Heart disease news archives

January - March 2009

Heart disease news summaries:

New study finds finger monitors can predict heart attacks, strokes. A simple finger sensor test is highly predictive of heart attack or stroke for people considered at low or even moderate risk.

The non-invasive device, called EndoPAT, uses two probes that hook up to each index finger to measure blood flow. The device evaluates endothelial cells, which are the cells that line blood vessels regulating blood flow. If the endothelial cells are not working properly, the arteries may harden leading to a greater risk of cardiovascular diseases.

"If this response is normal, it's indicative of normal vascular function, normal endothelial function. If this response is abnormal then it tells you the vascular vessels are not functioning well, which indicates there is endothelial dysfunction," said Dr. Amir Lerman, a cardiologist at the Mayo Clinic and senior author of the study.

He said the device will help classify patients who are at a high risk for heart disease or stroke.

The device takes 15 minutes to use and contains a machine with two prongs and a blood pressure cuff. A reading of the blood flow is taken through the prongs for three timed readings.

The researchers at Mayo Clinic tested the EndoPAT on 270 low-to-medium risk patients between the ages of 42 and 66, and followed their progress from August 1999 to August 2007. The patients were declared low-to-medium risks based on their Framingham Risk Score, a commonly used test for heart disease.

Of the 270 test subjects, 49 per cent of those with a low endothelia function suffered a cardiac event within the test period.

The EndoPAT device is approved by the US Food and Drug Administration, but Health Canada has not given the device the green light yet.

Canwest News Service (March 30, 2009)

Pregnancy hormone shows promise in reducing heart failure. A pregnancy hormone that relaxes blood vessels appeared to reduce symptoms of acute heart failure and improve survival according to a preliminary study released by US researchers.

The findings suggest that early administration of the hormone relaxin, in addition to standard therapy, might be associated with more rapid, sustained, and complete resolution of acute heart failure, as well as more favorable long-term outcomes according to John Teerlink of the University of California.

In pregnancy, the hormone helps relax and lengthen the cervix to prepare for childbirth, but it is also thought to be a natural vasodilator, widening blood vessels and allowing blood to flow more freely.

Vasodilators are often given to people with high blood pressure, which is common in heart failure, a condition in which the heart gradually loses its ability to pump blood efficiently, leaving organs starved for oxygen.

Teerlink and colleagues studied 234 elderly patients with heart failure and high blood pressure who were given either a 48-hour intravenous infusion of the drug or a placebo.

They found it was safe and helped reduce shortness of breath in 40 percent of patients who received a moderate dose of the drug, compared with 23 percent who took a placebo.

It also reduced the number of patients in the study who died from heart problems or were readmitted to the hospital within two months for kidney failure compared with the placebo, according to the results, which were also presented at the American College of Cardiology meeting in Florida.

Reuters (March 29, 2009)

Creeping Waistline Speeds Path to Grave, Study Says. A report by British scientists reviewed past studies of almost 1 million people in Europe and North America and found carrying 1/3 more pounds than doctors deem ideal raises a person’s chance of dying early by 30 percent.

The World Health Organization expects obesity levels to swell 75 percent to 700 million people by 2015, an epidemic tied to rising diabetes and heart disease rates.

“This is a reaffirmation of how fundamentally important it is for society to rally against obesity,” said David Katz, founder of Yale University’s Prevention Medicine Center. “The takeaway message is that obesity is lethal,” said Katz, who wasn’t involved in the study.

The Lancet study looked at the effect of increasing body-mass index(BMI), a common measure of body fat that compares a person’s weight and height. The ideal BMI is between 22.5 to 25, or about 154 pounds for a man or woman 5-foot-7-inches tall, the authors said.

Every 1/3 increase in a person’s BMI score raises the chance of dying by a third, and the risks of stroke, diabetes, and heart problems by more, the study said.

The main way extra pounds turn deadly is by causing heart attacks and strokes, the leading killers worldwide, along with increasing cancer risks, said researcher Richard Peto, from the Clinical Trial Service Unit at the University of Oxford. Added weight may be responsible for a quarter of heart attacks and strokes in the UK and a third in the US, as well as 6 percent to 8 percent of cancer deaths, Peto said.

Keeping weight off in the first place may be the best solution, said Linda Antinoro, a dietician at Boston's Brigham & Women’s Hospital.

In the US, obesity rates doubled among adults between 1980 and 2000, according to the Centers for Disease Control and Prevention in Atlanta. The agency estimates 30 percent of the population is now obese, meaning their BMI is more than 30.

The Lancet review, funded by the Medical Research Council, the British Heart Foundation, and other groups, compiled data from 57 studies including 894,576 participants with an average age of 46 and a BMI of 25.

Bloomberg (March 18, 2009)

Depressed women more likely than other females in a study to die from heart disorders.

Women who reported symptoms of depression or antidepressant use had twice the risk of death from cardiac arrest and at least 37 percent more risk of mortality from coronary heart disease researchers said in the Journal of the American College of Cardiology. The study followed 63,4690 women without a history of heart disease from 1992 to 2004.

This study supports research linking mental health to cardiac disorders and underscores the need for attentive care by a physician.

“It’s important for women with depression to be aware of the possible association between depression and heart disease, and work with their health-care providers to manage their risk for coronary heart disease,” said, William Whang, an assistant professor of clinical medicine at Columbia University Medical Center in New York.

Women on antidepressants had more sudden cardiac deaths in the study than those with self-reported symptoms of depression. The increased risk was “very low,” about 46 cases for every 100,000 years of patient data, and may be due to chance, the authors said. Also, patients on medication may have worse depression, or the drugs may be altering the normal rhythm in the heart’s lower chambers, leading to cardiac arrest, the authors said.

“It’s certainly worth investigating further but based on this study alone, it’s premature to make any conclusions,” Whang said.

Bloomberg ( March 9, 2009)

Health monitoring comes to the iPhone. Heart patients will be able to check their electrocardiogram on an iPhone, using a new system demonstrated by Deutsche Telekom subsidiary T-Systems at the Cebit trade show in Hanover, Germany.

The system consists of a measuring device, which sends the results to a central server using GPRS (General Packet Radio Service). The server can then forward the results in real-time to, for example, an iPhone.

The server is used to enable more people to access the data, including patients and their doctors, according to Victor Grogger, head of solution development at T-Systems Austria. They would both log in with a user name and password to get access to the data.

IDG News Service (March 2, 2009

Optimists live longer, healthier lives than pessimists says a US study.

Researchers at the University of Pittsburgh looked at rates of death and chronic health conditions among participants of the Women's Health Initiative study, which followed more than 100,000 women ages 50 and over since 1994.

Women who were optimistic were 14 percent less likely to die from any cause than pessimists and 30 percent less likely to die from heart disease after eight years of follow up in the study.

Optimists were also less likely to have high blood pressure, diabetes, or smoke cigarettes.

The team, led by Dr. Hilary Tindle, also looked at women who were highly mistrustful of other people - a group they called "cynically hostile."

"Cynically hostile women were 16 percent more likely to die (during the study period) compared to women who were the least cynically hostile," Tindle said.

Tindle said the study does not prove negative attitudes cause negative health effects, but she said the findings do appear to be linked in some way.

"I think we really need more research to design therapies that will target people's attitudes to see if they can be modified and if that modification is beneficial to health," she said.

Reuters (March 7, 2009)

Risk of having another heart attack nearly doubled if Plavix is taken together with a heartburn drug like Prilosec, researchers say.

Plavix, also known as clopidogrel, and aspirin are often used to thin a patient's blood after a heart attack.

Doctors also may prescribe a proton pump inhibitor, or PPI, such as the heartburn drug Prilosec to cut the risk of gastrointestinal bleeding from blood thinners.

A study published in the Journal of the American Medical Association tracked 8,205 US patients treated for a heart attack or chest pain known as unstable angina and given Plavix and aspirin.

Two-thirds of these patients also took a PPI, primarily Prilosec, and had almost double the risk of having another heart attack or bout of unstable angina compared to those not taking a PPI, the researchers said.

Dr. Michael Ho of the Denver VA Medical Center said, "Our study highlights a potential interaction between clopidogrel and PPI medication. And it suggests that maybe PPI medication should not just be prescribed routinely in patients who are on aspirin and clopidogrel."

Some doctors urged caution regarding the findings.

"If we stop prescribing PPIs for these patients, we will see more bleeding complications. A big bleed for a patient with significant coronary artery disease could easily prove fatal," said Dr. Kirk Garratt of Lenox Hill Hospital in New York.

Reuters (March 3, 2009)

Editor's Note: Do not stop taking any of your medications without talking to your doctor first.

Anger and other strong emotions can trigger potentially deadly heart rhythms in certain vulnerable people, US researchers said.

Dr. Rachel Lampert of Yale University in New Haven, Connecticut, whose study appears in the Journal of the American College of Cardiology studied 62 patients with heart disease and implantable heart defibrillators.

Patients in the study took part in an exercise in which they recounted a recent angry episode while Lampert's team did a test called T-Wave Alternans that measures electrical instability in the heart.

Researchers specifically asked questions to get people to relive the angry episode. "We found in the lab setting that yes, anger did increase this electrical instability in these patients," Lampert said.

Next, they followed patients for three years to see which patients later had a cardiac arrest and needed a shock from their implantable defibrillator.

"The people who had the highest anger-induced electrical instability were 10 times more likely than everyone else to have an arrhythmia in follow-up," she said.

Lampert said the study suggests that anger can be deadly, at least for people who are already vulnerable to this type of electrical disturbance in the heart.

But she cautioned against extrapolating the results to people with normal hearts. "How anger and stress may impact people whose hearts are normal is likely very different from how it may impact the heart which has structural abnormalities," she said.

Lampert is now conducting a study to see if anger management classes can help decrease the risk of arrhythmia in this group of at-risk patients.

Reuters (February 23, 2009)

People paid to stop smoking are about 3 times more likely to quit and not have another cigarette than those given no cash, a study found.

Almost 15 percent of study participants who were given money as a reward were still not smoking six months after quitting compared with 5 percent in the group that didn’t get the cash incentive, research in this week’s New England Journal of Medicine found. Some people in both groups eventually started smoking again after the financial offers ended.

Smoking is the top cause of preventable death, responsible for killing about 438,000 people in the US each year, according to the study. Getting one person to stop smoking can save businesses about $3,400 a year by boosting productivity, decreasing absenteeism, and reducing illnesses, according to estimates from the Centers for Disease Control and Prevention.

Smoking can cause lung cancer, lung disease, heart disease, stroke and cataracts, according to the National Institutes of Health.

The study included 878 people who worked at GE in the US. Of those, 436 employees were given information about smoking- cessation programs along with an offer of cash incentives and 442 were only provided information about the programs, without money.

Those in the financial incentives group received $100 for completing the smoking-cessation program, $250 for not smoking within six months after enrolling in the study and $400 for abstinence after six months more, confirmed by saliva or urine tests. The trial was designed to see how many people remained nonsmokers nine or 12 months after enrolling in the study, depending on whether they initially stopped smoking within three months or six months of participating.

After an additional six months, 9.4 percent of the paid group still wasn’t smoking though they were no longer receiving cash rewards, compared with 3.6 percent of the other group.

About 70 percent of those who smoke in the US say they want to quit, but only 2 percent to 3 percent succeed each year, researchers said. Most relapses occur within the first month of quitting and about 90 percent of those who start smoking again do so within the first six months, according to the authors.

The study was supported by the US Centers for Disease Control and Prevention and the Pennsylvania Department of Health.

Bloomberg (February 11,2009)

Measuring a woman's heart rate at rest can help predict risk of heart attack or dying from heart disease, giving doctors a simple, inexpensive way to monitor health risks, researchers say.

The study published in the British Medical Journal showed that postmenopausal women with the highest resting heart rate were 26 percent more likely to suffer a heart attack or die from heart disease than those with the lowest rates.

Previous studies linked resting heart rate to similar problems in men but the relationship has been less certain for women, in part because trials did not include enough women to get a statistically significant result.

The US team measured the heart rates of 129,135 postmenopausal women with no history of heart problems. Resting heart rate measures beats per minute after sitting still to measure how well the heart works when not stressed.

Women with resting heart rates of more than 76 beats per minute were 26 percent more likely to have a heart attack or die from heart disease than those with heart rates of 62 beats per minute or lower, researchers said.

The researchers compensated for factors known to increase heart disease risk such as high blood pressure, high cholesterol, smoking and drinking, and monitored the women for an average of nearly eight years.

Although resting heart rate is usually lower among people who are physically fit, researchers said this measurement could help predict heart attack risk for women regardless of how much they exercise.

Reuters (February 4, 2009)

Patients who take clopidogrel following a heart attack are at significant risk of a recurrent heart attack if they also take certain widely used acid-lowering medications called proton pump inhibitors. The finding was the result of a study conducted by Dr. David Juurlink and colleagues at the Institute for Clinical Evaluative Sciences (ICES) in Toronto.

The research (over six years) involved more than 16,000 heart attack patients aged 66 years and older who were started on the blood-thinning drug clopidogrel (also known as Plavix). Scientists found that patients' risk for readmission to hospital for another heart attack was significantly higher if they were taking one of several proton pump inhibitors (PPIs). The PPIs found to increase this risk were omeprazole, lansoprazole, and rabeprazole. The investigators found no such increased risk for patients taking the PPI drug pantoprazole, or among those taking other acid-lowering medications called H2 receptor antagonists.

Clopidogrel, which makes blood platelets less "sticky" and thus less likely to clot, is routinely prescribed after a heart attack to prevent a recurrence. Previous research suggests that, with the exception of pantoprazole, PPIs can inhibit the liver's ability to convert clopidogrel to its active form, a critical step required for clopidogrel to exert its effect. Until now, clinicians have had no "real world" information about the clinical significance of the drug interaction between clopidogrel and PPIs.

Most patients treated with clopidogrel also receive acetylsalicylic acid (ASA) to prevent another heart attack, but ASA can cause bleeding from the stomach. Recent guidelines from the American Heart Association, the American College of Gastroenterology, and the American College of Cardiology recommend that patients aged 60 years or older who are receiving ASA also be treated with a PPI to reduce the risk of bleeding.

PPIs are among the most commonly prescribed drugs in the world, and are used to reduce gastric acid in patients with peptic ulcer disease and gastroesophageal reflux, as well as other conditions.

Researchers say their findings highlight an extremely common and completely avoidable drug interaction in a population of patients at very high risk for early re-infarction. They suggest that indiscriminate treatment with certain PPIs could result in thousands of additional cases of recurrent heart attack each year.

Marketwire - (January 28, 2009)

Health regulators reviewing effectiveness of the widely used blood thinner Plavix in some patients.

The move comes after several studies found the drug did not work as well in certain people possibly because patients metabolized it differently depending on their genetic makeup or their other medications, said the US Food and Drug Administration (FDA). While some reports have suggested a possible interaction that makes Plavix less effective, others have not found such an issue, the FDA said.

One type of drug often prescribed for patients taking Plavix is heartburn drugs such as AstraZeneca PLC's Nexium and Prilosec and other proton pump inhibitors.

Sanofi and Bristol, the makers of Plavix have agreed to conduct studies on genetic factors and drug interactions with Plavix, also known as clopidogrel bisulfate, the FDA said in a statement on its website.

The FDA said doctors and patients should continue to use Plavix as directed until further information is available. Doctors should reevaluate the use of some heartburn drugs, including over-the-counter versions, in patients taking Plavix, the FDA added.

Reuters (January 26, 2009)

Better air quality makes longer lives, Harvard Study says. Pollution from small particles is known to cause heart attacks, early death, decreased lung function and asthma, according to the US Environmental Protection Agency. The particles, which come from coal plants, car exhaust, fireplaces, furnaces, and other sources, are common in urban areas.

“Reductions in air pollution have improved life expectancy,” said the study’s lead author, C. Arden Pope, a professor of economics at Brigham Young University.

The researchers matched life-expectancy data from counties surrounding the cities with data on air quality, comparing two periods: 1979 - 1983, and 1999 - 2000. The scientists then analyzed the data by removing other variables that could affect life span such as income, education, and cigarette smoking.

Americans were living about 2.7 years longer at the end of the study compared with the start. About 15 percent of that came from a reduction in air pollution from fine air particles.

The study’s 51 cities included Boston, New York, Philadelphia, Washington, Pittsburgh, Atlanta, Houston, Dallas, Oklahoma City, Denver, San Diego, Los Angeles, San Francisco, Portland, Seattle, Minneapolis, St. Louis,

Bloomberg (January 21, 2009)

Study tracking a group of women for a decade casts doubt on value of testing for a certain genetic trait linked to heart disease to predict chances of illness, US researchers said.

Knowing a woman had the abnormality on chromosome 9 did not improve cardiovascular illness prediction compared to typical risk factors such as high blood pressure, smoking, cholesterol levels, diabetes, family history of heart attack and C-reactive protein as an indicator of arterial inflammation.

"Once you already know the traditional risk factors, the additional information about the genetic variation doesn't help any. It doesn't improve your ability to predict," said Nina Paynter of Brigham and Women's Hospital in Boston, who led the study reported in the Annals of Internal Medicine.

Genetic tests increasingly are being developed to help people gauge their risk for various ailments, but the value of some such tests has been unclear.

Paynter and colleagues tracked 22,129 US female doctors, nurses, dentists, and other health care professionals for 10 years, and determined whether they had the chromosome 9 trait through blood samples given at the outset of the study.

The study confirmed that women with the trait had about a 25 to 30 percent higher chance of getting cardiovascular disease, the researchers said. Scientists have not yet pinpointed the specific gene related to the trait, Paynter said.

Knowing a woman had the trait did not improve the ability to predict whether she had a low, medium or high risk for heart attack, stroke, death from cardiovascular disease or other cardiovascular illness, Paynter said.

Reuters (January 19, 2009)

Carb addiction blamed for bigger waistlines. Low-fat food versions backfiring, researchers say.

Addiction to high-glycemic index foods (which includes white bread, white bagels, white rice, and breakfast cereals) is playing a key role in why people are getting fatter, researchers from new Zealand say. The glycemic index is a measure of how fast and by how much a food raises blood sugar and insulin levels. High-glycemic foods also drive up insulin production, which tells the body to make and store fat.

With the focus on getting fat out of food, a food's carb content often increases. And despite a drum beat of bad news about the health risks, the numbers of overweight and obese are rising.

Canwest News Service (January 18, 2009)

Thousands of Canadians with high blood pressure being treated with a drug combination that increases the risk of sudden cardiac death, kidney disease, and the likelihood of dialysis, warns the Heart and Stroke Foundation.

The Foundation urges patients who have been prescribed a combination of ACE inhibitors and Angiotensin II Receptor Blockers (ARBs) to see their family physicians as soon as possible for a treatment change.

“These two popular categories of hypertension medication are each safe and effective treatments – but not together,” says Dr. Sheldon Tobe, spokesperson for the Heart and Stroke Foundation and CHEP executive member.

As many as 175,000 Canadians with high blood pressure may be currently treated with this combination of medications.

Angiotensin Converting Enzyme (ACE) inhibitors are a type of blood pressure medication that helps widens blood vessels, making it easier for blood to flow through. Angiotensin II Receptor Blockers (ARBs) inhibit the action of a peptide called angiotensin, which causes blood vessels to narrow, helping to relax the blood vessels and lower blood pressure.

In the ONTARGET study of 25,620 patients, the drug combination of an ACE inhibitor and an ARB was found to be only marginally more effective at lowering blood pressure than either of the drugs taken alone. In addition, patients on this combination experienced more side effects such as kidney problems than those on only one of the drugs. Patients were age 55 and over with vascular disease or high-risk diabetes.

If you are on this particular combination treatment for high blood pressure do not stop taking your medication. Instead go directly to your doctor for an alternative treatment.

Heart and Stroke Foundation of Canada(January 16, 2009)

French study found strong correlation between blood pressure and outdoor temperature in a large sample of the elderly. The study, which monitored 8801 participants over the age of 65 in the French Three-City study, found that systolic and diastolic blood pressure values differed significantly across the four seasons of the year and according to the distribution of outdoor temperature. The higher the temperature, the greater the decrease in blood pressure. These changes in blood pressure were greater in subjects 80 years or older.

Participants' blood pressure was measured at the beginning of the study in 1999 and again about two years later. Outdoor temperatures on the day of measurement were obtained from local meteorological offices. Participants in the Three-City study were from Bordeaux, Dijon and Montpellier.

Researchers said that although the study does not demonstrate a causal link between blood pressure and external temperature, the observed relationship nevertheless has potentially important consequences for blood pressure management in the elderly.

One possible explanation for the study findings lies in the emerging link between vitamin D and blood pressure. The elderly, especially those in care homes, are subject to vitamin D deficiency, largely as a result of their limited exposure to sunlight.

A report from the Framingham Heart Study published in 2008 found that moderate vitamin D deficiency nearly doubles the risk of heart attack, stroke, and heart failure over a mean of 5.4 years in patients with high blood pressure. The Nurses Health Study, also reporting in 2008, found that lower blood levels of vitamin D are independently associated with increased risk of hypertension; women with the lowest levels had a 66 per cent higher incidence of hypertension than those with the highest levels.

ScienceDaily (Jan. 16, 2009)

A smoking ban caused heart attacks to drop by more than 40 percent in one US city according to federal health experts.

Pueblo, Colorado, passed a municipal law making workplaces and public places smoke-free in 2003. The US Centers for Disease Control and Prevention (CDC) officials tracked hospitalizations for heart attacks afterward.

They found a decline of 41 percent (in the first year) and the effect lasted three years. "We know that exposure to second-hand smoke has immediate harmful effects on people's cardiovascular systems, and that prolonged exposure to it can cause heart disease in nonsmoking adults," said Janet Collins, director of CDC's National Center for Chronic Disease Prevention and Health Promotion. "This study adds to existing evidence that smoke-free policies can dramatically reduce illness and death from heart disease."

Long-term exposure to secondhand smoke can raise heart disease rates in adult nonsmokers by 25 percent to 30 percent, the CDC says.

Reuters (January 2, 2009)

Obstructive sleep apnea is a common disorder that increases the risk of developing cardiovascular diseases. Epidemiological studies have shown significant independent associations between sleep apnea and high blood pressure, coronary artery disease, arrhythmias, heart failure, and stroke. In randomized trials, treating sleep apnea with continuous positive airway pressure lowered blood pressure, attenuated signs of early atherosclerosis, and, in patients with heart failure, improved cardiac function; however, large-scale randomized trials are needed to determine, definitively, whether treating sleep apnea improves cardiovascular outcomes.

The Lancet (January 1, 2009)

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