"Researchers are using a computer-generated course simulator that helps stroke victims learn to drive again.

The researchers, at the Medical College of Georgia, said patients receiving the five-week simulator training are nearly twice as likely as stroke patients without the training to pass an official driving test.

Abiodun Akinwuntan, a physical therapy instructor and the study's lead researcher, said patients traditionally re-learn driving skills using conventional methods, such as paper-and-pencil-based training.

In 2003, Akinwuntan and colleagues at the Katholieke Universiteit in Leuven, Belgium, the Belgian Road Safety Institute in Brussels and University Hospital in Pellenberg, Belgium, studied 83 stroke patients in the hospital's rehabilitation unit.

Using a 20-mile computer-simulated course Akinwuntan developed, patients practiced driving in virtual rural and urban settings, each testing a different skill level.

The patients "drive" in a specially equipped car on a course projected onto a large screen. Mistakes are monitored both by computer and an observer.Simulator helps stroke victims drive again

"Being overweight or obese, compared with being normal weight or very obese, appears to confer a survival advantage following a heart attack or near heart attack -- collectively called acute coronary syndrome.

However, researchers caution that these findings must be interpreted carefully "and should not be used as evidence against weight reduction."

The findings come from a study that was comparing two drug treatments for people with an acute coronary event. The researcher noticed that mortality rate "was higher for normal weight versus those with a higher BMI" -- i.e., body mass index, a measure of weight in relation to height -- Dr. Eric L. Eisenstein told Reuters Health.

"However, higher BMI individuals were also younger and had other risk factors," he explained, so it wasn't clear that weight itself was a survival factor.

Eisenstein, at the Duke Clinical Research Center, Durham, North Carolina, and his colleagues now report in the American Journal of Medicine that the mortality rate was indeed higher for normal-weight subjects than for other BMI groups when other factors were accounted for.

Compared with normal-weight subjects, after adjustment, the chances of dying within the 30 days after an acute coronary syndrome were reduced by 34 percent in the overweight patients, by 39 percent in the obese and 11 percent in the very obese. The results were similar for dying within 90 days and 1 year.

Eisenstein pointed out that "because overweight and obese individuals in this study have better 1-year incremental survival, it does not follow that they will have a longer life. Age is a primary determinant of life expectancy."

Therefore, he concluded, "although patients who are overweight may, for a variety of reasons, have better initial survival after an acute coronary event, managing obesity remains an important target for risk factor modification and reduction of morbidity and mortality from heart disease in the long run.""Brigham & Women's Hospital {CLICK FOR MORE}

Italian and British researchers compared the effect of a range of pieces, from Beethoven to techno, on musicians and non-musicians.

Tempo, rather than style, was found to be the greatest stress-buster in both groups, the study in Heart found.

But the effects were stronger for the musicians among the 24 people studied, as they had been trained to synchronise breathing with musical phrases.BBC NEWS...CLICK FOR MORE

"Using local anesthetics to temporarily block nerve signals from the heart is a safe and effective treatment for chronic refractory angina, a painful condition resulting from inadequate blood flow to the heart, new research suggests. One injection provides about 3 weeks of relief.

Angina is a common heart problem that can usually be remedied with drug therapy, angioplasty, or surgery. However, for patients with chronic refractory angina, the drugs do not work and due to the presence of other illnesses, they are not candidates for angioplasty or surgery. Thus, these patients are often left with severe, debilitating chest pain.

There are a growing number of patients with angina who, for whatever reason, are not candidates for angioplasty or surgery, lead author Dr. Roger Moore, from The Cardiothoracic Center in Liverpool, UK, and colleagues note. Temporary nerve block or "sympathectomy" has been endorsed as treatment for such patients who have not respond to other measures.

To better understand the risks and benefits of temporary sympathectomy as a treatment for chronic refractory angina, the researchers assessed the outcomes of 59 patients who underwent a total of 327 nerve blockades over a 2-year period. Although the blockades work to control heart pain, the injections themselves are not in the heart, but rather at sites where the nerves travel.

The researchers' findings appear in the Journal of Pain and Symptom Management.

Depending on where the local anesthetic was injected, nerve blockade provided pain relief for 2.8 to 3.5 weeks, on average. About 3 percent of patients experienced complications from the blockade, but all were mild, fully reversible, and just one patient required overnight hospitalization." National Library of Medicine {CLICK FOR MORE}

Abstract

Background

Gastro-esophageal reflux disease (GERD) may cause chest pain. The aim was to determine the correlation between ischemia and gastro-esophageal reflux in patients with CAD and to assess the influence of short-term “anti-reflux” therapy on the ischemia in patients with GERD and C

Conclusions

Gastro-esophageal reflux disease is common in patients with CAD and may provoke myocardial ischemia. Short-term proton pump inhibitors therapy that restores normal esophageal pH significantly reduces myocardial ischemia, possibly due to elimination of acid-derived esophago-cardiac reflex compromising coronary perfusion—the phenomenon known as “linked angina”.ScienceDirect - International Journal of Cardiology :
MORE

A major longitudinal study confirms what experts have long suspected: High blood pressure is key to the increased risk of fatal heart attack and stroke in overweight and obese people. n the study, French researchers tracked the health of more than 240,000 people for an average of 14 years.

"We observed that cardiovascular risk is not clearly increased unless hypertension is present in these overweight and obese subjects," Dr. Athanase Benetos, of the Medical School of Nancy, said in a prepared statement. "In our population, the presence of hypertension was the most important factor that led to increased cardiovascular disease mortality among overweight subjects."

The researchers also found that:

Overweight men and women who had high blood pressure faced double the risk for fatal heart attack or stroke of overweight people with normal blood pressure.
Overweight women who had high blood pressure and diabetes were at more than four times the risk of cardiovascular death and overweight men with high blood pressure had triple the risk, compared to women and men with normal weight and normal blood pressure.
Overweight people with diabetes and normal blood pressure weren't at increased risk of cardiovascular death. Overweight men with high cholesterol were at a slightly increased risk of cardiovascular death, but that was not the case for women.
The best way to reduce the risk of cardiovascular death in overweight and obese people with high blood pressure is treatment that targets both blood pressure and weight, Benetos said.Yahoo! News

Stroke survivors improve in rehab at equal rates, regardless of whether or not they are cognitively impaired, researchers report.


The level of improvement was linked to the severity of the patients' overall post-stroke disability but not to the level of pre-rehabilitation cognitive impairment, researchers reported at the annual meeting of the American Neurological Association.


"At least half of the patients had a cognitive impairment when they entered rehabilitation," principal investigator Larry Goldstein, M.D., said in an interview. Dr. Goldstein is a professor of neurology and director of the Center for Cerebrovascular Diseases at Duke University School of Medicine in Durham, N.C.


"We were looking at whether the initial cognitive impairment predicted or was associated with how they improved in terms of their general neurological impairment," Dr. Goldstein said. "It turned out that, at least in this population, it didn't really matter. The rate of improvement was similar, regardless of whether they had a cognitive impairment at baseline or not."{CLICK FOR MORE}- CME Teaching Brief - MedPage Today

The Food and Drug Administration has approved Pfizer Inc.'s powerhouse statin, Lipitor (atorvastatin calcium) for primary prevention of stroke and myocardial infarction in people with type 2 diabetes.


The FDA also approved Lipitor for primary stroke prevention in non-diabetics who have no evidence of heart disease but have other risk factors such as modest elevations in LDL cholesterol, controlled hypertension, smoking or obesity.


Lipitor is already the top-selling statin in the U.S., and the new indications are likely to be icing on the cake for the popular statin.{CLICK FOR MORE} - CME Teaching Brief - MedPage Today

Women who suffer certain complications during pregnancy apparently run a higher risk of having a stroke later in life, according to findings reported Tuesday at the annual meeting of the American Neurological Association in San Diego, California.

Dr. Monique V. Chireau and colleagues at Duke University Medical Center in Durham, North Carolina, used the university's Perinatal and Health Services Outcomes database to investigate a possible link between pregnancy complications and stroke risk.ABC News: {CLICK FOR MORE}

An elevated blood level of a molecule produced by liver damage also appears to predict the risk of heart disease and stroke, according to an Austrian study published in the Sept. 27 issue of Circulation.

The researchers report that men with even moderately high levels of the molecule, called gamma-glutamyl transferase, were at a 28-percent-higher risk of dying from cardiovascular disease than were those with low levels. For men with the highest levels, the risk was 68 percent greater. In women the increase in risk ranged from 35 percent to 51 percent, the researchers found.

The study was done as a follow-up to an Italian report linking elevated GGT levels to atherosclerosis, the "hardening of the arteries" that leads to heart disease and stroke, according to a statement by study author Hanno Ulmer, an associate professor of medical statistics at Innsbruck Medical University.

Ulmer and his colleagues used medical data on nearly 164,000 Austrian participants in a long-running health-monitoring program.

A follow-up of more than 11 years found that an elevated GGT level was a better predictor of cardiovascular death than high levels of blood sugar and cholesterol, but not as good a predictor as two other major risk factors, smoking and high blood pressure.

A blood test for GGT is widely used to monitor liver function.

For example, many doctors give it routinely to people who take cholesterol-lowering statins, where liver damage is a possible side effect.

But, Ulmer says, "beyond its role as an indicator of liver function, GGT is very likely to predict cardiovascular disease."

There are two possible reasons why GGT is a marker for cardiovascular disease, Ulmer says. One is that it is an indicator of general damage to the arteries. Alternatively it could indicate the damage done to blood vessels by heavy drinking. The Austrian researchers could not rule out the possibility that heavy drinking was the only cause of elevated levels, because they did not have information on alcohol consumption by the study participants.

Further studies are needed to determine the value of GGT testing to assess cardiovascular risk, Ulmer says, adding that it should be included as a major parameter in future cardiovascular-intervention studies.

More studies are necessary, agrees Dr. JoAnn Manson, a professor of medicine at Harvard Medical School in Cambridge, Mass., and a spokeswoman for the American Heart Association.

"It isn't clear whether it is an independent indicator if you rule out other biomarkers of cardiovascular risk," she says.

The nature of the Austrian study "makes it difficult to tease out the confounding effect of alcohol consumption," Manson adds.

"It is an interesting study that warrants confirmation in other populations, especially where you can control for alcohol intake in detail and other biomarkers of risk."

National Library of Medicine

Homocysteine is increasingly being recognized as an independent risk factor for stroke, myocardial infarction (heart attack), atherosclerosis (narrowing or blocking the arteries), high blood pressure, and cardiovascular disease death. Homocysteine is a toxic waste product produced during metabolism of an amino acid called methionine. Diets high in meat and dairy generate excess methionine, which is converted by the body into homocysteine.

Folic acid helps break down homocysteine in the body. Studies have shown that higher blood levels of B vitamins are related to lower concentrations of homocysteine, and additional evidence demonstrates that low blood levels of folic acid are linked with an increased risk of fatal heart attack and stroke.

A study in the July issue of American Journal of Clinical Nutrition examined the effect of folic acid on pulse pressure as well as stiffness in large arteries. Pulse pressure is the difference between the systolic and the diastolic readings and appears to be an indicator of stiffness and inflammation in the blood-vessel walls. They used a randomized, placebo-controlled, double-blind, crossover design on 41 people. The individuals randomly received 5 mg of folic acid per day or a placebo for 3 weeks.

They found that short-term supplementation with folic acid reduced pulse pressure in young men with normal or mildly elevated blood pressure. No adverse effects were reported and there were no significant changes in concentrations of vitamin B-12.

The authors conclude that, “In summary, short-term folic acid treatment reduces pulse pressure and arterial stiffness in young men. Our data indicated that folic acid is a safe and effective supplement that targets large artery stiffness and may reduce isolated systolic hypertension.”
HealthSentinel.com

Statins are currently used to minimize the risk of cardiovascular disease in people with high cholesterol. But researchers have found the treatment could benefit many more potential heart disease patients, including patients with low cholesterol levels.

Researchers Colin Baigent and colleagues from the Clinical Trial Service Unit at Oxford University and Anthony Keech and colleagues from the NHMRC Clinical Trials Centre in Sydney reached their conclusions by combining data from 14 randomized trials of statins involving over 90,000 patients, The Lancet reports.
Lancet - Pharmaceuticals

"
Using medical records from a U.S. health insurance database, researchers found that adults who had been diagnosed with panic disorder were nearly twice as likely as those without the disorder to develop coronary heart disease. The risk was higher still among patients diagnosed with both panic disorder and depression -- two psychiatric conditions that are often seen together.

Estimated to affect more than 2 million Americans in any given year, panic disorder involves "attacks" of intense fear that come out of nowhere. The physical symptoms, including chest pain, breathlessness and dizziness, can mimic a heart attack. And some evidence has suggested that panic attacks may actually predispose a person to developing heart disease.

In the new study, reported in the journal Psychosomatic Medicine, researchers examined data from a managed care database on nearly 40,000 people diagnosed with panic disorder and a similar number without the condition.

Overall, those with panic disorder were 87 percent more likely to suffer a heart attack or develop chest pains caused by impaired blood flow to the heart.

People with a history of depression were also at heightened risk of heart disease -- something that has been seen in previous studies -- and the combination of panic disorder and depression was linked to a 3-fold increase in heart disease risk, according to the researchers, led by Dr. Andres Gomez-Caminero.

The findings, they conclude, suggest that "early detection of panic disorder may prevent the occurrence of coronary heart disease."

Gomez-Caminero, who was based at the University of Pennsylvania in Philadelphia at the time of the study, is now with drug maker Bristol-Myers Squibb.

The study was funded by GlaxoSmithKline Pharmaceuticals, which makes Paxil, an antidepressant that is also prescribed for panic disorder.

It's not fully clear why panic disorder may increase heart disease risk, but chronic effects on the nervous system may be involved, according to the researchers. A number of studies have linked chronic stress to heart disease risk, and depression, scientists speculate, may harm the heart through effects on the nervous system, stress hormones or blood-clotting substances.

The fact that panic disorder and depression had an additive effect in this study, Gomez-Caminero and his colleagues note, suggests that the two conditions have different effects on the cardiovascular system.

The findings, they write, "reaffirm" the need for early treatment of panic disorder and other forms of chronic anxiety -- though studies have not shown whether treatment lowers patients' risk of developing heart disease.

Besides antidepressants, panic disorder can be treated through cognitive behavioral therapy, which aims to change the thoughts and behaviors that set the stage for panic attacks."MedlinePlus: Panic Disorder Seems to Raise Heart Disease Risk

"A University of Michigan study in Ann Arbor indicates women surviving a stroke are less likely than men to receive heart and neck artery tests.

Such tests can help improve stroke victims' treatment and reduce their risk of a second stroke, the researchers said.

The difference in testing between men and women may help explain why women tend to have a worse long-term outcome from stroke, including a higher death rate.

The findings, from a study of 1,234 stroke patients treated in Texas community hospitals, show about 88 percent of all strokes are ischemic, which means they're caused by blood clots traveling to the brain or by blockages in the carotid arteries in the neck that supply blood to the brain.

"Diagnostic evaluations that should be done on every ischemic stroke patient still aren't being performed on a third to a half of patients, and they're less likely to be performed on women," said senior author Dr. Lewis Morgenstern, director of the stroke program in the U-M Cardiovascular Center. "Intervention is needed to increase access to quality stroke care for all patients, but especially women." National Library of Medicine

A large-scale study led by researchers at Beth Israel Deaconess Medical Center (BIDMC) has found that heavy alcohol consumption - 35 or more drinks per week -- can significantly increase men's risk of developing atrial fibrillation, a dangerous type of arrhythmia and one of the leading risk factors for stroke.

Reported in Circulation, the findings - which showed that risk of this rapid, irregular heartbeat was as much as 45 percent higher among heavy drinkers than abstainers--also support the existence of what has come to be known as "holiday heart syndrome."

"Holiday heart syndrome refers to heart rhythm disturbances which develop while a person is on vacation or away from work, and appears to be linked to heavier-than-normal alcohol consumption," explains the study's lead author Kenneth J. Mukamal, MD, MPH, an internist in BIDMC's Division of General Medicine and Primary Care.

"Since our research found that the risk of developing atrial fibrillation begins to increase at about four drinks per day, and clearly goes up at five drinks per day, this would seem to confirm what has long been suspected regarding periods of significant alcohol consumption, like during vacations."

Atrial fibrillation develops when muscles in the heart's upper chambers contract too quickly, resulting in an ineffective, irregular heartbeat. As a result, blood is not adequately pumped from the heart, and may pool and form clots. Blood clots that travel to the brain result in a stroke, and, indeed, statistics show that having atrial fibrillation results in a nearly five-fold increase in a person's stroke risk.

Using information obtained from the Copenhagen City Heart Study in Denmark, the researchers studied 16,415 individuals (7,588 men and 8,827 women) with an average age of 50. The study included the administering of routine electrocardiograms (ECGs) on three separate occasions between 1976 and 1994 to measure the hearts' electrical activity for each participant.

After adjusting for numerous factors including smoking, education, income, physical activity, body mass index, and diabetes, the researchers analyzed data concerning the participants' consumption of alcohol (beer, wine or spirits).

The researchers documented 1,071 cases of atrial fibrillation during the study period.

"Our results showed that the risk of developing irregular heart beat was similar among both non-drinkers and individuals who drank fewer than 14 drinks per week," explains Mukamal, who is also an Assistant Professor of Medicine at Harvard Medical School.

"But among men who typically drank 35 or more alcoholic beverages per week, the risk of atrial fibrillation increased significantly, by 45 percent. [Because so few women in the study qualified as "heavy drinkers," the researchers did not see similar results among the female participants.]{CLICK FOR MORE}

There is nothing like the joy of finding out that something sinful is actually good for you, whether it's sex, chocolate or a glass of fine red wine—or, for that matter, beer, schnapps, whisky or a satisfying aperitif. We've long heard intoxicating hints that red wine has unique benefits for the heart. Certainly it has inspired greater flights of rhetorical fancy than any other drink in history—"A meal without wine is like a day without sunshine," wrote Anthelme Brillat-Savarin in 1825. But the same sunny reputation for heart health is now starting to shine on all liquor. "No matter where you look, the dominant alcoholic beverage is beneficial—whether it's red wine in France and Italy, sake in Japan or beer in Germany," says Dr. Walter Willett, chair of nutrition at the Harvard School of Public Health.{CLICK TO READ MORE} MSNBC.com

"Gastric bypass surgery (also known as bariatric surgery) can be a safe operation for obese patients with heart disease, provided they receive a proper evaluation before the surgery, a new study shows.

In fact, gastric bypass surgery, which makes the stomach smaller so patients can eat less, and cuts out a long stretch of small intestine so fewer nutrients are absorbed, can lead to substantial improvements in heart disease risk factors, according to the study.

In their study, bariatric surgery was "about as safe" for patients with heart disease as it was for patients without heart disease, lead author Dr. Francisco Lopez-Jimenez, from the Mayo Clinic in Rochester, Minnesota, told Reuters Health. Moreover, for the heart disease patients, "the operation was associated with an impressive improvement in heart disease risk factors," he said.

The Mayo team compared the safety and effectiveness of gastric bypass in 52 obese heart patients and 507 obese patients without heart disease.

None of the patients died in the hospital, the report indicates. The rate of cardiac complications in the heart disease group was 5.8 percent, higher, but not significantly different than the 1.4 percent rate seen in the non-heart disease group.

After about 2.5 years of follow up, the heart disease group showed a significant drop in body mass index and blood pressure as well as levels of total cholesterol, "bad" LDL cholesterol, triglycerides and HbA1c, a measure of blood sugar, investigators report in the Mayo Clinic Proceedings.

As with any operation, for bariatric surgery to be successful, heart disease patients must receive an appropriate preoperative evaluation by an internist or cardiologist, Lopez-Jimenez emphasized. There may be some patients, he acknowledged, with severe heart disease that are not suitable candidates for bariatric or any other type of surgery.

SOURCE: Mayo Clinic Proceedings September" 2005.Reuters Health

"When Dr. Christian Barnard performed the world's first successful heart transplant back in 1967, he reached a new peak of human scientific achievement.

However, almost 40 years later, the criteria for receiving a new heart is quite stringent, and heart transplants are granted to those patients who have the highest chance for recovery. For thousands of elderly or gravely ill patients with damaged hearts, a transplant is not an option.

Now Israeli researchers are at the forefront of research which could one day make heart transplants obsolete - using stem cell technology, they're developing a way to use the blood of a newborn baby's discarded umbilical cord (UCB) as an unlimited source of stem/progenitor cells that could be injected into the injured heart in order to regenerate damaged heart tissue.

Despite major advances in diagnosis and prevention, myocardial infarction (MI) continues to be a leading cause of morbidity and mortality around the world. According the American Heart Association, over 13 million Americans suffer from coronary heart disease, which account for over one million deaths a year.

The loss of heart muscle cells - or myocytes - in an injured heart often leads to irreversible deficits in cardiac function. Current clinical interventions to minimize the devastating effects of heart attack have not found a way to regenerate the damaged cells and prevent possible heart failure.

But recently, stem-cell based therapy has emerged as a novel strategy to repair
myocardial damage. However, according to Professor Jonathan Leor, one of the pioneers of the UCB research, one of the biggest unmet challenges so far has been to produce a sufficient number of suitable cells. He said that stem cell transplantation into the damaged tissue has limitations from both a practical and clinical points of view.

"The two main groups of stem cells that have been investigated until now as potential sources of tissue for repair are human embryonic stem cells and adult stem cells," explained Leor, director of the Neufeld Cardiac Research Institute, a Tel-Aviv University Institute located at the Sheba Medical Center.

"The limitation of the former is that it's difficult to control its differential - its conversion to adult tissue - and the risk of tumor formation is high. Another limitation is the likelihood of serious complications of immunosuppressive therapy - this could result in infections, or cancer," Leor told ISRAEL21c.

"Adult stem cells on the other hand are autologous - they're taken from the patient themselves, so they're a perfect match. However, these stem cells are rare, and difficult to isolate. And if you're dealing with a sick or elderly patient - which is mostly the case - their capacity of their cells to regenerate and proliferate is low," he added.

For all those reasons, Leor said that there's been a need to find alternative sources of stem cells for regeneration and repair. And, according to his research, umbilical cord blood has turned out to be a very attractive source for myocardial repair.

"UCB cells are readily available, are used in patients with hematologic disorders including genetic diseases and hematologic malignancies, and have many advantages that are relevant to cell therapy for cardiac healing and repair," he said, adding, "The use of UCB stem cells is of importance to elderly and sick people in whom the availability of autologous stem cells is limited."

Among the advantages he outlined are the UCB cells' richness in stem and progenitor cells, with improved characteristics for regeneration. These cells can be easily obtained, expanded in vitro have the potential for enhanced self-renewal and can be 'banked' for future use.

The collection of UCB from as many donors as possible would also increase the likelihood of finding a match for people from many ethnic groups. And according to Leor's research, it appears that there is reduced risk of rejection by the recipient's immune system with UCB-derived stem cells. And finally, the use of UCB may make stem cell transplants available more quickly for patients with severe cases of heart disease who may die before a donor match can be made.

"The cells can participate in repair in more than one way - there's the potential for them to be converted into heart cells or cells that create new vessels to repair the damaged heart tissue. In addition, the cells release molecules and hormones that promote the healing and repair of damaged heart cells," he said.

Just as importantly, there is no ethical issue involved with using the stem cells of UCB, as there are with using stem cells from embryos.

"Usually, the umbilical cord is thrown away anyway, there's no ethical dilemma involved, we're not using an embryo," said Leor.

Leor - who worked together with Prof. Arnon Nagler, director of the Sheba Medical Center Hematology Department, its Bone Marrow Transplantation Unit, and its Cord Blood Bank, performed a pilot study to demonstrate the safety and feasibility of intracoronary delivery of UCB progenitor cells into the infarcted myocardium of pigs, and to track cell migration and colonization.

They discovered clusters of human cells had colonized and survived in the infracted myocardium - thus, the experiment proved that UCB-derived cells can be delivered to the infracted myocardium by a catheter-based technique and some cells can survive..

The mechanism by which cell transplantation improves cardiac function is uncertain and in many studies remains speculative, explained Leor.

"One of the challenges today is to develop a technique to expand the cells and increase their number," he said, adding that he's collaborating in this effort with Israeli stem cell research innovators Gamida-Cell in this effort.

Gamida-Cell is a leader in the expansion of blood stem cell therapeutics in clinical development for cancer and autoimmune diseases, as well as future regenerative cell-based medicines including cardiac and pancreatic repair.

"They have a patent on how to expand and increase the number of stem cells - we're doing research for them. They're expanding the cells, and we test them in animal model of heart disease. We have the proof of concept that even after expansion the cells are able to generate new tissue and improve heart function." said Leor.

His team plans to initiate pre-clinical trials using pigs sometime before the end of the year. "Israel21c

"Implanted cardioverter defibrillators, or ICDs, and pacemakers were "directly responsible" for 61 deaths out of nearly 3 million implants between 1990 and 2002, according to a Food and Drug Administration report released on Friday.

Those deaths were ones that had been linked to a malfunctioning device that was removed and checked by the manufacturer, it said.

Defibrillator malfunctions dipped in the mid-1990s but rose since 1999, after which more than half occurred, it also found.

"The results demonstrate a marked increase," William Maisel, a Boston-based cardiologist and an FDA consultant, said at a Washington meeting of cardiologists.

The study said the reasons for the increase were unclear, but could be due to the devices' growing complexity, or more physician reports.

The event, sponsored by the Heart Rhythm Society, focused on how to better monitor and report problems. The group represents doctors who deal with irregular heartbeats, which can be treated with devices that shock the heart to normal rhythms.

It will eventually make formal recommendations for change, but said the process could take months or longer.

The last two years has seen thousands of recalled heart devices. Current makers include Guidant Corp., Medtronic Inc. and St. Jude Medical, Inc..

A debate erupted earlier this year after it was disclosed that Guidant did not make public for three years a potential problem with some ICDs.

FDA officials said their review, which analyzed yearly reports submitted by companies from 1990 through 2002, was an attempt to be more forthcoming.

Pacemaker problems since 1990 have dropped, they also found, to a mean annual rate of 4.6 replacements per 1,000 implants compared with 20.7 per 1,000 for defibrillators.

Irregular heartbeats, or arrhythmias, are common, and medication are also used as treatments. A procedure using radio frequency to destroy problematic heart tissue also may help.

Daniel Schultz, head of the FDA's device center, said it was "too soon" to determine the agency's specific next steps.

At the meeting, experts debated how much information device makers and the FDA should release and when.

"Public communication of advisories has an adverse impact on unaffected and potential patients," said Tim Samsel, head of regulatory affairs for Medtronic's cardiac rhythm unit who argued information should come from doctors.

Advocate Lisa Salberg said patients should also hear about problems directly from companies and the FDA.

Some questioned if the agency had enough resources.

"I think the FDA can do a better job," said Thomas Gross, head of post-market device surveillance at the agency. "There are gaps in the system."

One such gap is getting devices returned when there is a problem, or even death. Some called for a new system requiring all such devices to be registered.

Many panelists recognized the industry's tarnished image but argued that the devices' benefits outweighed any risks." Reuters.co.uk

The US drug giant Merck withdrew Vioxx in September 2004 after evidence linking it to heart attacks and stroke.

Now a US team at Duke University says taking low-dose aspirin alongside Vioxx might prevent these side effects, the journal Cell Metabolism reports.

A Texan court recently found Merck guilty of negligence over its handling of Vioxx, prompting worldwide lawsuits.

Unwanted side effects

COX-2 inhibitors are more "stomach friendly" alternatives to traditional pain relief drugs called non-steroidal anti-inflammatory drugs (NSAIDs), which can sometimes cause side effects such as ulcers and bleeding.

They are used to treat pain and inflammation in arthritis and to relieve acute pain.

Since the heart safety concerns surrounding Vioxx and other COX-2 inhibitors were raised, researchers have been investigating how they might be avoided.

Dr Thomas Coffman, along with colleagues from the University of North Carolina, Pennsylvania University and Durham VA Medical Center, looked at some of the chemical processes that occur in the body in response to COX-2s.

COX-2s and other NSAIDs, including aspirin and ibuprofen, reduce inflammation and pain by blocking the function of enzymes called cyclo-oxygenases.

These enzymes normally produce chemicals called prostaglandins, such as prostacyclin, and thromboxanes.

Prostacylin keeps blood vessels open and prevents clots, while thromboxane constricts vessels and promotes clot formation.

COX-2 inhibitors cause a decline in prostacyclin without any change in thromboxane levels. In comparison, aspirin lowers both thromboxane and prostacyclin.

Landmark data from the PROactive Study, presented today at the 41st meeting of the European Association for the Study of Diabetes (EASD) demonstrated that ACTOS® (pioglitazone HCl) significantly reduced the combined risk of heart attacks, strokes and death by 16% in high-risk patients with type 2 diabetes.
"The PROactive study is the first in the world to prospectively show that a specific oral glucose lowering medication, namely pioglitazone, can significantly improve cardiovascular outcomes by helping to delay or reduce heart attacks, strokes and death in high-risk patients," said John Dormandy, M.D., professor of Vascular Sciences at St. George's Hospital, London, UK, and chairman of the PROactive Study Steering Committee. "This groundbreaking study gives new hope to people with type 2 diabetes who, despite their attempts to control blood glucose and take medications, fear these life-threatening events."

PROactive (PROspective PioglitAzone Clinical Trial In MacroVascular Events) was a randomized, double blind, placebo-controlled outcome study to determine the effects of ACTOS on mortality and morbidity associated with cardiovascular disease progression in more than 5,000 high risk patients with type 2 diabetes when added to standard of care treatment.

Standard of care included the routine use of anti-hypertensives such as ACE inhibitors and beta blockers; glucose-lowering agents such as metformin, sulfonylureas and insulin; antiplatelet drugs such as aspirin, and lipid-modifying medicines such as statins and fibrates.

Compelling Study Results

This study focused on two key endpoints: a primary combination endpoint of seven different macrovascular events of varying clinical importance; and a principal secondary combination endpoint of life-threatening events including death, heart attack and stroke.

The primary endpoint was reduced by 10% but had not reached statistical significance by study end (p=0.095). The principal secondary endpoint of life-threatening events showed that pioglitazone significantly reduced the risk of heart attacks, strokes and death by 16% (p=0.027).

According to Professor Dormandy, these results predict that 10 heart attacks, strokes or deaths will be prevented for every 500 high-risk patients treated with ACTOS® (pioglitazone HCl) over three years. Additional PROactive study results of ACTOS showed:


HbA1c levels (a measurement of long-term blood glucose control) were significantly reduced as compared to placebo (p<0.001). p="0.003)." p="0.03);" href="http://www.eurekalert.org/pub_releases/2005-09/k-pss091205.php">CLICK HERE FOR ARTICLE

Johns Hopkins Medicine-- Testing for exercise capacity and heart rate recovery improves on traditional risk-factor scoring

Performing cardiac stress tests that measure exercise capacity and heart rate recovery can improve dramatically on existing techniques that predict who is most likely to suffer a heart attack or die from coronary heart disease (CHD), the leading cause of death in the United States, a team of cardiologists at Johns Hopkins reports.

In the Sept. 13 edition of the journal Circulation, the Johns Hopkins team reports that 90 percent of men and women with no early signs of CHD who, nevertheless, died from it had had below average results from their cardiac stress tests conducted 10 to 20 years earlier.

The team's analysis showed these asymptomatic people were two to four times more likely to die from CHD within 10 to 20 years than people with average or better-than-average stress test results, even though traditional scoring for major risk factors for the disease, such as such as age, blood pressure, blood cholesterol levels and smoking status, had determined the asymptomatic people to be at low or intermediate risk of having heart problems.

According to the cardiologists, these exercise stress tests are easy to perform, lasting less than 20 minutes and requiring only that a person walk on a treadmill at progressively higher speeds and inclines every three minutes until they become markedly fatigued. During the test, people are hooked up to a heart monitor.

"This is the strongest evidence to date that selective use of cardiac stress testing improves prediction of who is really at high risk of suffering a fatal heart attack when traditional risk assessment suggests they are not at high risk of a heart attack within the next 10 years," says senior study author and cardiologist Roger S. Blumenthal, M.D., an associate professor and director of the Ciccarone Preventive Cardiology Center at The Johns Hopkins University School of Medicine and its Heart Institute.
The traditional risk factors combine to give a score called the Framingham Risk Score, or FRS, that was developed in the last 20 years. Considered the gold standard, the score is based on a summary estimate of the major risk factors for heart disease: age, blood pressure, blood cholesterol levels and smoking status. It consists of a percentage range of how likely a person is to suffer a fatal or nonfatal heart attack within 10 years.

However, Blumenthal says that many people, especially women, with cardiovascular problems go undetected despite use of the Framingham score, which does not factor in a person's family history, weight or exercise habits. Blumenthal is also a spokesman for the American Heart Association, which estimates that 656,000 Americans died from CHD in 2002, the last year for which statistics are available.

More than 6,100 people took part in the study, conducted from 1972 to 1995, and part of a larger project known as the Lipid Research Clinics Prevalence Study. All participants in this smaller Johns Hopkins study were age 30 to 70. None had early signs of heart disease, but every participant did have at least one major risk factor for it.

At 10 medical centers across the United States, study participants were given a physical examination, had blood tests performed and were scored on the FRS. Each participant also underwent cardiac stress testing, which included stress testing for exercise capacity and heart rate recovery, plus any changes in the heart's electrical signaling that are typical of decreased blood flow to the heart muscle.

Those with a Framingham score of less than 10 percent were gauged to be at low risk for future CHD, while participants with a score between 10 percent and 20 percent were ranked at intermediate risk for future CHD, and those with a score higher than 20 percent were judged to be at high risk of CHD.

Once participants were ranked by Framingham score, the researchers monitored their health every six months until death or the end of the study to find out who did or did not die from a heart attack or CHD.

Cardiac stress testing is used to gauge how well the heart works when it has to pump harder and use more oxygen, for example, while walking on a treadmill. The exercise, sustained for five to 10 minutes, mimics the strain placed on the heart when arteries are blocked or narrowed.

The researchers' goal, however, was to determine if more accurate prediction of whether or not a person will die from a heart attack could be made by adding exercise capacity and heart rate recovery to current assessment techniques that relied mostly on monitoring the heart's electrical signaling.

During stress testing, a person's breathing, blood pressure and heart rate are monitored while the intensity of their exercising is slowly increased to see how their heart responds. The amount, in number of beats per minute, that the heart rate drops two minutes after exercise stops is also recorded to determine heart rate recovery.

Using tables that take into account a person's age, gender and weight, the results can be compared against average scores to see if a person is below, at or above the norm. There is very little risk of harm associated with the testing because participants are closely monitored.

The researchers report that 246 participants died from CHD even though they had initially been categorized by their FRS as at either low or intermediate risk of the disease. However, 225 of those who died also had below average test scores for exercise capacity and heart rate recovery.

"Our best means of preventing coronary heart disease is to identify those most likely to develop the condition and intervene before symptoms appear," says the study's lead author, cardiologist Samia Mora, M.D., M.H.S., then a research fellow at Johns Hopkins.
"Cardiac stress testing could significantly improve our abilities to find and aggressively treat these people so that they are much less likely to suffer a heart attack."

According to the researchers, these latest results support conclusions from earlier this year that traditional risk assessment with the FRS can be improved with selective use of cardiac CT scans to measure calcium scores in individuals with more than one risk factor, such as obesity, smoking, sedentary lifestyle or a family history of heart disease

CLICK HERE FOR ARTICLECoretta Scott King, 78, is in an Atlanta hospital, facing speech, occupational and physical therapy after a stroke and minor heart attack on Aug. 16. Those events were preceded by two transient ischemic attacks, known as TIAs or ministrokes, during which she had trouble speaking, according to published reports.
Senate Democratic leader Harry Reid, 65, of Nevada had a ministroke the same week but has suffered no complications, according to wire service reports.
These two cases have raised the profile of TIAs and sparked questions, including how any stroke can be properly described as "mini."
Ministrokes are essentially the same thing as a stroke, except that the patient gets better and the symptoms go away, said Chelsea Kidwell, medical director of the Stroke Center at Washington Hospital Center.
Mrs. King's experience is not unique – those who have had ministrokes are at increased risk for a major stroke. Patients should view TIAs as "an opportunity to prevent a subsequent stroke," Dr. Kidwell said. The only difference between someone who has had a TIA and someone who has had a stroke "is the person with the TIA got very lucky," she said. "But next time they may not get so lucky."
Strokes are the third-leading cause of death in the United States, according to the Centers for Disease Control and Prevention.
Some symptoms of TIA are subtle but ignoring them can be deadly, so those known to be at higher risk for stroke should be aware of the signs and contact a doctor immediately if they experience them. Symptoms depend on "which blood vessel is involved ... but for the most part consciousness is not affected," said Larry B. Goldstein, director of the stroke center at Duke University School of Medicine and chair of the stroke council for the American Stroke Association.
Because there is no way to tell in the short term whether symptoms are from a TIA or an acute stroke, "patients should assume that all strokelike symptoms signal an emergency and should not wait to see if they go away," according to the National Institute of Neurological Disorders and Stroke (NINDS).
More questions and answers:
Question: How would I know if I'm having a ministroke?
Answer: It may start suddenly and last only a few minutes. You may be confused or have sudden difficulty seeing, walking, talking or understanding conversation. According to the Mayo Clinic, common signs include: slurred or garbled speech or trouble understanding others; double vision or sudden blindness in one or both eyes; dizziness, loss of coordination or balance; numbness, weakness or paralysis in the face, leg or arm – often on one side of the body.
But the symptoms disappear, usually quickly – at most, in 24 hours. You may not even realize what's happening.
In fact, the mildness of the symptoms can make TIAs difficult for a person to recognize. In an ASA-sponsored study of more than 10,000 people published in 2003, about 200 said they had been told by a doctor that they'd had a TIA. Of those, only 64 percent had seen a doctor within 24 hours of the ministroke. Another 300 "recalled symptoms consistent with TIA but did not seek medical attention."
Question: How often do TIAs lead to strokes?
Answer: About a third of those who have had a TIA will go on to have a stroke, according to Med- linePlus, a service run by the National Library of Medicine and the National Institutes of Health. And about a third of people who have a TIA will have another ministroke. "It's generally understood that the more [TIA] events you have, the greater your risk" of stroke, Dr. Kidwell said.
Question: Do some people with TIAs know they're having a stroke?
Answer: Yes, but they don't always dial 911. In some cases, the part of the brain used to make quick-reaction decisions may be affected, said Dr. Goldstein. If you're at risk, it's important that your loved ones know what to do, too. Talk with them about the symptoms today, he suggests.
Question: Is there really a difference between a "mini" and a "major" stroke?
Answer: Yes. The effects of a TIA are temporary, while the effects of a major stroke can be permanent. Any type of stroke is caused by interruption of blood supply to parts of the brain, which causes decreased brain function. If symptoms resolve themselves within 24 hours, the episode is deemed a TIA; if they continue beyond that, it is called a stroke.
A variety of factors can cause loss of blood flow to the brain, including blood clotting in an artery; narrowing, injury or inflammation of a blood vessel; cancer, a blood disorder (such as sickle cell anemia) or other condition; and a blood clot moving to the brain from another place in the body.
TIAs are "ischemic" strokes – where the blood vessel clogs from within. This type accounts for about 83 percent of all strokes, according to the ASA.
A second type – which is not involved in TIAs – are "hemorrhagic" strokes, where a weakened blood vessel ruptures, causing blood to accumulate in the brain and compress brain tissue. These account for about 17 percent of all strokes.
Question: How do I know if I'm at risk for a TIA or stroke?
Answer: Risks for having TIAs are similar to those for heart disease. They include "things you can do things about" and "things you can't do anything about," said Dr. Goldstein.
Factors you can't control include family history, age, sex and race. You're at greater risk if a family member has had a TIA or stroke. Men have strokes more often than women. Blacks face greater risks of death from stroke than other groups, according to the Mayo Clinic's Web site.
As for those things you can control, they include high blood pressure, diabetes and cholesterol. Proper weight, diet and exercise decreases your risk for stroke, according to the ASA. Heart disease and cigarette smoking put you at higher risk for stroke, too.
Question: Does my risk of TIA or stroke increase as I get older?
Answer: Yes. After age 55, the risk doubles every decade through at least the 80s, Dr. Goldstein said. Two-thirds of strokes and TIAs happen in those 65 and older.
Question: Is there any way to predict risk of a major stroke after a TIA?
Answer: A group of British researchers found that likelihood of stroke within seven days of a TIA is "highly predictable," based on blood pressure readings, clinical features and duration of symptoms, according to a study in The Lancet in July.
In a 2000 study of more than 1,700 TIA patients, published in the Journal of the American Medical Association, 91 people had a stroke within two days of their ministrokes. Another 89 patients had strokes within 90 days.
Question: Are there treatments for TIA or stroke?
Answer: Examination within 60 minutes of the start of symptoms provides the best opportunity for successful treatment, according to NINDS. Your doctor may prescribe or administer medication to dissolve blood clots and reduce the chances of future blockages, but some drugs are effective only within three hours of symptom onset. Your doctor might also recommend surgery or an angioplasty to unblock arteries. More on stroke: Warning signs, treatments and prevention. Log on for official links.

A team of scientists from the Johns Hopkins Department of Radiology and Institute of Cell Engineering has used a non-invasive imaging technique, called SPECT/CT, to successfully trace stem cells' destinations after being injected into the body to treat animal hearts damaged by myocardial infarction, or heart attack.

In the study, researchers surgically induced acute myocardial infarctions in seven dogs, six of which later received canine mesenchymal stem cells (MSCs) labeled with a radioactive tracer and magnetic resonance imaging (MRI) contrast agent to enhance image quality. Both the tracer and contrast agent are widely used in research and routine clinical practice.

The internal distribution of the injected stem cells was tracked with SPECT/CT and MRI scanners immediately after injection as well as at multiple time points over seven days to assess whether the MSCs preferentially migrated or "homed" in on damaged cardiac tissue. Previous studies in animals were only able to demonstrate homing by examining the tissue microscopically after death.

The team's results, reported in the Sept. 6, 2005, issue of Circulation, revealed redistribution of the radiolabeled MSCs from the initial localization in the lungs to the target organ, the heart, at 24 hours post-injection. Moreover, the cells remained visible in SPECT/CT images until seven days after the injection.

SPECT/CT also found redistribution of the MSCs to non-target organs, such as the liver, kidney and spleen. Measuring the radiation levels in tissues obtained from the animals after their death validated these findings.

MRI, because of its lower sensitivity, was unable to demonstrate targeted cardiac localization of MSCs.

"Our study demonstrates that SPECT/CT imaging is well suited to dynamically track the biodistribution and movement of stem cells to both target and non-target organs," says lead investigator Dr. Dara L. Kraitchman, an associate professor of radiology at the Johns Hopkins Russell H. Morgan Department of Radiology and Radiological Science. "Such a non-invasive means of studying stem cell movement could be very helpful in monitoring therapeutic safety and efficacy in clinical trials." With her co-workers, Drs. Jeff W.M. Bulte, Mark F. Pittenger, Benjamin M.W. Tsui, Randell G. Young, and Richard L. Wahl, she anticipates that this technique will useful in developing customized therapies for future patient trials.

SPECT, or single photon emission computed tomography, is a special type of emission computed tomography (ECT) scan in which a small amount of a radioactive tracer is injected into a vein, and a scanner is used to make detailed images that are highly sensitive to the location of the radioactive materials inside the body. CT, or computed tomography, uses X-rays to produce high-resolution images of the anatomical structure of the body's interior. Combining the two techniques greatly enhances anatomical mapping and localization, permitting researchers to know more precisely what cells or organs are taking up the radiolabeled tracer.

Photographs and videos of the SPECT/CT images can be viewed online at http://www.hopkinsmedicine.org/Press_releases/2005/08_30a_05.html

Under certain circumstances, mobile phones can have adverse effects on the function of pacemakers, but the devices usually start working properly again once the phones are moved away, researchers in Turkey report.

"Patients must not get into a panic about this issue (because) modern pacemakers are quite protected devices from interference," Dr. Izzet Tandogan told Reuters Health.

Tandogan, of the University of Cumhuriyet, Sivas, and colleagues examined the effects of mobile phones on pacemaker function in a study involving 679 patients with permanent pacemakers.

During the tests, two mobile phones were symmetrically placed on both sides of the implanted pacemaker with the antennas being equidistance at 50, 30, 20, and 10 cm. The team performed the tests when both mobile phones were opened, on stand-by, receiving a call, during the call and closed.

Thirty-seven patients with pacemakers (5.5 percent) were adversely affected by the mobile phones, the team reports in the International Journal of Cardiology.

About half of the adverse effects occurred when the phone was 10 cm or closer to the pacemaker. The older the pacemaker, the more likely it was to be affected by the phones, the investigators found.

However, no permanent changes in pacemaker programs or function were observed.

"The most essential recommendation to patients is that mobile phones must be kept at least 20 cm away from pacemakers," Tandogan said in an interview.

"For this purpose, it is sufficient for patients not to use the ear on the side of the pacemaker while talking on the mobile phone and not to carry the mobile phone in the shirt pocket on the side of the pacemaker," he explained.

Patients who need to be most careful are those who are "without spontaneous cardiac rhythm and completely dependent on pacemakers, in whom pacemaker inhibition can lead to a drastic and fatal outcome."

Despite the note of caution, Tandogan said a lot more needs to be clarified about this issue. "Vulnerability of pacemakers made by various manufacturers and effects of mobile phones produced by different firms, and the effect of mobile phone base stations, are other subjects to be investigated."MedlinePlus:

Obesity is a risk factor for deep venous thrombosis and pulmonary embolism, especially for men and women younger than 40, according to an analysis of millions of U.S. hospital patient records accrued over 20 years.

Obese individuals had more than twice the risk of deep venous thrombosis and pulmonary embolism compared with people of healthy weight, reported Paul D. Stein, M.D., of the Saint Joseph Mercy Oakland Hospital here.

Furthermore, obese persons younger than 40 had more than five times the risk, Dr. Stein and colleagues concluded in the September issue of The American Journal of Medicine.

Obesity has long been thought to be a risk factor, but previous studies were not definitive, the researchers said. In an attempt to settle the question once and for all, the researches mined the database of the National Hospital Discharge Survey to find patients diagnosed with obesity between 1979 and 1999. They then determined the number of these patients also diagnosed with deep venous thrombosis or pulmonary embolism.

The 20 years of hospital records from nearly 500 hospitals in all 50 U.S. states involved huge numbers. The analysis included data on about 12 million hospitalizations of obese patients and a staggering 700 million hospitalizations of non-obese patients. All races and ages were represented.


Obesity had the greatest impact on patients younger than 40. In this age group, the relative risk compared with normal weight for deep venous thrombosis was 5.20 (95% CI=5.15-5.25) and for pulmonary embolism was 5.19 (95% CI=5.11-5.28).

Obese women had significantly greater risk than obese men. Compared with women of normal weight, obese women had relative risk for deep venous thrombosis of 2.75 (95% CI=2.74-2.76), versus 2.02 (95% CI=2.01-2.04) for obese men.

The greater risk for women was particularly pronounced for those younger than 40. Compared with women of normal weight, obese women in this group had a relative risk for deep venous thrombosis of 6.10 (95% CI=6.04-6.17) versus 3.71 (95% CI=3.64-3.79) for obese men.

"Now that we know with certainly that obesity is a risk factor for pulmonary embolism, particularly in men and women under age 40, the presence of obesity may alert physicians to a possibility of the diagnosis," Dr. Stein said.

"The diagnosis of pulmonary embolism is frequently missed even though pulmonary embolism is the third most common acute cardiovascular disease after myocardial infarction and stroke," he added.


CME Teaching Brief - MedPage Today

Women are nearly twice as likely as men to die from complications of heart bypass surgery, and their typically smaller body size may be one of the reasons, according to a study published Tuesday.

In a review of records for 15,440 patients who had undergone coronary artery bypass grafting (CABG), researchers found that 4.24 percent of women died during or immediately after surgery, versus 2.23 percent of men, a statistically significant difference.

The main reasons for the gender gap were the higher rates of "traditional risk factors" among women, said lead study author Dr. Ron Blankstein. In general, the study found, women were older and more likely than men to have problems such as diabetes and advanced heart failure.

But another factor was body size. Patients with a relatively smaller "body surface area" were at greater risk of dying from heart bypass surgery, and in general, women have smaller bodies than men.

Body surface area is an indication of the size of a person's coronary arteries, and smaller vessels can make the surgery "technically more difficult," explained Blankstein, a cardiology fellow at the University of Chicago Hospitals.

This fact, he and his colleagues speculate, may be why smaller body size was linked to poorer survival.

However, body size and traditional risk factors did not fully explain the higher death risk among female patients, Blankstein told Reuters Health.

"Just being female is itself a risk factor," he said. "We need to figure out why this is."

Blankstein and his colleagues report their findings in the annual Cardiovascular Surgery Supplement of Circulation, a journal published by the American Heart Association.

During CABG, a surgeon takes blood vessels from a patient's leg or elsewhere in the body and uses them to reroute blood around a blockage in the arteries that normally supply the heart. Though coronary artery disease can often be managed with drug therapy or angioplasty -- a less invasive procedure that opens up clogged arteries -- some patients require CABG.

Blankstein said that while the new findings are "sobering," they should not discourage women from having the surgery if they need it.

"For a lot of women," he noted, "bypass still represents the best option for their disease."

The study involved patients who underwent CABG at one of 31 hospitals in the Midwestern U.S. in 1999 and 2000. Overall, women were 90 percent more likely than men to die during or soon after surgery.

When the researchers accounted for a variety of potential risk factors, including age, co-existing diseases and body size, the gender gap narrowed substantially. Still, women remained 22 percent more likely to die compared with men.

It will be important to find out why this discrepancy persists even when standard risk factors are considered, Blankstein said.

Some open questions, according to the researchers, are whether body fat plays a role, since it affects healing in tissues and blood vessels, and whether hormonal differences between women and men could be at work.

MedlinePlus

: "Tens of thousands of heart attacks, strokes, and deaths could be prevented each year if people took a combination of newer high blood pressure drugs rather than the old standbys"...Additionally, the newer regimen may cut the risk of diabetes by about one-third, says researcher Bjorn Dahlof, MD, associate professor of medicine at the University of Goteborg in Sweden.

"The more modern therapy fared better than the older treatment in almost every regard," he tells WebMD.

Is Newer Really Better?

The new study does not agree with previous research showing that water pills (diuretics) were better at preventing heart failure and stroke than newer blood pressure drugs.

A landmark trial in 2002 showed that compared with the cheaper diuretic, people taking Norvasc had a 38% higher risk of developing heart failure and a 35% higher chance of being hospitalized with heart failure. Those on an ACE inhibitor, also a newer class of drugs, had a 15% higher risk of stroke, a 19% higher risk of developing heart failure, and other increased risks compared with people taking a diuretic.

In response to those previous findings, experts told WebMD in 2002 that doctors should begin drug treatment for high blood pressure with a diuretic.

Drugs Battle It Out

The new study, presented here at the annual meeting of the European Society of Cardiology, included more than 19,000 people with high blood pressure and at least three other heart disease risk factors, such as smoking and family history.

About half got Norvasc -- a member of the newer class of drugs known as calcium-channel blockers -- while the rest got atenolol, an older drug belonging to the class called beta-blockers. The study was funded by Pfizer, which manufacturers Norvasc. Pfizer is a WebMD sponsor.

If either of the drugs failed to lower blood pressure, another medication was added: People on Norvasc were also given the ACE inhibitor Aceon, while those on atenolol added a diuretic.

After 5.5 years, the trial was stopped prematurely when results showed the Norvasc-based treatment beat out the older approach: They were 23% less likely to have a stroke, 11% less likely to die, and 30% less likely to develop diabetes than people who took the beta-blocker. Both regimens were equally safe.

Additionally, 32% of the people with diabetes and 60% of those without diabetes achieved their blood pressure goals: less than 140/90 for patients without diabetes and 130/80 for patients with diabetes.

The study was simultaneously published online in The Lancet. [webmd.com]

Since the popularity of the Atkins Diet, South Beach Diet and other high protein diets, many Americans are avoiding carbohydrates in favor of meat and high fat dairy sources such as cheese. Little information is available on the long-term effects of these diets on human health although studies show a strong correlation between countries with high animal protein intake and coronary heart disease [CHD], although short-term ecologic studies show a favorable effect on blood fats and a lower risk of ischemic (decreased blood flow to the heart) heart disease.

A 20-year follow-up study of over 25,000 California Seventh-day Adventists showed a positive association between meat consumption and ischemic heart disease. A 14-year follow-up study in over 80,000 women showed a significant increased risk of major CHD events. In that same study, a subgroup of over 57,000 postmenopausal women showed that processed meats, such as hog dogs, bacon, sausage, salami, and bologna, was associated with a 44% increased risk of CHD.

Studies on that animal protein fed to rabbits increase plaque formation in the arteries independent of dietary fat and cholesterol, whereas soy protein fed to rabbits did not show such a relationship, and other studies consistently show the positive effect soy protein has on blood fats. More recently, studies have shown a positive association between consumption of meat that has been fried, barbecued, or broiled with the development of several cancers, where the connection is explained by the creation of potent and bioavailable carcinogenic heterocyclic amines.

A study in the February issue of the American Journal of Epidemiology examined the long-term relationship of protein intake of over 29,000 postmenopausal women followed over 15 years. The authors found that there was a 30% increased risk of CHD in the group that had the highest animal protein intake compared to the group that had more vegetable protein. The authors also found that, “A composite of red and processed meat servings in place of carbohydrate food servings was associated with a 44 percent increase risk of CHD mortality, and a similar increased risk was observed with dairy servings.”

The authors note that the increased risk of CHD may be because animal protein contains large amounts of methionine. Methionine is an amino acid that eventually increases homocysteine levels in the body. Homocysteine has been shown in many studies to be a significant risk factor in heart disease.

The authors conclude that, “our results, together with the lack of benefit to sustained weight loss due to consumption of high-animal-protein diet such as promoted by Atkins and tested in a recent randomized trial, do not support any salutary gain of these diets and suggest potential harm. Long-term adherence to popular high-protein diets, without discrimination toward protein source, may have potentially adverse health consequences.”[HealthSentinel.com]

Researchers may have pinned down one important reason for the positive effect olive oil appears to have on cardiovascular health: it contains a naturally occurring anti-inflammatory chemical.

The substance, which the researchers call oleocanthal, has the same anti-inflammatory effect as drugs like ibuprofen and aspirin, which can inhibit the sometimes harmful effects of enzymes called cox-1 and cox-2.

The report appears in the Sept. 1 issue of Nature.

Scientists have long known that low-doses of the cox inhibitors confer various benefits on the people who use them.

Now, the researchers are speculating that the health benefits that are widely linked to the Mediterranean diet, which is rich in olive oil in various forms, may stem at least in part from the same mechanism.

"There is ample evidence that chronic low-dose anti-inflammatories have multiple health benefits that may range from reducing the risk of heart disease, stroke and certain cancers - breast, lung, colon - to reducing the risk of terminal dementias such as Alzheimer's," said Paul A. S. Breslin, who is a co-author of the report and a researcher at the Monell Chemical Senses Center in Philadelphia.

"Olive oil contains an ibuprofen-like anti-inflammatory that may turn out to convey similar benefits," he continued.

The extra-virgin olive oil, according to Dr. Breslin, has the most benefit, but consumers do not necessarily need to buy the most expensive brands.

"What matters is that it is an extra-virgin olive oil that has a good throat sting indicating it has high levels of oleocanthal," he said.

Dr. Breslin suggested that the Mediterranean diet - with extra-virgin olive oil used liberally on bread and vegetables and in salad dressing - may be the best way to consume it.

"If used this way," he said, "I think it will be good for you, particularly if it substitutes for butter, margarine and creamy dressings."

New York Times

The key to successful stroke rehabilitation is a well-organized, multidisciplinary approach that includes the patient's family and caregivers, according to the latest practice guidelines.

The American Heart Association and the American Stroke Association, which endorsed the new practice guidelines, said early initiation and an organized strategy are essential to a stroke patient's recovery.

"Better clinical outcomes are achieved when post-acute stroke patients who are candidates for rehabilitation receive coordinated, multi-disciplinary evaluation and intervention," wrote Pamela Duncan, Ph.D., of the University of Florida in Gainesville and colleagues. She was co-chair of the committee that wrote the guidelines, which were published in the September issue of Stroke.

The guidelines reflect a review of the literature through 2002, using criteria from the U.S. Preventative Services Task Force. The recommendations were based on randomized clinical trials, uncontrolled studies, and consensus expert opinion.

Dr. Duncan and colleagues recommended that:

* Stroke rehabilitation begins at the beginning, as soon as a stroke diagnosis has been made.

* Post-stroke rehabilitation care can occur in a stroke unit or in a rehabilitation setting where care will be formally coordinated and organized. If an organized rehabilitation team is not available on-site, patients with moderate to severe symptoms should be referred to an appropriately equipped facility. The team may consist of a physician, a nurse, a physical therapist, a speech pathologist, a psychologist, an occupational therapist, a recreational therapist, and a kinesiotherapist.

* Patients should undergo an early assessment using the National Institutes of Health Stroke Scale to determine stroke severity.

* Rehabilitation therapies should begin as early as possible; for example, testing for swallowing ability.

* Steps be taken to prevent recurrent stroke.

* Patients walk 50 feet daily to prevent deep vein thrombosis.

* There is implementation of anticoagulant therapy in ischemic strokes to prevent deep vein thrombosis.

* Treatment for depression or any mood disorders is included.

* A speech-and-language pathologist conduct an evaluation of the patients' communication and cognitive skills.

The investigators also noted that the patient's loved ones need to be involved in the rehabilitation process.

"Recognizing the stroke survivor, caregiver and family members are essential members of the rehabilitation team and should be involved in all phases of the rehabilitation process," they wrote.

Stroke is one of the leading causes of death in the U.S. Up to 70% of stroke patients are left with moderate to severe physical and emotional disabilities.

"In addition to providing state-of-the-art direction for clinicians," the authors concluded, "the guidelines can also help researchers to identify areas for further investigation. In turn, this research can result in more effective procedures and more efficient technology." CME Teaching Brief - MedPage Today

Researchers from Finland and the United States report evidence that diets high in cereal fiber and whole-grain products may slow the progression of atherosclerosis, plaque build-up in the arteries, of postmenopausal women.

Several studies have linked increased dietary fiber, especially cereal fiber, with a reduced risk of cardiovascular disease and death, but most of them have been conducted in patients without coronary artery disease and have not directly assessed the effect of fiber intake on the progression of plaque build-up in the arteries of patients with established heart disease.

Dr. Alice H. Lichtenstein from Tufts University in Boston and colleagues looked at the effects of whole grain consumption in 229 postmenopausal women with coronary blockages of at least 30 percent who were participating in the Estrogen Replacement and Atherosclerosis Trial. As part of study, a diet questionnaire was used to estimate fiber intake.

Women consuming more than 3 grams of cereal fiber or more than 6 servings of whole grains per week over a 3-year period showed modestly smaller declines in coronary artery blockage compared with women with lower intakes of fiber per week, the group reports in the American Heart Journal.

However, the differences in disease progression were almost that same as that seen in patients treated with cholesterol-lowering statin drugs, the investigators point out.

Lichtenstein told Reuters Health: "There are now good data that women with heart disease who reported consuming products made with whole grains have slower rates of progression of their disease. This conclusion is based on direct measures of (plaque) progression over a three-year period."

"It is likely," Lichtenstein added, "the benefits of diets rich in whole grains are applicable to a more general population."[National Institute of Health- Reuters]

More than half of all strokes and heart attacks in people with high blood pressure can be prevented by taking a mixture of modern drugs, researchers said on Sunday.


The largest study of high blood pressure treatment ever conducted in Europe found newer anti-hypertensive drugs worked better than older ones and had a dramatic impact on patients' health, especially when given with a cholesterol pill.

The 19,000-person trial was halted last November because the drugs proved so much better than conventional treatment, but final details have only now been presented to clinicians and published in the Lancet medical journal.

The 5-year trial compared the older drug regime of a beta blocker and a diuretic with a combination of two newer blood pressure medicines -- Pfizer Inc.'s Norvasc and Aceon/Coversyl from CV Therapeutics Inc. and Solvay SA.

Norvasc, known generically as amlodipine, is a calcium channel blocker, while Aceon/Coversyl, or perindopril, is an ACE inhibitor, originally developed by France's Servier.

In addition, 10,000 patients were also treated with Pfizer's cholesterol-lowering drug
Lipitor.

The researchers found the newer blood-pressure drugs reduced the risk of strokes by about 25 percent, heart attacks by 15 percent, cardiovascular deaths by 25 percent and new cases of diabetes by 30 percent compared with standard treatment.

Adding Lipitor, or atorvastatin, cut the remaining risk still further, even when patients did not have especially high cholesterol levels.

Pfizer was the trial's principal sponsor.

REVIEWING GUIDELINES?

Professor Peter Sever of Imperial College in London, co-chairman of the study, said the data would cause doctors to re-evaluate guidelines for using beta blockers as first-line treatment and highlighted the need for holistic treatment.

"We can now say with confidence that we can reduce the risk of heart attacks and strokes in the high blood pressure population by more than 50 percent," he told Reuters.

"If you could translate that to the millions people with hypertension that would result in a colossal saving of life."

In the past, there had been a tendency for doctors to take a "silo" approach to treating different risk factors, he said, but avoiding strokes and hearts attacks was all about tackling interacting risk factors.

The latest findings will re-ignite debate about treating high blood pressure and may mean international recommendations for managing the condition need to be reviewed.

Beta blockers, which are mostly off patent and sold generically, have been standard therapy for high blood pressure, chest pain and heart failure for years.

In a separate editorial commentary on the study in the Lancet, Jan Staessen of the University of Leuven, Belgium, said the study showed the value to society of treating blood pressure effectively to head off the danger of heart attacks and stroke.

"Governments and health care insurers will have to accept that the use of anti-hypertensive drugs cannot be rationed," he wrote.

Treating burst aneurysms by blocking them with platinum coils could offer patients better long-term survival than major brain surgery, researchers say.

Tests of the technique in an international study were halted early in 2002 because results were so good.

Now a longer-term follow-up confirms it does boost the chances of patients - who risk a stroke without treatment - surviving without disability.

The latest study, by the University of Oxford, is published in The Lancet.

A brain aneurysm is a ballooning-out of the wall of an artery in the brain.

It can be associated with high blood pressure and commonly develops in middle age, but the reasons for this are not clear.

Aneurysms are not always life-threatening, but if one bursts it can cause a haemorrhagic stroke.

Every year in the UK about 6,000 patients suffer this kind of stroke. Many are quite young - half are in their 40s and 50s.

Traditional treatment involves surgically opening the skull, and clipping the aneurysm to stop further bleeding.

In contrast, the coiling treatment is performed by making a tiny puncture wound in the groin and feeding the coil through the blood vessels to the brain.

The researchers also found that the coil patients were more likely to survive up to seven years after treatment than the brain surgery group.

Coil patients were also much less likely to develop seizures.

They were more likely to experience renewed bleeding - but the risk was still low.

Researcher Dr Andrew Molyneux said use of the coil technique could reduce the risk of death or disability by about 24% - potentially saving 74 out of every 1,000 patients from severe problems.

"Our results from following up patients for seven years will be reassuring to patients and doctors alike.

"Although treatment changed from surgery to coiling in many countries after our promising preliminary results in 2002, some countries have been slow to adopt coiling because there was still concern among neurosurgeons over the potential risks of re-bleeding.

"The reassuring thing is that we now have good evidence that the coil treatment is not only better short-term but it is also better in the medium to long-term."

Dr Gavin Britz, of the Harborview Medical Centre in Seattle, said: "Each patient and their aneurysm is different and the decision has to be made about what is in the best interest for each patient.

"Some patients should be clipped and some should be coiled.

"The ultimate decision is complex, including many variables to ensure the most appropriate care."

Dr Peter Coleman, of the Stroke Association: "Rupture of an aneurysm in the brain can cause a haemorrhagic stroke, so effective treatments for repairing cerebral aneurysms are vital.

"This research is a welcome development. Coiling is a less invasive surgical technique than neurosurgical clipping, but can only be used in a minority of patients whose aneurysms are suitable for this treatment."

BBC NEWS | Health |

Along with diet, regular exercise is an essential ingredient for improving an unhealthy cholesterol profile. Exercise can lower “bad” low-density lipoprotein (LDL) cholesterol and triglycerides, and raise levels of high-density lipoprotein (HDL) – the “good” cholesterol. Plus, exercise is a crucial element in any weight-control program, and the National Cholesterol Education Program’s (NCEP) guidelines for therapeutic lifestyle changes emphasize weight control as an important component of treatment.

Almost as important, exercise can overcome the unfortunate tendency of a low-fat, lower-calorie diet to reduce levels of HDL, particularly in women. In one classic study, called the Stanford Weight Control Project, women on a low-fat diet saw their HDL levels drop 7% during a year of dieting. But women who combined diet and exercise — about eight miles of brisk walking or jogging a week — increased their HDL levels in addition to losing weight and lowering their levels of total and LDL cholesterol. For men, a low-fat diet alone didn’t change HDL levels, but diet plus exercise substantially increased them.

Even if you’re already somewhat active, the more exercise you get, the better. A landmark study of 17,000 Harvard alumni suggested that men who burn an extra 700 or so calories a week by walking, playing sports, or doing some other form of exercise live longer than those who aren’t active. The health benefits continue to increase up to about 2,000 calories a week, and then seem to level off from there. Information from a long-term study of female nurses shows similar trends for women.

The list below shows you activities that will burn 150 calories. If you undertake any of these activities five times a week, you’ll burn 750 calories, enough to start realizing health benefits. If you do two of these activities every day of the week, you’ll burn a little over 2,000 calories per week and reap a health bonanza. (These figures are based on a body weight of 150 pounds. If you weigh less than 150 pounds, it’ll take you longer to burn the same amount of calories. The opposite is true if you weigh more than 150 pounds.)

Biking, 6 mph (38 minutes)
Biking, 12 mph (22 minutes)
Jogging, 5.5 mph (12 minutes)
Running, 10 mph (7 minutes)
Walking, 2 mph (38 minutes)
Walking, 4.5 mph (20 minutes)
Tennis, singles (23 minutes)
Gardening (30–45 minutes)
Washing windows or floors (60 minutes)
Water aerobics (35 minutes)
Swimming, 25 yards/minute (33 minutes)
Raking leaves (35 minutes)
Shooting baskets (35 minutes)
For more information on how to manage your cholesterol, order our special health report, What To Do About High Cholesterol. www.health.harvard.edu/HC.

A history of migraine without aura is associated with the occurrence of spontaneous cervical artery dissection (sCAD), a blood vessel rupture that is a common cause of stroke in young adults, Italian investigators report.

Studies examining a link between migraine and sCAD have yielded conflicting results.

To further clarify any relationship between the two conditions, Dr. Alessandro Pezzini, from Universita degli Studi di Brescia, and colleagues conducted a comparison study that included 72 patients with sCAD, 72 with stroke due to other causes, and 72 without stroke.

A history of migraine was diagnosed in 60 percent of patients with sCAD. By contrast, just 30 percent of patients with other causes of stroke and 18 percent of patients without strokes had a history of migraines, the team reports in the medical journal Cephalalgia.

A family history of migraine was also associated with sCAD.

The association between migraine and sCAD was mostly due to migraine without aura -- migraine with aura was no more prevalent among those with sCAD than those in the other two groups. Auras are non-pain symptoms that can accompany migraines, such as seeing flashing lights before the headache starts.

As to the reason for the association, the authors theorize that there may be a generalized blood vessel disorder that is responsible for both migraines and sCAD. Another possibility is that the association reflects shared susceptibility factors, they add.MedlinePlus