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Wednesday, December 5, 2012

Healthy Diet Protects Against Recurrent Heart Attacks & Strokes

A heart-healthy diet may help protect people with cardiovascular disease against recurrent strokes and heart attacks.

The finding came from research that was published in the American Heart Association journal Circulation and was funded by Boehringer Ingelheim.

Mahshid Dehghan, Ph.D., researcher of the study and a nutritionist at the Population Health Research Institute, McMaster University in Ontario, Canada, said:

"At times, patients don't think they need to follow a healthy diet since their medications have already lowered their blood pressure and cholesterol - that is wrong. Dietary modification has benefits in addition to those seen with aspirin, angiotensin modulators, lipid-lowering agents and beta blockers."

The researchers surveyed 31,546 adults (aged 66.5 on average) that either had cardiovascular disease or damage to major organs in order to determine how frequently they drank milk and ate fruits, veggies, meat, fish, grains, and poultry in the previous year. Questions about lifestyles choices, such as exercise, smoking, and alcohol consumption, were also asked in the interview.

The amount of fruits, veggies, milk, and grains that were consumed daily, as well as the ratio of fish to meats consumed, determined the total scores. The team discovered, during a five year follow-up, that 5,190 cardiovascular events had occurred among the participants.

Analysis showed that people who consumed a heart-healthy diet experienced a:

Although people in different parts of the world have various food habits, a healthy diet was linked to protection against recurrent cardiovascular disease throughout the world, regardless of a country's economic level, Dehghan revealed.

The team also discovered that when a person has a diet rich in fruits and veggies, and eats more fish than meat, they receive more protection against heart disease than they do against cancer, injury, or fractures.

This study supports previous research which indicated that an unhealthy diet causes an increased risk of developing heart disease.

Dehghan concluded:

"Physicians should advise their high-risk patients to improve their diet and eat more vegetables, fruits, grains and fish. This could substantially reduce cardiovascular recurrence beyond drug therapy alone and save lives globally."

Written by Sarah Glynn
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

Visit our nutrition / diet section for the latest news on this subject.
Relationship Between Healthy Diet and Risk of Cardiovascular Disease Among Patients on Drug Therapies for Secondary Prevention/i>
Mahshid Dehghan, Andrew Mente, Koon K. Teo, Peggy Gao, Peter Sleight, Gilles Dagenais, Alvaro Avezum, Jeffrey L. Probstfield, Tony Dans, Salim Yusuf, D.Phil
Circulation 2012; doi: 10.1161/​CIRCULATIONAHA.112.103234
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Thursday, November 29, 2012

Grapefruit-Drug Interaction Seen With More Drugs (CME/CE)

MedPage Today Cardiovascular Grapefruit-Drug Interaction Seen With More Drugs (CME/CE)

By Cole Petrochko, Staff Writer, MedPage Today
Published: November 28, 2012
Reviewed by Dori F. Zaleznik, MD; Associate Clinical Professor of Medicine, Harvard Medical School, Boston

The number of drugs that react adversely with grapefruit is higher than previously recognized, and the interactions occur at lower levels of grapefruit intake, according to a Canadian review.

More than 85 drugs currently approved in Canada have adverse reactions with grapefruit, and 43 have potentially serious adverse reactions, according to David Bailey, PhD, of the London Health Sciences Center in Ontario, and colleagues.

Common adverse events related to drug-grapefruit interactions included torsade de pointes, myelotoxicity, rhabdomyolysis, loss of drug efficacy, gastrointestinal bleeding, urinary retention, dizziness, postural hypotension, nephrotoxicity, and respiratory depression, they wrote online in CMAJ.

"Grapefruit and certain other citrus fruits represent examples of foods generally considered to be healthful, but with the potential for a pharmacokinetic interaction causing greatly enhanced oral drug bioavailability," the authors noted. The fact that more drugs are now being marketed that have interactions with grapefruit "necessitates an understanding of this interaction and the application of this knowledge for the safe and effective use of drugs in general practice."

The researchers analyzed 161 studies, including mostly randomized controlled trials, and 29 drug monographs and prescribing information sheets. Research evaluated changes in patient-drug effects after ingesting grapefruit.

Drugs that interact poorly with grapefruit have a lower innate bioavailability, can require as little as 200 mL to 250 mL of grapefruit juice to react, are administered orally, and are metabolized by the cytochrome P450 3A4 (CYP3A4) enzyme, the investigators noted, adding that "older patients have the greatest possibility of ingesting grapefruit and interacting medications."

They added that although any exposure to any interacting drug may not cause a reaction, case reports "uniformly cited the circumstance of a patient whose therapeutic dose of a susceptible drug was stabilized, who subsequently showed serious toxicity that occurred after several days of simultaneous intake of the drug and grapefruit in a normal or high quantity."

"Unless healthcare professionals are aware of the possibility that the adverse event they are seeing might have an origin in the recent addition of grapefruit to the patient's diet, it is very unlikely that they will investigate it," they cautioned, adding that it is likely that the occurrence of drug-grapefruit-related adverse events is under-reported.

The researchers also included a list of interacting drugs -- sorted by drug type -- that noted each drug's bioavailability, dose-related adverse event or events, how likely risk of an interaction was, and potential alternatives to the drug.

The list included anticancer agents, anti-infective agents, lipid-lowering drugs, cardiovascular drugs, drugs affecting the central nervous system, gastrointestinal drugs, immunosuppressants, and urinary tract agents. Most drugs had a high or greater predicted interaction risk.

The authors also noted that one of two studies of breast cancer risk found a 30% increased risk of breast cancer in postmenopausal women taking estrogen (95% CI 1.06 to 1.58) who consumed one-quarter or more of a grapefruit per day compared with women who did not eat grapefruit, though a follow-up study showed no such interaction.

Although they focused on the CYP34A system, the authors also noted that grapefruit and some other citrus fruits may act on drug transporters as well, causing lower concentrations of certain drugs.

The authors also cautioned that, while grapefruit was the citrus tested in the analyzed studies, the same effects can be found with some other citrus fruits.

The authors declared no conflicts of interest.


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Statin-Exercise Combo Lowers Mortality Risk (CME/CE)

MedPage Today Cardiovascular Statin-Exercise Combo Lowers Mortality Risk (CME/CE)

By Charles Bankhead, Staff Writer, MedPage Today
Published: November 27, 2012
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco

Statin therapy and physical fitness amounted to a one-two punch for lowering mortality risk in a large cohort of middle-age and older patients with dyslipidemia followed for 10 years.

Patients who took statins and were physically fit had as much as a 70% reduction in the risk of dying during the follow-up period as compared with the least physically fit patients who were taking statins, according to Peter Kokkinos, PhD, of George Washington University in Washington, and colleagues.

Physical fitness also had an independent effect on mortality risk among patients who were not taking statins, reducing the likelihood of death during follow-up by as much as 47%, they reported online in The Lancet.

"Statin treatment and increased fitness are independently associated with low mortality among dyslipidemic individuals," the authors wrote. "The combination of statin treatment and increased fitness resulted in substantially lower mortality risk than either alone, reinforcing the importance of physical activity for individuals with dyslipidemia."

Expert and consensus panels on lipid management have endorsed statin therapy and lifestyle changes, including increased physical activity, to reduce cardiovascular risk. The benefits of statins have been demonstrated in multiple large clinical trials, and evidence from large epidemiologic studies has shown robust inverse associations between physical fitness and mortality risk in healthy individuals and those with cardiovascular disease.

Studies to date have provided limited information about the combined effects of statins and physical fitness on mortality risk or other clinical events. No study has evaluated the potential of increased fitness to lower mortality risk in dyslipidemic patients who cannot take statins, the authors noted.

To evaluate the combined effects of fitness and statin therapy on mortality risk, Kokkinos and colleagues identified dyslipidemic patients who had exercise tolerance tests at two Veterans Affairs medical centers during 1986 to 2011. Investigators rated each patient's fitness on the basis of metabolic equivalents (METs).

The primary endpoint was all-cause mortality, adjusted for age, body mass index (BMI), ethnicity, sex, and history of cardiovascular disease, drug therapy, and risk factors.

The search of medical records identified 10,043 patients, who had a mean age of 59, mean BMI of about 29 kg/m2, and peak MET of 7.4. The cohort comprised 5,046 statin users and 4,997 who were not taking statins.

Statin users tended to be older and had lower exercise capacity, higher BMI, and higher rates of cardiovascular disease, risk factors, and use of cardiovascular drugs.

The lipid profile for statin users at baseline and after a median treatment period of 70 months was:

  • Total cholesterol: 238 mg/dL and 172 mg/dL
  • High-density lipoprotein (HDL): 47 mg/dL for both time points
  • Low-density lipoprotein (LDL) 164 mg/dL and 101 mg/dL
  • Triglycerides: 142 mg/dL and 134 mg/dL

In the nonstatin group, the lipid profile at baseline and at last follow-up with lipid assessment (median 51 months) was:

  • Total cholesterol 234 mg/dL and 199 mg/dL
  • HDL: 47 mg/dL for both time points
  • LDL: 156 mg/dL and 140 mg/dL
  • Triglycerides: 134 mg/dL and 134 mg/dL

During median follow-up of 10 years, 2,318 patients died. The statin group had an overall mortality of 18.5% compared with 27.7% among patients not taking statins (P<0.0001).

Mortality decreased with increasing physical fitness in both groups. In the statin group, the most-fit patients (>9 METs) had 70% lower mortality risk compared with the least-fit (≤5 METs) patients (P<0.0001). In the nonstatin group, the least-fit subgroup had a 35% increase in the mortality hazard (P<0.0001), whereas the most-fit members of the group had a 47% reduction in the hazard ratio (P<0.0001).

For the entire cohort, each 1 MET increase in exercise capacity was associated with a 12% reduction in the mortality hazard (17% in the statin group, 11% in the nonstatin group).

The study had some limitations, most notably the male veteran patient population, making it difficult to generalize the results to women. Also, the authors did not have data for cardiovascular interventions or cardiovascular mortality. Finally, there was no data on adverse effects of statins especially if the treatment interfered with exercise capacity.

In an accompanying commentary, Pedro Hallal, PhD, from the Federal University of Pelotas in Rio Grande do Sul, Brazil and I-Min Lee, MD, from Harvard Medical School in Boston said that the prescription of physical activity should be placed on a par with drug prescription.

"The cost of becoming physically active is lower than that of buying drugs, and moderate intensity physical activity has fewer side effects" they pointed out. "Unlike statins, physical activity should be part of everyday life."

The study authors and the commentary authors reported no conflicts of interest.

Charles Bankhead

Staff Writer

Working from Houston, home to one of the world's largest medical complexes, Charles Bankhead has more than 20 years of experience as a medical writer and editor. His career began as a science and medical writer at an academic medical center. He later spent almost a decade as a writer and editor for Medical World News, one of the leading medical trade magazines of its era. His byline has appeared in medical publications that have included Cardio, Cosmetic Surgery Times, Dermatology Times, Diagnostic Imaging, Family Practice, Journal of the National Cancer Institute, Medscape, Oncology News International, Oncology Times, Ophthalmology Times, Patient Care, Renal and Urology News, The Medical Post, Urology Times, and the International Medical News Group newspapers. He has a BA in journalism and MA in mass communications, both from Texas Tech University.


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Monday, November 19, 2012

CDC Reports: Cardiac Patients at High Risk for Flu Hospitalization

Dear Clinician:

Here is the information you requested (sponsored by Centers for Disease Control and Prevention [CDC]).

Influenza can be a serious illness in your patients with heart disease. Studies show that your strong recommendation for flu vaccination significantly increases a patient's willingness to get a flu vaccine.

The CDC recommends annual vaccination for all adults and children 6 months and older, Vaccination is, especially important for those at highest risk of severe flu illness, hospitalization and death, such as people with heart disease.1 An annual flu vaccine is recommended by the American Heart Association, and the American College of Cardiology for persons with cardiac disease for secondary prevention of cardiac-related events in persons with coronary and other atherosclerotic vascular disease.2

Cardiac disease has long been recognized as a risk factor for complications from the flu, including hospitalization and death. According to a three-year study conducted from 2005 through 2008, more than 1/3 of adults hospitalized with laboratory-confirmed influenza had cardiac disease.3

During the 2010-11 influenza season, among adults hospitalized with lab-confirmed flu, 38 percent had underlying cardiac disease—and cardiac disease was the most often reported high risk condition.

Data from the 2009 H1N1 pandemic also support the contribution of cardiac disease to influenza hospitalizations.4,5 A study in Canada published in 2011, was conducted among patients with lab-confirmed flu, reflecting 2009 H1N1 flu cases. In this study, having cardiac disease was associated with a 2.7 times increased risk of flu-related hospitalization.4

Benefits of Influenza Vaccine Among Patients With Cardiac Disease

Two randomized studies have been conducted among patients with cardiac disease, both of which demonstrated a reduction in cardiovascular events in vaccinated patients.

A study in Argentina published in 2004 was conducted among patients with recent ischemic events or who were undergoing angioplasty. The study found significant reductions in cardiovascular deaths at one year, from 17 percent in unvaccinated patients to six percent among vaccinated patients.6,7

In a study in Thailand published in 2011, patients were included if they were recently hospitalized with acute coronary syndrome. This study found a reduction in a combined endpoint of major cardiovascular events, including death, from 19 percent among those who were unvaccinated to 9.5 percent among those who were vaccinated against influenza.8

For more information, visit the CDC website: www.cdc.gov/flu. You can order free materials, review the ACIP guidelines, or find further information for yourself, your staff, and your patients.

  1. CDC. Prevention and control of influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices (ACIP), 2010. MMWR. 2010;59(rr08);1-62.
  2. Davis MM, et al. Influenza vaccination as secondary prevention for cardiovascular disease. Circulation. 2006;114:1549-1553.
  3. Dao CN, et al. Adult hospitalizations for laboratory-positive influenza during 2005-06 through 2007-08 seasons in the United States. J Infect Dis. 2010;202:881-8.
  4. Gilca R, et al. Risk factors for hospitalization and severe outcomes of 2009 pandemic H1N1 influenza in Quebec, Canada. Influenza Other Respir Viruses. 2011;5:247–255.
  5. Fowlkes AL, et al. Epidemiology of 2009 pandemic influenza A (H1N1) deaths in the United States. Clin Infect Dis. 2011;52(Suppl 1):S60-8.
  6. Gurfinkel EP, et al. Flu vaccination in acute coronary syndromes and planned percutaneous coronary interventions (FLUVACS) Study. Eur Heart J. 2004;25:25–31.
  7. Gurfinkel EP, et al. Two-year follow-up of the FLU vaccination acute coronary syndromes (FLUVACS) registry. J Am Coll Cardiol. 1995;31:28-32.
  8. Phrommintikul A, et al. Influenza vaccination reduced cardiovascular events in patients with acute coronary syndrome. Euro Heart J. 2011;32:1730-5.

The above message was sponsored by Message Sponsor, who is solely responsible for its content.

Centers for Disease Control and Prevention (CDC)
1600 Clifton Road
Atlanta, GA 30333

You have received this content because you requested follow-up information to a DocAlert message delivered through the Epocrates system. If you do not want to receive an email from this sponsor, please do not select "Email More Info" in the DocAlert message sent on behalf of this sponsor. The sponsor name can be found in the DocAlert message. For more information about DocAlert messages, please click here.

All trademarks referenced are properties of their respective owners.

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Sunday, November 18, 2012

One in Six

One in six people will have a stroke at some point in their lifetime, and that a stroke will be the cause of someone's death every six seconds

According to the World Stroke Organization, there are six steps that anyone can take to reduce their risk of stroke:
  • Know your personal risk factors: high blood pressure, diabetes, and high blood cholesterol
  • Be physically active and exercise regularly
  • Avoid obesity by keeping to a healthy diet
  • Limit your alcohol consumption
  • Avoid cigarette smoke. If you smoke, seek help to stop
  • Learn to recognise the warning signs of a stroke

Monday, October 29, 2012

Exercise Benefits Brain In Middle Age

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.

Saturday, October 27, 2012

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.


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

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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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.


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Sunday, October 21, 2012

Discovery Health "Advice for Beginning Runners"

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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5 things that I want my patients to know

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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Saturday, October 20, 2012

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…


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Monday, October 15, 2012

Sitting For Long Periods Raises Your Risk Of Diabetes, Heart Disease

Sitting For Long Periods Raises Your Risk Of Diabetes, Heart Disease

Featured Article
Academic Journal
Main Category: Diabetes
Also Included In: Sports Medicine / Fitness;  Heart Disease;  Obesity / Weight Loss / Fitness
Article Date: 15 Oct 2012 - 4:00 PDT

Sitting around for long periods raises the risk of developing type 2 diabetes, heart disease and premature death, even for people who have the amount of daily physical activity recommended by health professionals.

These were the conclusions of a large piece of research covering nearly 800,000 participants published in Diabetologia this week.

Emma Wilmot of the University of Leicester in the UK, and colleagues, pooled the results of 18 studies covering a total of 794,577 participants, and found people who sit for long periods have twice the risk of developing type 2 diabetes, heart disease and premature death compared to people who do not.

In a press statement issued over the weekend, they say their analysis found these links were still strong when they took into account the amount of moderate to vigorous physical activity people underwent; even those who met typical physical activity guidelines may still be harming their health by sitting around for long periods the rest of the time.

"The average adult spends 50-70% of their time sitting so the findings of this study have far reaching implications," says Wilmot, a a Clinical Research Fellow in Diabetes and Endocrinology working at the Leicester Diabetes Centre, in Leicester General Hospital.

"By simply limiting the time that we spend sitting, we may be able to reduce our risk of diabetes, heart disease and death," she urges.

Their analysis revealed that the most consistent links were between sitting and diabetes. Wilmot says this finding is particularly important for those groups who already have a higher risk for type 2 diabetes, such as people of South Asian descent, or with a family history of the disease.

The study is not the first to highlight the health risks of sitting for prolonged periods. For example earlier this year, researchers at Leicester's departments of health sciences and cardiovascular science revealed how they found women who sit for most of the day have a greater risk for developing the metabolic symptoms that precede type 2 diabetes.

Another study found that interrupting prolonged periods of sitting with regular, two-minute breaks of light or moderate intensity activity like walking helped overweight people keep glucose and insulin levels under control.

This latest review also involved researchers from Loughborough University, where co-researcher Stuart Biddle is professor of physical activity and health. He suggests a number of ways people can reduce their sitting time, "such as breaking up long periods at the computer at work by placing our laptop on a filing cabinet."

Another co-researcher, Melanie Davies, professor of diabetes medicine at Leicester, is a director of the National Institute for Health Research's Leicester-Loughborough Diet, Lifestyle and Physical Activity Biomedical Research Unit, and is also honorary consultant at University Hospitals of Leicester. She says the paper also has an important message for health care professionals:

"... namely that being sedentary is common and dangerous for our long term health, particularly for diabetes and cardiovascular disease, and that this link appears to be over and above other lifestyle factors such as our diet and physical activity."

Written by Catharine Paddock PhD
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

Visit our diabetes section for the latest news on this subject.

Contact Our News Editors

For any corrections of factual information, or to contact the editors please use our feedback form.

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Note: Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a health care professional. For more information, please read our terms and conditions.

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Friday, October 12, 2012

Statins Decrease Glaucoma Risk in Those With Hyperlipidemia (mobile format)

Statins Decrease Glaucoma Risk in Those With Hyperlipidemia

October 10, 2012 — In patients with hyperlipidemia, statin use for 1 year decreased the hazard of developing open-angle glaucoma (OAG) by 5%, and use for 2 years decreased it by 9%, according to a retrospective, longitudinal cohort analysis. Individuals who used statins also had a decreased risk of progressing from suspected glaucoma to OAG and needing intraocular pressure–lowering medications.

Joshua D. Stein, MD, an assistant professor in the Department of Ophthalmology and Visual Sciences at the University of Michigan in Ann Arbor and colleagues, published their findings in the October issue of Ophthalmology.

This study was prompted by findings from an earlier study in which they evaluated whether patients with components of metabolic syndrome had an increased risk for OAG, said Dr. Stein.

"We found that, unlike diabetes and high blood pressure (each of which was associated with an elevated risk for OAG), the presence of hyperlipidemia was associated with a reduced risk for glaucoma. That result led us to wonder whether it might in fact be the medications used to treat hyperlipidemia (primarily agents from the class of drugs called statins), rather than the condition of hyperlipidemia itself, that could protect against the onset of OAG," Dr. Stein explained.

To find out, they analyzed data for eye-related claims obtained from detailed records of all enrollees in a managed care network with members located across the United States.

Of the 524,109 enrollees with hyperlipidemia, 316,182 (60.3%) had 1 statin prescription, 20,776 (4%) were prescribed nonstatin cholesterol-lowering medications only, and 187,151 (35.7%) were prescribed no cholesterol-lowering drug during follow-up.

A total of 92,955 (29.4%) statin users also filled 1 prescription for a nonstatin cholesterol-lowering drug.

Of the 241,711 patients eligible for the incident OAG analysis 10,266 (4.3%) patients were given at least 1 incident diagnosis of OAG while in the medical plan.

With every additional month of statin use the hazard of developing OAG decreased 0.3% (adjusted hazard ratio [HR], 0.997; 95% confidence interval [CI], 0.994 - 0.999; P < .0056) after adjustments for sociodemographic factors, and medical and ocular comorbid conditions.

Individuals who took statins for 1 year during the 2 prior years had a 4% decreased hazard (adjusted HR, 0.960; 95% CI, 0.933 - 0.988) of OAG relative to those who took no statins in the 2 prior years, if all other characteristics were alike.

Similarly, those who used statins continuously for 2 years had an 8% decreased risk (adjusted HR, 0.922; 95% CI, 0.870 - 0.976) of OAG relative to patients who used no statins during the prior 2 years.

No association was found between use of nonstatin cholesterol-lowering drugs and OAG development (P = .12).

After individuals given a diagnosis of OAG during their first 2 years of enrollment were excluded, 6934 individuals (14.0%) developed OAG among the 49,628 patients in whom suspected glaucoma was diagnosed during the look-back period.

After adjustment for confounders, the risk of progressing from suspected glaucoma to OAG decreased 0.4% (adjusted HR, 0.996; 95% CI, 0.993 - 0.999; P = .0062) for every additional month of statin use.

Individuals who used statins for 1 year during the prior 2 years had a 5% decreased risk (adjusted HR, 0.952; 95% CI, 0.920 - 0.986) of progressing from suspected glaucoma to OAG relative to patients with suspected glaucoma who used no statins in the prior 2 years.

Individuals who used statins continuously for 2 years had a 9% decreased hazard (adjusted HR, 0.907; 95% CI, 0.846 - 0.973) of OAG relative to those who used no statins in the prior 2 years.

There was no difference in the hazard in patients who used nonstatin cholesterol-lowering drugs (P = .077).

The risk for receiving a glaucoma medication prescription decreased 0.4% (adjusted HR, 0.996; 95% CI, 0.993 - 0.998; P = .0002) for every additional month of statin use after adjustment for confounders.

Use of statins for 1 year during the prior 2 years resulted in a 5% decreased risk (adjusted HR, 0.950; 95% CI, 0.924 - 0.976) of needing an intraocular pressure–lowering drug relative to those who used no statins in the prior 2 years.

Individuals who used stains continuously for 2 years had a 10% decreased risk (adjusted HR, 0.902; 95% CI, 0.854 - 0.953) of needing a pressure-lowering drug relative to those who used no statins in the prior 2 years.

Individuals who used nonstatin cholesterol-lowering medications had a 0.6% (adjusted HR, 0.994; 95% CI, 0.990 - 0.998; P = .0017) hazard per month for being prescribed a glaucoma medication.

Use of a nonstatin cholesterol-lowering medication for 1 year during the prior 2 years resulted in a 7% decreased risk (adjusted HR, 0.928; 95% CI, 0.886 - 0.972) of being prescribed glaucoma medications. Use of a nonstatin cholesterol-lowering medication for 2 years was associated with a 14% (adjusted HR, 0.862; 95% CI, 0.785 - 0.946) decreased risk of receiving a prescription for a glaucoma medication.

A total of 8236 individuals with an incident OAG diagnosis had no glaucoma surgical intervention coded before that diagnosis. Of those patients, 1009 (12.3%) later required laser or incisional glaucoma surgery while enrolled in the plan.

The risk of an enrollee going on to require laser or incisional glaucoma surgery was not significantly different (adjusted HR, 1.002; 95% CI, 0.994 -1.010) with each additional month of statin use (P = .68) after adjustment for confounders. Findings were similar for nonstatin cholesterol-lowering medications (adjusted HR, 0.992; 95% CI, 0.978 - 1.006; P = .27).

New Treatment Pathway?

"This is a very exciting new report suggesting that there may be an entirely new pathway for treating or preventing glaucoma," said Joel Schuman, MD, a clinical correspondent for the American Academy of Ophthalmology. Dr. Schuman, who was not involved in the study, is a professor at the Eye & Ear Foundation, chairman of ophthalmology at the University of Pittsburgh School of Medicine, director of the UPMC Eye Center, and interim director of the Fox Center for Vision Restoration in Pittsburgh, Pennsylvania.

Encouraged by his team's findings, Dr. Stein told Medscape Medical News, "Although physicians already have various effective treatment options...the discovery of a lower-cost option with relatively few side effects could be enormously useful. Also, because strict adherence to prescribed treatment regimens involving topical glaucoma medications can be challenging for many patients, the prospect of a potential alternative taken orally could ultimately mean the difference between sight loss and preserved vision for countless adults."

He said the next step should be a "randomized controlled trial to test the potential efficacy of statin drugs to prevent glaucoma or halt disease progression."

However, Dr. Schuman cautioned that these findings may not apply to everyone. "It is important to remember that subjects studied were treated with statins for hyperlipidemia. While this retrospective study sets the stage for a larger-scale prospective trial to assess the benefit of statin treatment in people predisposed to or with glaucoma, it does not mean that all such people should be treated with statins to prevent or manage the disease."

This study was supported by the National Eye Institute K23 Mentored Clinician Scientist Award; American Glaucoma Society Clinician Scientist Grant, Blue Cross Blue Shield of Michigan Foundation, Research to Prevent Blindness, and a National Eye Institute Core Grant. The authors and Dr. Schuman have disclosed no relevant financial relationships.

Ophthalmology. 2012;119:2074-2081. Full text

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Thursday, October 11, 2012

Troubled Sleepers at Risk for Soft Plaque

Troubled Sleepers at Risk for Soft Plaque

By Chris Kaiser, Cardiology Editor, MedPage Today
Published: October 11, 2012
Reviewed by Zalman S. Agus, MD; Emeritus Professor, Perelman School of Medicine at the University of Pennsylvania and Dorothy Caputo, MA, BSN, RN, Nurse Planner

Obstructive sleep apnea has been linked with cardiovascular disease, but it also may be linked with the deadliest type of coronary artery plaque, a small study suggests.

Of patients with obstructive sleep apnea (OSA), 63% had noncalcified or mixed plaques compared with 16% of those without OSA (P<0.0001), according to Sunil Sharma, MD, of East Carolina University in Greenville, N.C., and colleagues.

The unadjusted odds ratio was 9.3 (95% CI 3.0 to 28.4), but even when researchers adjusted for other risk factors, the association of OSA with soft plaque "remained strong" (OR 7.0, 95% CI 1.9 to 26.5, P<0.05), they reported in the study published online in Clinical Cardiology.

"The broad confidence interval was most likely due to small sample size, but we cannot rule out the effect of unobserved confounding factors," researchers noted.

However, Sharma told MedPage Today that the investigators "felt comfortable" with their unique finding regarding more soft plaque in those with OSA because of similar findings linking hard, calcified plaques with OSA.

"We know that hard plaques don't cause acute events. So we wanted to see if those with sleep-disordered breathing had a higher prevalence of soft plaque," Sharma said.

Despite the known connection between sleep apnea and cardiovascular disease, data are limited on whether OSA "causes or accelerates the process of atherosclerosis and plaque formations."

And data are similarly lacking on exactly what type of plaque is most prevalent in those with OSA.

To categorize plaque type, researchers retrospectively reviewed the cardiac CT images of 81 patients who were part of a larger radiology study at the Medical University of South Carolina in Charleston involving emergency room patients with acute chest pain.

All patients had undergone a gold-standard polysomnography test within the prior 3 years of the CT scan, and 51 had OSA.

Baseline characteristics were similar between patients with and without OSA, except in three categories: age (60 versus 54, P=0.05), race (75% white versus 53%, P=0.04), and past smoking (62% versus 39%, P=0.004).

Besides there being an overall strong association of OSA with noncalcified/mixed plaques, the severity of OSA was linearly associated with soft plaques, but the confidence intervals were wide.

Those with an apnea-hypopnea index (AHI) of between 10 and 20 (mild OSA) had an odds ratio of 3.2 (95% CI 0.2 to 43.7) compared with 14.2 (95% CI 1.3 to 158.5) for those with an AHI greater than 20 (moderate to severe OSA). These odds were adjusted for age, sex, race, smoking history, and hypercholesterolemia.

This pattern repeated itself when researchers evaluated patients for multivessel disease and stenosis severity (both P<0.05). Again, however, the confidence intervals were very wide.

Significantly more patients with OSA had multiple coronary artery involvement (85.7% versus 34.5%), which correlated linearly with the severity of apnea (ORs 9.6 for mild OSA and 42.1 for moderate to severe OSA).

Also, more patients with OSA had significantly higher severity of stenosis (22.5% versus 6%), and the severity of artery stenosis correlated with the severity of OSA (7.7% with multivessel disease had mild OSA compared with 24% with severe OSA).

"These findings tend to suggest that sleep-disordered breathing accelerates the process of atherosclerosis," Sharma told MedPage Today.

However, the results should be confirmed in larger, randomized studies, he said.

There is speculation that OSA might actually influence the duration of soft plaques, meaning that they stay in a soft stage longer than usual, Sharma said. "But this is mere speculation at this point," he said.

The next steps include determining what impact the higher prevalence of soft plaques has on outcomes and evaluating whether the use of continuous positive airway pressure (CPAP) therapy could make these vulnerable plaques more stable.

There is evidence from carotid ultrasound studies that CPAP therapy is associated with a reduced level of plaque, Sharma said.

Limitations of the current study include its retrospective nature, small number of patients, potential referral bias, and not having data on compliance with CPAP therapy.

The authors reported they have no conflicts of interest.

From the American Heart Association:


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Wednesday, October 10, 2012

Terrific Idea

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** Standard text messaging rates may apply. Contact your wireless provider if you have questions regarding your SMS plan.

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Fast walking and jogging halve development of heart disease and stroke risk factors, research indicates

Fast Walking and Jogging Halve Development of Heart Disease and Stroke Risk Factors, Research Indicates

ScienceDaily (Oct. 8, 2012) — Daily activities, such as fast walking and jogging, can curb the development of risk factors for heart disease and stroke by as much as 50 per cent, whereas an hour's daily walk makes little difference, indicates research published in the online journal BMJ Open.

The findings indicate that it is the intensity, rather than the duration, of exercise that counts in combating the impact of metabolic syndrome -- a combination of factors, including midriff bulge, high blood pressure, insulin resistance, higher than normal levels of blood glucose and abnormal blood fat levels -- say the authors.

Genes, diet, and lack of exercise are thought to be implicated in the development of the syndrome, which is conducive to inflammation and blood thickening.

The authors base their findings on more than 10,000 Danish adults, between the ages of 21 and 98, who were initially assessed in 1991-94 and then monitored for up to 10 years. All the participants were quizzed on the amount of physical activity they did, which was categorised according to intensity and duration.

At the initial assessment, around one in five (20.7%) women and just over one in four (27.3%) men had metabolic syndrome. Prevalence was closely linked to physical activity level.

Among the women, almost one in three of those who had a sedentary lifestyle had the syndrome whereas only one in 10 of those who were very physically active had it. Among men, the equivalent proportions were just under 37% and just under 14%

Of the remaining 6,088 participants without metabolic syndrome, just under two thirds (3,992) completed the fourth and final survey and assessment, by which point one in seven (15.4%; 585) had developed it.

Again, the prevalence was higher among those leading a sedentary lifestyle, with almost one in five (19.4%) affected compared with around one in nine (11.8%) of those who were very physically active.

It was not only the amount of exercise, but also the intensity which helped curb the likelihood of developing the syndrome.

After taking account of factors likely to influence the results, fast walking speed halved the risk, while jogging cut the risk by 40 per cent. But going for an hour's walk every day made no difference.

"Our results confirm the role of physical activity in reducing [metabolic syndrome] risk and suggest that intensity rather than volume of physical activity is important," conclude the authors.

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The above story is reprinted from materials provided by BMJ-British Medical Journal.

Note: Materials may be edited for content and length. For further information, please contact the source cited above.

Journal Reference:

  1. A. H. Laursen, O. P. Kristiansen, J. L. Marott, P. Schnohr, E. Prescott. Intensity versus duration of physical activity: implications for the metabolic syndrome. A prospective cohort study. BMJ Open, 2012; 2 (5): e001711 DOI: 10.1136/bmjopen-2012-001711

Note: If no author is given, the source is cited instead.

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.

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Monday, October 8, 2012

Sleep apnea plays dual role in stroke

Sleep Apnea Plays Dual Role in Stroke

ScienceDaily (Oct. 2, 2012) — Improvements to the diagnosis and screening of sleep apnea are critical to stroke prevention, according to new stroke care guidelines released October 2 at the Canadian Stroke Congress.

Obstructive sleep apnea, a disorder where the flow of air to the brain pauses or decreases during sleep, is both a risk factor for stroke and a complication following stroke, according to the Canadian Best Practice Recommendations for Stroke Care.

Among the general population sleep apnea increases the likelihood of having a stroke, even after controlling for other stroke risk factors, such as high blood pressure and diabetes, researchers say.

At absolute minimum, four per cent of men and two per cent of women have serious sleep apnea, says Dr. Brian Murray, an associate professor of neurology and sleep medicine at the University of Toronto. Dr. Murray adds that clinically significant forms of the disorder affect more than 10 per cent of the population.

"There are ways to prevent sleep apnea from occurring," says Dr. Murray. "Keep your body weight low as obesity is a major contributor to sleep apnea; avoid medications and substances that relax the airways and cause snoring, such as sedatives and alcohol; and sleeping on your side can minimize sleep disordered breathing."

Signs of sleep apnea include significant snoring, pauses in breathing during sleep and daytime fatigue despite adequate sleep time. If any of these symptoms are present, says Dr. Murray, you should be evaluated by your doctor to determine next steps.

Obstructive sleep apnea is common after stroke. According to the updated best practice recommendations, at least 60 per cent of stroke patients experience sleep apnea. The new recommendations call for more screening of stroke patients who say they experience snoring, fragmented sleep or fatigue. Although, in many cases with stroke patients, daytime fatigue does not appear as a symptom, says Dr. Murray.

It is crucial for stroke patients to be screened for sleep apnea because untreated sleep apnea increases the chances of a second stroke and small studies have found that stroke patients with sleep apnea tended to have worse rehabilitation outcomes, says Dr. Murray.

The best practices also describe "higher rates of mortality and other complications in patients with stroke and untreated obstructive sleep apnea."

"This innovative Canadian research continues to show that there is more to learn about rehabilitation and recovery following stroke," says Ian Joiner, director of stroke for the Heart and Stroke Foundation. "Reflecting these advances in tools such as the Best Practices Recommendations for Stroke Care will help improve outcomes for Canadians."

The new recommendations are the fourth update to the Canadian Best Practice Recommendations for Stroke Care and this is the first time the recommendations have included a section on sleep apnea. The best practices were first released in 2006 to improve stroke care for Canadians living with stroke and future stroke patients. They are updated every two years.

"The new recommendations take stroke care a step further," says Dr. Michael Hill, Canadian Stroke Congress Co-Chair. "Stroke care is not only about giving the best possible treatment to patients. It is also about preventing new and recurrent strokes."

The Canadian Stroke Congress is a joint initiative of the Canadian Stroke Network, Heart and Stroke Foundation of Canada and the Canadian Stroke Consortium.

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Note: Materials may be edited for content and length. For further information, please contact the source cited above.

Note: If no author is given, the source is cited instead.

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.

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Many drugs are just fine years after they 'expire,' study finds - latimes.com

Many drugs are just fine years after they 'expire,' study finds

Chances are, your medicine cabinet contains some pills that are past their expiration date. You might even have some pain relievers, some cough syrup or some sleeping pills that were purchased back when Richard Nixon was in the White House. But you can't seem to throw them away because you suspect they might still be OK to take.

If you've wondered whether medicines really do need to be tossed after their expiration date, you're got some company at the California Poison Control System, UC San Francisco and UC Irvine. Researchers from those institutions decided to satisfy their curiosity by testing the effectiveness of eight drugs that had been sitting around, unopened, in pharmacies for years after they had supposedly gone bad.

These drugs were not just a few years past their prime, these medications were a full 28 to 40 years past their official expiration dates.

The eight drugs contained a total of 15 active ingredients. The researchers couldn't find a standard test for one of them (homatropine), so they focused their analysis on the other 14.

The tablets and capsules were dissolved and subjected to chemical analysis using a mass spectrometer. That revealed how much of the active ingredients remained in the pills.

Out of the 14 active ingredients, 12 were still at high enough concentration – 90% of the amount stated on the label – to qualify as having "acceptable potency," the researchers found. These included:

Acetaminophen (the pain reliever in Tylenol)

Codeine (an opiate that treats pain and coughs)

Hydrocodone (an opiate used to treat moderate to severe pain)

Phenacetin (an analgesic that's not used much anymore)

Caffeine (a stimulant)

Chlorpheniramine (an antihistamine used to treat colds and allergies)

Pentobarbital (a short-acting barbiturate)

Butalbital (a barbiturate that lasts for an intermediate period of time)

Secobarbital (a barbituate used to treat insomnia)

Phenobarbital (a barbiturate that controls seizures and relieves anxiety)

Meprobamate (a tranquilizer to treat anxiety)

Methaqualone (a sedative and muscle relaxant known by the brand name Quaaludes)

The only active ingredients that missed that cutoff were aspirin and the stimulant amphetamine.

The expiration date on a drug is usually one to five years after it was manufactured. But those dates are often set arbitrarily, since the Food and Drug Administration doesn't require pharmaceutical makers to test how long the active ingredients will last, the researchers wrote.

They noted that the Shelf-Life Extension Program allows drugs in federal stockpiles to be retained for up to 278 months after their stated expiration date if tests show they are still potent. But some of the ingredients tested in this study remained good for 480 months – so far.

The research team's obvious conclusion? "Our results support the effectiveness of broadly extending expiration dates for many drugs," they wrote.

"The most important implication of our study involves the potential cost savings resulting from lengthier product expiration dating," they added. "Given that Americans currently spend more than $300 billion annually on prescription medications, extending drug expiration dates could yield enormous health care expenditure savings."

The analysis was published online Monday by Archives of Internal Medicine. The full report is behind a paywall, but you can can read the first page here.

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