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March 24, 2006, 0:26 AM CT

A Better Look At Heart

A Better Look At Heart Image courtesy of Yale Medicine
Transesophageal echocardiography (TEE) is a newer development in echocardiography providing doctors with better imaging of the heart. In this procedure, a probe is inserted into the esophagus that transmits radio waves. Those waves are bounced off the heart and provide a moving image that can be seen more clearly than a traditional echocardiogram.

These more in depth images are providing further insight into certain conditions, and how doctors treat them. For example, TEE results were found to change or impact the therapy or evaluation of patients with stroke entities in 22 to 32 percent of individuals. This demonstrates that appropriate care can be improved in a large percentage of these patients by using TEE in the diagnostic work-up.

As a result of this research, TEE is increasingly being utilized in the diagnostic evaluation of patients with stroke, transient ischemic attack, or peripheral embolism.........

Posted by: Daniel      Permalink         Source


March 21, 2006, 9:56 PM CT

Low-dose Aspirin Suppresses Clumping Of Blood Platelets

Low-dose Aspirin Suppresses Clumping Of Blood Platelets
A once-daily pill of low-dose aspirin helps lower the potential for clot-forming blood cells - in both men and women - to stick together in narrow blood vessels, a study from Johns Hopkins shows.

In what is thought to bethe first direct comparison of blood cell testing in both sexes of 81 milligrams of acetyl salicylic acid a day, Hopkins scientists found aspirin treatment prevents the clumping together of these clot-forming cells, called platelets. Clots in blood vessels of the heart and brain can cause heart attacks and strokes.

However, while the drug's overall effects on blood cell function were the same for men and women, the researchers found that women's platelets reacted somewhat more strongly to aspirin before the start of treatment, and remained so even after therapy.

The study findings are reported in the Journal of the American Medical Association online March 21, and challenge the conclusions from several other recent studies, including the federal Women's Health Study, which showed low-dose aspirin had no effect in preventing heart attacks in women, even though it worked in men. Prior results, the scientists say, were not likely caused by the failure of aspirin to prevent platelets from clumping together and forming blood clots in women.........

Posted by: Daniel      Permalink         Source


March 16, 2006, 11:18 PM CT

Don't Stop That Plavix

Don't Stop That Plavix
Recent media reports regarding the results of the CHARISMA Trial may be misinterpreted by patients with coronary stents and other conditions, causing these patients to inappropriately stop taking the anti-clotting drug clopidogrel (Plavix). Patients taking Plavix- for any reason should consult with their cardiologist or other health care provider before stopping this medication.

The CHARISMA Trial was presented at the Annual Scientific Sessions of the American College of Cardiology on Sunday, March 12 in Atlanta and simultaneously reported in the New England Journal of Medicine. Eventhough the CHARISMA trial showed no benefit to combining Plavix and aspirin and for certain patients, this study does not invalidate use of the drug for approved indications, such as stenting. Certain other patients are given Plavix after hospitalization for heart attack or stroke. Patients with these conditions must discuss the benefits and risks of anti-clotting medicine with their health care provider and should not stop Plavix- on their own. Discontinuation of Plavix in patients with recently-placed stents can cause clot formation within the stent, resulting in serious harm or death.

As per the 2006 ACC/AHA/SCAI Guideline Update for Percutaneous Coronary Intervention (PCI), Class I recommendations indicate the use of aspirin and clopidigrel in patients undergoing angioplasty with stent implantation (contraindications include aspirin resistance, allergy or risk of bleeding).........

Posted by: Daniel      Permalink         Source


March 15, 2006, 9:33 PM CT

Treating Hypertension Early

Treating Hypertension Early
Treating pre-high blood pressure with medicine and lifestyle modifications reduces the risk of patients progressing to hypertension, a new study involving scientists at UT Southwestern Medical Center has concluded.

The findings, appearing in an upcoming issue of The New England Journal of Medicine, are the result of a four-year study of more than 800 patients who had a condition known as pre-hypertension. A blood pressure between 120 and 139 mm Hg systolic and 80 to 89 mm Hg diastolic indicates pre-hypertension.

"The recommended guidelines currently list lifestyle modifications for therapy of pre-hypertension," said Dr. Shawna Nesbitt, associate professor of internal medicine at UT Southwestern and an author on the study. "But the long-term maintenance of a lifestyle change is dismal. Patients typically don't stick to it."

Present guidelines recommend that pre-high blood pressure be managed with changes in the patient's lifestyle through weight loss, salt restriction, exercise and dietary modification. Despite intense efforts to keep patients from developing hypertension, an increasing number of people are diagnosed each year. High blood pressure is one of the leading causes of other cardiovascular ailments, including heart disease and stroke.

Dr. Nesbitt collaborated with scientists at several institutions to find out if therapy with angiotensin-receptor blockers, or ARBs, could prevent the development of hypertension. This is the first human study involving therapy of prehigh blood pressure with an ARB.........

Posted by: Daniel      Permalink         Source


March 15, 2006, 6:58 AM CT

New way to quit smoking

New way to quit smoking
Smokers trying to kick the habit might stand a better chance of staying smoke-free if they begin using replacement nicotine patches or gum in the weeks before they quit cigarettes.

That's a theory a team led by the Clinical Trials Research Unit (CTRU) at The University of Auckland's School of Population Health is testing in a study funded by the Health Research Council and National Heart Foundation.

Principal investigator Dr Chris Bullen says the conventional wisdom is that people trying to quit throw away their cigarettes and immediately replace them with a nicotine substitute, such as nicotine patches or chewing gum.

But some recent small-scale studies have suggested that the earlier use of a nicotine substitute might improve the chances of a person staying smokefree.

"It's been suggested that if a smoker starts using nicotine substitutes about a fortnight before quitting cigarettes, they are significantly more likely to remain smokefree six months later.

"We want to test this idea in a properly controlled, randomised trial".

Scientists from The University of Auckland together with colleagues in The Quit Group and the University of Otago will work with 1100 people, enlisted through the national Quitline. Half the participants will be offered nicotine patches or gum two weeks before they attempt to quit; the other half will begin using the patches or gum on the day that they quit.........

Posted by: Janet      Permalink         Source


March 13, 2006, 10:50 PM CT

Intensive statin therapy may partially reverse plaque build-up

Intensive statin therapy may partially reverse plaque build-up
A study presented today at the American College of Cardiology's 55th Annual Scientific Session demonstrates, for the first time, that very intensive cholesterol lowering with a statin drug can regress (partially reverse) the buildup of plaque in the coronary arteries. This finding has never before been observed in a study using statin drugs, the most usually used cholesterol lowering therapy. Prior research had indicated that intensive statin treatment could prevent the progression of coronary atherosclerosis, or arterial plaque build-up, but not actually reduce disease burden. ACC.06 is the premier cardiovascular medical meeting, bringing together more than 30,000 cardiologists to further breakthroughs in cardiovascular medicine.

The intense statin treatment used in this study resulted in significant regression of atherosclerosis as measured by intravascular ultrasound (IVUS), a technique in which a tiny ultrasound probe is inserted into the coronary arteries to measure plaque. The study showed that regression occurred for all three pre-specified IVUS measures of disease burden. The mean baseline LDL cholesterol of 130.4 mg/dL dropped to 60.8 mg/dL in the study patients, an reduction of 53.2 percent. This is the largest reduction in cholesterol ever observed in a major statin outcome trial. Mean HDL cholesterol (43.1 mg/dL at baseline) increased to 49.0 mg/dL, a 14.7 percent increase, which was also unprecedented. The arterial plaque overall was reduced by 6.8 to 9.1% for the various measures of disease burden.........

Posted by: Daniel      Permalink         Source


March 13, 2006, 10:39 PM CT

Obesity Surgery May Confer Cardiac Benefit

As rates of obesity in America continue to soar, surgery has become an increasingly popular solution when diet and exercise regimens fail. Bariatric surgery is now an approved therapeutic intervention for class II-III obesity, and may correlate to improved risk for heart disease. In a study presented today at the American College of Cardiology's 55th Annual Scientific Session, a team of scientists from the Mayo Clinic in Minnesota evaluated the effect of bariatric surgery on longterm cardiovascular risk and estimated prevented outcomes. ACC.06 is the premier cardiovascular medical meeting, bringing together over 30,000 cardiologists to further breakthroughs in cardiovascular medicine.

The team completed a historical study between 1990 and 2003 of 197 patients with class II-III obesity who undertook Roux-en-Y gastric bypass surgery (sometimes referred to as "stomach stapling"), compared to 163 control patients enrolled in a weight reduction program. With an average follow-up time of 3.3 years, the team recorded changes in cardiovascular risk factors such as cholesterol levels, body mass index (BMI) and diabetes criteria.

Though the team originally estimated a higher 10-year risk for cardiac events in the surgical group at the start of the study due to their associated conditions, scientists found at follow-up that the patients had a much lower risk than the control group for having a heart complication (18.3 vs. 30 percent). Using the study parameters and risk models based on previously published data, the team estimated that for every 100 patients, the surgery would prevent 16.2 cardiovascular events and 4.1 overall deaths, as compared to the control group. However, should the number of deaths during surgery approach 4 percent, the protective effect is limited, as may be in the case in centers with very low volumes of weight loss surgeries.........

Posted by: JoAnn      Permalink         Source


March 12, 2006, 10:28 PM CT

Drug-eluting Stents Outperform Radiation

Drug-eluting Stents Outperform Radiation
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 therapy 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 scientists at NewYork-Presbyterian Hospital/Columbia were reported 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 therapy 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).........

Posted by: Daniel      Permalink         Source


March 8, 2006, 9:39 PM CT

Pills To Lower LDL Cholesterol

Pills To Lower LDL Cholesterol
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.........

Posted by: Daniel      Permalink         Source


March 7, 2006, 0:13 AM CT

Finding and Treating Fetal Heart Defects

Finding and Treating Fetal Heart Defects
Doctors with Duke University Medical Center's Fetal Cardiology Program can accurately diagnose heart defects before birth with fetal echocardiograpy, a test similar to the ultrasound performed in an obstetrician's office.

"We believe the best care of a child with suspected or known congenital heart disease begins before the child is born," said Piers Barker, M.D. assistant professor of pediatric cardiology at Duke.

About 40,000 babies in the U.S. are born with heart defects each year, as per the March of Dimes. Heart defects are among the most common birth defects and are the leading cause of birth defect-related deaths, the organization says.

A fetal echocardiogram is similar to an obstetrical ultrasound; both use sound waves to create an image of the fetus. However, fetal echocardiography ultrasound is designed to clearly capture pictures of a tiny, fast beating fetal heart. It is painless and non-invasive.

Early diagnosis of congenital heart defects is important because it allows parents and physicians time to prepare for care after the baby is born, Barker said. In most cases, expectant mothers can continue to see their regular obstetrician, he said. "However, if a fetus has complex congenital heart disease, we often recommend the mother deliver at a tertiary care hospital with immediate access to a level III NICU and pediatric cardiothoracic surgeons," Barker said. A NICU is a neonatal intensive care unit.........

Posted by: Daniel      Permalink         Source



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Did you know?
An advanced study launched at Yale School of Medicine is evaluating the role of statin therapy in patients with heart failure, one of the leading causes of hospitalization in people over age 65.While statins-drugs that inhibit cholesterol production in the liver-are used primarily to lower cholesterol levels, there is evidence that these drugs may also have beneficial effects on blood vessel function independent of cholesterol levels. Heart failure patients are known to have vascular dysfunction, but are impaired and not routinely considered for statin therapy. The Yale trial, "Short Term Effects of Statin on Vascular Function in Heart Failure," will assess vascular function before and after a short course of statin therapy in heart failure patients with normal cholesterol levels. The randomized trial will include 30 patients with mild to moderate chronic heart failure.

Medicineworld.org: Archives of heart news blog

Aggressive heart therapies still underused| Aspirin might prevent vioxx cardiac damage| Bariatric surgery to control weight in cardiac patients| Black immigrants from africa arrive healthier than those from europe| Exercise stress management gives physiological benefits for heart patients| Heart and cell signaling| Link between obesity inflammation and vascular disease found| Pig hearts in nonhuman primates a success story| Strategies to raise hdl cholesterol levels| Stress test identifies high risk people for coronory heart disease|

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