Heart Watch Blog: From Medicineworld.org
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Researchers say that chronic stress can induce rapid blocking of arteries after a balloon angioplasty procedure. These researchers from the Georgetown University Medical Center say that blocked coronary arteries after angioplasty affect 41 percent of patients who undergo the procedure and can lead to death.
The only comforting news is that, stress-induced atherosclerosis could be prevented by blocking a certain neuropeptide in blood vessels. Their findings are published in the American Heart Association journal Arteriosclerosis, Thrombosis and Vascular Biology.
This study is the newest addition to a series of new studies that showed how chronic stress can be a high risk factor for accelerated atherosclerosis and heart attack. The study showed that the effects of stress were more rapid than the effects of a fat-rich diet in causing atherosclerosis.
For us it may be easier to control our diet than controlling our stress level. Somehow it accumulates through the day. If only the stress reduction concept was that simple, then I would have adopted it instantaneously, but the problem is that most of that stress is beyond your control. We constantly worry about many things including our jobs, financial difficulties, personal relationships and more. What is the solution? Where is the cure?
I was reading a study, which was presented in the recent meeting of the American Medical association. Basically it did not suggest anything that we didn't know, but just reconfirmed our thoughts.
Researchers said that a combination of diet and low-dose pravastatin (prvachol) reduced the risk of coronary heart disease (CHD) in people with moderately elevated cholesterol. I am sure an active exercise program would add to the benefits, even though the researchers did not mention this.
The study showed 33 percent reduction in the coronary artery disease in those people with high cholesterol level who were taking pravachol and eating a healthy diet compared to those who were on diet therapy alone. This was a study from Japan and it was the first study in Japan to show reduction in the coronary artery disease from statin therapy. The benefits were seen both in men and women.
These interesting findings are published in the recent issue of Archives of Internal Medicine. Researchers compared the patterns of care and outcomes of 28,521 Medicare patients with 8,180 similarly aged patients hospitalized in Canada. Compared to Canadian patients, those in the U.S. had almost a 20 percent lower risk of dying within 30 days of being hospitalized for heart failure, but by one year there was virtually no difference in the survival rates.
"Despite being based on the same medical literature, the health care systems in the United States and Canada have very different results with respect to patients with heart failure," said principal investigator Harlan M. Krumholz, M.D., professor of medicine at Yale and director of Yale-New Haven Hospital Center for Outcomes Research and Evaluation. "The findings raise questions about whether the American system is poised to provide better acute care, whereas the Canadian system is better positioned to provide chronic care."
Dennis Ko, M.D., lead author of the article and assistant professor, University of Toronto, said there are several potential explanations for our results. "The Canadian system has a greater emphasis on primary care and all patients have health insurance, including a drug benefit. It is possible that our approach leads to better patient follow-up and fewer financial barriers to care."
The study also showed that patients hospitalized in the United States were more likely to undergo tests and procedures, but just as likely to receive medications.
"Both systems can likely improve, but the American system may want to focus attention on outpatient care whereas the Canadian system may want to examine their inpatient care more closely," said Krumholz.
"Patients with depression are more likely to suffer heart attacks and heart failure, and more likely to die of heart disease, and no one knows why," says Whooley "These results give us two intriguing clues: one behavioral, one biological."
One of her studies looked at the association between depression and self-reported medication adherence in 940 patients with stable coronary heart disease, 204 of whom had diagnosis of depression. Fourteen percent of the depressed patients reported not taking their medications as prescribed over a 30-day period, compared with 5 percent of the non-depressed patients. This study appears in the November 28 issue of Archives of Internal Medicine.
Another study examined 24-hour urinary norepinephrine levels in 598 coronary disease patients, 106 of whom had depressive symptoms. A total of 9.4 percent of the depressed participants had a urinary norepinephrine value above the normal range, compared with 3.3 percent of the non-depressed participants. In addition, the more depressive symptoms a participant had, the higher the participant's norepinephrine levels. This paper appears in the November 2005 issue of the American Journal of Psychiatry.
Neither study indicates a mechanism for adverse coronary outcomes "because we were only looking at cross-sectional data," stresses Whooley, who is also an associate professor of medicine at the University of California, San Francisco.
The Hopkins team found that shifting about 10 percent of calories from carbohydrate to either protein-rich foods, mostly from plant sources, or to monounsaturated fats, contained in olive and canola oil, provided a major benefit to the heart.
"Our study provides strong evidence that replacing some carbohydrate with either protein or monounsaturated fat has important health benefits," says internist Lawrence Appel, M.D., M.P.H., a professor of medicine at the Johns Hopkins School of Medicine and lead author of the study. "There is already agreement that reducing saturated fat lowers risk for heart disease, but the question of which macronutrient to emphasize has been controversial.".
Appel makes clear that his study does not support extremely high-saturated-fat, low-carbohydrate diets such as the Atkins diet, which he says is not a healthy diet plan.
The study, called the Optimal Macronutrient Intake Trial to Prevent Heart Disease (OmniHeart), evaluated three healthy diets that differed mainly in the amount of macronutrients - protein, fat and carbohydrate - that provide calories used for energy in the body. All three diets were low in saturated fat, cholesterol and sodium, and rich in fruits, vegetables, fiber, potassium and other minerals. However, one diet was a traditional healthy diet, rich in carbohydrate, while in the other two diets approximately 10 percent of its calories from carbohydrate were replaced with either monounsaturated fat or protein. In the protein-rich diet, about half came from plants.
"All three diets reduced overall heart disease risk, lowering blood pressure and improving cholesterol levels," says Appel. "But the protein and monounsaturated fat diets had an edge over the carbohydrate-rich diet".
Image courtesy of Johns HopkinsResearchers at Johns Hopkins are doing their homework! Using magnetic resonance imaging (MRI) scans of the heart wall, researchers at Johns Hopkins have found that people whose muscle wall thickness contained more than 25 percent scar tissue were approximately nine times more likely to test positive for a fast and dangerous heart rhythm known as ventricular arrhythmia.
Patients at risk of such arrhythmias often have a heart defibrillator implanted, a small device that delivers an electrical shock to restore their cardiac rhythm in case the heart beats too rapidly to pump enough blood to the rest of their body.
United States Centers for Disease Control and Prevention estimate that each year more than 400,000 Americans suffer a sudden cardiac death, at least 30 percent of which are due to arrhythmia.
"If further tests confirm that MRI measurements of scar tissue accurately predict the risk of arrhythmia-related sudden death, these could become the gold standard for screening who really needs or does not need a defibrillator," says the study's senior author, electrophysiologist Henry Halperin, M.D., a professor of medicine, radiology and biomedical engineering at The Johns Hopkins University School of Medicine and its Heart Institute. "While tests are widely available to screen patients with coronary artery disease for risk of sudden cardiac death, tests are not so effective for identifying the many who will die suddenly from arrhythmias."
"Our MRI technique has significant advantages over existing methods because it avoids the risks of infection that come with surgery, it is noninvasive, there are no catheters, and it is relatively easy to perform, taking only 45 minutes," says study co-author and cardiologist Joao Lima, M.D., an associate professor of medicine and radiology at Hopkins.
Lima notes that a patient with an ejection fraction of 60 percent has normal pumping ability, but anything less than 30 percent for a period of nine months or longer is considered low and an immediate risk factor for arrhythmia. He adds that if a patient has an ejection fraction that is slightly above 30 percent, then an electrophysiology test is used to determine if a patient requires a defibrillator. In this test, a thin catheter is inserted into the heart to try to induce an arrhythmia, something that will fail if the heart is healthy and not at risk. However, if it happens once, it is known to be two to four times more likely to happen again, he says.
This new finding is from a report of research findings announced in the American Heart Association Scientific Sessions.
"The minimally invasive procedure effectively bypassed or opened blocked arteries in all 27 patients, an outcome as good or better than you would expect with open chest surgery," saya Marc R. Katz, M.D., lead author of the study and chief of cardiac surgery and director of the Virginia Transplant Center at Henrico Doctors' Hospital in Richmond.
"The patients stayed in the hospital an average of only two and a half days, compared with five or six days for conventional CABG surgery," Katz said. "And they were back to work in a week or so, compared with the usual six to 12 weeks."
The study involved patients with multi-vessel coronary disease, including obstruction of the left anterior descending coronary artery (LAD), the main artery in the front of the heart.
During the closed-chest bypass procedure, the left internal mammary artery (in the chest) was harvested. Doctors then sutured the mammary artery to the obstructed LAD, bypassing the obstruction, all done endoscopically.
During the angioplasty procedure, doctors used stents (mesh tubes) to unblock other arteries and then prop them open.
"Using the left internal mammary artery to bypass the LAD is the one thing we can do for patients with coronary artery disease that has a proven survival advantage," Katz said. "Here is a way to accomplish that and also open other vessels in a very minimally invasive way."
The daVinci robotic system is a powerful computer interface that allows surgeons to sit at a console with full vision of the operative field. The surgeon's usual surgical hand movements are translated through the miniature robotic arms inside the patient. The robotic arms, with interchangeable instruments at their tips, precisely follow the surgeon's hand movements.
These findings from a Swedish study are published in a recent issue of the journal Circulation which is journal published by the American Heart Association.
"In this study, pre-term birth was identified as a new and very early risk factor for high blood pressure," said Stefan Johansson, M.D., lead author of the study and a neonatologist at the Karolinska University Hospital in Stockholm. "The risk was particularly high among young men who were born at least eight weeks early.
"The association between pre-term birth and high blood pressure is unlikely to be explained by family history or genetic factors. Instead, early environmental challenges faced by the premature baby may affect development permanently, contributing to higher blood pressure in adulthood."
The study participants were men born of Nordic women, a predominately-Caucasian population. More research is needed to determine whether these results apply across racial lines, Johansson said.
The study involved 329,495 Swedish men born between 1973 and 1981 and drafted for military service between 1993 and 2001. Compared with men born full-term, researchers found that men who were born: extremely pre-term have almost twice the risk of high blood pressure.
The increased risk associated with loud noise is because of the physiological and psychological stress caused by the noise which includes work noise as well.
"Workplace protection for noisy workplaces should be reconsidered," said lead researcher Dr. Stefan Willich, director of the Institute for Social Medicine, Epidemiology and Health Economics at Charite University Medical Center, Berlin.
"Currently, in many countries the threshold for ear protection is 85 decibels," Willich said. "According to our results it should be lowered to somewhere between 75 and 80 decibels," he said.
This research finding is published on the latest issue of European Heart Journal. In this study, Willich's and colleagues team compared data on 2,000 heart attack patients with data on more than 2,000 patients admitted to trauma and general surgery departments for reasons other than heart attack.
They found that exposure to environmental noise, such as that of traffic, tripled the risk of heart attack for women and boosted it by nearly 50 percent for men.
"Reducing traffic noise makes sense from a medical point of view," Willich said.
On the other hand, his team found that workplace noise increased heart risks for men by nearly a third but did not seem to affect women.
Patients with diabetes are at high risk of developing of cardiovascular events, and should be on preventative aspirin therapy. This is as per the current recommendations of American Diabetes Association and U.S. Preventive Services Task Force.
This survey, which was conducted by Harris Interactive in collaboration with the ACPM, was supported by an unrestricted educational grant from Bayer HealthCare, the makers of Bayer Aspirin.
Heart attack and stroke are the most life-threatening consequences of diabetes, occurring more than twice as often among people with diabetes than in those who do not have the disease, and accounting for approximately 65% of deaths in people with diabetes. According to the American Diabetes Association, a diagnosis of diabetes as an adult presents a similar level of coronary heart disease risk as already having suffered a heart attack.
"The survey findings suggest that insufficient numbers of Americans with diabetes are aware of the cardio-protective benefits of aspirin," commented George K. Anderson, MD, MPH, past president of the ACPM.
It's important to remember that aspirin is not appropriate for everyone, so be sure to talk to your doctor before you begin an aspirin regimen. If you are taking a prescription product for diabetes, it is especially important to talk to your doctor because aspirin can interfere with certain diabetes medications.
Doctors commonly try to aggressively lower LDL cholesterol level with statin drugs like Lipitor in patients with established coronary heart disease. In a recent clinical trial among patients with acute coronary syndromes, there was no significant benefit was observed for aggressive lowering of LDL cholesterol to a target value well below 100. The most common treatment regimen among these patients was Zocor (simvastatin).
It is to be mentioned that another study comparing high and low doses of Lipitor (atorvastatin) in stable coronary artery disease patients had found significant improvement in prognosis with respect to cardiovascular disease. In that study, however, the benefit of reduced cardiovascular death appeared to have been offset by a higher number of deaths due to non-cardiovascular causes. Even though this may have occurred just by chance, it led to a call for further safety information on the use of Lipitor (atorvastatin) at a dose of 80 mg/d.
The authors conclude that when comparing standard and intensive LDL cholesterol lowering therapies in patients with previous myocardial infarction, there was no significant reduction in the major coronary events, but there was reduced risk of other events like nonfatal acute myocardial infarctions. There were no differences in cardiovascular and all-cause death rates. The results indicate that patients with myocardial infarction may benefit from intensive lowering of LDL-C without increase in noncardiovascular mortality or other serious adverse reactions," the authors conclude.
"The prevalence of diabetes mellitus in industrialized countries is rapidly increasing, and diabetes is suspected to carry a particularly high risk for sudden cardiac death," Dr. Xavier Jouven, of Universite Paris-5, France, and colleagues wrote.
The researchers examined the association between blood sugar level, diabetes and the risk of sudden cardiac death among individuals enrolled in the Group Health Cooperative of Puget Sound.
The study included 2,040 subjects who experienced out-of-hospital cardiac arrest between 1980 and 1994. They were compared with 3,800 control subjects, derived from a random sample of enrollees.
The researchers classified the subjects as having no diabetes, borderline diabetes, diabetes without disease of the small blood vessels, and diabetes with disease of the small blood vessels.
After accounting for potential contributing factors, the team found a progressively higher risk of sudden cardiac death associated with borderline diabetes (24 per cent), diabetes without disease of the small blood vessels (73 per cent), and diabetes with disease of the small blood vessels (266 per cent) compared with no diabetes.
High blood sugar levels can promote disease of the small blood vessels without causing symptoms, they note, which might contribute to sudden cardiac death risk.
About 13 million Americans (about 7 percent of the total population) suffer from coronary artery disease. Coronary artery disease is the leading cause of death in American men and women amounting a staggering 20 percent of all causes of death. About half of all deaths related to cardiovascular diseases occur from coronary artery disease. Through this heart watch blog we will have our humble contribution towards making men and women aware of the risks of heart diseases.
Heart Watch Blog: From Medicineworld.org
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