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In the first published trial of its kind, a multi-center clinical study has shown that drug-eluting stents outperform the current "gold standard" radiation treatment in managing coronary restenosis and in preventing further clogging of coronary arteries.
Results of the TAXUS Express stent trial led by Columbia University Medical Center researchers at NewYork-Presbyterian Hospital/Columbia were published in the March 15 issue of the Journal of the American Medical Association. The study results were also presented March 12 at the American College of Cardiology's annual scientific meeting in Atlanta.
The trial studied 396 patients whose bare metal stents had become clogged with scar tissue, a common complication called restenosis. About half of the patients received paclitaxel-eluting stents, while the other half received vascular brachytherapy, which delivers radiation to the inside of the artery via a catheter. Vascular brachytherapy is currently the only FDA-approved treatment for restenosis after bare metal stent implantation. Paclitaxel is a drug that inhibits cell migration and prevents restenosis. The TAXUS Express stent is made by Boston Scientific Corp.
After 9 months, the trial showed that the paclitaxel-eluting stents reduced by 40 percent the number of patients needing additional procedures to clear the artery, compared to vascular brachytherapy. Angiographic measurements in both groups showed that patients who had drug-eluting stents experienced less than half as much restenosis (14.5 percent) as those who had brachytherapy (31.2 percent). If coronary artery blockage is more severe these patients may require heart bypass surgery, which is an open heart surgery procedure.
March 8, 2006
Pills To Lower LDLCholesterol
A pill containing plant substances called sterols can help lower cholesterol, as per scientists at Washington University School of Medicine in St. Louis.
The scientists studied patients who already were eating a heart-healthy diet and taking statin drugs to control cholesterol. The addition of plant sterols helped further lower total cholesterol and contributed to a nearly 10 percent reduction in low-density lipoprotein (LDL) cholesterol, the so-called "bad" cholesterol. Results of the study were reported in the American Journal of Cardiology.
The National Cholesterol Education Program recommends that those with elevated cholesterol eat foods containing plant sterols as a way to lower cardiovascular risk, but a number of sterol-containing foods are inconvenient for some patients.
Structurally similar to cholesterol, plant sterols can reduce the absorption of cholesterol in the gut by competing with cholesterol to get absorbed and transported into the body. When consumed in the diet, sterols are known to lower cholesterol levels, but sterols are not readily absorbed in the intestine unless they have been dissolved in something that the intestine can easily absorb. Because sterols are not water-soluble, past strategies have involved dissolving them in fat.
Most sterol-containing foods studied so far have been brands of margarine. Studies have observed that a daily intake of one or two tablespoons of sterol-containing margarine could significantly lower LDL cholesterol. Some juices and puddings also contain plant sterols.
"One problem is a number of of our patients already have lowered their intake of fats and calories and don't use products like margarine on a regular basis," says Anne Carol Goldberg, M.D., lead author of the new study and associate professor of medicine at Washington University. "In addition, a number of of these people eat out regularly, and they can't easily take a particular brand of margarine to a restaurant."
March 3, 2006
Heart Health And Marital Harmony
Hardening of the coronary arteries is more likely in wives when they and their husbands express hostility during marital disagreements, and more common in husbands when either they or their wives act in a controlling manner.
Those are key findings of a study of 150 healthy, older, married couples - mostly in their 60s - conducted by Professor Tim Smith and other psychologists from the University of Utah. Smith was scheduled to present the findings Friday March 3 in Denver during the annual meeting of the American Psychosomatic Society, which deals with the influence of psychological factors on physical health.
"Women who are hostile are more likely to have atherosclerosis [hardening of the coronary arteries], especially if their husbands are hostile too," Smith says. "The levels of dominance or control in women or their husbands are not related to women's heart health."
"In men, the hostility - their own or their wives hostility during the interaction - wasn't related to atherosclerosis," he adds. "But their dominance or controlling behavior - or their wives dominance - was related to atherosclerosis in husbands." Smith summarizes: "A low-quality relationship is a risk factor for cardiovascular disease."
Smith conducted the study with University of Utah psychologists Cynthia Berg, a professor; Bert Uchino and Paul Florsheim, both associate professors; and Gale Pearce, a Utah postdoctoral fellow now on the faculty of Westminster College in Salt Lake City.
The study - which began in 2002 and ended in 2005 - involved 150 married couples with at least one member between 60 and 70 years of age and the other one no more than five years older or younger. The couples were recruited through newspaper advertisements and a polling firm. Those who participated had no history of cardiovascular disease and were not taking medicine for it.
Each husband and wife was paid $150 to participate, and also received free of charge a $300 CT scan to look for calcification in their coronary arteries - the arteries that supply the heart muscle and that can cause a heart attack when clogged. Smith says that in otherwise healthy people, calcification represents hardening and narrowing of the arteries that puts them at risk for later heart attack.
Each couple was told to pick a topic - such as money, in-laws, children, vacations and household duties - that was the subject of disagreements in their marriage. Then, while sitting in comfortable chairs and facing each other across a table, each couple discussed the chosen topic for six minutes while they were videotaped.
Psychology graduate students coded the videotaped conversations so that "each comment that reflected a complete thought" was given a code indicating the extent to which it was friendly versus hostile, and submissive versus dominant or controlling.
For example, comments like, "You can be so stupid sometimes" or "you're too negative all the time," were coded as hostile and dominant. Another dominant or controlling comment would be, "I don't want you to do that; I want you to do this."
"A warm, submissive comment would be, 'Oh that's a good idea, let's do it,'" Smith says. "A less warm one would be, 'If it's important to you, I'll do what you want.' An unfriendly, submissive comment is, 'I'll do what you want if you get off my back.'"
March 1, 2006
Overactive Thyroid Causes Abnormal Heart Rhythm
Having an overactive thyroid gland is linked with an increased risk for atrial fibrillation (a type of abnormal heart rhythm), but neither an over- or under active thyroid gland is associated with a higher risk for other cardiovascular problems or increased risk of death, according to a study in the March 1 issue of JAMA.
Thyroid hormone excess and deficiency are common, and can be readily diagnosed and treated. Previous studies have suggested that abnormal levels of thyroid stimulating hormone (TSH) may represent a cardiac risk factor. Cardiovascular diseases (CVD) are the most common cause of death in the U.S. Even mildly altered thyroid status reportedly affects serum cholesterol levels, heart rhythm and rate, ventricular function, risk of coronary artery disease, and cardiovascular death. However, the relationship between abnormal thyroid function and cardiovascular outcomes remains unclear, according to background information in the article.
The researchers found that 82 percent of participants had normal thyroid function, 15 percent had subclinical (before symptoms) hypothyroidism (an underactive thyroid gland), 1.6 percent had symptomatic hypothyroidism, and 1.5 percent had subclinical hyperthyroidism (an overactive thyroid gland). After exclusion of those who had atrial fibrillation at the start of the study, individuals with subclinical hyperthyroidism had nearly twice the incidence of developing atrial fibrillation compared with those with normal thyroid function. No differences were seen between the subclinical hyperthyroidism group and the normal thyroid function group for the occurrence of coronary heart disease, cerebrovascular disease, cardiovascular death, or all-cause death. Likewise, there were no differences between the subclinical hypothyroidism or symptomatic hypothyroidism groups and the normal thyroid function group for cardiovascular outcomes or death.
Feb 27, 2006
Treatment Of Severe Coronary Artery Disease
Severe stenosis (blockage) to the left main coronary artery - a condition commonly called a "widow-maker"- can result in sudden death. For nearly 30 years, the gold standard for treatment has been coronary artery bypass surgery (CABG).
A study conducted at Cedars-Sinai Medical Center, however, suggests that angioplasty with coronary stenting may be a viable alternative treatment to more complicated bypass surgery for patients with left main coronary artery (LMCA) disease when medication-releasing stents are used. Introduced two years ago, these types of stents slowly release medication that helps to prevent reclosure of the coronary artery.
The study reports on the short- and intermediate-term clinical outcomes of 123 patients who underwent bypass surgery and 50 who were treated medically with angioplasty and medication-releasing stents, also called drug-eluding stents. None of the patients had prior bypass surgery.
"Despite the greater percentage of high risk patients in the group who underwent coronary stenting, there was no increase in the immediate or medium-term complications compared with the group treated with bypass surgery," said Raj Makkar, M.D., director of the Interventional Cardiology and Cardiac Catheterization Laboratory at Cedars-Sinai, and principal investigator on the study. According to Makkar, this is one of the first studies in the United States on the use of medicated stents for the treatment of LMCA disease. LMCA disease is found in five to seven percent of patients who undergo angiography.
The American College of Cardiology and the American Heart Association have discouraged the medical treatment of left main coronary artery disease based on poor clinical outcomes. The authors suggest that a re-evaluation of the optimal treatment for LMCA disease be considered based the results of this study and on recent data showing that angioplasty with drug-eluding stents provides better outcomes than bare-metal stenting for LMCA disease.
Compared to the bypass surgery group, the group treated with drug-eluding stents had more patients with chronic renal insufficiency and more patients with unstable angina as the presenting symptom. Forty-six percent of the bypass surgery group was considered high-risk patients compared to 64 percent in the group treated with drug-eluting stents.
Patients treated with bypass surgery had longer hospitalizations and, after one-month, had a higher percentage of strokes, but there was no statistically significant difference in mortality or myocardial infarction. Six months after treatment, there had been seven deaths in the bypass surgery group and two in the group treated medically.
Feb 23, 2006
New Heart-healthy Oat Now Available
The new HiFi oat cultivar is about 50 percent higher in beta-glucan than oats you'd buy at the grocery store. Click the image for more information about it.Health-conscious consumers can now get more of the soluble oat fiber called beta-glucan in their diets, thanks to a new oat variety developed by Agricultural Research Service (ARS) and North Dakota State University (NDSU) scientists.
Combined with a healthy diet, beta-glucan can help lower blood levels of so-called "bad" cholesterol, diminishing the risk of heart disease. In August, ARS and NDSU scientists published their joint registration of "HiFi," a new spring oat bred specifically for increased beta-glucan content.
According to Doug Doehlert, a cereal chemist with ARS' Red River Valley Agricultural Research Center in Fargo, N.D., HiFi boasts 50 percent more beta-glucan than whole-oat products now sold in grocery stores.
This means a consumer could eat less of a whole-oat product made with HiFi to get the same health benefit. Or, more of the food could be eaten to gain even more of beta-glucan's benefits, according to Doehlert, in the ARS center's Cereal Crops Research Unit.
Doehlert and Mike McMullen of NDSU have been cooperatively breeding oats since 1993. During routine grain analysis, Doehlert noticed something odd: One of the oat lines furnished by McMullen contained more beta-glucan than usual.
The oat also had good agronomic characteristics and excellent disease resistance, so its seed was made available for production in the northern Plains region. There, farmers grow oats primarily to feed livestock, and they prefer varieties with high fat content rather than high fiber.
Interest in HiFi for food products initially looked bleak, since such oats are normally imported from Canada or oat-producing regions of the United States other than the northern Plains. But health-label claims now permitted for foods containing beta-glucan have rekindled interest in HiFi, according to Doehlert. In fact, Organic Grain and Milling, Inc., of Hudson, Wis., is negotiating licensing rights with the NDSU Research Foundation to market HiFi as an organic brand.
Feb 20, 2006
Heart Transplantation Pioneer Dies
Norman Shumway, MD, PhD, was the father of heart transplantation and one of the pre-eminent heart surgeons of his time. (Photo courtesy of Stanford University)Norman E. Shumway, MD, PhD, professor of cardiothoracic surgery, performed the first successful human heart transplant in the United States in 1968 at Stanford. The recipient, 54-year-old steel worker Mike Kasperak, lived for 14 days. Shumway, the father of heart transplantation and one of the pre-eminent heart surgeons of his time, died Feb. 10 at his Palo Alto home of complications from cancer,
His landmark operation created a burst of enthusiasm for heart transplantation, though cardiac surgeons quickly lost interest because of the high rate of post-surgical deaths.
Shumway nonetheless persevered in the field amid controversy over legal and economic issues, particularly the issue of what constitutes brain death among potential donors. For nearly a decade, Stanford stood virtually alone as the only center performing the pioneering operation. Shumway and his colleagues made steady progress, paving the way for a procedure considered routine today.
"Many people gave it up when they thought it was too difficult, but Dr. Shumway had the persistence and vision that it could work. His determination to make heart transplantation work was absolutely crucial," said Bruce Reitz, MD, the Norman E. Shumway Professor of Cardiothoracic Surgery at Stanford and former chair of the department.
Nearly 60,000 patients in the United States have enjoyed longer lives because they received new hearts through transplant programs at some 150 medical centers around the country. At Stanford, some 1,240 patients have benefited from heart transplants.
Feb 17, 2006
Liver Protein Linked To Coronary Artery Disease
Image shows CREBH (green), a liver-specific transcription factor, in the nucleus of liver cells where it activates inflammatory response genes. The nucleus is surrounded by endoplasmic reticulum (red). Photo credit: Kezhong Zhang, Ph.D., U-M Medical School.A protein made by the liver may be linked to the development of coronary artery disease as per new research from University of Michigan Medical School. These researchers have identified a liver protein, called CREBH that triggers an inflammatory response in the liver and also may be involved in the development of coronary artery disease. This protein is a transcription factor that turns on the activity of specific genes in liver cells and is activated in response to cellular stress.
"This is the first evidence indicating that an acute inflammatory response in the liver can be triggered by stress in the endoplasmic reticulum," says Randal J. Kaufman, Ph.D., a Howard Hughes Medical Investigator and professor of biological chemistry in the U-M Medical School, who led the research study.
Results of the study are scheduled for publication in the Feb. 10 issue of Cell.
Scientists have known for some time that immune system cells release biochemical signals called cytokines, which travel through the bloodstream and activate an inflammatory response elsewhere in the body. But no one knew that liver inflammation could be triggered by signals from individual liver cells.
Feb 14, 2006
Diuretics Reduce Risk Of Death From Congestive Heart Failure
Diuretics reduce the risk of death, delay heart deterioration and improve exercise capacity in patients with congestive heart failure, a new review of studies shows.
Although widely used for quick relief of CHF symptoms - cough, shortness of breath and swelling in the feet, legs and ankles - up until now it was not known whether diuretics had a more substantial effect in treating CHF.
"The available data from several small trials show that in patients with chronic heart failure, conventional diuretics appear to reduce the risk of death and worsening heart failure compared to placebo," according to the review team led by Dr. Rajaa Faris of Saudi Arabia.
Diuretics, which help the body get rid of excess fluid, should be used in conjunction with other heart medications in treating CHF, the reviewers said.
The review appears in the most recent issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.
The researchers looked at data from 525 patients from 14 randomized clinical trials - seven comparing diuretics with placebo and seven comparing diuretics with other heart medications in treating CHF. The studies involved three types of diuretics: thiazide, potassium-sparing and loop diuretics, such as Lasix.
Sixty-one percent of the participants were men with an average age of 59.
The authors estimate that "80 deaths could be avoided for every 1,000 patients treated" with diuretics for CHF, but add that this evidence was based on only 15 deaths out of 221 participants from the studies that reported mortality rates.
CHF, also known as heart failure and cardiac failure, involves a decrease in the heart's ability to pump blood efficiently through the body, leading to a lower delivery of nutrients and oxygen to the cells and causing symptoms such as fatigue, shortness of breath and difficulty with even basic physical activity.
Five million Americans have CHF and 550,000 new cases are diagnosed yearly, according to the American Heart Association. There is no cure or surgical treatment for the disorder and physicians rely on a variety of medications to control symptoms and decrease damage to the heart and other organs in the body while improving patients' quality of life.
But some doctors question whether the benefits of the drugs outweigh the risks. Diuretics can have serious side effects such as depleting electrolytes (potassium and magnesium), which can contribute to irregular heartbeat and kidney disorders.
Feb 13, 2006
Diabetic Hearts Make Unhealthy Switch
The high-fat "diet" that diabetic heart muscle consumes helps make cardiovascular disease the most common killer of diabetic patients, according to a study done at Washington University School of Medicine in St. Louis. The study will appear in the February 7 issue of the Journal of the American College of Cardiology and is now available online.
Sixty-five percent of people with diabetes die from heart attack or stroke. When the researchers investigated fuel consumption in heart muscle, they found that heart muscle of type 1 diabetic patients relies heavily on fat and very little on sugar for its energy needs.
In contrast, heart muscle in non-diabetics doesn't have this strong preference for fat and can use either sugar (glucose) or fat for energy, depending on blood composition, hormone levels or how hard the heart is working.
"The diabetic heart's overdependence on fat could partly explain why diabetic patients suffer more pronounced manifestations of coronary artery disease," says senior author Robert J. Gropler, M.D., professor of radiology, medicine and biomedical engineering and director of the Cardiovascular Imaging Laboratory at the Mallinckrodt Institute of Radiology at the School of Medicine. "The heart needs to use much more oxygen to metabolize fats than glucose, making the diabetic heart more sensitive to drops in oxygen levels that occur with coronary artery blockage."
Compared to non-diabetics, diabetic patients often have larger infarctions and suffer more heart failure and sudden death when the heart experiences an ischemic (low-oxygen) event.
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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.
Medicineworld.org: Archives of heart-watch-blog
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