease at standard risk for surgical complications. The FDA recommendation and subsequent practice guidelines sponsored by 14 organizations, including SCAI, underscore the safety and efficacy of CAS as an option for patients needing revascularization.

In the current study, David Cohen, MD, and colleagues from St. Luke's Mid America Heart and Vascular Institute in Kansas City, Mo., evaluated the cost-effectiveness of CAS versus END using SAPPHIRE trial data. The SAPPHIRE trial included 310 patients with accepted indication for END but at high risk for complication who were then randomized and underwent CAS (n=159) or END (n=151). Researchers prospectively assessed clinical outcomes, resource use, costs and quality of life for all participants over a one-year period following the procedures.

"Our findings show that CAS with embolic protection offers a cost-effective alternative treatment option for patients with carotid artery atherosclerosis who are at high risk of adverse events with END," noted Dr. Cohen. Study results showed initial procedural costs were significantly higher for stenting ($7,000) than for END ($3,000). However, post-procedure hospital stay was one day shorter for CAS which reduced associated costs, resulting in initial costs for stenting being only $559 per patient higher than for END. Follow-up costs after discharge and total one-year costs did not differ between the two procedures.

Researchers also found after the first year, the rates of death, heart attack, major stroke and repeat carotid revascularization were lower with CAS compared with END (7% vs. 13%; 3% vs. 8%; 0.6% vs. 4%; 0.6% vs. 4%). Follow-up medical costs were $810 higher for stenting. "CAS appears to be a highly cost-effective option for high surgical risk patients," concluded Dr. Cohen. "Results should not be generalized to patients at low surgical risk, however. Further studies are needed to assess efficacy and cost-effectiveness of CAS in this patient population."

Story Source:

The above story is reprinted (with editorial adaptations by Heart Smart Advice staff) from materials provided by Wiley-Blackwell, via EurekAlert!, a service of AAAS.

New CPR Method Increases Survival Rate by 50 Percent, Study Suggests

2011-03-02T08:51:00.000-05:00

A five-year clinical trial led by University of Minnesota Medical School researchers has led to a new method of cardiopulmonary resuscitation (CPR) that improves long-term survival rates with good brain function by 50 percent.

The new technique goes beyond the standard hands-only compression-decompression method to include to two devices that increase blood circulation. Researchers found that the new device combination caused the heart and brain to receive nearly three times more blood flow during each compression-decompression cycle when compared to standard CPR.

Currently, nearly 300,000 Americans suffer out-of-hospital cardiac arrest every year, and overall survival rates average only 5 percent. Poor survival rates persist in part because manual chest compressions and ventilation, termed standard CPR, is inherently inefficient, providing less than 25 percent of normal blood flow to the heart and brain.

"The current method of CPR has saved countless lives and is an indispensable tool in emergency medicine, but we want to bring to light the potential of using this new dual device system in combination with compression-decompression," said Demetris Yannopoulos, M.D., Assistant Professor of Medicine and Research Director of Interventional Cardiology at the University. "This dual device system can not only increase survival rates, but can improve brain function after cardiac arrest."

According to Yannopoulos, the study's authors will recommend the method as the new standard for the American Heart Association. The device combination method is also a prospective treatment for shock and head injury, as it augments blood flow to the brain and other tissues.

In the new method, one device (ResQPump) consists of a suction cup that attaches to the patient's chest. It includes a handle to manually lift the chest after each compression, stimulating blood flow. A second device (ResQPOD) connects to the patient's airway with a facemask or breathing tube and prevents air from rushing into the lungs while the first device raises the chest. Combined, the two create a greater vacuum in the chest, pumping blood to the heart and brain more effectively.

The advance comes 50 years after the now-standard method of CPR was initially developed.

"We are moving from prehistoric times -- relying only on our hands -- to modern times, implementing tools to treat victims," said Keith Lurie, M.D., Professor of Medicine and Emergency Medicine at the University. "This advance is a product of collaboration between emergency medicine specialists, cardiologists, anesthesiologists, neurologists, and countless other professions. A multidisciplinary environment was absolutely necessary for our success."

CPR is an important rescue skill used to treat cardiac arrest, a condition characterized by sudden, abrupt loss of heart function. CPR can stimulate a small amount of blood flow to the heart and brain to "buy time" until a normal heart beat is restored by defibrillation or with the aid of drugs.

The CPR device (ResQPump, also called CardioPump) and the impedance threshold device (ResQPOD) are manufactured by Advanced Circulatory Systems in Roseville, Minn.

"By partnering with Advanced Circulatory Systems on their mission to restore life and improve quality of living for patients suffering cardiac arrest, we were able to develop devices that can advance a new model of collaborative patient care forward," said Yannopoulos.

The study was published in the online version of The Lancet on Jan. 19, 2011, and appeared in the print publication on Jan. 22, 2011. The National Institutes of Health funded the clinical trial.

Story Source: The above story is reprinted (with editorial adaptations by Heart Smart Advice staff) from materials provided by University of Minnesota, via EurekAlert!, a service of AAAS.

New Cell Therapy a Promising Atherosclerosis Treatment

2011-03-02T08:49:00.000-05:00

Researchers at Karolinska Institutet have shown in a new study on mice, that cell therapy can be used to reverse the effect of 'bad' LDL cholesterol and reduce the inflammation that leads to atherosclerosis. The new cell therapy, which is presented in the scientific journal Circulation, can open the way for new therapies for stroke and myocardial infarction if the results prove translatable to humans.

Atherosclerosis is a chronic inflammation of the blood vessels. Cholesterol is transported in the blood in particles called LDL ('bad' cholesterol) that can accumulate in the vessel walls. This triggers the body's immune system to react against LDL, which then cause inflammation in the vessels, and eventually thrombus formation. If such a thrombus forms in the coronary artery, the patient suffers a myocardial infarction; if it forms in the brain, a stroke can result.

The research group, under the direction of Professor Göran K Hansson at the Centre for Molecular Medicine, have developed a cell therapy that selectively dampens vascular inflammation induced by LDL. The therapy makes use of dendritic cells, which are characterized by a high degree of plasticity that renders them amenable to manipulation.

"With the appropriate treatment, dendritic cells can be made to inhibit rather than aggravate the inflammation around the LDL particles in the blood vessels," says Dr Andreas Hermansson, one of the researchers conducting the study. "A major advantage of this is that we can devise a treatment for vascular diseases that is highly specific."

The mouse studies now presented in Circulation have demonstrated substantial protective effects of the treatment, with a reduction of the atherosclerosis process of up around 70 percent. Last year, the researchers published results showing that antibodies recognizing the receptors that drive the immune reaction have protective effects, and now the same group is presenting a cell therapy that is at least as efficacious. It is hoped that this will pave the way for a completely new generation of selective anti-inflammatory therapies for cardiovascular disease.

"Treatments of atherosclerosis have traditionally targeted blood lipids, but a large proportion of treated patients still suffer life-threatening infarctions and stroke," says Professor Hansson. "We're now looking at the possibility of getting to the root of the problem and re-set, so to speak, the immune system's reaction to LDL, since it often has devastating consequences."

The Center for Molecular Medicine is a collaboration between Karolinska Institutet and Karolinska University Hospital. The present research has been financed with grants from the Swedish Research Council, the Swedish Foundation for Strategic Research, Vinnova (the Swedish governmental agency for innovation systems), the Swedish Heart and Lung Foundation, the Stockholm County Council and the EU Seventh Framework Programme. A patent application has also been submitted.

Story Source: The above story is reprinted (with editorial adaptations by Heart Smart Advice staff) from materials provided by Karolinska Institutet.

Heart Attack Patients With Depression Less Likely to Receive Priority Care in Emergency Rooms, Canadian Study Suggests

2011-03-01T09:02:00.000-05:00

Heart attack patients with a history of depression presenting at emergency departments were less likely to receive priority care than people with other conditions, found a study published in CMAJ (Canadian Medical Association Journal).

Several studies indicate that people with heart attacks and depression have worse outcomes than people without, although emergency department care has not been looked at as a possible contributor. In the United States, more than six million patients with mental health issues are seen in emergency departments each year and six million people visit for chest pain.

This study, by researchers from the Institute of Clinical Evaluative Sciences, looked at data on 6,874 patients admitted to 96 acute care hospitals in Ontario, Canada from April 2004 to March 2005. They found that 680 of these heart attack patients had a history of depression recorded in their medical charts, and 39% of these were assigned a low priority triage score in the emergency department, compared with 32.7% of the other patients with heart attacks.

"Ten per cent of acute myocardial infarction patients seen in the emergency department had a history of depression recorded in their chart, and it was associated with an increased risk of receiving a low priority emergency department triage score, as well as delays in diagnostic testing and definitive care," writes Dr. Clare Atzema, Institute for Clinical Evaluative Sciences, with coauthors. "Interestingly, other components of the medical history, including the traditional cardiac risk factors of diabetes, smoking, hypercholesterolemia and hypertension, were not associated with triage score in the models; only depression affected the score."

As well, a lower triage priority based on charted depression resulted in delays in diagnosis and treatment by physicians, nurses, cardiologists and laboratory teams.

The authors suggest this lower prioritizing by emergency staff may be based on assumptions that patients' symptoms are anxiety-related rather than due to an actual heart attack. Less than 10% of patients who come to emergency rooms with heart attack symptoms, such as chest pain or shortness of breath, are found to be suffering from the condition. Therefore staff are actively looking for other possible sources for the patients' symptoms.

"We suspect that mistriage of these patients is not due to purposeful discrimination by emergency department staff, but rather that most emergency department staff are unaware of data that suggests a link between depression and coronary artery disease," write the authors. They suggest this information needs to be disseminated to emergency room staff

Story Source: The above story is reprinted (with editorial adaptations by Heart Smart Advice staff) from materials provided by Canadian Medical Association Journal, via EurekAlert!, a service of AAAS.

Adult Care for Congenital Heart Disease Patients Should Begin in Adolescence

2011-03-01T09:00:00.000-05:00

Doctors should transition their patients from pediatric to adult medical care for congenital heart disease during early adolescence, experts recommend in a scientific statement published in Circulation: Journal of the American Heart Association.

"It's not as simple as getting the name of a new doctor and going to see them when a patient turns 18," said Craig Sable, M.D., co-chair of the statement committee and director of echocardiography and cardiology fellowship training at Children's National Medical Center in Washington, D.C. "There are multiple steps associated with the transition process that need to be started at a very young age, so that by the time these children become adults the process is well under way."

The transition should be a joint effort between the healthcare provider (usually a pediatric heart specialist), the patient and the patient's family that starts when patients are between 12 to 14 years old, Sable said.

Critical steps include:

•Select an adult care physician to provide and coordinate comprehensive care;
•Offer reproductive/genetic and career counseling;
•Secure health insurance;
•Educate adult care providers in managing congenital heart disease;
•Maintain communication between patients, families and healthcare professionals.
Congenital heart disease occurs before birth and is the most common type of birth defect. These heart disorders are usually relatively mild and treatable.

Most children born with congenital heart disease today survive into adulthood and live normal lives. In the United States, more than half of those affected are now adults.

However, many patients need specialized and uninterrupted medical treatment. Ideally, the transition process minimizes disruption and stress while maintaining appropriate treatment continuity. But less than one-third of adults with congenital heart disease receive care from qualified, trained specialists, Sable said.

"The vast majority of the patients we see are not necessarily the most severe, so there's a real concern that some of the patients who really need care are not seeking it," he said. "The bottom line is to ensure that, as patients grow up, they receive the necessary care."

Beginning in 2008, Sable and his team researched transition literature to identify the most effective practices that they presented in the paper.

Co-authors are: Karen Uzark, Ph.D., P.N.P., co-chair; Elyse Foster, M.D., co-chair; Kathy Bjornsen, B.S.N., A.R.N.P.; Mary M. Canobbio, R.N., M.N.; Heidi M. Connolly, M.D.; Thomas P. Graham, M.D.; Michelle Z. Gurvitz, M.D., M.S.; Adrienne Kovacs, Ph.D., C.Psych.; Graham J. Reid, Ph.D., C.Psych.; John G. Reiss, Ph.D.; Paul J. Sagerman, M.D., M.S.; Arwa Saidi, M.B.,B. Ch.; Sangeeta Shah, M.D.; Elizabeth Tong, M.S., R.N., C.P.N.P.; and Roberta G. Williams, M.D. Author disclosures are on the manuscript.

Story Source: The above story is reprinted (with editorial adaptations by Heart Smart Advice staff) from materials provided by American Heart Association, via EurekAlert!, a service of AAAS.

Human Stem Cells from Fat Tissue Fuse With Rat Heart Cells and Beat

2011-03-01T08:54:00.003-05:00

If Dr. Doolittle is famous for talking to animals, then here's a story that might make him hold his tongue: According to new research published online in The FASEB Journal, scientists have successfully fused human stem cells derived from subcutaneous adipose (fat) tissue with muscle cells from rat hearts. Not only did these cells "talk" to form new muscle cells altogether, but they actually beat.

"Recovery of regenerative cells located in the stromal vascular fraction of a patient's own subcutaneous tissue is relatively simple and can be used for self-healing," said Christopher Alt, Ph.D., a researcher involved in the work from the Department of Molecular Pathology at the University of Texas in Houston. "A patient's quality of life can be improved by application of those recovered regenerative cells to the heart, as well as to bone, tendons, non-healing wounds and joints."

Using newborn rats, scientists studied the combination of rat heart muscle cells (cardiomyocytes) and human adipose (fat) stem cells derived from human subcutaneous adipose tissue. They found that the two fused and formed new heart muscle cells with several nuclei. When kept in a culture environment, these cells beat. These new cells exhibited an ability to compensate for a loss of cardiomyocytes as following a myocardial infarction, via fusion with cardiomyocytes. Furthermore, this study shows that contrary to previous findings suggesting that genetic modification of certain embryonic genes in adult stem cells is required as a prerequisite for turning into heart cells, the human stem cells used in this study were not genetically modified.

"Much work is still ahead before this method can be applied to humans, but the hope is that this technique might eventually make heart transplants unnecessary," said Gerald Weissmann, M.D., Editor-in-Chief of The FASEB Journal. "This study not only shows the power of stem cell fusion technology, but also that cardiac regeneration is on the horizon."

Story Source: The above story is reprinted (with editorial adaptations by Heart Smart Advice staff) from materials provided by Federation of American Societies for Experimental Biology, via EurekAlert!, a service of AAAS.

Close Linkage Between a Rare, Deadly Lung Condition and Blood Cell Abnormalities

2011-03-01T08:51:00.002-05:00

Results from a study published in Blood, the Journal of the American Society of Hematology reveal a close relationship between pulmonary arterial hypertension (PAH) -- exceedingly high blood pressure in the arteries carrying blood from the heart to the lungs -- and abnormalities of the blood-forming cells in the bone marrow (known as myeloid abnormalities).

The study, which was conducted by a team of researchers at the Cleveland Clinic, showed that blood progenitor cells (cells that are capable of forming white blood cells, red blood cells, or platelets in the bone marrow and are reported to affect blood vessel formation), are increased in the bone marrow, blood, and lungs of patients with PAH. These findings suggest that the disease processes in the bone marrow and the lungs are related.

"This research pieces together a number of previous studies and observations suggesting a very close relationship between PAH and underlying bone marrow abnormalities," said Serpil Erzurum, MD, co-author of the study and Chair of the Department of Pathobiology at the Cleveland Clinic. "Our study honed in on the stem cells involved in blood vessel maintenance to identify factors that might be involved in bone marrow stem cell abnormalities as well as progressive arterial disease."

The researchers examined production of hypoxia-inducing factors (HIF, protein complexes that govern the body's response to low oxygen concentrations, which are activated to help heal damaged tissue) in patients with PAH. They found that levels of HIF and proteins whose production it regulates, erythropoietin (EPO) and hepatocyte growth factor (HGF), were all increased in PAH patients. Since individuals with this disease often require lung transplantation, the investigators were able to examine the lung tissue of the patients and found that blood vessel lining cells in the lung produced more HGF and stromal derived factor a, a protein which plays a crucial role in the formation of new blood vessels by recruiting progenitor cells from the circulation. Because HIF, EPO, and HGF can affect bone marrow progenitors, it appeared that there may be an abnormal feedback loop connecting blood and lung cell behavior. The presence of such an abnormal loop could provide a previously unrecognized opportunity for intervening in PAH, depending on the results of further investigation.

"Continued research will help us gain a better understanding of the level of cross-influence between these two conditions in order to improve treatment strategies and, ultimately, the quality of patient care," said Samar Farha, MD, co-author of the study and staff physician in the Respiratory Institute at the Cleveland Clinic.

Story Source: The above story is reprinted (with editorial adaptations by Heart Smart Advice staff) from materials provided by American Society of Hematology.

Free Radicals May Be Good for You

2011-03-01T08:48:00.002-05:00

Fear of free radicals may be exaggerated, according to scientists from the Swedish medical university Karolinska Institutet. A new study, published in The Journal of Physiology, shows that free radicals act as signal substances that cause the heart to beat with the correct force.

Free radicals are molecules that react readily with other substances in the body, and this can have negative effects on health in certain circumstances, through the damage caused to cells. Free radicals can be counteracted by substances known as 'antioxidants', which are common ingredients in many dietary supplements. The idea that free radicals are generally dangerous and must be counteracted is, however, a myth, according to scientists who have conducted a new study of the role that free radicals play in heart physiology.

"As usual, it's a case of everything in moderation. In normal conditions, free radicals act as important signal substances, but very high levels or long-lasting increases can lead to disease," says Professor Håkan Westerblad, who has led the study.

When the body is subject to different types of stress, the sympathetic nervous system stimulates receptors known as beta-adrenergic receptors on the surface of heart muscle cells. This leads to several changes inside the cells, one of which is the phosphorylation of proteins. This leads to the contractions of the cells becoming stronger and the heart beats with greater force.

In the current study, the scientists show that stimulation of the beta-adrenergic receptors also leads to increased production of free radicals in the mitochondria of the cells, and these then contribute to stronger contractions of the cells. When the scientists exposed the cells to antioxidants, a major part of the effect of beta-adrenergic stimulation of the heart muscle cells disappeared.

The results reveal a previously unknown regulatory mechanism of the force production in the heart, and may lead to a better understanding of various types of heart deficiency.

"Free radicals play an important role, since they contribute to the heart being able to pump more blood in stress-filled situations," says Håkan Westerblad. "On the other hand, persistent stress can lead to heart failure, and chronically increased levels of free radicals may be part of the problem here."

Story Source: The above story is reprinted (with editorial adaptations by Heart Smart Advice staff) from materials provided by Karolinska Institutet.

Gender Does Not Play a Role in Risk of Death from Heart Attack, Study Suggests

2011-02-25T09:44:00.002-05:00

A study led by the University of Michigan Cardiovascular Center shows being a woman may not increase your risk of dying from treatment for a severe heart attack.

U-M researchers and colleagues in the Michigan Cardiovascular Consortium found women who received treatment such as an angioplasty had higher unadjusted in-hospital heart attack deaths.

But these differences appear to be related to women's ages and additional health problems -- not gender, says study lead author Elizabeth Jackson, M.D., M.P.H., an assistant professor of internal medicine at the U-M Health System and member of the Women's Heart Program.

"When we adjusted for factors such as age and co-morbidities like hypertension and diabetes, women had similar mortality rates at the time of the heart attack as men," says Jackson.

"But women still appear to be more likely to have a bleeding episode in the hospital that requires a transfusion or vascular complications," she says.

The five-year study published in the American Heart Journal showed that compared with men, women were older with more co-morbidities -- a medical condition in addition to the primary disease -- at the time of treatment.

Women account for about one-third of patients who undergo procedures such as percutaneous coronary interventions to clear the clogged arteries causing a heart attack.

Researchers examined the outcomes of 8,771 patients undergoing a procedure for an acute ST-elevation myocardial infarction, commonly known as a severe heart attack. Patients were part of the Blue Cross Blue Shield of Michigan Cardiovascular Consortium registry, a physician-led quality improvement collaborative that is supported by Blue Cross Blue Shield of Michigan and Blue Care Network.

Previous investigations using other registries have found women had higher in-hospital mortality rates than men, but recent advancements in treatment changed how doctors care for these patients and the team wanted to re-investigate with more current data, says Jackson.

"Overall, there have been tremendous improvements in the care of both men and women who suffer a heart attack, but further research on everyday patients, such as those in the registry, is needed to be able to continue improving our level of care," says Jackson.

Cardiovascular disease kills nearly twice as many women in the United States than all types of cancer, including breast cancer, according to the American Heart Association.

Story Source:

The above story is reprinted (with editorial adaptations by Heart Smart Advice staff) from materials provided by University of Michigan Health System. The original article was written by Heather Guenther.

Protein Could Be New Target to Reduce Damage After Heart Attack

2011-02-25T09:42:00.000-05:00

Scientists have identified a protein that plays a key role in debilitating changes that occur in the heart after a heart attack, according to research reported in Circulation Research: Journal of the American Heart Association.

These changes, or "remodeling" of the heart, often lead to fatal heart failure, which kills nearly 60,000 Americans each year. The findings suggest a possible future therapy for preventing or reducing heart muscle damage after a heart attack.

Researchers compared the effect of heart attacks in two groups of mice. One group was genetically engineered to lack fibronectin-EDA (FN-EDA), a protein that exists in the space surrounding cells and is important for processes such as cell migration and wound healing. The other mice were genetically normal.

After inducing a heart attack in the left coronary artery of each mouse, the team found that the hearts of mice lacking FN-EDA had less enlargement in the left ventricle, better pumping ability and less thickening of the heart muscle) compared to the control mice.

At the tissue level, the genetically engineered mice also had less inflammation; diminished activity of the enzymes metalloproteinase 2 and 9, which are involved in heart remodeling; and reduced myofibroblast transdifferentiation (a process in which cells near an injury site transform into myofibroblasts, which are cells that help heal injured tissue).

Bone marrow transplantation experiments revealed that the FN-EDA involved in the remodeling process came from the heart and not from cells circulating in the bloodstream.

Story Source:The above story is reprinted (with editorial adaptations by Heart Smart Advice staff) from materials provided by American Heart Association.

Menopausal Hot Flashes May Be a Good Sign for Heart

2011-02-25T09:40:00.002-05:00

You are enjoying a night out with friends when it starts; first you feel flush, then a sensation of warmth crawls down your body. Soon you begin perspiring and you feel as if everyone around you can tell what is happening -- another hot flash. An estimated three out of four women experience hot flashes associated with menopause and nearly all would agree they are a nuisance, but experts say there could be an upside to having hot flashes.

New research released February 24 in the online edition of the journal Menopause suggests that women who suffer from hot flashes and night sweats may be at lower risk for cardiovascular disease, stroke and death.

"While they are certainly bothersome, hot flashes may not be all bad," said Northwestern Medicine endocrinologist Emily Szmuilowicz, MD, who is lead author of the study. "Our research found that despite previous reports suggesting that menopause symptoms were associated with increased levels of risk markers for heart disease, such as blood pressure and cholesterol, the actual outcomes tell a different story."

Szmuilowicz, who co-chaired the study along with JoAnn Manson, MD, DrPH, and Ellen Seely, MD from Harvard Medical School, reviewed medical information from 60,000 women who were enrolled in the Women's Health Initiative Observational Study and followed for ten years, to determine the relationship between menopause symptoms and cardiovascular events. Subjects were grouped into four categories -- women who experienced hot flashes and night sweats at the onset of menopause, later in menopause, during both time periods, and not at all.

"We found that women who experienced symptoms when they began menopause had fewer cardiovascular events than those who experienced hot flashes late in menopause or not at all," said Szmuilowicz.

The results are significant since there has been concern that menopausal symptoms, which result from instability in the blood vessels in the skin, may put women at risk for other types of vascular problems as well.

"It is reassuring that these symptoms, which are experienced by so many women, do not seem to correlate with increased risk of cardiovascular disease," said Szmuilowicz.

Szmuilowicz and team say more research needs to be done in order to understand the mechanisms behind the association, but say it's good news for the millions of women who experience these troublesome symptoms at the time of menopause.

"Hot flashes will never be enjoyable, but perhaps these findings will make them more tolerable," said Szmuilowicz.

Story Source:The above story is reprinted (with editorial adaptations by Heart Smart Advice staff) from materials provided by Northwestern Memorial Hospital, via EurekAlert!, a service of AAAS.

Gender Does Not Play a Role in Risk of Death from Heart Attack, Study Suggests

2011-02-22T19:25:00.002-05:00

High Cholesterol and Blood Pressure in Middle Age Tied to Early Memory Problems

2011-02-22T19:23:00.000-05:00

Increasing Triglyceride Levels Linked to Greater Stroke Risk; Study Finds Higher Cholesterol Levels Only Increase Risk of Stroke in Men

2011-02-22T19:21:00.000-05:00

A study by researchers in Denmark revealed that increasing levels of non-fasting triglycerides are associated with an increased risk of ischemic stroke in men and women. Higher cholesterol levels were associated with greater stroke risk in men only. Details of this novel, 33-year study are now available online in Annals of Neurology, a journal published by Wiley-Blackwell on behalf of the American Neurological Association.

According to the World Health Organization (WHO) cardiovascular diseases are the number one cause of death globally -- responsible for an estimated 17.1 million deaths worldwide ( 2004), with 5.7 million due to stroke. The American Stroke Association states that stroke is the third leading cause of death in the U.S. and 87% of all cases are attributed to ischemic stroke, occurring when the supply of blood to the brain is obstructed. The obstruction or blockage is typically caused by the build-up of fatty deposits inside blood vessels (atherosclerosis).

Medical evidence suggests that elevated non-fasting triglycerides are markers of elevated levels of lipoprotein remnants, particles similar to low density lipoprotein (LDL), or bad cholesterol, both of which are thought to contribute to plaque build-up. "Interestingly, current guidelines on stroke prevention have recommendations on desirable cholesterol levels, but not on non-fasting triglycerides," said lead study author, Dr. Marianne Benn from Copenhagen University Hospital. "Our study was the first to examine how the risk of stroke for very high levels of non-fasting triglycerides compared with very high cholesterol levels in the general population."

The Danish team followed 7,579 women and 6,372 men who were enrolled in the Copenhagen City Heart Study, all of whom were white and of Danish decent. Participants had non-fasting triglycerides and cholesterol measurements taken at baseline (1976-1978) and were followed for up to 33 years. A diagnosis of ischemic stroke was made when focal neurological symptoms lasted more than 24 hours. During the follow-up period, completed by 100% of participants, 837 women and 837 men developed ischemic stroke.

Results confirmed in both women and men, stepwise increasing levels of non-fasting triglycerides associated with increased risk of ischemic stroke. In women, triglycerides levels of 1-2 mmol/L (89-177 mg/dL) carried a relative risk of 1.2 and levels of 5 mmol/L (443 mg/dL) or greater were associated with a 3.9-fold greater risk, compared with women whose triglycerides levels were less than 1 mmol/L (89 mg/dL). At similar triglyceride levels men had a relative risk that ranged from 1.2 to 2.3. Increasing cholesterol levels did not associate with greater risk of ischemic stroke, except in men whose cholesterol levels were equal to 9 mmol/L (348 mg/dL) or more (relative risk of 4.4).

"Our findings suggest that levels of non-fasting triglycerides should be included in stroke prevention guidelines which currently focus on total cholesterol and LDL cholesterol levels," concluded Dr. Benn.

Story Source: The above story is reprinted (with editorial adaptations by Heart Smart Advice staff) from materials provided by Wiley-Blackwell, via EurekAlert!, a service of AAAS.

Updated Heart Disease Prevention Guidelines for Women Focus More on 'Real-World' Recommendations

2011-02-21T08:10:00.002-05:00

Practical medical advice that works in the "real world" may more effectively prevent cardiovascular disease in women than recommendations based only on findings in clinical research settings, according to the 2011 update to the American Heart Association's cardiovascular disease prevention guidelines for women.

First published in 1999, the guidelines until now have been primarily based on findings observed in clinical research. That alone often doesn't consider the personal and socioeconomic factors that can keep women from following medical advice and treatment.

"These recommendations underscore the fact that benefits of preventive measures seen day-to-day in doctors' offices often fall short of those reported for patients in research settings," said Lori Mosca, M.D., M.P.H., Ph.D., chair of the guidelines writing committee and a medical advisor for the American Heart Association's Go Red For Women movement. "Many women seen in provider practices are older, sicker, and experience more side effects than patients in research studies. Factors such as poverty, low literacy level, psychiatric illness, poor English skills, and vision and hearing problems can also challenge clinicians trying to improve their patients' cardiovascular health."

The 2011 update identifies barriers that hinder both patients and doctors from following guidelines, while outlining key strategies for addressing those obstacles.

"Awareness continues to be a key driver to optimal care," said Mosca, director of preventive cardiology at New York-Presbyterian Hospital and professor of Medicine at Columbia University Medical Center. "Cause initiatives such as Go Red for Women and provider compliance programs such as Get With The Guidelines® are strong components in our efforts to broaden awareness and improve adherence among patients and providers."

She said getting a dialogue started between a woman and her doctor is a critical first step.

"If the doctor doesn't ask the woman if she's taking her medicine regularly, if she's having any side effects or if she's following recommended lifestyle behaviors, the problems may remain undetected," she said. "Improving adherence to preventive medications and lifestyle behaviors is one of the best strategies we have to lower the burden of heart disease in women."

To evaluate patient risk, the guidelines incorporate illnesses linked to higher risk of cardiovascular disease in women, including lupus and rheumatoid arthritis, and pregnancy complications such as preeclampsia, gestational diabetes or pregnancy-induced hypertension. Mosca said women with a history of preeclampsia face double the risk of stroke, heart disease and dangerous clotting in veins during the five to 15 years after pregnancy. Essentially, having pregnancy complications can now be considered equivalent to having failed a stress test.

"These have not traditionally been top of mind as risk factors for heart disease," she said. "But if your doctor doesn't bring it up, you should ask if you're at risk for heart disease because of pregnancy complications or other medical conditions you've experienced."

The updated guidelines also emphasize the importance of recognizing racial and ethnic diversity and its impact on cardiovascular disease. For example, hypertension is a particular problem among African-American women and diabetes among Hispanic women.

Although putting clinical research into practical, everyday adherence can be challenging, solid scientific evidence is still the basis for many of the guidelines, Mosca said. Some commonly considered therapies for women are specifically noted in the guidelines as lacking strong clinical evidence in their effectiveness for preventing cardiovascular disease and, in fact, may be harmful to some women. Those include the use of hormone replacement therapy, antioxidants and folic acid.

The update includes depression screening as part of an overall evaluation of women for cardiovascular risk, because while treating depression has not been shown to directly improve cardiovascular health, depression might affect whether women follow their doctor's advice.

Despite a growing body of clinical evidence to fight heart disease and stroke in women, more is needed, Mosca said. Coronary heart disease death rates in women dropped by two-thirds from 1980 to 2007, due to both effective treatment and risk factor reduction, according to the American Heart Association, but cardiovascular disease still kills about one woman every minute in the United States.

In future studies, researchers should look at interventions during specific times throughout a woman's lifespan ― including puberty, pregnancy and menopause ― to identify risks and determine effective prevention opportunities during those critical times, Mosca said. More cost-effective analyses and clinical trial research with male- and female-specific results are also needed, especially regarding risks posed by preventive therapies.

"Now that science has shown the benefits are often similar for men and women, there is a need to understand if the risks are also similar and acceptable," she said.

"These guidelines are a critical weapon in the war against heart disease, the leading killer of women," Mosca said. "They are an important evolution in our understanding of women and heart disease. And I cannot stress personal awareness and education enough. Initiatives such as Go Red For Women give women access to the latest information and real-life solutions to lower their risk of heart disease."

Other authors include Emelia J. Benjamin, M.D., Sc.M.; Kathy Berra, M.S.N., N.P.; Judy L. Bezanson, D.S.N., C.N.S.-M.S.; Rowena J. Dolor, M.D., M.H.S.; Donald M. Lloyd-Jones, M.D., Sc.M.; L. Kristin Newby, M.D., M.H.S.; Ileana L. Piña, M.D., M.P.H.; Véronique L. Roger, M.D., M.P.H.; Leslee J. Shaw, Ph.D.; and Dong Zhao, M.D., Ph.D. Author disclosures are on the manuscript.

Story Source: The above story is reprinted (with editorial adaptations by Heart Smart Advice staff) from materials provided by American Heart Association.

New Anti-Clotting Drug Added to Recommendations for Treating Irregular Heartbeat

2011-02-21T08:08:00.000-05:00

The newly approved drug dabigatran is an alternative to warfarin to help prevent dangerous blood clots in patients with atrial fibrillation, according to updated guidelines from the American College of Cardiology, American Heart Association and the Heart Rhythm Society.

The "Focused Update" -- published in Circulation: Journal of the American Heart Association, Journal of the American College of Cardiology and HeartRhythm Journal -- specifically updates the section on emerging antithrombotic agents in atrial fibrillation treatment guidelines released by the three organizations on Dec. 20, 2010.

Atrial fibrillation is an irregular heart rhythm that occurs when the heart's two upper chambers beat erratically, causing the chambers to pump blood rapidly, unevenly and inefficiently. Blood can pool and clot in the chambers, increasing the risk of stroke or heart attack. More than two million Americans live with the condition.

According to this most recent update, dabigatran is useful as an alternative to warfarin to prevent stroke and blood clots in patients with either paroxysmal (recurrent episodes that stop after seven days) or permanent (an on-going episode) atrial fibrillation, and with risk factors for stroke or blood clotting who do not have a prosthetic heart valve, significant heart valve disease, severe renal failure or advanced liver disease.

Warfarin, an anti-clotting drug used since the 1950s, requires patients to have regular testing to monitor its effectiveness and dosage adjustment.

In December 2010 the atrial fibrillation guidelines were updated and recommended that a combination of aspirin and the oral antiplatelet drug clopidogrel might be considered to prevent stroke or other types of blood clots in patients with atrial fibrillation who are poor candidates for the clot-preventing drug warfarin.

Authors are: L. Samuel Wann, M.D., Writing Committee chair; Anne B. Curtis, M.D.; Kenneth A. Ellenbogen, M.D.; N.A. Mark Estes III, M.D.; Michael D. Ezekowitz, M.B.; Warren M. Jackman, M.D.; Craig T. January, M.D., Ph.D.; James E. Lowe, M.D.; Richard L. Page, M.D.; David J. Slotwiner, M.D.; William G. Stevenson, M.D.; and Cynthia M. Tracy, M.D.

Story Source: The above story is reprinted (with editorial adaptations by Heart Smart Advice staff) from materials provided by American Heart Association.

Vegans' Elevated Heart Risk Requires Omega-3s and B12, Study Suggests

2011-02-21T08:05:00.002-05:00

People who follow a vegan lifestyle -- strict vegetarians who try to eat no meat or animal products of any kind -- may increase their risk of developing blood clots and atherosclerosis or "hardening of the arteries," which are conditions that can lead to heart attacks and stroke. That's the conclusion of a review of dozens of articles published on the biochemistry of vegetarianism during the past 30 years.

Duo Li notes in the review that meat eaters are known for having a significantly higher combination of cardiovascular risk factors than vegetarians. Lower-risk vegans, however, may not be immune. Their diets tend to be lacking several key nutrients -- including iron, zinc, vitamin B12, and omega-3 fatty acids. While a balanced vegetarian diet can provide enough protein, this isn't always the case when it comes to fat and fatty acids. As a result, vegans tend to have elevated blood levels of homocysteine and decreased levels of HDL, the "good" form of cholesterol. Both are risk factors for heart disease.

It concludes that there is a strong scientific basis for vegetarians and vegans to increase their dietary omega-3 fatty acids and vitamin B12 to help contend with those risks. Good sources of omega-3s include salmon and other oily fish, walnuts and certain other nuts. Good sources of vitamin B12 include seafood, eggs, and fortified milk. Dietary supplements also can supply these nutrients.

The article appears in ACS' Journal of Agricultural and Food Chemistry.

Story Source: The above story is reprinted (with editorial adaptations by Heart Smart Advice staff) from materials provided by American Chemical Society.

'Healthy' Patients at High Risk of Cardiac Death Identified

2011-02-21T07:49:00.002-05:00

The way the heart responds to an early beat is predictive of cardiac death, especially for people with no conventional markers of cardiovascular disease, according to new research from Washington University School of Medicine in St. Louis.

The conventional risk factors, such as high cholesterol, smoking, diabetes and high blood pressure, account for many but not all deaths from cardiovascular causes. As a result, doctors are always searching for better ways to identify patients at risk of cardiac death.

The new research indicates that an abnormal response to an early beat in the left ventricle, the heart's main pumping chamber, can identify high-risk patients even when they have no other evidence of cardiovascular disease.

Stein

"These are people we do not expect to die of cardiac causes," says Phyllis K. Stein, PhD, research associate professor of medicine and director of the Heart Rate Variability Laboratory at the School of Medicine. "They appear healthy, but they're not. We have shown a way they're not healthy that isn't showing up using standard tests."

The work appears Feb. 15 in the Journal of Cardiovascular Electrophysiology.

A ventricular premature beat (VPB) occurs when the ventricle gets an inappropriate signal causing it to beat before it should. VPBs are common, even in healthy people. The question is not whether VPBs occur, but how the body responds to them. The heart's response to a VPB is called heart rate turbulence. It can be measured with a Holter monitor, a device worn for 24 hours that records a person's electrocardiogram, the electrical signals produced by the heart.

When the ventricle beats early, the heart has not finished filling and it pumps less blood to the body than it should. To compensate, the heart rate speeds up to increase blood flow.

But an early beat also empties the heart early, leaving extra filling time afterward. So on the second beat after the VPB, the heart is extra full and pumps more blood to the body than it should. To compensate properly, the heart rate slows down.

A healthy heart will alternately speed up and slow down to compensate for the over- and under-filling that follows a VPB until the amount of blood filling the heart returns to normal.

Abnormal heart rate turbulence occurs when the heart can't compensate in this way.

"It's a clear test of whether the autonomic nervous system, which regulates your heart rate, can adapt to a challenge," Stein says.

Stein and colleagues analyzed Holter monitor recordings for almost 1,300 patients over age 65 recorded between 1989 and 1993.

The patients were divided into three groups based on an assessment of their cardiovascular health. Those in the "clinical" group had a history of cardiovascular disease such as heart attack or surgery to open narrow blood vessels. Those in the "subclinical" group had traditional risk factors for cardiovascular disease such as high blood pressure or diabetes but had never been treated for cardiovascular disease. And those in the "healthy" group had no evidence of clinical or subclinical disease.

In all three groups, abnormal heart rate turbulence was predictive of cardiac death. But the association was especially strong in the healthy group. Of the 357 patients classified as healthy, 21 had abnormal heart rate turbulence. These 21 people were almost eight times more likely to die of cardiac causes than the rest of the healthy group.

"Even though it's a small group of people, they're actually at very high risk," Stein says.

In fact, over the next 12 years, the people in the healthy group with abnormal heart rate turbulence had worse survival than the people with subclinical disease but good heart rate turbulence.

"They're actually not healthy," Stein says. "Something is wrong. But the conventional risk factors don't pick it up."

Stein and her colleagues also looked at levels of C-reactive protein, a measure of inflammation associated with cardiovascular disease. While C-reactive protein predicted cardiac death in the healthy group, it had no impact in the subclinical and clinical groups. Since heart rate turbulence was predictive in all three groups, it may prove better than C-reactive protein in predicting risk of cardiovascular death.

Though the Holter monitor is a common, noninvasive device, Stein says the software needed to measure heart rate turbulence is only available for clinical use on one commercial Holter monitor. She speculates that this work and other studies showing the value of measuring heart rate turbulence may make the software more widely available.

This work was supported by the National Heart, Lung, and Blood Institute and the National Institute of Neurological Disorders and Stroke.

Story Source:

The above story is reprinted (with editorial adaptations by Heart Smart Advice staff) from materials provided by Washington University School of Medicine. The original article was written by Julia Evangelou Strait.

Groundbreaking Technology Will Revolutionize Blood Pressure Measurement

2011-02-21T07:44:00.001-05:00

In a scientific breakthrough, a new blood pressure measurement device is set to revolutionise the way patients' blood pressure is measured. The new approach, invented by scientists at the University of Leicester and in Singapore, has the potential to enable doctors to treat their patients more effectively because it gives a more accurate reading than the current method used. It does this by measuring the pressure close to the heart -- the central aortic systolic pressure or CASP.

Blood pressure is currently measured in the arm because it is convenient however this may not always accurately reflect what the pressure is in the larger arteries close to the heart.

The new technology uses a sensor on the wrist to record the pulse wave and then, using computerised mathematical modelling of the pulse wave, scientists are able to accurately read the pressure close to the heart. Patients who have tested the new device found it easier and more comfortable, as it can be worn like a watch.

Being able to measure blood pressure in the aorta which is closer to the heart and brain is important because this is where high blood pressure can cause damage. In addition, the pressure in the aorta can be quite different from that traditionally measured in the arm. The new technology will hopefully lead to better identification of those who will most likely benefit from treatment by identifying those who have a high central aortic systolic pressure value. This will be especially important for younger people in whom the pressure measured in the arm can sometimes be quite exaggerated compared to the pressure in the aorta.

A key question is whether measurement of central aortic pressure will become routine in clinical practice. Professor Williams said: "it is not going to replace what we do overnight but it is a big advance. Further work will define whether such measurements are preferred for everybody or whether there is a more defined role in selective cases to better decide who needs treatment and who doesn't and whether the treatment is working optimally"

The University's close collaboration with the Singapore-based medical device company HealthSTATS International ("HealthSTATS") has led to the development of this world-first technique for more accurate blood pressure measurement.

The research work carried out by the University of Leicester was funded by the Department of Health's National Institute for Health Research (NIHR). The NIHR has invested £3.4million with a further £2.2million Capital funding from the Department of Health to establish a Biomedical Research Unit at Glenfield Hospital, Leicester, dedicated to translational research in cardiovascular research. The work, led by Professor Bryan Williams, Professor of Medicine at the University of Leicester and consultant physician at University Hospitals of Leicester NHS Trust, has the promise to change the way we measure blood pressure.

Professor Williams, who is based in the University of Leicester's Department of Cardiovascular Sciences at Glenfield Hospital, said: "I am under no illusion about the magnitude of the change this technique will bring about. It has been a fabulous scientific adventure to get to this point and it will change the way blood pressure has been monitored for more than a century. The beauty of all of this, is that it is difficult to argue against the proposition that the pressure near to your heart and brain is likely to be more relevant to your risk of stroke and heart disease than the pressure in your arm.

"Leicester is one of the UK's leading centres for cardiovascular research and is founded on the close working relationship between the University and the Hospitals which allows us to translate scientific research into patient care more efficiently. Key to our contribution to this work has been the support from the NIHR without which we would not have been able to contribute to this tremendous advance. The support of the NIHR has been invaluable in backing us to take this project from an idea to the bedside. Critical to the success of this project has been the synergies of combining clinical academic work here with HealthSTATS and their outstanding medical technology platform in Singapore. This has been the game-changer and I really do think this is going to change clinical practice."

Dr. Choon Meng Ting the Chairman and CEO of HealthSTATS said: "This study has resulted in a very significant translational impact worldwide as it will empower doctors and their patients to monitor their central aortic systolic pressure easily, even in their homes and modify the course of treatment for BP-related ailments. Pharmaceutical companies can also use CASP devices for clinical trials and drug therapy. All these will ultimately bring about more cost savings for patients, reduce the incidences of stroke and heart attacks, and save more lives."

Health Secretary Andrew Lansley said: "I saw this new technique in action in Leicester when I visited a few months ago. This is a great example of how research breakthroughs and innovation can make a real difference to patients' lives. We want the NHS to become one of the leading healthcare systems in the world and our financial commitment to the National Institute for Health Research reflects this.

"I believe patients deserve the best treatments available and science research like this helps us move closer to making that happen."

Professor Dame Sally Davies, Director General of Research and Development and Interim Chief Medical Officer at the Department of Health, said:

"This is fantastic work by Professor Williams and his team and I am delighted to welcome these findings. I am particularly pleased that the clinical research took place at the NIHR Biomedical Research Unit in Leicester. NIHR funding for Biomedical Research Centres and Units across England supports precisely this type of translational research, aimed at pulling-through exciting scientific discoveries into benefits for patients and the NHS by contributing to improved diagnostics and treatments."

Adherence Course Reduces Hypertension

2011-02-20T09:03:00.001-05:00

A high proportion of patients with high blood pressure are failing to take their medication properly and would benefit clinically from a course of 'adherence therapy', according to new research from the University of East Anglia (UEA).

High blood pressure -- or hypertension -- is one of the major cardiovascular diseases worldwide. It leads to stroke and heart disease and costs more than $300 billion each year. Around a quarter of the adult population is affected -- including 10 million people in the UK.

Around half of patients with hypertension fail to reduce their blood pressure because they are not taking their prescribed medication correctly. Some cease taking their medication altogether, others only take some of it, and others do not follow the instructions to take their medicine after food, for example.

The reasons for this non-adherence are complex and include ambivalence about taking drugs, concerns over side effects, and complexity of treatment regimes. Previous attempts to improve adherence with information leaflets, monthly outpatient visits, reminders and self-monitoring have been shown to be mostly ineffective.

The UEA resesarchers studied 136 patients with high blood pressure in three outpatient clinics in Jordan. Half were given a course of seven weekly 'adherence therapy' sessions and half continued with their usual treatment. The 20-minute face-to-face sessions allowed a trained clinician to provide tailored information about the illness and treatment, and explore the patient's individual beliefs, fears and lifestyle.

Published February 16 in the Journal of Human Hypertension, the results show that the patients given adherence therapy took 97 per cent of their medications (compared with only 71 per cent for those given treatment as usual) and, on average, reduced their blood pressure by around 14 per cent -- taking it to just above the healthy range.

Lead author Prof Richard Gray of UEA's School of Nursing and Midwifery said: "Our findings suggest a clear clinical benefit in these patient-centred sessions.

"High blood pressure affects millions of people in both the developed and developing world and the problem is likely to increase dramatically over the next 15 years. Tackling the widespread failure to take medication correctly would lead to a major reduction in stroke and heart disease.

"If adherence therapy were a new drug it would be hailed as a potentially major advance in hypertension treatment."

Adherence therapy was originally developed by Prof Gray for patients with mental health problems who failed to take their medication correctly. The total cost of delivering a course of seven weekly sessions is calculated to be approximately £80 per person. Although the UEA study was not designed to formally evaluate cost effectiveness, other studies predict that a long-term reduction of blood pressure would lead to a reduction in stroke of 56 per cent and a reduction in chronic heart disease of 37 per cent -- suggesting that adherence therapy would likely be a cost-effective intervention.

Only One Person out of Over 1,900 Met AHA's Definition of Ideal Heart Health, Study Finds

2011-02-20T09:02:00.001-05:00

Only one out of more than 1,900 people evaluated met the American Heart Association (AHA) definition of ideal cardiovascular health, according to a new study led by researchers at the University of Pittsburgh School of Medicine.

Their findings were recently published online in Circulation.

Ideal cardiovascular health is the combination of these seven factors: nonsmoking, a body mass index less than 25, goal-level physical activity and healthy diet, untreated cholesterol below 200, blood pressure below 120/80 and fasting blood sugar below 100, explained senior investigator and cardiologist Steven Reis, M.D., associate vice chancellor for clinical research at Pitt.

"Of all the people we assessed, only one out of 1,900 could claim ideal heart health," said Dr. Reis. "This tells us that the current prevalence of heart health is extremely low, and that we have a great challenge ahead of us to attain the AHA's aim of a 20 percent improvement in cardiovascular health rates by 2020."

As part of the Heart Strategies Concentrating on Risk Evaluation (Heart SCORE) study, the researchers evaluated 1,933 people ages 45 to 75 in Allegheny County with surveys, physical exams and blood tests. Less than 10 percent met five or more criteria; 2 percent met the four heart-healthy behaviors; and 1.4 percent met all three heart-healthy factors. After adjustment for age, sex and income level, blacks had 82 percent lower odds than whites of meeting five or more criteria.

A multipronged approach, including change at the individual level, the social and physical environment, policy and access to care, will be needed to help people not only avoid heart disease, but also attain heart health, Dr. Reis said.

"Many of our study participants were overweight or obese, and that likely had a powerful influence on the other behaviors and factors," he noted. "Our next step is to analyze additional data to confirm this and, based on the results, try to develop a multifaceted approach to improve health. That could include identifying predictors of success or failure at adhering to the guidelines."

The team includes Claudia Bambs, M.D., M.Sc., Pontificia Universidad Cato´lica de Chile, Santiago, Chile; Kevin E. Kip, Ph.D., University of South Florida, Tampa; Andrea Dinga, M.Ed., R.D., L.D.N., Suresh R. Mulukutla, M.D., and Aryan N. Aiyer, M.D., University of Pittsburgh School of Medicine.

The study was funded by the National Institutes of Health and the Pennsylvania Department of Health.

New Measure Trumps High-Density Lipoprotein (HDL) Levels in Protecting Against Heart Disease

2011-02-20T08:59:00.001-05:00

The discovery that high levels of high-density lipoprotein (HDL) cholesterol (the "good cholesterol") is associated with reduced risk of cardiovascular disease has fostered intensive research to modify HDL levels for therapeutic gain. However, recent findings have called into question the notion that pharmacologic increases in HDL cholesterol levels are necessarily beneficial to patients. Now, a new study from researchers at the University of Pennsylvania School of Medicine shows that a different metric, a measure of HDL function called cholesterol efflux capacity, is more closely associated with protection against heart disease than HDL cholesterol levels themselves.

Findings from the study could lead to new therapeutic interventions in the fight against heart disease. The new research will be published in the January 13 issue of the New England Journal of Medicine.

Atherosclerosis, a component of heart disease, occurs with a build-up along the artery wall of fatty materials such as cholesterol. Cholesterol efflux capacity, an integrated measure of HDL function, is a direct measure of the efficiency by which a person's HDL removes cholesterol from cholesterol-loaded macrophages (a type of white blood cell), the sort that accumulate in arterial plaque.

"Recent scientific findings have directed increasing interest toward the concept that measures of the function of HDL, rather than simply its level in the blood, might be more important to assessing cardiovascular risk and evaluating new HDL-targeted therapies," said Daniel J. Rader, MD, director, Preventive Cardiology at Penn. "Our study is the first to relate a measure of HDL function--its ability to remove cholesterol from macrophages--to measures of cardiovascular disease in a large number of people."

In the present study, Rader and colleagues at Penn measured cholesterol efflux capacity in 203 healthy volunteers who underwent assessment of carotid artery intima-media thickness, a measure of arthrosclerosis, 442 patients with confirmed coronary artery disease, and 351 patients without such confirmed disease.

An inverse relationship was noted between cholesterol efflux capacity and carotid intima-media thickness both before and after adjustment for the HDL cholesterol level. After an age- and gender- adjusted analysis, increasing efflux capacity conferred decreased likelihood of having coronary artery disease. This relationship remained robust after the addition of traditional cardiovascular risk factors, including HDL cholesterol levels, as covariates. Additionally, men and current smokers had decreased efflux capacity.

The researchers noted that although cholesterol efflux from macrophages represents only a small fraction of overall flow through the cholesterol pathway, it is probably the component that is most relevant to protection against heart disease.

Rader said, "The findings from this study support the concept that measurement of HDL function provides information beyond that of HDL level, and suggests the potential for wider use of this measure of HDL function in the assessment of new HDL therapies. Future studies may prove fruitful in elucidating additional HDL components that determine cholesterol efflux capacity."

This work was funded in part by grants from the National Heart, Lung, and Blood Institute, the National Center for Research Resources, and a Distinguished Clinical Scientist Award from the Doris Duke Charitable Foundation.

Food-Borne Bacteria Causes Potentially Fatal Heart Infection

2011-02-20T08:57:00.001-05:00

Researchers at the University of Illinois at Chicago College of Medicine have found that particular strains of a food-borne bacteria are able to invade the heart, leading to serious and difficult-to-treat heart infections.

The study is available online in the Journal of Medical Microbiology.

The bacteria Listeria monocytogenes is commonly found in soft cheeses and chilled ready-to-eat products. For healthy individuals, listeria infections are usually mild, but for susceptible individuals and the elderly, infection can result in serious illness, usually associated with the central nervous system, the placenta and the developing fetus.

About 10 percent of serious listeria infections involve a cardiac infection, according to Nancy Freitag, associate professor of microbiology and immunology and principle investigator on the study. These infections are difficult to treat, with more than one-third proving fatal, but have not been widely studied and are poorly understood.

Freitag and her colleagues obtained a strain of listeria that had been isolated from a patient with endocarditis, or infection of the heart.

"This looked to be an unusual strain, and the infection itself was unusual," she said. Usually with endocarditis there is bacterial growth on heart valves, but in this case the infection had invaded the cardiac muscle.

The researchers were interested in determining whether patient predisposition led to heart infection or whether something different about the strain caused it to target the heart.

They found that when they infected mice with either the cardiac isolate or a lab strain, they found 10 times as much bacteria in the hearts of mice infected with the cardiac strain. In the spleen and liver, organs that are commonly targeted by listeria, the levels of bacteria were equal in both groups of mice.

Further, the researchers found that while the lab-strain-infected group often had no heart infection at all, 90 percent of the mice infected with the cardiac strain had heart infections. The researchers obtained more strains of listeria, for a total of 10, and did the same experiment. They found that only one other strain also seemed to also target the heart.

"They infected the heart of more animals and were always infecting heart muscle and always in greater number," Freitag said. "Some strains seem to have this enhanced ability to target the heart for infection."

Freitag's team used molecular genetics and cardiac cell cultures to explore what was different about these two strains.

"These strains seem to have a better ability to invade cardiac cells," she said. The results suggest that these cardiac-associated strains display modified proteins on their surface that enable the bacteria to more easily enter cardiac cells, targeting the heart and leading to bacterial infection.

"Listeria is actually pretty common in foods," said Freitag. "And because it can grow at refrigerated temperatures, as foods are being produced with a longer and longer shelf life, listeria infection may become more common. In combination with an aging population that is more susceptible to serious infection, it's important that we learn all we can about these deadly infections."

The study was supported by a Public Health Service Grant; by Public Health Service post-doctoral training fellowships; and an American Heart Association Predoctoral Fellowship.

New Nanoparticles Make Blood Clots Visible

2011-02-20T08:56:00.001-05:00

For almost two decades, cardiologists have searched for ways to see dangerous blood clots before they cause heart attacks.

Now, researchers at Washington University School of Medicine in St. Louis report that they have designed nanoparticles that find clots and make them visible to a new kind of X-ray technology.

According to Gregory Lanza, MD, PhD, a Washington University cardiologist at Barnes-Jewish Hospital, these nanoparticles will take the guesswork out of deciding whether a person coming to the hospital with chest pain is actually having a heart attack.

"Every year, millions of people come to the emergency room with chest pain. For some of them, we know it's not their heart. But for most, we're not sure," says Lanza, a professor of medicine. When there is any doubt, the patient must be admitted to the hospital and undergo tests to rule out or confirm a heart attack.

"Those tests cost money and they take time," Lanza says.

Rather than an overnight stay to make sure the patient is stable, this new technology could reveal the location of a blood clot in a matter of hours.

Spectral CT

The nanoparticles are designed to be used with a new type of CT scanner that is capable of "seeing" metals in color. The new technology, called spectral CT, uses the full spectrum of the X-ray beam to differentiate objects that would be indistinguishable with a regular CT scanner that sees only black and white.

Lanza says the new scanner takes advantage of the same physics that astronomers use to look at the light from a star and tell what metals it contains.

"They're looking at the X-ray spectrum, and the X-ray spectrum tells them what metals are there," he says. "That's exactly what we do."

Bismuth nanoparticles

In this case, the metal in question is bismuth. Dipanjan Pan, PhD, research assistant professor of medicine, designed a nanoparticle that contains enough bismuth for it to be seen by the spectral CT scanner.

"Each nanoparticle is carrying a million atoms of bismuth," Lanza says. Since CT is a relatively insensitive imaging technique, this sheer quantity of metal is necessary for the particles to be visible to the scanner.

But bismuth is a toxic heavy metal, Pan says. It can't be injected into the body on its own. Instead, Pan used a compound made of bismuth atoms attached to fatty acid chains that can't come apart in the body. He then dissolved this compound in a detergent and encapsulated the mixture in a phospholipid membrane. Much like oil droplets suspended in a shaken vinaigrette, these particles self-assemble with the bismuth compound at the core.

As Pan showed in a mouse model, the design of the nanoparticles also allows the body to break them apart and release the inner bismuth compound in a safe form.

Once the nanoparticles carried enough bismuth to be visible to the scanner, Pan added a molecule to the particles' surface that seeks out a protein called fibrin. Fibrin is common in blood clots but is not found elsewhere in the vasculature.

"If you're having a heart attack, the lining of your coronary artery has ruptured, and a clot is forming to repair it," Lanza says. "But that clot is starting to narrow the vessel so blood can't get by. Now we have a nanoparticle that will see that clot."

A spectral CT image with the bismuth nanoparticles targeted to fibrin will provide the same information as a traditional black and white CT image, but the fibrin in any blood clots will show up in a color, such as yellow or green, solving the problem of calcium interference common to traditional CT scanners.

The spectral CT scanner used in this study is still a prototype instrument, developed by Philips Research in Hamburg, Germany. The nanoparticles have only been tested in rabbits and other animal models, but early results show success in distinguishing blood clots from calcium interference.

Saving lives

More than simply confirming a heart attack, the new nanoparticles and spectral CT scanner can show a clot's exact location.

Today, even if doctors determine the patient is having a heart attack, they can't locate the clot without admitting the patient to the cardiac catheterization lab, inserting a dye and looking for narrow plaque-filled arteries they could open with stents. But Lanza says looking for narrow arteries doesn't solve all the problems.

"The ones that have very narrow openings are not the worrisome ones," Lanza says. "We find those in the cardiac catheterization lab and we open them up."

What is worrisome is when blood is free to flow through the arteries, but there is unstable plaque on the artery wall, what Lanza calls "moderate-grade disease."

"Most people's heart attacks or strokes are from moderate-grade disease that breaks off and all of a sudden blocks an artery," Lanza says. "It's what happened to NBC newsman Tim Russert. You need something that tells you there is ruptured plaque even when the vessel isn't very narrow."

Since this nanoparticle finds and sticks to fibrin in the vessels, it would allow doctors to see problems that were previously difficult or impossible to detect.

With this imaging technique, Lanza predicts new approaches to treating coronary disease. Unstable plaque that doesn't restrict much blood flow does not require an expensive stent to prop the vessel open. Instead, Lanza foresees technologies that might act like Band-Aids, sealing weak spots in the vessel walls.

"Today, you wouldn't know where to stick the Band-Aid," Lanza says. "But spectral CT imaging with bismuth nanoparticles would show the exact location of clots in the vessels, making it possible to prevent the dangerous rupture of unstable plaque."

This work was supported by grants from the American Heart Association, National Cancer Institute, Bioengineering Research Partnership and the National Heart, Lung, and Blood Institute.

The spectral CT prototype is on loan to Washington University from Philips Research in Hamburg, Germany, for codevelopment of the scanner, software and nanoparticles.

Diet Soda May Raise Odds of Vascular Events; Salt Linked to Stroke Risk

2011-02-20T08:53:00.002-05:00

Even if you drink diet soda instead of the sugar variety you could still have a much higher risk of vascular events compared to those who don't drink soda, according to research presented at the American Stroke Association's International Stroke Conference 2011.

In findings involving 2,564 people in the large, multi-ethnic Northern Manhattan Study (NOMAS), scientists said people who drank diet soda every day had a 61 percent higher risk of vascular events than those who reported no soda drinking.

"If our results are confirmed with future studies, then it would suggest that diet soda may not be the optimal substitute for sugar-sweetened beverages for protection against vascular outcomes," said Hannah Gardener, Sc.D., lead author and epidemiologist at the University of Miami Miller School of Medicine in Miami, Fla.

In separate research using 2,657 participants also in the Manhattan study, scientists found that high salt intake, independent of the hypertension it causes, was linked to a dramatically increased risk of ischemic strokes (when a blood vessel blockage cuts off blood flow to the brain).

In the study, people who consumed more than 4,000 milligrams (mg) per day of sodium had more than double the risk of stroke compared to those consuming less than 1,500 mg per day.

At the start of both studies, researchers assessed diet by a food frequency questionnaire.

NOMAS is a collaboration of investigators at Columbia University in New York and Miami's Miller School of Medicine, launched in 1993 to examine stroke incidence and risk factors in a multi-ethnic urban population. A total of 3,298 participants over 40 years old (average age 69) were enrolled through 2001 and continue to be followed. Sixty-three percent were women, 21 percent were white, 24 percent black and 53 percent Hispanic.

In the soda study, researchers asked subjects at the outset to report how much and what kind of soda they drank. Based on the data, they grouped participants into seven consumption categories: no soda (meaning less than one soda of any kind per month); moderate regular soda only (between one per month and six per week), daily regular soda (at least one per day); moderate diet soda only; daily diet soda only; and two groups of people who drink both types: moderate diet and any regular, and daily diet with any regular.

During an average follow-up of 9.3 years, 559 vascular events occurred (including ischemic and hemorrhagic stroke, which is caused by rupture of a weakened blood vessel). Researchers accounted for participants' age, sex, race or ethnicity, smoking status, exercise, alcohol consumption and daily caloric intake. And even after researchers also accounted for patients' metabolic syndrome, peripheral vascular disease and heart disease history, the increased risk persisted at a rate 48 percent higher.

In the sodium research, 187 ischemic strokes were reported during 9.7 years of follow-up. Stroke risk, independent of hypertension, increased 16 percent for every 500 mg of sodium consumed a day, the scientists calculated. Those figures included adjustment for age, sex, race/ethnicity, education, alcohol use, exercise, daily caloric intake, smoking status, diabetes, high cholesterol, high blood pressure and previous heart disease.

Only a third of participants met the current U.S. Dietary Guidelines for Americans that recommend daily sodium intake fall below 2,300 mg, or about a teaspoon of salt, Gardener said. Only 12 percent of subjects met the American Heart Association's recommendations to consume less than 1,500 mg a day. Average intake was 3,031 milligrams.

"The take-home message is that high sodium intake is a risk factor for ischemic stroke among people with hypertension as well as among those without hypertension, underscoring the importance of limiting consumption of high sodium foods for stroke prevention," Gardener said.

Participants' reporting their dietary behavior is a key limitation of both studies, Gardener said.

In the soda study, investigators also lacked data on types of diet and regular drinks consumed, preventing analysis of whether variations among brands or changes over time in coloring and sweeteners might have played a role.

Obesity Alone Raises Risk of Fatal Heart Attack, Study Finds

2011-02-18T10:35:00.000-05:00

Obese men face a dramatically higher risk of dying from a heart attack, regardless of whether or not they have other known risk factors for cardiovascular disease, a new study reveals.

The finding stems from an analysis involving roughly 6,000 middle-aged men, and it suggests that there is something about carrying around excess weight that contributes to heart disease independent of risk factors such as high blood pressure, diabetes, high cholesterol and arterial disease.

What exactly that something is, however, remains unclear, although the researchers suggest that the chronic inflammation that typically accompanies significant weight gain might be the driving force behind the increased risk.

"Obese, middle-aged men have a 60 percent increased risk of dying from a heart attack than non-obese middle-aged men, even after we cancel out any of the effects of cholesterol, blood pressure and other cardiovascular risk factors," noted study author Jennifer Logue, a clinical lecturer of metabolic medicine with the British Heart Foundation's Cardiovascular Research Centre at the University of Glasgow, in Scotland. "This means [that] obesity itself may be causing fatal heart attacks through a factor that we have not yet identified."

Logue and her colleagues report their observations in the Feb. 15 online issue of Heart.

To explore the subject, the authors spent nearly 15 years tracking 6,082 male patients who were diagnosed with high cholesterol but had no history of either heart disease or diabetes.

Over the study period, the research team noted 214 heart disease fatalities, along with another 1,027 heart attacks and/or strokes that did not result in death.

The team confirmed the well-established theory that being obese is linked to a greater chance for having all of the classic risk factors linked to heart disease.

That said, even after ruling out relevant variables such as age and smoking history, the risk of death among obese men -- those with a body mass index (BMI) between 30 and 39.9 -- was still 75 percent higher than it was for non-obese men.

What's more, even after also accounting for risk factors such as high blood pressure and diabetes (as well as medication history), the chance of experiencing a fatal heart attack was 60 percent greater among obese men, as compared with non-obese men.

The one caveat: in and of itself, being obese was not linked to a higher risk of experiencing a non-fatal heart attack or stroke.

Logue cautioned that further research is needed to confirm the findings, and to uncover the exact mechanism by which obesity itself is a risk factor for fatal heart attacks.

"Possible reasons include particular chemicals that the fat cells are releasing. Or perhaps it is related to the fact that obese people tend to have larger hearts to cope with the additional stress of their larger size, and this already stressed heart does not manage to continue to work during a heart attack," she said.

"However, it certainly makes me think that we cannot just treat cholesterol, blood pressure and diabetes in obese men without also considering their weight," Logue added. "We need to find easier and more effective ways to help people lose weight and find out if losing weight can help reduce the risk of fatal heart attacks. We also need to dedicate far more resources to preventing obesity in the first place."

Dr. Gregg C. Fonarow, a professor of cardiology at the University of California, Los Angeles, said that the current study "provides further evidence as to why there needs to be global efforts to prevent and treat obesity though lifestyle modification."

"While obesity is associated with elevations in blood pressure, increased risk of diabetes and abnormal lipid levels, it has been less clear whether the increased risk of mortality associated with obesity can be entirely explained by these well-established cardiovascular risk factors or whether other factors related to obesity may also be contributing to excess mortality risk," he noted.

Dr. Murray A. Mittleman, director of the Cardiovascular Epidemiology Research Unit with the Beth Israel Deaconess Medical Center, Harvard Medical School in Boston, agreed.

"It's not surprising that not all of the risk can be explained by traditional risk factors," he said. "But no one study is going to definitively answer the question as to what other mechanisms for risk might be. So the primary issue would still continue to be working towards overall weight reduction, to reduce the risk for all of the pathways that we already know go along with obesity."

More information on obesity and heart disease, visit the American Heart Association .

Obama budget targets brand name medicines

2011-02-18T10:32:00.001-05:00

Big pharmaceutical companies could face increased competition from generic drugmakers under two proposals put forth by the Obama administration on Monday despite earlier savings extracted from drugmakers as part of last year's healthcare law.

President Barack Obama, as part of his 2012 budget proposal, called for cutting the number of years drugmakers could exclusively market brand-name biologic drugs to 7 years from 12.

He also set his sights on ending controversial "pay-for-delay" deals that affect traditional, chemical drugs by giving the U.S. Federal Trade Commission power to block them. Under such pacts, brand-name and generic drugmakers settle patent challenges with payoffs that delay lower-cost rivals from reaching the market.

The proposals face a tough challenge of getting through the divided Congress, but could alter the landscape for consumers' access to cheaper medicines.

They quickly drew industry protests.

While branded and generic drugmakers are divided over the biologics issue, "both the brand and generic drug industries will fight tooth and nail to preserve pay-to-delay settlements which provide substantial benefit to the industry," Bernstein analyst Aaron "Ronny" Gal said in a research note.

Still, they are unlikely to deliver a huge overall blow to the $890 billion global drug industry in which companies such as Pfizer Inc - and Merck & Co Inc - can see at least $1 billion a year in revenue from just one blockbuster medicine.

The Obama administration is turning to drugmakers to help squeeze out some savings to help reduce the deficit and cover other health initiatives such as the implementation of the health law passed last March that included about $80 billion in savings negotiated with brand name companies.

U.S. Health Secretary Kathleen Sebelius was unapologetic about the extra savings from industry, and saying the administration wants the best outcomes for patients. "This is a move in that direction," she told reporters.

The two proposals aimed at getting cheaper, generic medicines to the U.S. market would together save about $11 billion over 10 years.

The proposal impacting brand-name biologics is a more dramatic version of a similar provision included in the health law in which brand-name drugmakers won 12 years of exclusive sales under a new U.S. Food and Drug Administration approval process to allow generic versions of biologics.

Such medicines treat conditions ranging from cancer to arthritis and are made from proteins, which can make them more complex to manufacture and more costly.

Generic drugmakers had fought for a shorter period of exclusivity, and on Monday the administration said 12-years of protection harms consumer access to much needed drugs.

Its seven-year proposal "strikes a balance between promoting affordable access to medication while at the same time encouraging innovation to develop needed therapies," the White House said in budget documents.

The measure would start to see savings of $80 million starting in 2015 and altogether could save $2.3 billion from 2012 to 2021, it estimated.

The "pay-for-delay" plan would save $540 million starting in fiscal 2012 and nearly $8.8 billion through 2021, it added.

In a statement, branded industry group the Pharmaceutical Research and Manufacturers of America said both measures would discourage industry investment into research and development and could stifle new medicines.

The Biotechnology Industry Organization said reducing exclusivity to 7 years would prevent biotech firms from recouping their investments. Meanwhile, the Generic Pharmaceutical Association applauded the 7-year biogeneric plan but called Obama's move on "pay for delay" misguided. Obama's budget also renewed the call for generic drugmakers to pay fees for the FDA to review new generic medicines. Other proposed fees would cover FDA reinspections of drug and device companies after manufacturing problems are uncovered. Hospitals and others participating in an outpatient drug pricing program known as 340B are also targeted. Additionally, the administration calls for food safety industry fees starting in 2013 and pledged to work with Congress to enact them.

Study: Eating more fiber could mean longer life

2011-02-18T10:30:00.001-05:00

Eat more fiber and you just may live longer.

That's the message from the largest study of its kind to find a link between high-fiber diets and lower risks of death not only from heart disease, but from infectious and respiratory illnesses as well.

The government study also ties fiber with a lower risk of cancer deaths in men, but not women, possibly because men are more likely to die from cancers related to diet, like cancers of the esophagus. And it finds the overall benefit to be strongest for diets high in fiber from grains.

Most Americans aren't getting enough roughage in their diets. The average American eats only about 15 grams of fiber each day, much less than the current daily recommendation of 25 grams for women and 38 grams for men, or 14 grams per 1,000 calories. For example, a slice of whole wheat bread contains 2 to 4 grams of fiber.

In the new study, the people who met the guidelines were less likely to die during a nine-year follow-up period.

The men and women who ate the highest amount of fiber were 22 percent less likely to die from any cause compared to those who ate the lowest amount, said lead author Dr. Yikyung Park of the National Cancer Institute.

The study, appearing in Monday's Archives of Internal Medicine, included more than 388,000 adults, ages 50 to 71, who participated in a diet and health study conducted by the National Institutes of Health and AARP.

They filled out a questionnaire in 1995 or 1996 about their eating habits. It asked them to estimate how often they ate 124 food items. After nine years, more than 31,000 of the participants had died. National records were used to find out who died and the cause of death.

The researchers took into account other risk factors including weight, education level, smoking and health status and still saw lower risks of death in people who ate more fiber.

"The results suggest that the benefits of dietary fiber go beyond heart health," said Dr. Frank Hu of the Harvard School of Public Health, who wasn't involved in the new research but co-authored an editorial in the journal.

The evidence for fiber's benefits has been strongest in diabetes and heart disease, where it's thought to improve cholesterol levels, blood pressure, inflammation and blood sugar levels. Fiber's benefits also may come from its theorized ability to bind to toxins and move them out of the body quicker. High-fiber diets can promote weight loss by making people feel full, which has its own health-promoting effects.

However it works, fiber may offer a prevention benefit against killers like pneumonia and flu, the new study suggests. The cancer benefit may have shown up only in the men because they're more likely than women to die from cancers related to diet, Park said.

Fiber is found in fruits, vegetables and beans. But fiber from grains was most strongly tied to the lowered risk in the study.

"That's what seemed to be driving all these relationships," said Lawrence de Koning of the Harvard School of Public Health, a co-author of the editorial.

Whole grains also contain vitamins and minerals, which may play a role in reducing risk, he said. For that reason, supplements may not be as effective.

"Nothing beats the original food," he said. He suggested substituting whole wheat bread for white bread as a simple way to increase fiber from grains.

What does a high-fiber diet look like? A woman who wants to meet the 25 gram guidelines for daily fiber intake could eat one-third cup of bran cereal (9 grams), a half cup of cooked beans (10 grams), a small apple with skin (4 grams) and a half cup of mixed vegetables (4 grams).

To reach 38 grams, a man could eat all that — plus about 23 almonds (4 grams), a baked potato (3 grams), an oat bran muffin (3 grams) and an orange (3 grams). Experts recommend adding fiber gradually to allow your digestive system time to get used to it.

Study: Doctors order tests out of fear of lawsuits

2011-02-18T10:28:00.001-05:00

A new study finds that MRI scans and other imaging tests are often done more for the doctor's benefit than a patient's.

Researchers say that as many as one-fifth of tests that bone and joint doctors order are because the doctor fears being sued, not because the patient needs them. Unnecessary tests drive up costs and can expose people to radiation that over time can raise their risk of cancer.

The study involved 72 doctors in Pennsylvania who tracked tests ordered on nearly 3,000 patients. Results were discussed Wednesday at an orthopedics conference in San Diego.

S.Korea court rejects first tobacco lawsuit

2011-02-18T10:27:00.001-05:00

An appeals court on Tuesday rejected South Korea's first lawsuit against a tobacco company following a 12-year legal battle by lung cancer sufferers and their families.

Seen as a test case, Seoul High Court -- partially upholding a lower court ruling -- found there was no direct evidence that the victims' cases were caused directly by cigarettes produced by KT&G.

The case began in 1999 when 36 people -- cancer sufferers or relatives -- sued KT&G, the country's largest tobacco firm. Five of the plaintiffs have since died.

KT&G, a former state monopoly, was privatised in 2002 and controls more than half the domestic cigarette market.

The plaintiffs argued that long-time smoking caused the disease. They said the company failed in its duty to inform victims of the dangers of smoking by concealing most of its manufacturing records.

They sought about 365 million won (now $326,000) but both sides described the suit as a test case and said money was not the main issue.

A lower court rejected their claim in 2007, citing insufficient evidence to prove a direct link between individual illnesses and smoking and inadequate evidence of flawed products.

That court said KT&G did not violate its obligations because it printed a warning message on packs.

The appeals court acknowledged a "dynamic" link between smoking and cancer but said there was no illegal conduct in KT&G's cigarette design, production or warning messages.

"There is no evidence to prove that cancer was caused directly by KT&G's cigarettes," it said.

However, judges urged tobacco firms to be more aware of their social duty and set up clinics. They said the current case could open the door for future damages suits.

The lawyer for the plaintiffs, Bae Geum-Ja, said she would take the case to the Supreme Court.

"We are very disappointed by the ruling that does not ask the company to compensate for suffering by the plaintiffs and their families," Yonhap news agency quoted her as saying.

"The court ruled in favour of a company that causes damage to people's lives."

Company lawyer Park Kyo-Sun urged the plaintiffs to stop "meaningless" litigation. "Due to these suits, KT&G's reputation has been tarnished enough in the past 12 years," he said in a statement.

South Korea's adult smoking rate was around 40 percent last year compared to the 2008 average among all Organisation for Economic Cooperation and Development member nations of 27.3 percent.

The government is trying to reduce the rate and parliament has passed a law calling on provincial governments to restrict smoking in public places.

From 2012, Seoul city will ban smoking at bus stops, in parks, near schools and in other public spaces. But cigarettes remain cheap, with a locally made pack of Marlboro costing just 2,500 won. A dozen anti-smoking campaigners held a brief protest outside the court. "Considering more than 50,000 people die from smoking every year (in South Korea), the verdict in favour of the cigarette company neglected the people's rights to life," Korean Association of Smoking and Health said in a statement.

Senators call for baseball chewing tobacco ban

2011-02-18T10:19:00.001-05:00

Two U.S. senators have urged the heads of Major League Baseball and the players union to ban the use of smokeless tobacco products on the field and in the dugout and the locker room.

A similar ban on chewing tobacco has been in place in baseball's minor leagues for decades. Illinois Senator Dick Durbin and New Jersey Senator Frank Lautenberg, both Democrats, said it was time for the major leagues to follow suit.

"We now know conclusively that smokeless tobacco endangers the health of baseball players who use it, but it also affects millions of young people who watch baseball," Durbin and Lautenberg wrote in a letter to baseball commissioner Bud Selig, which was made available to news organizations on Tuesday.

In the letter, they cited a survey that found use of smokeless tobacco products by high school boys has increased by 36 percent since 2003.

"The use of smokeless tobacco by baseball players undermines the positive image of the sport and sends a dangerous message to young fans, who may be influenced by the players they look up to as role models," the senators wrote.

Baseball historians say smokeless tobacco gained a foothold in the sport in its earliest days because it was a way for players to keep their mouths from getting dry.

A 1988 study, published in the Journal of the American Medical Association, of 1109 members of major and minor league professional baseball teams found that 39 percent were using smokeless tobacco and most had started when they were teenagers.

In 1990, the league issued report on the hazards of smokeless tobacco and established programs to help players quit. But the league insists that any ban on the use of smokeless tobacco needs to be agreed with the players' union.

Last year, two Democratic members of the U.S. House of Representatives, Henry Waxman of California and Frank Pallone of New Jersey, called on baseball to prohibit players from using smokeless tobacco.

In a statement on Tuesday, Rob Manfred, Major League Baseball's executive vice president for labor relations, said use of smokeless tobacco "remains a significant concern to Major League Baseball."

He said the league has brought in experts to counsel players on the dangers posed by the products.

Antipsychotic Drugs Raise Heart Risks, Experts Warn

2011-02-18T10:14:00.002-05:00

Doctors must not forget about the physical health of people with serious mental health disorders who take antipsychotic drugs, experts warn.

The authors of an editorial in the Feb. 19 issue of The Lancet noted that patients with severe mental illness live an average of 16 years less than people in the general population. Heart disease, not suicide, is the major cause of death in these patients and antipsychotic drugs are a factor.

A study published recently in the Archives of General Psychiatry found that patients who took an antipsychotic drug gained 11 to 13 pounds within six to eight weeks after they starting taking the drug.

"The combination of antipsychotic side effects with poor diet, physical inactivity, high rates of smoking and other factors associated with psychotic illness, together with socioeconomic deprivation, has a devastating effect on cardiometabolic health," according to the editorial.

"If existing antipsychotics are here to stay -- at least for the foreseeable future -- what can be done to ameliorate their effects and improve patients' cardiometabolic health?" the authors asked.

Sole responsibility for safeguarding the physical health of patients with serious mental health conditions often falls to primary care providers, but mental health teams need to take an active role in that care, the editorial suggests. For example, a patient's physical health should be assessed when they enter mental health care.

"A lack of training in physical health issues is worrying in psychiatric doctors and nurses alike. In view of the wealth of evidence about the interconnections between mental health, physical health and prescribed medication, postgraduate psychiatric training should prioritize up-to-date knowledge about evidence-based management of cardiometabolic disease," the authors wrote.

They concluded: "Antipsychotic drugs are a clear risk to cardiometabolic health. This risk is, all too often, a necessary one. But the trade-off between mental and physical well-being is one that no patient should be forced to make. The mind-body dichotomy is both outdated and dangerous. The price of good mental health must not be a lifetime of physical illness."

More information: The U.S. National Institute of Mental Health has more about mental health medications.

Get Into Shape Before Spring Activities, Doctor Advises

2011-02-13T19:55:00.002-05:00

Winter couch potatoes who decide to get active in the spring may be at risk for injury if they don't take the proper steps to safely get into shape, an expert warns.

Before you begin an exercise program or new sport, you need to get an assessment of your physical condition, including weight and cardiovascular fitness, advised Dr. Anders Cohen, chief of neurosurgery and spine surgery at The Brooklyn Hospital Center. He suggested that this may be a good time to get your annual physical.

Cohen also recommends people spend three weeks working on areas such as strength and flexibility to prepare for taking part in new sports or activities. This preparation may include things such as working out at the gym, following along with an exercise video, climbing stairs or doing Pilates exercises.

Another important thing to remember is to take steps to prevent chronic injuries or re-injuries.

"These are the injuries that make people give up a sport. If, for example, you always sprain your ankle, pay attention to strengthening that area," Cohen said in a hospital news release.

He compared chronic injuries to a tire with a slow leak.

"Once you have an injury, that part of your body is always more susceptible. Pay attention to preexisting conditions and work on strengthening those areas," he suggested.

It also helps to be sports-specific in your physical preparations, Cohen noted.

"For example, if you're a baseball player, you want to start playing catch, alternating distances and angles to increase flexibility, reflexes and loosen your arm. That's also a good idea for tennis players since catching a ball and volleying with a tennis racket require the same motion. Basketball players will want to increase cardio endurance by running up stairs," Cohen said.

Additional tips offered by the doctor include: taking 10 minutes to warm up (stretching and loosening up) before any physical activity and 10 minutes cooling down afterwards; and monitor your progress and physical condition in order to improve your performance/results.

More information: The U.S. Centers for Disease Control and Prevention has more about physical activity.

China restricts smoking in films, TV

2011-02-13T19:54:00.001-05:00

China has ordered that smoking scenes in films and television series be restricted, amid concern it is failing to deliver on pledges to help its 300 million smokers kick the habit.

The State Administration of Radio, Film and Television (SARFT), China's media watchdog, called for "strict control" of smoking scenes and banned minors from being present in shots involving anyone lighting up.

Cigarette brands are banned from appearing in films and television series, and smoking scenes must be kept as short as possible, a circular posted on SARFT's website said Saturday.

According to the official Xinhua news agency, a survey conducted among 11,000 middle school students in Beijing showed nearly 33% wanted to try smoking after seeing actors lighting up on television.

Tobacco is the top killer in China -- the world's largest tobacco producer and consumer -- and smoking and exposure to second-hand smoke exact high medical and social costs.

Last month, Chinese and foreign medical experts issued a joint report warning that smoking deaths in the world's most populous country could triple by 2030.

The report said more than 3.5 million Chinese could die from smoking-related illnesses every year by 2030 compared with 1.2 million in 2005, if strong steps were not taken.

China became a party to the World Health Organization's Framework Convention on Tobacco Control (FCTC) five years ago.

Experts say it lags behind in its implementation of FCTC requirements, including a ban on indoor smoking, leaving people free to light up in restaurants and office buildings.

Are You About to Have A Heart Attack? 7 Heart Attack Signs Women -- And Doctors -- Often Miss

2011-02-05T09:47:00.001-05:00

Conventional wisdom has it that heart attacks come out of the blue. We're also trained to expect a heart attack to happen a certain way: The victim clutches his chest, writhes in pain, and collapses. But for women, it often doesn't happen that way. Study after study shows heart attacks and heart disease are under-diagnosed in women, with the explanation being that they didn't have symptoms.

But research shows that's not the case. Women who've had heart attacks realize, looking back, that they experienced significant symptoms -- they just didn't recognize them as such.

In a study funded by the National Institutes of Health and published in Circulation: Journal of the American Heart Association, 95 percent of women (that's almost all!) who'd had heart attacks reported experiencing symptoms that were decidedly new or different from their previous experience a month or more before their attacks.

Even when a heart attack is occurring, women are often slow to realize what's happening and call a doctor. The reason? Women's heart attack symptoms are different than men's. This failure to recognize heart attack signs in women has led to a grim statistic: Women are more likely to die from sudden cardiac death than men are, and two thirds of women who have a heart attack don't recover completely.

To prevent a heart attack from sneaking up on you, watch for these 7 little-known signs of heart attack

The Top Little-Known Signs of Heart Attack

Fatigue. More than 70 percent of women in the NIH study reported extreme fatigue in the month or months prior to their heart attacks. This was not just your run-of-the-mill tiredness -- the kind you can power through -- this was an overwhelming fatigue that sidelined them from their usual schedules for a few days at a time.

Sleeplessness or Insomnia. Despite their fatigue, women who've had heart attacks remember experiencing unexplained inability to fall asleep or stay asleep during the month before their heart attacks.

Anxiety and Stress. Stress has long been known to up the risk of heart attack. But what women report is the emotional experience; before their heart attacks they felt anxious, stressed, and keyed up, noticeably more than usual. Moments before or during a heart attack, many women report a feeling they describe as "impending doom;" they're aware that something's drastically wrong and they can't cope, but they're not sure what's going on.

Indigestion or Nausea. Stomach pain, intestinal cramps, nausea, and digestive disruptions are another sign reported by women heart attack patients. Become familiar with your own digestive habits, and pay attention when anything seems out of whack. Note especially if your system seems upset and you haven't eaten anything out of the ordinary.

Shortness of Breath. Of the women in the NIH study, more than 40 percent remembered experiencing this symptom. One of the comments the women made is that they noticed they couldn't catch their breath while walking up the stairs or doing other daily tasks.

Flu-Like Symptoms. Clammy, sweaty skin, along with feeling lightheaded and weak, can lead women to wonder if they have the flu when, in fact, they're having a heart attack.

Jaw, Ear, Neck, or Shoulder Pain. While pain and numbness in the chest, shoulder, and arm is a common sign of heart attack (at least, among men), women often don't experience the pain this way. Instead, many women say they felt pain and a sensation of tightness running along their jaw and down the neck, and sometimes up to the ear, as well. The pain may extend down to the shoulder and arm--particularly on the left side--or it may feel like a backache or pulled muscle in the neck and back.

What You Can do to Protect Yourself

In addition to the symptoms they do have, women differ from men in another significant way -- they may not experience many of the symptoms we traditionally associate with heart attacks. This, experts say, is a major reason why women's heart attacks go unrecognized and untreated. Almost half of all women in the NIH study felt no chest pain, even during the heart attack itself. Numbness is another symptom women may not experience, experts say.

If your body is doing unusual things and you just don't feel "right," don't wait. Go see your doctor and ask for a thorough work-up. And if you have any risk factors for cardiac disease, such as high blood pressure, high cholesterol, smoking, or family history of heart disease, mention these to the doctor. Time is of the essence, so don't count on medical staff to know your background or read your chart -- tell them your risk factors right away, so your condition can be evaluated fully and completely.

Some Tips for Avoiding Injury on Super Bowl Sunday

2011-02-05T09:40:00.001-05:00

Super Bowl-related partying, drinking and excitement can lead to injuries -- and even death -- for fans watching the big game on TV, warns an emergency room doctor.

"I've seen a number of injuries, some fatal, occur on Super Bowl Sunday because people often pay more attention to the game than to their health and safety. The ER is usually busy after the game and we expect it to be no different this Sunday," Dr. Jeff Kalina, associate medical director of emergency medicine at Methodist Hospital in Houston, said in a hospital news release.

His patients have included victims of drunken driving crashes, those with stomach ills from a combo of alcohol and junk food, revelers who threw out their backs when they jumped up to cheer, and even a boozed-up fan who broke his teeth trying to open a beer bottle with them.

Another problem, albeit rare, may occurs when someone drinks too much and doesn't bother to get up and go to the bathroom, Kalina added. This can lead to urinary retention, a condition in which the bladder gets so full that the muscles aren't strong enough to generate a urine stream.

"During most sporting events people will get up and use the restroom during the commercials and not have any problem. However, most of the time the commercials are the best part of the Super Bowl, so we have seen people who have to come in and have a catheter put in to relieve themselves," Kalina said.

A rise in domestic violence has also been documented on Super Bowl Sunday.

"There is a lot of testosterone flying around during the Super Bowl. You mix that with alcohol and underlying relationship problems and you have a recipe for disaster. If a woman is in a relationship where this is happening, it might be best to stay away from the house or party on Sunday," Kalina advised.

If Mom Had a Stroke, Daughter May Be Prone to Heart Attack

2011-02-02T15:26:00.001-05:00

A mother's history of stroke can help predict a daughter's chances of not only having a stroke but also her chances of having a heart attack, new research shows.

"Our new study shows that stroke in mothers is associated with heart attacks in daughters," said Dr. Amitava Banerjee, a clinical research associate at the Stroke Prevention Research Unit at the University of Oxford, in England.

In other words, a stroke in mothers or other first-degree relatives can help identify women at increased risk for heart attacks -- even if their mother has not had a heart attack.

The research, published in Circulation: Cardiovascular Genetics, shows an association, but a cause-and-effect relationship has yet to be determined, Banerjee said.

Putting the research in perspective, he said: "We know that, in men and women, stroke or heart attack in the parents increases the risk of heart attack. Previous studies have not looked at these issues by sex of the parent or sex of the patient and have not looked in a 'prospective' way -- that is, they have not followed up a population over time."

In the new study, Banerjee and his colleagues evaluated 2,210 men and women who had either heart attacks or other coronary syndromes or strokes. Complete family histories were not available for all of them. But the researchers found that more than 24 percent of those who'd had heart attacks and angina -- and about the same percentage of patients who had had strokes or transient ischemic attacks (called TIAs, or mini-strokes) -- had a history of stroke in one or more first-degree relatives, such as their parents or siblings.

This indicates that stroke history in parents and siblings is as important to a person's risk for a heart attack as it is to stroke risk, according to Banerjee.

Maternal stroke was more common than paternal stroke history in women with heart attacks or unstable angina. Women heart patients were more than twice as likely to have a mother who'd had a stroke than a father who did. The same link was not found in men with heart problems, however.

Exactly why mothers' history of stroke seems to play a role in their daughters' heart attacks is not known. Banerjee said it's not possible to say whether environment or genes are playing the larger role in the mother-daughter association.

The link found between a mother's stroke history and a daughter's heart attack and stroke held even if the mother had only a stroke, with no heart attack history, Banerjee said.

Dr. Tatjana Rundek, an associate professor of neurology, epidemiology and public health at the University of Miami Miller School of Medicine, said that the association between maternal stroke and a daughter's heart attack is relatively new but that it ties in with other research, including her own, that examines sex differences in cardiovascular risk.

In her own recent study, Rundek said, she found that genetic variations in genes involved in fat metabolism may have gender-dependent effects on plaque in arteries.

Research also has found that women have more systemic inflammation, she said. Inflammation is linked with buildup of fatty deposits in arteries.

What the new findings mean for women whose mothers had a stroke, Rundek said, is the need to "understand your own personal risk of stroke or heart attack." Be sure you know your numbers -- blood pressure, blood glucose and cholesterol levels, she said, and change behaviors to improve the numbers if need be.

Banerjee added that "women whose mothers have had stroke -- particularly before the age of 65 -- should have their blood pressure and cholesterol checked, and think about lifestyle factors such as smoking more than women without family history of stroke."

More information

The American Stroke Association has more about risk factors for stroke.

Scientists grow blood vessels for human surgery

2011-02-02T15:24:00.001-05:00

Scientists can grow blood vessels in a lab for use in coronary bypass or dialysis, a promising alternative to harvesting from the patient, said a study published on Wednesday.

The process involves taking smooth muscle cells from a human cadaver and grafting them onto tubes made of the material used in making dissolvable stitches, called polyglycolic acid.

Within eight to 10 weeks, the tubes degrade and a "fully formed vascular graft" remains, said the research by scientists from Duke University, East Carolina University and Yale University.

The veins have been tested in baboons and dogs. They were not rejected by the animals' bodies and functioned well for six months, said the study, published in the journal Science Translational Medicine.

The bio-engineered vessels could also be stored in saline solution for up to a year, suggesting that one day surgeons could pluck a vein "off the shelf" for use in a sick patient, the study said.

"These can be made ahead of time and then are ready to go whenever they are needed," the paper said.

Clinical trials in humans are expected to begin soon, according to a spokeswoman from Humacyte, a regenerative medicine company based in North Carolina that also contributed to the study and funded the research.

"Currently, grafting using the patient's own veins remains the gold standard," said co-author Alan Kypson of the Brody School of Medicine at East Carolina University.

"But, harvesting a vein from the patient's leg can lead to complications, and for patients who don't have suitable veins, the bio-engineered veins could serve as an important new way to provide a coronary bypass."

The engineered vessels also have "decreased potential for infection, obstruction or clotting," the study noted.

Shannon Dahl, senior director of Scientific Operations at Humacyte, said veins can be made in a variety of sizes for use in different operations.

"We can make the bio-engineered veins in large and small diameter which means they can be used for procedures ranging from hemodialysis for patients with kidney failure and for coronary by-pass," she said.

The National Kidney Foundation says that 320,000 patients require dialysis, and "more than half of dialysis patients lack the healthy veins necessary and must undergo an arteriovenous graft (AV graft) placement" for the procedure.

Around 400,000 coronary bypass procedures are performed annually in the United States, according to the American Heart Association.

More On Fish Oil Tablets

2011-02-01T16:17:00.000-05:00

Fish oil is rich in omega 3 fatty acids which help improve your health in several ways. Fish oil is extracted form the tissues of oily fish. Mostly, fish oil is derived from farmed salmons. Other fish like herring, mackerel, tuna, krill, trout, cod, etc. also offer good quality oil. Pure fish oil tablets are used to treat various health problems. Here is an overview of fish oil benefits.

Fish Oil Tablets Benefits

Fish oil tablets are good for diabetes, skin care, eye problems, Alzheimer's disease, pregnancy, cancer, Attention Deficit Hyperactivity Disorder (ADHD), hair care, and several other conditions. Fish oil helps strengthen your immune system and thus helps prevent a number of diseases, disorders and infections. Fish oil helps reduce pain and inflammation due to arthritis. It is often used to treat rheumatoid arthritis as it helps reduce inflammation of joints, eyes, kidney, heart, blood vessels, lungs, nerves, etc.

The omega 3 fatty acids docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) help prevent inflammation. They also help maintain heart health. Regular consumption of fish oil helps lower bad cholesterol levels in your body. Thus it helps prevent blockage of arteries and reduces the chances of heart attack. It can lower the chances of stroke and sudden cardiac death. Salmon oil is richer in omega 3 fatty acids than fish oil. It helps increase your good cholesterol levels significantly. You may like to read more on salmon oil vs fish oil. One of the important benefits of fish oil tablets is that vitamins, minerals and proteins present in fish oil help improve the efficacy of exercise and promote weight loss.

Krill oil is obtained from a shrimp like marine animal 'krill', which lives in cold water. To know about the benefits of krill oil, you may refer to the article krill oil vs fish oil. Fish oil helps improve blood circulation in the body and thus improves your overall health. Patients suffering from lupus are given fish oil tablets as they help lower the symptoms significantly. Fish oil also helps stabilize blood pressure levels. Fish oil tablets are recommended to people diagnosed with hypertension. Fish oil tablets taken during pregnancy promote proper development of the eye and brain of the fetus. It also promotes normal, safe delivery. Fish oil also works as a stress reliever and helps prevent anxiety, depression and other mental conditions. You may read more on benefits of fish oil supplement.

Fish Oil Tablets Side Effects

Fish oil tablet reviews inform us that too much fish oil in the body can lead to bleeding in the intestine and brain. Excessive consumption of fish oil tablets can result in allergic reaction and the person may suffer from breathing difficulty and/or skin rashes. Fish oil supplement side effects include severe headache due to ruptured blood vessels in the brain, brain hemorrhage leading to speech or vision problems, increased weakness in the lower part of the body, etc.

You need to follow the instructions of your physician regarding fish oil dosage. Pregnant women especially should take care while taking fish oil tablets. Impure fish oil may contain traces of mercury which can prove to be harmful for the fetus. All those who want to take fish oil regularly, should consult their physician for fish oil tablets dosage and reliable brand. The physician may help select the best fish oil supplement. Always take the best fish oil tablets and follow the instructions of your physician religiously. This will help avoid devastating side effects of fish oil tablets.
With proper care, you can enjoy the benefits of fish oil.

Fish vs. Fish Oil for Healthy Hearts

2011-02-01T10:31:00.000-05:00

The next time you go for a checkup, it's unlikely that your doctor will write you a prescription for twice-weekly doses of trout and salmon. And that means he's ignoring a cheap, easy way to improve your heart health, says Carl Lavie, MD, medical director of cardiac rehabilitation and preventive cardiology at the Ochsner Heart and Vascular Institute in New Orleans. Dr. Lavie recently published a review of studies on the heart benefits of omega-3 fatty acids, which are abundant in fish and easily available in the form of fish oil supplements. The research consistently shows, he found, that omega-3s reduce heart failure, cut down on artery disease, and reduce the risk of death from major cardiac events. "Many people have recognized that omega-3 is a healthy food, but mostly the promotion of omega-3 has mainly come from the health-food industry or nutraceutical companies [supplement manufacturers]," he says. Very few doctors, he adds, seem aware of the clinical trials supporting their use.

Yet while the science on omega-3s seems clear, the best way to get those oils can be a little murky. Making the right choice is important: Fish are high in industrial pollutants, and harvesting too many now could mean that down the line, there won't be enough of them left in the sea to save our hearts. So should you go for the real thing, or get your oil from over-the-counter supplements?

Fish Oil

Pros: For people who don't like the taste of fish, fish oil supplements provide an alternative without having to eat any fish. Oils are also less likely than whole fish to be contaminated with mercury, which is concentrated in muscle tissue rather than in fats or oils. Furthermore, the nonprofit Environmental Defense Fund (EDF) says that most fish used in fish oils are from small fish like anchovies and sardines, which aren't under pressure from overharvesting. Fish oil made from wild Alaskan salmon is also an ecofreindly, heart-healthy choice.

Cons: While those tiny fish may be abundant, they're also food for other fish, and removing them from the food chain can leave a lot of larger species to go hungry. And although mercury levels may be low in fish oil supplements, those pills may have high levels of polychlorinated biphenyls (PCBs), which build up in the fat of fish and make their way into oils. Finally, anyone who's swallowed a fish oil supplement has likely experienced the unpleasant side effect of "fish burp."

Fish

Pros: Healthy people can get the recommended level of omega-3s, 500 milligrams per day, by eating fish twice a week, says Dr. Lavie, and nutritionists note that it's easier for your body to absorb nutrients directly from food than from a pill. And fish are more than just a source of beneficial fatty acids. They’re also high in protein, as well as antioxidants like vitamin E and beta-carotene.

Cons: Deciphering the "good" fish from the "bad" fish, in terms of both fishery management and environmental contaminants such as mercury and PCBs, can give any fish-lover a headache. Both wild fish and farmed fish have environmental problems, and some types of farmed fish can have even higher levels of PCBs than their wild counterparts.

When you weigh the eco pros and cons of eating real fish or digesting all your omega-3s in pill form, going with oils has a lighter impact on the planet, says EDF. Companies use small fish that reproduce quickly and are lower in contaminants (contaminants build up in the food chain, so that large predatory fish have higher levels than the small fish on which they feed), and those tiny fish are also harvested in ways that don't impact the surrounding aquatic environments. Alternately, the few brands made from wild Alaskan salmon get their oil from some of the most responsibly managed fisheries around.

Nutritionally, you'll get more from eating whole fish if you're healthy (use the EDF's seafood selector to make the best choice). That presumes you'll eat fish a few times a week, consistently. But if your goal is a healthy heart, fish oils are better. Omega-3s are very effective in lowering triglycerides, a form of fat that can trigger coronary artery disease, and Dr. Lavie says the most beneficial level of omega-3s found to lower triglycerides is at least 2,500 milligrams (mg) per day. That's hard to come by through diet alone. Even people who want to ward off heart disease need 1,000 mg of omega-3s per day. "That’s four or five fish meals a week, and very, very few people are going to get that," he notes.

Some people may even find that fish oil supplements slash their healthcare costs. "If you think of fish oil as a pharmaceutical therapy [rather than simply a vitamin], it’s very cheap compared to what people spend on medicine, and it has the same effect," says Dr. Lavie. "In some of the trials, fish oils led to a 30 percent greater reduction of events than you saw from expensive medicines." Just talk to your doctor before switching from prescription meds to fish oil pills.

Here are a few shopping tips, whether you're looking for fish oil pills or the real thing:

• Oils can still be contaminated. Although most fish oils used in supplements come from species that aren't high in mercury and PCBs, that doesn't mean a few poisoned poisson don't make it into the mix. EDF surveyed 75 fish oil manufacturers in 2008 to see if they purify their fish oils to remove PCBs and mercury, and published a list of the healthier supplements.

• It's still OK to eat the real thing. Many of the fish highest in omega-3s also come from well-managed fisheries or from stocks that aren't overharvested, such as wild Alaskan salmon, U.S.-farmed rainbow trout, and U.S.-farmed catfish. Order your fish grilled, rather than fried, to protect your heart, whether or not you're at risk for cardiovascular disease. And see our simplified list of the best fish for you and for the oceans.

FDA declines to approve Orexigen diet drug

2011-02-01T10:19:00.001-05:00

Orexigen Therapeutics Inc. said Tuesday that U.S. health officials declined to approve the experimental weight loss pill Contrave and want the company to conduct an additional study to address potential heart safety concerns.

The announcement sent shares of the company plunging nearly 75 percent in pre-market trading.

The Food and Drug Administration's request for an additional study suggests the agency may yet approve the drug, but makes that path more difficult.

Orexigen said it is disappointed with the FDA's decision and will work with the agency to determine its next step.

"We are surprised and extremely disappointed with the agency's request in light of the extensive discussion and resulting vote on this topic at the Dec. 7 advisory committee meeting," said President and CEO Michael Narachi.

Narachi said the company wants to gather more specific information on what the FDA is seeking. But he acknowledged that studies of the kind requested by the FDA are normally "fairly large."

"It's safe to say we would need additional capital," he said, in a conference call with investors.

Analysts have viewed Contrave as the most promising of three new diet pills recently submitted to the agency. Contrave is a combination pill, mixing an antidepressant with an anti-addiction drug to curb appetite. Four out of 10 patients taking Contrave for a year lost at least 5 percent of their body weight. Those results narrowly met FDA's guidelines for effectiveness.

La Jolla, Calif.-based Orexigen does not currently have any products on the market, making Contrave a key to the company's growth and survival. In pre-market trading Tuesday, Orexigen shares tumbled $6.67, or 73 percent, to $2.42.

Analysts expect any obesity drug reaching the market to have the potential to become a billion-dollar seller.

With the U.S. obesity rate for adults nearing 35 percent, the FDA has acknowledged the need for new weight loss drugs. But the agency rejected two other drugs last year due to safety risks, a long-standing issue that has plagued weight loss treatments for decades. Those drugs were made by fellow California drug developers Vivus Inc. and Arena Pharmaceuticals Inc. Both companies have said they plan to resubmit their drugs for approval.

Contrave has been pegged as a more promising treatment because of its relative safety. Unlike the other two drugs reviewed last year, it received a positive vote from the FDA's panel of outside advisers, who voted 13-7 that the drug's modest weight loss benefits outweighed its risks.

But the FDA meeting assessing the drug was not free of criticism. FDA scientists and safety advocates complained that the company enrolled few elderly patients or patients with a history of heart disease in its trials, making it difficult to determine the drug's safety in patients who are likely to need it most.

Heart side effects have been an issue with diet drugs, most notably with Wyeth's diet drug combination fen-phen, which was pulled off the market in 1997. In October, Abbott Laboratories withdrew its drug Meridia after evidence it increased the risk of heart attack and stroke.

Currently there is just one prescription drug on the market for long-term weight loss: Roche's Xenical, which is not widely used. Several other generic drugs are approved for short-term weight loss, including phentermine.

Stroke survival better for African Americans

2011-01-31T18:10:00.002-05:00

Despite facing a greater risk of stroke, African Americans may have better survival rates than whites in the first year after the event, a study published Monday suggests.

The findings are surprising, researchers say, because black stroke patients are generally thought to have worse outcomes.

"Based on mortality rates, we found the exact opposite," said Dr. Robert G. Holloway, a neurologist at the University of Rochester Medical Center in New York and one of the researchers on the study.

He and his colleagues found that among more than 23,000 stroke patients treated at New York State hospitals over two years, six percent of African Americans died within one month, versus 11 percent of white patients.

After one year, 16.5 percent of black patients had died, compared with just over 24 percent of whites.

Even with other factors taken into account -- like age and other medical conditions -- African Americans had a lower risk of dying in the first year, the researchers report in the Annals of Internal Medicine.

The reasons for the racial gap are not clear, Holloway told Reuters Health.

But he said the results point to one potential explanation: African Americans were more likely than whites to receive aggressive, life-sustaining measures -- like being placed on a ventilator if they could not breathe on their own, receiving dialysis when their kidneys failed, or getting CPR if they went into cardiac arrest.

Just over 15 percent of black patients received some form of life-sustaining measure, compared with just under 13 percent of white patients.

"That doesn't prove a causal relationship," Holloway said. "But I think this tells us that we have to take a look at how life-sustaining interventions may play a role in this."

But even if more-aggressive care plays a part in African Americans' higher short-term survival, it does not mean that aggressive is always better, according to Holloway.

Depending on the amount and type of brain damage, strokes can leave people severely disabled. The current study looked only at short-term survival rates, and not at patients' ability to function or their quality of life.

"The critical question is, what is the quality of life for these patients?" Holloway said.

The findings are based on 5,319 African-American and 18,340 white patients treated for a stroke at any of 164 New York hospitals from 2005 through 2006.

While black patients had a higher rate of aggressive, life-sustaining care, white patients were more likely to go into hospice care -- just over two percent did, versus 0.5 percent of African Americans.

Hospice care focuses on easing symptoms and improving quality of life for people who are terminally ill.

There's no way to tell why black patients more often received life-prolonging treatments. But past studies have found that African Americans are more likely than whites to want such measures, Holloway said.

Studies have also shown that African Americans are less likely than whites to have documented plans in place for their end-of-life care -- like living wills, which spell out the types of treatments you do or do not want in the event that you are too ill to make those decisions. Without those documents, family members are left to make the choice on their own. Holloway said that future studies need to look at the "quality" of treatment decision-making -- including how doctors communicate with patients and families. "How well," Holloway said, "is the physician communicating and hearing and understanding the patient's and family's preferences?"

SOURCE: http://bit.ly/an7XRm Annals of Internal Medicine, online February 1, 2011.

New US diet guidelines call for less salt

2011-01-31T17:57:00.001-05:00

The US government on Monday released new dietary guidelines urging all Americans to cut their daily salt intake by one-third and those over 50 to make more drastic reductions.

"The 2010 Dietary Guidelines are being released at a time when the majority of adults and one in three children is overweight or obese," Agriculture Secretary Tom Vilsack said in a statement.

"This is a crisis that we can no longer ignore," he added.

The guidelines, which are updated and published every five years, also urge Americans to eat less calories and exercise more.

"The bottom line is that most Americans need to trim our waistlines to reduce the risk of developing diet-related chronic disease," Vilsack said.

The new guidelines recommend reducing daily salt intake to less than 2,300 milligrams, or one teaspoon, and urge further reductions to 1,500 milligrams for people 51 and over, African Americans and those with hypertension, all of whom now account for around half of the population.

The Center for Disease Control (CDC) estimates that Americans currently eat 3,466 milligrams, or about teaspoon and a half of sodium, which has been linked to hypertension and other cardiovascular disease.

Most of that sodium comes from processed foods, not the salt shaker, and the government has urged the food industry to cut back as well.

The guidelines also suggest that consumers cut back on fats, added sugars and refined grains while eating more whole grains, fruits, vegetables, low-fat dairy products, lean meats, poultry and seafood.

They also suggest eating more reasonable portions and filling half the plate with fruits and vegetables, as well as drinking more water and less soft drinks.

First Lady Michelle Obama has championed better nutrition through her "Let's Move" campaign to combat obesity by improving school meals, offering kids more physical activity and raising awareness of healthy habits.

Earlier this month she signed a partnership with retail giant Wal-Mart to market healthier food with less fat, salt and sugar.

The guidelines can be found online at www.dietaryguidelines.gov

Nicotine study opens path for anti-smoking drug

2011-01-31T09:16:00.001-05:00

Scientists have pinpointed a source of nicotine craving in the brain, opening up a new path towards drug treatments to help smokers kick their habit, according to a study released Sunday.

Tobacco kills more than five million people every year and accounts for nearly one-in-10 adult deaths, 90 percent of them due to lung cancer.

In experiments with mice and rats, the researchers mapped the functioning of a gene called CHRNA5 that has been previously fingered in nicotine addiction.

The gene controls a receptor -- an entry point on the surface of brain cells -- which responds to nicotine molecules.

With a normal version of this gene, anything more than a tiny dose of nicotine triggers a message to the brain which says, in effect, "stop consuming," the scientists found.

Larger doses unleash a sense of repulsion, similar to "bad-tasting food or drink," lead researcher Paul Kenny at the Scripps Research Institute in Florida said in an email exchange.

But the effect was quite different in mice in which a tiny sub-unit of the receptor, known as alpha5, had been knocked out.

The negative message was never sent -- and as a result, the rodents couldn't get enough of the potent drug.

A similar scenario occurs naturally in some humans, the researchers believe.

Genome-wide screening studies have identified genetic alterations which impair the alpha5 unit's functioning.

Between 30 and 35 percent of the population in the United States is thought to have a form of the CHRNA5 gene that encourages unbridled nicotine craving.

"Our data probably explain the fact that individuals with this genetic variation have increased vulnerability to developing tobacco addiction," Kenny said.

"They are likely to be far less sensitive to the averse properties of the drug, and are thus more likely to acquire a nicotine habit."

On the strength of the new findings, published online in the journal Nature, Kenny has received funding from the National Institute of Drug Abuse to design a new category of drugs.

"This study has important implications for new approaches to tobacco cessation," said Jon Lindstrom, a neuroscientist at the University of Pennsylvania who has investigated other nicotine receptors in the brain and will participate in the follow-up research.

A truly effective anti-smoking drug may require targeting more than one receptor, he said.

"Nicotine influences complex brain circuits involved in reward" -- mainly through the release of dopamine -- "and memory," Lindstrom explained.

"It has beneficial effects on anxiety and attention, among other things, thus making quitting very difficult. Withdrawal symptoms from quitting smoking make this worse." Nicotine treatments, such as "patches", boost these reward circuits but can themselves be addictive. Another widely-used drug reduces the craving and pleasure associated with cigarettes by partially blocking these other receptors. "Restoring or increasing the aversion to high doses of nicotine may complement these approaches and increase their efficacy, or replace them," Lindstrom said.

Cardiac deaths mount after US Super Bowl loss

2011-01-31T09:13:00.001-05:00

US researchers have found an increased number of cardiac deaths, particularly among women, after a city's home team lost in the famed Super Bowl, the biggest American football game of the year.

The study, published Monday in the journal Clinical Cardiology, examined residents of Los Angeles where the home team lost to the Pittsburgh Steelers in 1980 and won against the Washington Redskins in 1984.

It looked at how the rise in deaths after the loss related to age and sex and race, and found that in women, there was a 27 percent increase in all circulatory deaths.

In men, there was a 15 percent increase in such deaths associated with the loss.

"The Super Bowl may elicit an emotional response that is similar in US females and males, or perhaps a male's reaction to the Super Bowl loss adversely affected the emotional state of a female partner," the study said.

Women also fared better than men after the Super Bowl win four years later.

"For women, but not men, there was a reduction in all-cause death and circulatory deaths associated with the Super Bowl win," the study said.

After the loss, more cardiac deaths occurred overall across sex barriers. And among people over 65, there was a 22 percent increase in circulatory deaths, though no statistically significant differences were found among various races.

"Physicians and patients should be aware that stressful games might elicit an emotional response that could trigger a cardiac event," said lead study author Robert Kloner.

Previous studies of football (soccer) fans in Europe found an increase in acute coronary syndrome and arrhythmia, more so among men than women, during the 2006 World Cup.

This year's Super Bowl takes place February 6 between the Green Bay Packers and Pittsburgh Steelers.

"Stress reduction programs or certain medications might be appropriate in individual cases," said Kloner.

Brain scan can tell if a smoker will quit

2011-01-31T09:11:00.001-05:00

US researchers have found a way to predict how successful a smoker will be at quitting by using an MRI scan to look for activity in a region of the brain associated with behavior change.

The scans were performed on 28 heavy smokers who had joined an anti-smoking program, according to the study published Monday in the peer-reviewed journal Health Psychology.

Participants were asked to watch a series of commercials about quitting smoking while a magnetic resonance imaging machine scanned their brains for activity.

After each ad, subjects in the study "rated how it affected their intention to quit, whether it increased their confidence about quitting, and how much they related to the message," researchers explained.

Those who showed activity in the medial prefrontal cortex during the ads were "significantly linked to reductions in smoking behavior" in the month that followed, regardless of how the people said they were affected by the ad.

"What is exciting is that by knowing what is going on in someone's brain during the ads, we can do twice as well at predicting their future behavior, compared to if we only knew their self-reported estimate of how successful they would be or their intention to quit," said lead author Emily Falk.

"It seems that our brain activity may provide information that introspection does not," added Falk, director of the Communication Neuroscience Laboratory at the University of Michigan.

She said researchers would next try to determine which kind of messages were most effective by matching brain activity to the ads.

The study was funded by the National Institutes of Health and the National Science Foundation, and took place at University of California, Los Angeles.

Judge may escalate battle over healthcare reform

2011-01-31T09:09:00.001-05:00

A Florida judge could on Monday become the second U.S. judge to declare President Barack Obama's healthcare reform law unconstitutional, in the biggest legal challenge yet to federal authority to enact the law.

The judge, Roger Vinson of the U.S. District Court in Pensacola, Florida, was expected to rule on a lawsuit brought by governors and attorneys general from 26 U.S. states, almost all of whom are Republicans. Obama is a Democrat.

The plaintiffs represent more than half the U.S. states, so the Pensacola case has more prominence than some two dozen lawsuits filed in federal courts over the healthcare law.

No specific time has been given for Vinson's ruling, which was unlikely to end the legal wrangling over the contentious reform law, which could well reach the U.S. Supreme Court.

But an aide said he was determined to issue his opinion in the course of Monday on the suit filed on March 23, 2010, just hours after Obama signed the reform into law.

The healthcare overhaul, a cornerstone of Obama's presidency, aims to expand health insurance to cover millions of uninsured Americans while also curbing costs. Administration officials insist it is constitutional and needed to stem huge projected increases in healthcare costs.

Two other district court judges have rejected challenges to the "individual mandate," the law's requirement that Americans start buying health insurance in 2014 or pay a penalty.

But a federal district judge in Richmond, Virginia, last month struck down that central provision of the law in a case in that state, saying it invited an "unbridled exercise of federal police powers."

The provision is key to the law's mission of covering more than 30 million uninsured. Officials argue it is only by requiring healthy people to purchase policies that they can help pay for reforms, including a mandate that individuals with pre-existing medical conditions cannot be refused coverage.

'WITHOUT PRIOR PRECEDENT'

Vinson has suggested strongly that he too will rule the individual mandate oversteps constitutional limits on federal authority. He may also move to invalidate the entire law, by granting the plaintiff states' request for an injunction to halt its implementation.

"The power that the individual mandate seeks to harness is simply without prior precedent," Vinson wrote in an earlier opinion in October.

Speaking during another hearing last month, he added that it would be "a giant leap" for the courts to encroach on the freedom of citizens to buy or not buy a commercial product.

The 70-year-old appointee of President Ronald Reagan even noted that he himself had been uninsured, paying out of pocket when the first of his five children was born.

Vinson's comments did not necessarily conclusively signal how he might rule on the full merits of the case.

He has also shown little sympathy for the plaintiffs' secondary argument for striking down the reform law, on the grounds that it violates state sovereignty by imposing a vast expansion of Medicaid, the federal-state program that provides healthcare for the poor and disabled.

But his ruling on the individual mandate could mark a major setback for Obama on an issue that will likely end up at the Supreme Court, the highest U.S. legal authority.

If Vinson orders an injunction, the government would almost certainly appeal and seek an immediate stay of the ruling. Vinson's ruling will come after the U.S. House of Representatives voted earlier this month to repeal the healthcare reform law. The repeal is unlikely to go any further as the Democratic-controlled Senate is expected to drop it. Since a full legislative repeal seems like a non-starter in the current Congress, legal experts all agree the real battle over reform is destined for the Supreme Court.

Women: Eliminate Heart Attack Risk by Nearly 90 Percent

2011-01-29T08:29:00.001-05:00

Job stress and worrying about job security can both take a toll on a woman's body, although the two issues affect female health differently, according to research presented last month at the American Heart Association's Annual Meeting in Chicago. But whether chronic work-related stress is eating at your nerves or ballooning your waistline, there are natural solutions with no toxic side effects that you can use to relax the pressure.

The details: In a recent study looking at work stress and women, researchers from Harvard and Brigham and Women's Hospital studied more than 17,000 otherwise healthy women (generally in their 50s) enrolled in the Women's Health Study for 10 years. Women who reported work-related strain, such as having little or no authority over decisions or being unable to contribute creativity and skills to the job, were up to 88 percent more likely to experience a heart attack than women who reported no work strain. Overall, working women reporting high job strain faced a 40 percent higher rate of cardiovascular disease, too.

Soothe Stress with a 1,000-Year-Old Trick
Worrying about losing a job did not appear to increase heart attack risk, but it was linked to obesity, high blood pressure, and high cholesterol, all of which can eventually lead to cardiovascular disease.

What it means: Whether it's a nightmarish cubicle neighbor, an unrelenting workload, or an ornery boss that has your stress meter ready to pop at any second, you can get a grip: It's all about mind over matter. An August study published in the Proceedings of the National Academy of Sciences found that students taking part in Integrative Body-Mind Training (IBMT) enjoyed changes in white brain matter (within 11 hours of practice) that seemed connected to better regulation of emotions and behavior.

Rewire Your Brain for Health and Happiness

Although now very common the U.S. yet, IBMT involves the practice of maintaining a state of restful alertness to tap into body-mind awareness while a trained coach guides your breathing and mental imagery. It's somewhat similar to more widely available mindfulness-based stress reduction (MBSR), which involves focusing on your present-moment thoughts and feelings in a non-judgmental way. MBSR has been shown to help people make clearer decisions in times of crisis, which could help when all health breaks loose at the office.

Here's how to lower your stress levels without turning to meds.

Get your daily IBMT.
Previous research out of the University of Oregon and three Chinese institutes has found that you could adopt stress-zapping properties of IBMT before the workweek's out. After practicing it for 20 minutes a day for five days in a row, participants reported reduced stress and increased energy. Prevention suggests this intro IBMT exercise: Sit quietly in a comfortable position. Close your eyes and think of your mind as a full cup; as thoughts come and go, keep returning to an image of the cup becoming empty. Repeat for five minutes.

Regardless of your meditation style, know this: Compared to non-meditators, women who practice meditation enjoy up to a 66 percent drop in stress hormone levels, which can dramatically improve heart health.

Pop a piece of gum.
If you're in need of an emergency quick freak-out fix, reach for a piece of gum. (Avoid artificial sweetened gum, though—some are linked to health issues.) One study found that chewing gum boosts blood flow to the brain by up to 40 percent, helping you stay calm and in the present. This prevents you from ruminating over some aggravating office event.

Learn more about meditation.
You don't need to be a monk to enjoy the benefits of meditation. In fact, more and more Western integrative medicine practitioners are using it as a nontoxic health improver. To learn more about meditation, read: Meditate Like a Marine to Pump Up Your Mental Muscles.

7 Symptoms Women Ignore

2011-01-28T11:52:00.001-05:00

Heart attack symptoms aren't unisex. "What we think of as characteristic heart attack pain—like an elephant sitting on your chest—is much more likely to occur in men than in women," says Marianne Legato, MD, director of the Partnership for Gender-Specific Medicine at Columbia University. In fact, 43% of women having a coronary don't experience any chest discomfort at all.

Women and Medicine: Could your doctor's bias be harmful to your health?

Women also wait longer to go to the ER than men do (their top reason for hesitating: They don't want to bother anyone). But that can be fatal: Your odds of surviving improve by 23% if you get treatment within 3 hours and 50% within 1 hour.

14 Worst health mistakes even smart women make.

Don't be a cardiac cautionary tale. If you have any of these warning signs, act fast. As Dr. Legato says: "It's better to be embarrassed than dead."

Fatigue
In the weeks before an attack, 71% of women have flulike symptoms. Days before, you may feel too tired to lift your laptop.

Non-chest Pain
Rather than an explosion in your chest, you may feel less-severe pain in your upper back, shoulders, neck, or jaw.

Sweating
You may find yourself suddenly drenched in perspiration for no apparent reason, and your face may be pale or ashen.

Stop heart disease in its tracks with these tips: 28 Days to a healthier heart.

Nausea or Dizziness
During an attack, women often vomit or feel like they're going to pass out.

Breathlessness
Almost 58% of women report panting or inability to carry on a conversation.

Sleeplessness
In the month before a coronary, nearly half of women have trouble sleeping.

Anxiety
"Many women experience a sense of impending doom or fear before a heart attack," says Dr. Legato. "That's your body telling you to pay attention. Trust those instincts."