http://www.medicalnewstoday.com/articles/252115.php

Exercise Benefits Brain In Middle Age

Gym-style exercise may improve not only general health in middle age, but also brain function, according to new research presented at the Canadian Cardiovascular Congress that is taking place in Toronto from 27 to 31 October.

The study, conducted by the Montreal Heart Institute (MHI), with the University of Montreal, and the Montreal Geriatric University Institute, found that cognitive ability improved significantly in a group of six middle-aged people with increased cardiovascular risk who followed a four-month program of high intensity interval training combined with resistance training.

High Intensity Interval Training

High Intensity Interval Training (HIIT) or High Intensity Training (HIT), is a form of exercise where you do a number of shorts bursts of intense and effortful activity alternating with short, less effortful work, such as a series of 30-second sprints with 30 seconds of walking or jogging in between.

It is not a new idea, but has come to prominence in recent years as more researchers have looked into and measured its health benefits. It came under the media spotlight in the UK in February 2012, when medical journalist Michael Mosley appeared in a TV program, where he tried a form of high intensity interval training and was pleasantly surprised by the results.

There are various forms of HIIT, depending on the intensity and duration of the effortful bursts, and fitness goals.

The Study

In this study the HIIT training the participants underwent alternated between short periods of low and high intensity aerobic exercise on stationary bicycles.

For four months, they had twice-weekly sessions of high intensity interval training combined with twice-weekly resistance training.

One of the researchers, Anil Nigam, chief of clinical care at MHI and also of the University of Montreal, says in a statement they worked with six middle-aged people who followed this program.

All six participants were overweight (their BMI was between 28 and 31) and had one or more cardiovascular risk factors. BMI is short for Body Mass Index, a measure of obesity that equals a person's weight in kilos divided by the square of their height in meters (BMI over 30 is considered obese, 25 to 30 is overweight).

Nigam explains the range of physical and mental measurements the participants underwent:

"Our participants underwent a battery of cognitive, biological and physiological tests before the program began in order to determine their cognitive functions, body composition, cardiovascular risk, brain oxygenation during exercise and maximal aerobic capacity."

The cognitive tests covered a range of memory and thinking exercises, such as remembering pairs of numbers and symbols.

Brain Oxygen

Using very sensitive instruments, the researchers also looked at how the participants' brains used oxygen while they exercised or did the mental tests. The instruments, which rely on near-infra red spectroscopy (NIRS), can detect minute changes in the volume and oxygenation of blood in the brain.

"Cognitive function, VO2max and brain oxygenation during exercise testing revealed that the participants' cognitive functions had greatly improved thanks to the exercise," says Nigam.

VO2max is a measure of the body's ability to take in, transport, and use oxygen during physical exertion. It also affects the body's ability to provide the brain with oxygen, which in turn impacts cognitive function.

At the end of the program, the participants also had smaller waists and less fat mass around the trunk of the body.

"We also found that their VO2max, insulin sensitivity had increased significantly, in tandem with their score on the cognitive tests and the oxygenation signals in the brain during exercise," says Nigam.

The study, which was funded by the ÉPIC Centre and Montreal Heart Institute Foundations, appears to support other recent research on the effect of exercise on the brain. Earlier this month, scientists at the University of Edinburgh reported that exercise may protect aging brains better than mental or leisure pursuits.

Now You See the Stent, Now You Don't

Now You See the Stent, Now You Don't

MIAMI -- Some say bioabsorbable stents need more data, others say current drug-eluting stents are fine, but none of that mattered to the standing-room-only crowd who heard the latest research here on this novel technology.

The truth is that the current generation of drug-eluting stents have a good safety profile, with a very late stent thrombosis rate of about 0.5%.

But that was not the case when research began on bioabsorbable stents. Those were the days of first-generation drug-eluting stents, and even though DES revolutionized coronary revascularization, the advance came with two costs, Thomas Tu, MD, of Louisville Cardiology Group in Louisville, Ky., told MedPage Today at the Transcatheter Cardiovascular Therapeutics scientific symposium here.

"First, was the price, which was significantly higher than bare metal stents. Second, was the concern for longer duration of dual antiplatelet therapy," Tu said. "The fact that there were still questions about drug-eluting stents spurred further interest in perfecting this technique of opening blocked arteries."

Implanting a stent is an intentional injury to the coronary wall. It's a trade-off for unblocking the artery. Bare metal stents had no way of healing this acute injury, so, researchers developed stents with drugs that softened the acute intrusion.

This worked well for a while until it was evident that drug-eluting stents incurred a risk for late and very late stent thrombosis (after a year). Many pegged the source of the problem as the stent polymer, the drug carrier.

The next logical step was to develop a stent whose polymer would dissolve over time, leaving only a bare metal stent behind. In theory, this would solve the problem of the acute injury because the drug elutes early to help heal the endothelium and solve the problem of late stent thrombosis because the polymer disappears within 3 to 9 months.

How is this theory holding up under the research? Pretty good, discussant Antoine LaFant, MD, of the Hospital European Georges Pompidou in Paris, told MedPage Today.

"From this session, we can learn that bioabsorbable stents in humans have longer follow-up, from 3 to 5 years, which is quite reassuring in terms of the safety and efficacy," LaFant said.

Interestingly, LaFant and colleagues are pushing the envelope even further. They are developing a stent without a drug that disappears 3 months after implantation. "We take advantage of the positive remodeling resulting from the dismantling of the stent," he said. In preclinical studies, they have seen negative late loss at 9 months without any drugs. In July, they implanted the first human with this stent in a trial called ARTDIVA.

Patrick W. Serruys, MD, PhD, of Erasmus Medical Center in Rotterdam, The Netherlands, presented 5-year data from the all-comers LEADERS trial that compared two stents: the BioMatrix Flex, which has a biodegradable polymer that dissolves within 6 to 9 months and elutes biolimus (a semi-synthetic sirolimus analogue), and the Cypher Select, a first-generation sirolimus-eluting durable polymer stent that has been discontinued.

The BioMatrix Flex proved noninferior in the long-term to the Cypher in terms of major adverse cardiovascular events, and showed a significant reduction in very late stent thrombosis (0.66% versus 2.5%, P=0.003 for superiority).

Several bioabsorbable stents are approved in Europe, but none are FDA-approved.

Dual Antiplatelet Therapy

One of the theoretical advantages of the bioabsorbable stent is the potential to shorten the duration of dual antiplatelet therapy. But all studies of bioabsorbable stents so far have not veered from the recommended 12-month duration.

"How will we know if we can shorten therapy duration if no one will conduct a trial comparing 12-month duration with 6- or even 3-month duration," said Sigmund Silber, MD, of the Heart Center at the Isar in Munich, Germany, in an interview with MedPage Today.

Silber was involved in developing the original guidelines for dual antiplatelet therapy for the European Society of Cardiology. He and others looked at the data (no randomized trials), which suggested a threshold of 6 months would be optimal.

"The American's later became a little nervous and arbitrarily picked 1 year as the duration, but there are no data to support that," he said.

Interestingly, Silber and colleagues reviewed pooled data from the RESOLUTE global studies, which compared two second-generation drug-eluting stents with permanent polymers. About 1,000 of the 5,000 patients had interrupted or discontinued their dual antiplatelet therapy. Those who discontinued therapy after at least 1 or 3 months did not have any stent thrombosis at 1 year. But those who discontinued therapy in less than a month did have stent thrombosis within a year, he reported here at the TCT meeting.

"This was a very surprising finding, and although this post hoc analysis must be interpreted with caution, it does put the duration of dual antiplatelet therapy with a durable polymer in an interesting perspective," he said.

Silber is not convinced that the polymer is solely responsible for late stent thrombosis. He has yet to see convincing data. He also doubts he would use a bioabsorbable stent because the latest generation of drug-eluting stents are very good and without a shorter duration of antiplatelet therapy, he doesn't see an advantage.

Another concern is the price, which is about four to five times that of current drug-eluting stents. In Europe, these stents are not reimbursed, Silber said.

When, Not If

There seemed to be more people who believed that it's only a matter of time before drug-eluting stents with bioabsorbable polymers become routine in the cath lab. The evidence so far is good for relatively simple lesions, but these novel stents have not been tested in complex lesions, bifurcations, left main disease, heavily calcified lesions, total occlusions, and tortuous vessels, noted Ricardo Costa, MD, of the Cardiovascular Research Center in Sao Paulo, Brazil, in an interview with MedPage Today.

"I believe bioabsorbable stents have the potential to be incorporated in a significant proportion of PCI cases, but it will be very difficult to replace the low-profile modern drug-eluting stents we have today because they have very good results," he said.

Trying to convince interventional cardiologists to use bioabsorbable stents instead of those with a durable polymer may be challenging.

"I think saying that we have a tool that has the same advantages of the current stents but is a little better is probably not the best way to think about bioabsorbable technology," he said.

Tu suggested that bioabsorbable stents might find a home in other vascular beds, such as the superficial femoral artery, which is in constant motion and has resisted for the most part efforts from conventional stents.

He also said that it might be possible to use a completely bioabsorbable stent to deliver drugs to vulnerable plaque. The drug would heal the soft plaque and there would be no concomitant risk of having a permanent metallic stent in the body.

http://www.medpagetoday.com/MeetingCoverage/TCT/35552

Atrial Fibrillation: Radiofrequency Catheter Ablation And Antiarrhythmic Drug Therapy Compared | CardioBrief

http://cardiobrief.org/2012/10/24/atrial-fibrillation-radiofrequency-catheter-ablation-and-antiarrhythmic-drug-therapy-compared/

Atrial Fibrillation: Radiofrequency Catheter Ablation And Antiarrhythmic Drug Therapy Compared

A trial comparing radiofrequency catheter ablation (RFA) to antiarrhythmic drug therapy (AAD) as initial therapy for atrial fibrillation (AF) found no difference in the overall burden of AF between the groups. But the trial also turned up evidence supporting the use of RFA as an initial treatment strategy in some patients.

In a paper published in the New England Journal of Medicine, European investigators report on 294 patients with paroxysmal AF with no previous use of AADs who were randomized in the MANTRA-PAF (Medical Antiarrhythmic Treatment or Radiofrequency Ablation in Paroxysmal Atrial Fibrillation) trial. Patients– under 70 years of age and with no other major heart disease– were healthier than the general AF population.

The investigators found no significant differences in the cumulative burden of AF or the burden at  3, 6, 12, or 18 months. However, at 2 years the AF burden was significantly reduced in the RFA group compared with the AAD group (90th percentile of AF burden: 9% for RFA versus 18% for AAD, p=0.007). In addition, the percentage of patients with no AF and no symptomatic AF was higher in the RFA group than in the AAD group (85% vs. 71%, p=0.004; 93% vs. 84%, p=0.01, respectively). In the RFA group, there were three cases of cardiac tamponade in addition to one death after a procedure-related stroke. In the AAD group 36% of the patients received supplementary RFA.

The overall results, write the authors, "support the current guidelines recommending antiarrhythmic drugs as first-line treatment in most patients with paroxysmal atrial fibrillation." However, the positive findings for RFA, as well as the high number of crossovers from AAD to RFA, suggest that "a substantial minority of patients" treated with AAD "may eventually require ablation for adequate rhythm control."

In an accompanying editorial, William Stevenson and Christine Albert mention the "substantial procedural risks" associated with RFA and warn that the results should not be extrapolated to different patient populations, since the MANTRA-PAF population was younger and healthier than the general AF population. They express hope that the much larger CABANA (Catheter Ablation versus Anti-arrhythmic Drug Therapy for Atrial Fibrillation) trial will provide more definitive evidence about RFA. RFA, they conclude, is "a reasonable option for patients with symptomatic paroxysmal atrial fibrillation before therapy with an antiarrhythmic drug."

PFO Closure With Investigational Device Does Not Decrease Ischemic And Bleeding Events Compared To Medical Therapy

Cardiovascular / Cardiology News From Medical News Today PFO Closure With Investigational Device Does Not Decrease Ischemic And Bleeding Events Compared To Medical Therapy

Main Category: Cardiovascular / Cardiology
Article Date: 27 Oct 2012 - 0:00 PDT

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PFO Closure With Investigational Device Does Not Decrease Ischemic And Bleeding Events Compared To Medical Therapy

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Results of the PC trial presented at TCT 2012

A clinical trial that compared catheter-based PFO closure using an investigational device found that there was no significant reduction in ischemic and bleeding events compared to standard medical therapy; stroke risk was non-significantly reduced with device therapy. The PC Trial was presented at the 24th annual Transcatheter Cardiovascular Therapeutics (TCT) scientific symposium. Sponsored by the Cardiovascular Research Foundation (CRF), TCT is the world's premier educational meeting specializing in interventional cardiovascular medicine.

A PFO (patent foramen ovale) is a hole between the left and right upper chambers (atria) of the heart that fails to close just after birth. Approximately one in four people grow up with a PFO. In some cases a blood clot may pass through the PFO and can potentially travel to the brain causing an ischemic stroke. It is estimated that PFO rates are three times higher in the population of patients with cryptogenic stroke, or stroke without an overt source.

The PC Trial compared the efficacy of the percutaneous closure of a PFO using the Amplatzer PFO Occluder with medical treatment in patients with cryptogenic stroke with peripheral embolism. Made of wire mesh, the investigational device is inserted into the PFO through a catheter to seal the passageway between the left and right atria.

Patients were randomized in 29 centers in Europe, Brazil, Canada, and Australia. Enrollment of 414 patients was completed in February 2009. The primary endpoint of the trial was a composite of death from any cause, non-fatal stroke, transient ischemic attack (TIA), and peripheral embolism.

For the primary composite endpoint (death from any cause, non-fatal stroke, TIA, and peripheral embolism) researchers found a relative risk reduction of 37 percent when using the investigational device; this reduction was not statistically significant. Results also indicated no significant reduction in ischemic and bleeding events in patients who underwent PFO closure compared to those who received medical therapy (2.9 percent versus 5.7 percent, HR 0.49, 95 percent CI 0.19 - 1.32, P=0.16). The relative risk reduction of stroke through use of the device was 80 percent with a number needed to treat (NNN) of 40, but this reduction was also not statistically significant.

"Percutaneous PFO closure with the investigational Amplatzer PFO Occluder device for secondary prevention of thromboembolism showed no significant reduction in ischemic and bleeding events compared with medical treatment in this trial," said study investigator Stephan Windecker, MD. Dr. Windecker is a Professor and Head of Interventional Cardiology at the Swiss Cardiovascular Center in Bern.

"However, the observed difference in stroke may be clinically relevant if confirmed in further studies," Dr. Windecker said.

http://www.medicalnewstoday.com/releases/252045.php

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http://health.howstuffworks.com/wellness/diet-fitness/exercise/beginner-running.htm

Discovery Health "Advice for Beginning Runners"

When initiating a running program, some of us simply aspire to improve our health and fitness level, while others strive to complete a marathon. Whatever the goal, running is a cheap form of exercise that embodies all the general benefits of exercise as well as cardiovascular support. It can be done nearly anywhere at any time. 

There are a few dangers to jumping in and hitting the pavement. The body needs to have time to adapt to the demands of running. The impact to the lower leg with each step is 2-3 times your body weight. This means if you are a 150 pound runner who goes out for a 3 mile run, you will be subjecting your legs to about 400 pounds of force for approximately 2,500 repetitions. This is a big jump in demand if you have not been running.

Thankfully, your body adapts quite quickly with regular training. Over time, the bones and muscles of the legs become stronger and able to withstand the forces placed upon them. Starting out too fast, too often or too far are the most common errors. What follows is a guide to avoiding these missteps while still getting out on the road to becoming a runner.

One of the most important factors in starting a program is running form. Your posture should be upright with the arms relaxed. The body should be held still with the arms and legs moving freely. The feet should stay pointed straight ahead with the knees bending so that the heels reach the height of the knees when observed from the side or back. Hands can stay relaxed as though holding on to a potato chip without breaking it. The legs should generally feel relaxed and freely moving as though you were riding downhill on a bicycle while keeping up with the pedals.

Excessive strain or pounding can suggest that you are pushing the intensity and speed too much, which leads us to our first of the common errors. Starting out too fast means running at a pace for which your body is not ready. If you're not sure about whether you are prepared, start with walking. As walking speed and distance become more comfortable, add a little running; about 1 minute, separated by 5 minutes of walking. Initially, only run (or walk/run) every other day for the first couple of months to help your legs get adapted to your new activity.

Running too often limits the amount of time available for your body to adapt and recover. Your body actually gets stronger and more resistant to injury when it's resting. During your rest days and at night during sleep your body builds the areas you worked to a stronger level. Think of it like this: While you work out, you are providing your body the plans and instructions it needs. Then, while quiet and at rest, it does the actual work. If your body is not finished working by the time you go out for your next run, you will limit how well it can adapt. This can actually cause injury and, if extreme, will result in the symptoms of overtraining.

Running too far too early in your running program also causes the body to be under too much demand and stress. To prevent this, start out with a mileage that you can do in 20-30 minutes (when you can sustain a run for that amount of time without stopping to walk). Once a week, run no more than 1 mile farther than your longest run. Add 1 mile each week. Every 4-5 weeks cut your longest run mileage in half, then start back where you were the previous week adding 1 mile once a week. If your desire is to run farther multiple times a week, again add miles 1 at a time, and do it slowly. In general, increase your mileage by no more than 10 percent per week to allow your body to adapt sufficiently.

Starting a running program is really pretty simple. Sustaining one safely and patiently is the tough part. Follow our simple suggestions and try out our sample program for training for a marathon. Who knows, you might just become a runner yet!

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http://www.kevinmd.com/blog/2012/09/5-patients.html

5 things that I want my patients to know

Today's healthcare consumer is constantly barraged with conflicting information. Does wine prevent or predispose to cancer? Should I eat certain foods or avoid them? Is this new medication going to hurt me or help me? Many issues are still controversial, but there are some things that have a large amount of evidence behind them.

1. Antibiotics will not help the common cold. Colds are caused by viruses, and antibiotics kill bacteria, which is a whole different type of organism. All of us have been through colds. We know that they are unpleasant–lots of sneezing, coughing, body aches, fever, feeling run down. All of us also know that colds will go away on their own. Some patients will swear that taking antibiotics will help them, but we know scientifically that this is not true; the cold is self-limited and was going to go away on its own anyway. Much better than taking a pill that doesn't work is to strengthen your immune system, and prevent the cold from happening in the first place. Get adequate sleep. Eat a healthy diet. If you do have a cold, drinking lots of fluids and taking Tylenol and ibuprofen is key to your recovery–not antibiotics.

2. A CT scan will not help a headache. Having a headache, just like catching a cold, is unpleasant. Your head throbs. You might feel that you can't concentrate and go about your daily activities. While there are potentially serious causes of headache, the vast majority of them are due to tension headache or migraine. These will go away with time. Again, over-the-counter medications like tylenol and ibuprofen can help, as can rest in a quiet, dark room and lots of fluids. A CT scan will only show what you DON'T have, and, in the vast majority of cases, will not help make your diagnosis–and certainly won't make you feel better.

3. Every test has potential side effects. Patients often ask their doctors for tests to figure out what's wrong; in the same way, doctors often rely on tests to save them time of speaking to patients to make the diagnosis. The problem is that tests can only tell you what you DON'T have, and not what you actually have. Studies have shown that actually sitting down with the patient and talking to her will much more likely yield the diagnosis than any test. And every test has potential side effects.  CT scans involve radiation, and studies have shown that each individual scan increases your lifetime risk of getting cancer. Some CTs and MRIs involve administering contrast dye that could cause kidney damage. Even the simple blood draw can lead to complications like infection and bruising. This is not to say that you should never get tests done; it's just a reminder that tests are not always the answer, and that you should make sure you know ahead of time what the risks and benefits are of every test.

4. Lifestyle changes make a huge difference. Study after study show that the single most important contributor to decreasing your risk of heart disease, for example, is your lifestyle. You can take pills to decrease your blood pressure, lower your cholesterol, and control your diabetes–but even better is to eat a healthy diet with low saturated fat and exercising. Similarly, the single biggest risk to health that is preventable is smoking. Within even a few months of stopping smoking, the risk of cancers and heart disease begins to decrease. Don't get me wrong: it's not easy. Working on your lifestyle requires far more investment in your time and energy than popping a pill. But it's the most effective way to really make a difference in your health.

5. Aspirin is one of few medications that's been definitively shown to help you. Big pharma would like us to believe that the newest and greatest drug is the best thing out there to prevent heart attack and stroke, but actually aspirin is one of very few medications that's proven its weight. It reduces the risk of hear attack and stroke, and some studies are demonstrating that it may even be preventative against cancer. People who experience chest pain get aspirin first, before they get anything else, because it is the one thing that helps them if they are already having a heart attack. Not everyone needs to take aspirin, and there are some for whom it may be harmful (all medications, just like all tests, have side effects), but this is one more reminder that the newest and greatest isn't always the best; sometimes it's the tried and true that you need.

Leana Wen is an emergency physician who blogs at The Doctor is Listening. She is the co-author of When Doctors Don't Listen: How to Prevent Misdiagnosis and Unnecessary Tests.  She can also be reached on Twitter @drleanawen. 

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Chocolate And Nobel Prizes Linked In Study

CardioBrief Chocolate And Nobel Prizes Linked In Study

You don't have to be a genius to like chocolate, but geniuses are more likely to eat lots of chocolate, at least according to a new paper published in the august New England Journal of Medicine. Franz Messerli reports a highly significant correlation between a nation's per capita chocolate consumption and the rate at which its citizens win Nobel Prizes. Building on research raising the possibility that the flavanols in chocolate may enhance cognitive performance, Messerli "wondered whether there would be a correlation between a country's level of chocolate consumption and its population's cognitive function." Using More…


http://cardiobrief.org/2012/10/10/chocolate-and-nobel-prizes-go-together/

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