News flashes from the AHA
Updates from this week's annual American Heart
Association Scientific Sessions in New Orleans
November 13 - 16, 2000
by DrRich
November 16, 2000
"Benefits" of laser heart surgery are sustained?
Investigators from Northwestern University report that the remarkable
benefits realized from direct myocardial revascularization
(DMR) is sustained
for years. DMR is a technique in which laser energy is used to drill tiny
holes through the heart muscle to try to improve blood flow to that muscle, and
thus improve symptoms of angina.
In this study, investigators followed 78 patients for an average of 5 years
after DMR, and found that the relief they had received from the procedure had
continued. Investigators apparently did not comment on the much larger,
recently reported DIRECT trial (discussed in my recent article Laser
Heart Surgery - Dead on the Vine?) in which the remarkable improvement
seen with DMR was exactly matched by placebo, and which concluded that
DMR offered no measurable benefit whatsoever. One hopes that this seeming
omission by the Northwestern investigators does not really indicate that
proponents of DMR are planning to entirely ignore the evidence.
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http://dailynews.yahoo.com/h/nm/20001115/hl/heart_40.html
The time delay in enrolling patients in clinical trials in the emergency
room is worth it.
Investigators from Duke University report that the time delay in enrolling
patients with acute heart attacks in randomized clinical trials in the emergency
room, prior to administering therapy, takes an average of only 8 minutes (and
thus delays treatment by "only" 8 minutes). The extra 8 minutes
was used "to determine if the patient qualifies for the trial, to explain
the trial to the patient or family member and have a consent form signed, to
telephone a study center to "randomize" the patient to a treatment
arm, and to retrieve a specified drug kit and administer it." DrRich
is impressed. As a former clinical investigator and former IRB chairman
himself, DrRich would like to meet the physician who could adequately explain
even the pertinent ramifications of randomization to a patient in the throes of
an acute heart attack, let alone do all that other stuff, in only 8
minutes.
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http://www.eurekalert.org/releases/dukemed-cpb110900.html
Aggressive management for mild heart attacks saves lives
Two studies showed that patients with mild heart attacks have significantly
improved outcomes with aggressive medical management, including a) immediate and
aggressive use of statin drugs (whatever the cholesterol levels), and b) early
cardiac catheterization and angioplasty or bypass surgery. (The statin
drugs are thought to reduce inflammation in coronary arteries (thus reducing the
risk of acute blockage) in addition to lowering cholesterol.) It has long
been known that patients with large heart attacks do better with aggressive
management. Data are now accumulating that the same is true for patients
with mild heart attacks.
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November 15, 2000:
Heart
attacks can be precipitated by heavy meals!
We've all seen it in the movies; now it turns out to be true.
People with coronary artery disease, according to this new study, have an
increased risk of heart attack in the first two hours after eating a big
meal. Gluttony, it seems, carries not only long-term risks, but acute
risks as well. Beware the holidays.
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http://www.eurekalert.org/releases/aha-hmm110900.html
Measuring
cholesterol with a skin test?
In a study presented yesterday, results were presented using a new means
of measuring cholesterol - a
skin test. The test does not measure HDL
or LDL cholesterol levels, but is
meant to give an index of total cholesterol. The new skin test is designed
to be marketed some day for home use, apparently as a screening test. (If
the skin cholesterol test reads "high," then presumably the consumer
would report for a full blood lipid study.)
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Stem
cell therapy for heart failure?
Investigators from Montreal have implanted bone marrow stem cells into
rat hearts, and were able to demonstrate that the stem cells took on
characteristics of heart muscle cells - including the ability to contract.
This finding opens up a new avenue of research into the treatment of heart
failure in humans.
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November 14, 2000:
Risk factors
in women and children
Women with the "deadly quartet" of risk factors - obesity,
hypertension, diabetes and high triglycerides
- have five times the risk of death as men with the same risk factors. And
children with obesity were found to have a greatly increased incidence of risk
factors for coronary artery disease. The upshot is, controlling obesity in
women and children appears even more important than previously thought.
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If
you've had a heart attack, risk factors are even more important
Tobacco use and reduced HDL
cholesterol levels are even riskier if you've already had a heart
attack. This means, among other things, that smoking after a heart attack
is even more stupid than smoking before a heart attack.
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Using
statins and niacin together can reduce heart attacks by 70%
High risk patients who take statins (to reduce LDL
cholesterol) and niacin (to increase HDL
cholesterol) can realize a striking clinical benefit, in terms of reduced angina
and heart attacks. Doctors will need to take another look at combination
therapy.
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Link
between gum disease and heart attacks
Elevated C-reactive protein
levels are associated with an increased risk of heart attack. This
study shows that heart attack survivors with gum disease have higher C-reactive
protein levels than heart attack survivors without gum disease. What the
study does not address is whether the high CRP levels associated with gum
disease leads to a worse outcome for these patients, or whether treating the gum
disease would reduce the risk of further heart problems.
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http://www.sciencedaily.com/releases/2000/11/001113071724.htm
