RxPG News : Cardiology

New device performs better than old for removing blood clots

Fri, 03 Feb 2012 05:00:00 PST

( from http://www.rxpgnews.com ) An experimental blood clot-removing device outperformed the FDA-approved MERCI; retriever device, according to late-breaking science presented at the American Stroke Association's 2012 International Stroke Conference.

The SOLITAIRE; Flow Restoration Device is a self-expanding stent-based design that mechanically removes blood clots from blocked vessels after a stroke. After insertion into the clot using a thin tube, or catheter, the device traps the clot then both device and clot are removed, restoring blood flow. The MERCI retriever uses a tiny corkscrew, guided by a balloon-tipped wire, to snare and remove the blood clot.

In the Solitaire With the Intention for Thrombectomy (SWIFT) trial, the first U.S. clinical trial to compare the two devices, 113 stroke patients at 18 hospitals were randomly assigned to undergo clot removal with either device within eight hours of stroke onset between Feb. 2010-Feb. 2011.

The trial was ended at the suggestion of a safety monitoring committee nearly a year earlier than planned due to significantly better outcomes with the new device. The experimental device opened blocked vessels without causing symptomatic intracranial hemorrhage in 61 percent of patients. The currently approved device had the same result in 24 percent of cases - a statistically significant difference, said Jeffrey L. Saver, M.D., lead author of the study, professor of neurology and director of the Stroke Center in the Geffen School of Medicine at the University of California in Los Angeles.

The use of the new device also led to better survival three months after stroke. There was a 17.2 percent mortality rate with the new device versus 38.2 percent with the older one.

Stroke caused by a blood clot blocking a blood vessel supplying the brain is the most common type of stroke, accounting for about 87 percent of all strokes. The FDA-approved treatment for stroke with the most robust body of evidence is use of a clot-busting drug, but the drug must be given within 4.5 hours of symptom onset, and more quickly in older patients. When clot-busting drugs cannot be used or are ineffective, the clot can sometimes be mechanically removed, during or even after the 4.5 hours. The study didn't compare mechanical clot removal to drug treatment.

Although not yet approved in the United States, the new device is approved in Europe.

Other specific findings - all of which were statistically significant - were:

Two percent of SOLITAIRE-treated patients had symptoms of bleeding in the brain compared to 11 percent of MERCI patients.

At the 90-day follow-up, overall adverse event rates, including bleeding in the brain, were similar for the two devices.

Fifty-eight percent of SOLITAIRE-treated patients had good mental/motor functioning at 90 days compared to 33 percent of MERCI patients.

The SOLITAIRE device also opened more vessels when used as the first treatment approach, necessitating fewer subsequent attempts with other devices or drugs.

Patients' average age was 67 years and 68 percent were male. Forty percent had not improved with standard clot-busting medication prior to the study, while the remainder had not received it.

The time from the start of symptoms to start of the clot retriever treatment was on average 4.9 hours for SOLITAIRE and 5.3 hours for MERCI. The study results account for this time difference.

This heralds a new era in acute stroke care, said Saver. We're going from our first generation of recanalization procedures, which were only moderately good in reopening target arteries, to now having a highly effective recanalization device. This really is a game-changing result.

Cardiovascular Nursing Spring Meeting

Thu, 02 Feb 2012 05:00:00 PST

( from http://www.rxpgnews.com ) New scientific findings and hot topics in cardiovascular nursing will be the focus of the 12th Annual Spring Meeting on Cardiovascular Nursing. Managing in today's challenging financial environment and dealing with the increasing issue of cardiovascular disease in dementia patients are just two items on the packed agenda.

Some 200 abstracts will be presented by nurses and allied professionals on a wide range of topics including arrhythmias, heart failure, prevention, acute care, myocardial infarction and implantable devices. There's such a breadth of research and quality improvement projects that nurses and AHPs (allied health professionals) bring to this congress, says Professor Christi Deaton, immediate past-chairperson of the Council on Cardiovascular Nursing and Allied Professions (CCNAP).

This year's meeting, 'Health at Heart', is organised jointly by the (CCNAP) of the European Society of Cardiology (ESC) and the Professional Society for Cardiovascular and Thorax Surgery Nurses, based in Denmark. It will be held 16-17 March 2012 at the state of the art Bella Centre in Copenhagen, Denmark.

New scientific findings will be presented on risky behaviours in adolescents with congenital heart disease, the links between depression and heart disease, the impact of art on quality of life in stroke survivors, and numerous other subjects of interest to journalists and the wider public.

This year will see a record number of moderated posters presented, a great opportunity for journalists to get stories and speak to the researchers. We increased the number of moderated poster sessions because it was such a popular forum last year, says Dr Kaat Siebens, chairperson of the CCNAP. It was an excellent opportunity to see the posters up close and have a good discussion with the scientists.

In addition to the abstracts, sessions will be held on hot topics in cardiovascular nursing that affect large numbers of patients. A session on fear in cardiovascular patients will consider whether fear is a positive coping strategy or negative emotional status, how fear can lead to delays in seeking treatment, and the relationship between fear and inflammation, which is associated with worse outcomes. Another session will explore the growing problem of how to manage complex cardiovascular problems in older patients with dementia.

A session will be devoted to leadership and management in difficult times, including how to get nurse-patient ratios right and how to motivate and retain experienced nurses. This is particularly newsworthy given today's financial climate. We are in difficult financial times and that affects healthcare, says Professor Deaton. Oftentimes healthcare systems decrease staffing when there is an economic crisis.

For the first time a daily congress news will be distributed which highlights events not to be missed by delegates and the press, and the day's top three abstracts (oral, moderated poster, and poster), chosen by the CCNAP and dubbed the 'Reviewers Choice'.

Also new will be on-site interviews with key figures, including a nurse prescriber who can discuss this important subject ahead of the 2013 meeting in Glasgow, where nurses can prescribe.

The meeting attracts around 600 nurses, allied professionals and technicians from Europe and beyond. Delegates and journalists will stay at the striking Bella Sky Comwell Hotel, which is attached to the congress centre. For those who wish to visit the city centre, Copenhagen Central Station is just 10-15 minutes' drive away.

We drafted the scientific programme with topics that are really important for our delegates, concludes Dr Siebens. And everybody is feeling the crisis, so I think one of the most important sessions will be the one regarding leadership and management in difficult times.

The effect of occasional binge drinking on heart disease and mortality among moderate drinkers

Thu, 02 Feb 2012 05:00:00 PST

( from http://www.rxpgnews.com ) Most studies have found that binge drinking is associated with a loss of alcohol's protective effect against ischemic heart disease (IHD) and most studies have found an increase of coronary risk among binge drinkers.

This study followed 26,786 men and women who participated in the Danish National Cohort Study in 1994, 2000, and 2005 and sought to see if binge drinking increased the risk of IHD or all-cause mortality among light-to-moderate drinkers: (up to 21 drinks/week for men and up to 14 drinks/week for women). A drink was 12g.

Binge drinking (more that 5 drinks on an occasion) did not show differences in risk of ischemic heart disease (coronary disease) or total mortality than among always moderate drinkers. These results are somewhat different from results of many other epidemiologic studies that have shown increased risk of health problems (even higher risk of coronary disease) to be associated with what was referred to as binge drinking.

Why there were no adverse effects of binge drinking in this study has provoked considerable discussion among members of the Forum. The assessments of alcohol were based on consumption in the week prior to the examination, so data was not available to judge whether or not binge-drinking episodes occurred rarely or regularly. Data was available for smoking, education, physical activity, BMI, and self-reported hypertension and diabetes. There was a strong increase in IHD risk and mortality from binge drinking among heavy drinkers, but the authors were comparing outcomes in binge vs. non-binge drinkers among subjects in the light-to-moderate categories, and so in all comparisons, the relative risk of IHD and all-cause mortality was higher for non-drinkers than for all other categories of drinkers.

The general consensus of opinion among Forum members is the definition of binge drinking. The rapid consumption of more than 5 drinks on an empty stomach surely has different effects than the consumption of alcohol over several hours with food, such as during a prolonged dinner. The rate of consumption strongly affects the consequences of alcohol; the speed of drinking and context should constitute part of the definition of 'bingeing' and not just the total number of drinks.

The Forum concludes that binge drinking, however defined, is not a healthy pattern of alcohol consumption. But the circumstances of consumption (rate of consumption, with or without food, etc.) may also be important in its definition and in judging its effects on health.

The Forum does not take the results of this single study to support binge drinking. What the Danish results suggest is that the occasional excess embedded in a moderate consumption pattern is not shown to be harmful in this study. As recognized in responsible drinking guidelines from Australia, Canada and the US, occasional episodes of consumption greater than the recommended daily levels do not necessarily change the classification of a normally moderate drinker into that of an abuser.

Clot-busting drugs appear safe for treating 'wake-up' stroke patients

Wed, 01 Feb 2012 05:00:00 PST

( from http://www.rxpgnews.com ) Clot-busting drugs may be safe for patients who wake up experiencing stroke symptoms, according to preliminary research presented at the American Stroke Association's International Stroke Conference 2012.

In wake-up stroke, the person wakes up with symptoms after going to sleep with none. Not knowing when the stroke began excludes these patients from anti-clotting drugs that must be given within 4.5 hours of the beginning of the stroke.

Because wake-up strokes are common, occurring in up to a quarter of stroke sufferers, more research is needed on how to treat these patients, said Dulka Manawadu, M.D., lead researcher and a stroke medical consultant at King's College Hospital in London, U.K. Patients who experience stroke symptoms should call Emergency Medical Services urgently and get to the hospital fast, regardless of the time of onset. This will help specialists decide if novel interventions are appropriate and feasible.

In the study, researchers used a stroke registry to compare clot busting treatments received by 326 patients within 4.5 hours of symptom onset to 68 wake-up stroke patients, with unknown onset.

All the patients were treated in the same London medical center, where 20 percent suffered wake-up stroke. Researchers didn't randomly assign patients to receive different treatments for comparison, which is the gold standard and, thus, a limitation of the study.

Our study shows that administering clot-busting drugs to patients with wake-up stroke who have the same clinical and imaging features as those treated within current guidelines is feasible and safe, Manawadu said.

Researchers analyzed information on patients who received the clot-buster alteplase, sold under the name Activase, between January 2009 and December 2010. Wake-up stroke patients received clot-busting treatments if their clinical presentation and early stroke changes on CT scan images were comparable to those treated with a known time of onset. Both groups had similar blood pressure, blood sugar levels and scores on the National Institutes of Health Stroke Scale, which is a standardized method used by healthcare professionals to measure the level of impairment caused by a stroke.

After three months, the researchers found the wake-up stroke patients' death rates, risk of bleeding inside the brain, and the proportion that made a good recovery were similar to those patients treated within a known 4.5 hours of stroke onset.

Sometimes, doctors are reluctant to give clot-busting drugs to patients in whom the time of stroke onset is not known, because the risks of bleeding are not known, Manawadu said. However, a significant proportion of patients who have stroke symptoms on waking may have suffered stroke in the early hours of the morning and may still be within the window of time where clot-busting treatments are known to be effective. It is also likely that advanced imaging techniques may help to identify patients with wake-up stroke who have the potential to benefit from clot-busting drugs.

This is an area of growing importance because it may allow us to extend the indication for this effective treatment, Manawadu said. Research has been limited to date but the time is ripe to investigate effective treatments in this group of patients.

Infections in childhood linked to high risk of ischemic stroke

Wed, 01 Feb 2012 05:00:00 PST

( from http://www.rxpgnews.com ) Common infections in children pose a high risk of ischemic stroke, according to research presented at the American Stroke Association's International Stroke Conference 2012.

In a review of 2.5 million children, the researchers identified 126 childhood ischemic stroke cases and then randomly selected 378 age-matched controls from the remaining children without stroke. They discovered that 29 percent of those who suffered a stroke had a medical encounter for infection in the two days preceding the stroke versus one percent of controls during the same dates.

In the three- to seven-day window, 13 percent of children had an infection compared to 2 percent of controls.

The elevated risk of stroke didn't persist after the first month of infection, researchers said.

This is the first large study to establish the relationship between infection and stroke in children, said Heather Fullerton, M.D., the study's principal investigator and director of the Pediatric Stroke and Cerebrovascular Disease Center at the University of California in San Francisco.

Researchers analyzed diagnostic and radiologic databases of children enrolled in the Kaiser Permanente healthcare plan from 1993 to 2007. They evaluated medical records and chart reviews for infections during the two years prior to the childhood stroke, and the same time period for the age-matched controls.

The children with stroke ranged from infants to adolescents, average 10.5 years old (oldest child was 19). Researchers identified three stroke-free controls per case. Findings between girls and boys or ethnic groups didn't differ.

Researchers found acute infections are more important in triggering stroke than chronic infections over time.

These were predominantly minor acute infections and represented a variety of infections, including upper respiratory infections, urinary tract infections and ear infections, Fullerton said. No particular type of infection predominated.

The study findings hold implications for the secondary prevention of stroke in children, she said.

Most previously healthy children with an ischemic stroke have a disease of the blood vessels to the brain, and these children are at highest risk of recurrent stroke. This study may provide some insight into why children develop this arteriopathy: the inflammatory process that results from an infection which may lead to stroke by causing vascular injury, researchers said.

The standard treatment for ischemic stroke in children is blood thinners. But the study suggests that future research should focus on the potential role for anti-inflammatory medications in preventing the recurrence of stroke in this population.

The incidence of stroke in childhood is about five per 100,000 in the United States each year, Fullerton said.

About half of childhood strokes are hemorrhagic (bleeding in the brain), according to American Heart Association statistics.

Childhood infections are exceedingly common, while childhood strokes are uncommon, Fullerton said. Parents should not be alarmed at the findings of this study. We suspect that there are rare genetic factors that may place some children at risk for this uncommon effect of common infections.

Infection is an established risk factor for ischemic stroke in adults. In the United States, stroke is the fourth leading cause of death and a leading cause of serious disability among adults.

NIH launches trials to evaluate CPR and drugs after sudden cardiac arrest

Thu, 26 Jan 2012 05:00:00 PST

( from http://www.rxpgnews.com ) The National Institutes of Health has launched two multi-site clinical trials to evaluate treatments for out-of-hospital cardiac arrest. One will compare continuous chest compressions (CCC) combined with pause- free rescue breathing to standard cardiopulmonary resuscitation (CPR), which includes a combination of chest compressions and pauses for rescue breathing. The other trial will compare treatment with the drug amiodarone, another drug called lidocaine, or neither medication (a salt-water placebo) in participants with shock-resistant ventricular fibrillation, a condition in which the heart beats chaotically instead of pumping blood.

The majority of the approximately 350,000 people who have cardiac arrest in the United States each year are assessed by emergency medical service (EMS) providers. During a cardiac arrest, the heart stops beating, and unless it is restarted within minutes, the person usually dies. Although immediate CPR can be lifesaving, more than 90 percent of people who experience a cardiac arrest outside of a hospital die before reaching a hospital or soon thereafter.

Increasing survival rates for people who experience out-of-hospital cardiac arrest is a major public health goal, said Susan B. Shurin, M.D., acting director of the NIH's National Heart, Lung, and Blood Institute, which is the lead federal sponsor of the studies. These new trials could provide critical insight about which resuscitation efforts are most effective for cardiac arrest.

The trials will serve a combined population of nearly 21 million people from diverse urban, suburban, and rural regions across the U.S. and Canada.

The CCC trial will compare survival-to-hospital-discharge rates for two CPR approaches delivered by paramedics and fire fighters. Persons experiencing cardiac arrest will be randomly assigned to receive continuous chest compressions, or standard CPR by emergency responders. Standard CPR, the approach recommended by the American Heart Association (AHA) for use by emergency responders, includes chest compressions with short pauses for assisted breathing. This approach has been called into question by emerging data suggesting that stopping chest compressions to provide assisted breathing interrupts overall blood flow, thereby lowering survival.

Previous studies have shown that people who suffer cardiac arrest outside of the hospital and are treated by bystanders are more likely to survive when given compressions alone, according to Graham Nichol, M.D., M.P.H., principal investigator of the CCC trial and a professor of medicine and director of the Center for Prehospital Emergency Care and medical director of the Clinical Trials Center at the University of Washington, Seattle. In 2010, AHA adopted new guidelines that recommended continuous chest compressions only for bystanders.

The CCC trial will help to determine if continuous compressions is equal to or better than standard professional CPR when paramedics, who are better able to provide assisted breathing than bystanders, intervene, said Nichol.

Trained emergency personnel will give all participants in the CCC trial three cycles of CPR followed by heart rhythm analysis and, if needed, an electrical shock (defibrillation), applied to the chest. Half will be randomly assigned to receive continuous compressions combined with pause-free rescue breathing and half will receive standard professional CPR.

The CCC trial will enroll up to 23,600 participants at eight major regional locations across the U.S. and Canada.

The Amiodarone, Lidocaine, or neither (Placebo) for Out-Of-Hospital Cardiac Arrest Due to Ventricular Fibrillation or Tachycardia study (ALPS) will determine whether amiodarone or lidocaine improves survival-to-hospital-discharge rates for participants with shock-resistant ventricular fibrillation. Participants will receive one or the other drug or a placebo.

About 25 percent of cardiac arrests are due to ventricular fibrillation. When shock treatment with a defibrillator fails to restore normal heart rhythm during ventricular fibrillation, medications such as amiodarone or lidocaine are often given, but their effectiveness in improving survival is unknown.

Answering these questions is crucial and will determine the role of these drugs for patients who experience out-of-hospital cardiac arrest, said Peter Kudenchuk, M.D., principal investigator of the ALPS trial and the Seattle-King County Resuscitation Outcomes Consortium (ROC) clinical site, and professor of medicine and heart rhythm specialist at the University of Washington School of Medicine (UW Medicine).

The ALPS trial will enroll up to 3,000 participants at nine locations across the U.S. and Canada.

CCC and ALPS are part of the NIH-supported Resuscitation Outcomes Consortium (ROC), the first large-scale clinical research network in the world designed to study, improve, and standardize how EMS teams deliver very early, pre-hospital interventions to improve patient survival after cardiac arrest or trauma. ROC has forged innovative multidisciplinary research partnerships between emergency physicians, cardiologists, EMS workers, trauma surgeons, and neurosurgeons to bring diverse perspectives to research that ultimately will lead to better clinical practice. As with all clinical trials funded by the NIH, an independent group of experts will monitor patient safety throughout both trials.

The NHLBI is the lead federal sponsor for both of the new studies, and the U.S. Army Medical Research and Materiel Command is a federal co-sponsor. Additional funding is provided by the Canadian Institutes of Health Research, the Heart and Stroke Foundation of Canada, the Defense Research and Development Canada, and the AHA.

Almost 60 fire and EMS organizations will participate in the ALPS trial, and approximately 125 EMS organizations will participate in the CCC trial.

Participating centers include:

Canada's first renal denervation procedure to reduce high blood pressure performed today

Tue, 17 Jan 2012 05:00:00 PST

( from http://www.rxpgnews.com ) Doctors at the Peter Munk Cardiac Centre today performed a minimally invasive surgical procedure to treat high blood pressure, called renal denervation, for the first time in Canada. The procedure can significantly reduce high blood pressure in patients who cannot effectively treat their hypertension through drugs. These patients, numbering approximately 250,000 Canadians, have to endure an especially high risk of heart attacks and stroke, which continues to kill thousands of Canadians every year.

The first Canadian patient to undergo renal denervation, a 57-year-old male from Toronto, will be discharged tomorrow after overnight observation. The procedure was performed by a multi-disciplinary team, led by Dr. Dheeraj Rajan, Interventional Radiology Specialist; Dr. Douglas Ing, Cardiologist and Dr. George Oreopoulos, Vascular Surgeon. The team recently returned from Germany, where they trained for the procedure. Germany has approved the use of renal denervation to treat selected patients with hypertension.

The Peter Munk Cardiac Centre was the first centre in Canada to receive approval for renal denervation from Health Canada under the Special Access Program that allows practitioners to request access to procedures or drugs that are currently not otherwise approved for use in Canada. As the Health Canada web site notes: This access is limited to patients with serious or life-threatening conditions on a compassionate or emergency basis when conventional therapies have failed, are unsuitable, or are unavailable.

Said Dr. Barry Rubin, Medical Director at the Peter Munk Cardiac Centre: Decreasing a patient's systolic blood pressure from 160 to 130 mm Hg over a period of six months, which this procedure has been shown to do, could prevent many heart attacks and strokes from ever happening.

In addition, renal denervation could also save the health care system countless millions of dollars by minimizing the need for anti-hypertension drugs that patients have to take, often for the rest of their lives, to say nothing of the millions more in savings from not having to treat heart attacks and strokes that don't happen.

The procedure was first used in patients in Melbourne, Australia, and its effects were reported in a clinical trial published in the December 4, 2010 issue of The Lancet. This trial saw cardiologists from Australia, New Zealand, the United Kingdom and several European countries de-activate the nerves located on the outside of the artery that feeds blood to the kidney, with a resulting drop in blood pressure. It has been known for over 50 years that the kidney plays a defining role in determining blood pressure.

Said Dr. Rubin: Our multidisciplinary renal denervation program, which also includes hypertension and kidney specialists, will treat many more patients with hypertension in the months ahead. Our focus will be directed at studying the safety and efficacy of the procedure, which could also have important secondary benefits. For example, many Canadians with heart failure have high blood pressure. Using renal denervation to treat high blood pressure in these patients could improve heart failure, a major cause of death of Canadians.

New predictor of heart attack or stroke

Mon, 19 Dec 2011 05:00:00 PST

( from http://www.rxpgnews.com ) CHICAGO --- A hike in your blood pressure during middle age significantly raises the risk of having a heart attack or a stroke during your lifetime, according to new Northwestern Medicine research. The study offers a new understanding on the importance of maintaining low blood pressure early in middle age to prevent heart disease later in life.

Men and women who developed high blood pressure in middle age or who started out with high blood pressure had an estimated 30 percent increased risk of having a heart attack or stroke compared to those who kept their blood pressure low.

Previous estimates of a person's risk of cardiovascular disease were based on a single blood pressure measurement. The higher the blood pressure reading, the greater the risk. The new Northwestern Medicine study expands on that by showing a more accurate predictor is a change in blood pressure from age 41 to 55.

The study is published in Circulation: Journal of the American Heart Association.

We found the longer we can prevent hypertension or postpone it, the lower the risk for cardiovascular disease, said lead author Norrina Allen, assistant professor of preventive medicine at Northwestern University Feinberg School of Medicine. Even for people with normal blood pressure, we want to make sure they keep it at that level, and it doesn't start increasing over time.

There hasn't been as much of a focus on keeping it low when people are in their 40's and 50's, Allen added. That's before a lot of people start focusing on cardiovascular disease risk factors. We've shown it's vital to start early.

People that maintain or reduce their blood pressure to normal levels by age 55 have the lowest lifetime risk for a heart attack or a stroke.

The study used data from 61,585 participants in the Cardiovascular Lifetime Risk Pooling Project. Starting with baseline blood pressure readings at age 41, researchers measured blood pressure again at age 55, then followed the patients until the occurrence of a first heart attack or stroke, death or age 95.

Men who developed high blood pressure in middle age or who started out with high blood pressure had a 70 percent risk of having a heart attack or stroke compared to a 41 percent risk for men who maintained low blood pressure or whose blood pressure decreased during the time period. Women who developed high blood pressure had almost a 50 percent risk of a heart attack or stroke compared to a 22 percent risk for those who kept their blood pressure low or saw a decrease.

Men generally have a 55 percent risk of cardiovascular disease in their lifetimes; women have a 40 percent risk.

Our research suggests people can take preventive steps to keep their blood pressure low early on to reduce their chances of a heart attack or stroke, said Donald M. Lloyd-Jones, MD, study co-author, chair of preventive medicine at Northwestern's Feinberg School and a cardiologist at Northwestern Memorial Hospital. Maintaining a healthy diet, combined with exercise and weight control, can help reduce blood pressure levels and, consequently, your risk for cardiovascular disease later in life.

Northwestern scientist gets mentoring award at White House

Fri, 16 Dec 2011 05:00:00 PST

( from http://www.rxpgnews.com ) CHICAGO --- Teresa Woodruff, the Thomas J. Watkins Professor of Obstetrics and Gynecology at Northwestern University Feinberg School of Medicine, received the prestigious Presidential Award for Excellence in Science, Mathematics and Engineering Mentoring at the White House from President Barack Obama Monday, Dec. 12.

The award was for a Northwestern Medicine program called the Women's Health Science Program for High School Girls and Beyond. The program mentors urban minority high-school girls for college and careers in science and health.

Meeting President Obama in the Oval Office was a true honor and humbling event, said Woodruff, also director of the Institute for Women's Health Research. In his remarks, the president affirmed his deep commitment to science and engineering and the role that basic science plays in the health of our nation. He made time to congratulate us on our efforts and comment on the critical role that science mentorship plays in the development of the next generation of innovators on whom we count to solve our world's most pressing needs.

This award is for the hundreds of faculty, staff and students throughout Northwestern University and Northwestern Memorial Hospital who donate their time to mentorship, Woodruff added. Our program focuses on the next generation of female leaders. Our goal is to ensure that the future is filled with a diverse group of problem solvers ready to meet the world's challenges.

The Women's Health Science Program for High School Girls and Beyond (WHSP), a four-year-old program, targets primarily African American and Latina girls from disadvantaged backgrounds in Chicago. The young women can study at four different Northwestern academies: cardiology, physical science, infectious disease and oncofertility. The science program is part of the Institute for Women's Health Research at the Feinberg School.

Carole LaBonne, an associate professor of molecular biosciences at Northwestern and faculty member in the mentoring program, emphasized the importance of increasing the representation of women and minorities in the STEM disciplines.

The program developed by Dr. Woodruff has had amazing impact and is truly transformative, said LaBonne, a member of Northwestern's diversity committee. It should be used as a model for how universities across the country can address the pipeline problem by helping to educate and excite students from underrepresented groups about science from an early age.

Of the 90 students who have participated in the Women's Health Science Program from the Young Women's Leadership Charter School in Chicago, 18 are seniors in high school, 70 are attending college and two have received undergraduate degrees. Of those attending college, 51 percent are pursuing science majors.

WSHP has grown beyond Chicago through Woodruff's efforts. Similar informal education programs based on the Chicago model have been running in San Diego, Oregon and Philadelphia. Plans also are underway to expand the program to other Chicago high schools.

Woodruff, a reproductive endocrinologist, researches female reproductive health and infertility and is chief of the division of fertility preservation at the Feinberg School. She also leads the Oncofertility Consortium, a national a team of oncologists, fertility specialists, social scientists, educators and policymakers to translate her research to the clinical care of women who will lose their fertility due to cancer treatment. In addition, she has been an advocate for sex and gender inclusivity and study in basic science, translational studies and clinical trials.

President Obama honored nine individuals and eight organizations as recipients of the Presidential Award for Excellence in Science, Mathematics and Engineering Mentoring.

Through their commitment to education and innovation, these individuals and organizations are playing a crucial role in the development of our 21st century workforce, President Obama said when the award was first announced. Our nation owes them a debt of gratitude for helping ensure that America remains the global leader in science and engineering for years to come.

The White House award recognizes the crucial role mentoring plays in the academic and personal development of students studying science and engineering -- particularly those who belong to groups underrepresented in these fields. By offering their expertise and encouragement, mentors help prepare the next generation of scientists and engineers, while ensuring that tomorrow's innovators reflect and benefit from the diverse talent of the United States.

Wyss Institute founding director, Donald Ingber, M.D., Ph.D., receives 2011 Holst Medal

Fri, 16 Dec 2011 05:00:00 PST

( from http://www.rxpgnews.com ) The Wyss Institute for Biologically Inspired Engineering at Harvard University announced today that its Founding Director, Donald Ingber, M.D., Ph.D., has received the 2011 Holst Medal in recognition of his pioneering work exploring the cellular mechanisms that contribute to mechanical control of tissue and organ development, and his groundbreaking development of bioinspired technologies, ranging from Organ-on-Chip replacements for animal studies, to new engineering approaches for whole organ engineering.

Ingber is also the Judah Folkman Professor of Vascular Biology at Harvard Medical School, Professor of Bioengineering at Harvard's School of Engineering and Applied Sciences, and a Senior Research Associate in the Vascular Biology Program at Children's Hospital Boston.

The prestigious annual award was presented today at the High Tech Campus Eindhoven in the Netherlands during a ceremony at the close of the 2011 Holst Symposium. This year's symposium, which focused on integrated heart repair, was organized by Eindhoven University of Technology (TU/e) and Philips Research, a leading corporate research organization that helps introduce innovations that improve people's lives.

As the medal winner, Ingber also presented the 2011 Holst Memorial Lecture entitled From Cellular Mechanotransduction to Organ Engineering. Starting with an exploration of the role that cell structure and mechanics play in controlling tissue and organ development, Ingber's lecture extended to provide a more comprehensive overview of his most recent innovations, including development of Organ-on-Chip microsystems technologies that recapitulate human organ functions, bioinspired materials that promote whole tooth organ formation, and injectable programmable nanotherapeutics that restore blood flow to occluded blood vessels.

The Holst award and lecture were established in 1977 to commemorate TU/e's 21st anniversary by honoring the important contributions of Dutch physicist Gilles Holst (1886-1968) to research and technology. Holst was the first director of the Philips Physics Laboratory in Eindhoven.

Holst Medal winners are among the most eminent researchers who have made major contributions in the natural sciences for the benefit of industry and society. They are selected by a committee chaired by the Rector Magnificus of the TU/e and the CEO of Philips Research. Previous recipients include several Nobel Laureates and scientific luminaries from around the world.

Donald Ingber has made groundbreaking contributions to the understanding of the mechanobiology of cellular behavior, said Joep Huiskamp, Secretary of the Holst Memorial Lecture Award Committee 2011, on its behalf. Ingber's recent development of a breathing Lung-on-a-Chip concept is an outstanding example of convergent technologies.

This year's Holst events were dedicated to the global health issue of heart disease, in recognition of its enormous emotional, medical, economical, and societal implications. The symposium brought together a few select leading international experts, including Wyss Institute core faculty member Kevin Kit Parker, Ph.D., to discuss key facets of heart disease, regeneration, and repair. Parker's lecture addressed the issue of heart failure and described the microengineered beating heart tissues developed in his laboratory.

Parker is also an Associate Professor in the School of Engineering and Applied Sciences at Harvard University and Director of the Disease Biophysics Group, whose research focuses on mechanotransduction in neural and cardiovascular systems.

At the Wyss Institute, Ingber and Parker co-lead a project funded by the U.S. Food and Drug Administration and National Institutes of Health to combine their technologies to develop a Heart-Lung Micromachine that will replicate the complex physiological functions and mechanical microenvironment of a human breathing lung and beating heart.

Such capabilities will enable the device to provide accurate and immediate measures of the efficacy and safety of inhaled drugs, nanotherapeutics, and other medical products on integrated lung and heart function. The micromachine will also provide a model to study the effects that pollutants and nanoparticles have on the heart after having entered the body through the lung. As an alternative to traditional animal testing methods, the technology could greatly shorten the time required to bring drugs to patients, increase their efficacy, decrease their costs, and improve clinical outcomes.

$3.8 million grant investigates link between sleep apnea and atrial fibrillation

Tue, 22 Nov 2011 05:00:00 PST

( from http://www.rxpgnews.com ) Case Western Reserve University School of Medicine has received a $3.8 million grant from the National Heart, Lung, and Blood Institute (NHLBI) to study sleep apnea as a possible cause of atrial fibrillation (AF), the most commonly diagnosed type of arrhythmia, or irregular heart rhythm.

AF is characterized by an abnormally rapid heart rate that can inhibit blood flow, and raise the risk of stroke and heart failure. The five-year, NHLBI grant will enable researchers to study how sleep apnea, a treatable disorder in which breathing repeatedly stops and starts during sleep, produces functional and structural changes in the heart that may well contribute to the development of AF.

The new research will characterize what aspects of sleep apnea lead to AF, honing in on the effects of sleep apnea-induced changes to the structure of the heart, including increases in blood pressure and reductions in oxygen levels, says the study's principal investigator, Reena Mehra MD, MS, associate professor of medicine in the Department of Medicine at Case Western Reserve University School of Medicine and a pulmonary, critical care and sleep medicine physician at University Hospitals Case Medical Center. The data generated from the research will fuel the development of new approaches for prevention and treatment of AF, and, will help identify key factors for future clinical trials, she says.

More fully identifying AF risk factors and developing new treatments is instrumental to stemming the growing rate of AF, a condition that could afflict up to 16 million individuals by the year 2050, according to research projections.

The growing prevalence of AF is not fully explained by known risk factors, such as age, existing heart disease and family history, highlighting the need to more precisely identifying potential novel AF triggers, Dr. Mehra explains.

Because sleep disorders like sleep apnea are common among patients with heart disease, Dr. Mehra and her team believe that the repetitive episodes of breathing pauses during sleep may provide a potential basis for much of the unexplained risk factors underlying AF.

In prior research, she and her colleagues established a strong association between sleep apnea and AF, basing their findings on thousands of participants in large scale epidemiologic cohorts. The data, however, did not include information characterizing changes in heart structure, nor did it include temporally collected, detailed biochemical measures collected from blood and urine, which can indicate how inflammation and oxidative stress caused by sleep apnea may lead to AF.

The newly funded research aims to gather more specific data, obtained by examining images of the heart that detail its pumping function and the condition of its walls.

Sleep apnea results in intermittent lowering of oxygen levels, alteration of nervous system function and changes the pressures within the chest, resulting in immediate, direct changes in the heart. Some or all of these factors may increase AF propensity, Dr. Mehra explains. Sleep apnea may also result in longer-term changes in cardiac structure which can also increase AF risk, prior research has shown.

The basis of the new research will be a case control study of 150 individuals with paroxysmal AF (PAF), an occasional, irregular heart rhythm and early-stage risk factor for persistent AF, which occurs before changes in the heart's condition and function are present and also involves 150 individuals serving as matched controls. A subset of those with PAF who are identified to have sleep apnea will also undergo treatment for their sleep apnea.

In addition, the researchers seek to clarify the extent by which the frequency of stopped breathing, the type of sleep apnea and reduced oxygen supply are associated with PAF, independent of any structural abnormalities in the heart. Throughout their study, researchers will assess how changes in cardiac structure, inflammation, or autonomic nervous system dysfunction are involved in the relationship between sleep apnea and PAF, identifying if patterns of AF differ in patients with sleep apnea.

The research findings could identify key outcomes for clinical trials and ultimately bolster evidence for considering sleep apnea as a potential target for new strategies to reduce AF-related morbidity including stroke, heart failure and also death.

Psoriasis is associated with impaired HDL function, Penn study finds

Wed, 16 Nov 2011 05:00:00 PST

( from http://www.rxpgnews.com ) Orlando - Collaborative research from Perelman School of Medicine at the University of Pennsylvania has shown that psoriasis patients have an increased risk of heart attack, stroke and cardiovascular death, especially if the psoriasis is moderate to severe. Now, Penn researchers have discovered the potential underlying mechanism by which the inflammatory skin disease impacts cardiovascular health. In two new studies presented at the 2011 American Heart Association Scientific Sessions, Penn researchers show that the systemic inflammatory impact of psoriasis may alter both the makeup of cholesterol particles and numbers, as well as impair the function of high density lipoprotein (HDL), the good cholesterol.

Anecdotally, many researchers have observed that HDL levels may be lower in states of inflammation, such as rheumatoid arthritis, psoriasis and even obesity, said lead study author Nehal Mehta, MD, MSCE, director of Inflammatory Risk in Preventive Cardiology at Penn. However, these new findings suggest that in addition to lower levels, chronic inflammation associated with conditions like psoriasis may change the composition and decrease the function of HDL as well.

In the current studies, researchers enrolled 78 patients with psoriasis and 84 control subjects. In the first study, the authors measured fasting lipid levels and examined the number and size of cholesterol particles using nuclear magnetic resonance (NMR) spectroscopy. This analysis revealed that patients with psoriasis had a higher number of smaller LDL particles, or bad cholesterol, which was independent of traditional risk factors and obesity. It was striking that the NMR profiles from patients with psoriasis resembled those seen in patients with diabetes, and that these patients with psoriasis had otherwise normal traditional lipid panels Dr. Mehta added.

In the second study, the researchers measured HDL efflux, which is the ability of a patient's HDL to remove cholesterol from cells involved in atherosclerosis. This process, known as 'reverse cholesterol transport', is why HDL may have protective properties. In a previous study, researchers at Penn have demonstrated that measuring HDL efflux capacity may be a more effective barometer of protection from heart disease than measuring HDL levels alone.

In this same group of patients who had normal cholesterol levels compared to controls, patients with psoriasis demonstrated dramatically reduced HDL efflux capacity compared to control patients. This negative association observed between psoriasis and HDL efflux persisted after adjusting for traditional lipid levels and other traditional risk factors, including body mass index (BMI).

Patients with psoriasis had an approximate 25 percent reduction in the HDL efflux capacity than the controls, despite their relatively normal overall lipid profiles which leads to the question of whether function is more important than concentration in chronic inflammatory states Dr. Mehta noted.

The new findings may provide a critical clue to the link between psoriasis and heart disease, but the researchers say larger studies are needed to validate their findings. Joel M. Gefland, MD, MSCE, assistant professor of Dermatology and Epidemiology, and a senior author on the studies, said We've been able to show that psoriasis is an important risk factor for vascular disease, and now we may finally be able to identify and ultimately treat the pathways by which psoriasis increases these risks.

Atherosclerotic plaques' downstream spread linked to low shear stress

Tue, 15 Nov 2011 05:00:00 PST

( from http://www.rxpgnews.com ) In human coronary arteries, atherosclerotic plaques tend to spread downstream because of the changes in blood flow patterns the plaque causes, researchers have found.

This insight comes from a study of fluid dynamics in the arteries of people being treated for coronary artery disease. The results are being presented Tuesday, Nov. 15 at the American Heart Association Scientific Sessions meeting in Orlando.

The study leader is Habib Samady, MD, professor of medicine and director of interventional cardiology at Emory University School of Medicine. Postdoctoral researcher Parham Eshtehardi is presenting the data.

Shear stress is a measure of how hard blood pulls on the walls of arteries, and is calculated based on intracoronary ultrasound and measurements of blood flow. Shear stress influences how sticky the cells lining the arterial walls are and how much white blood cells and cholesterol build up.

The researchers found that atherosclerotic plaques are often linked to a region of low shear stress immediately downstream, which in turn forms conditions favorable for additional plaque buildup. In contrast, regions of high shear stress are most often found within plaques.

Our findings confirm, for the first time in humans, some of the relationships between fluid dynamics and atherosclerosis that have been predicted by laboratory studies, Eshtehardi says. This may provide an insight to the role of shear stress in how plaques in human coronary arteries enlarge and progress.

The goal of Samady's research is to help doctors identify vulnerable plaque, or plaque likely to spill open and form a blood clot, leading to a heart attack or stroke. Mature atherosclerotic plaques often have components such as a fibrous cap, dense calcium and a necrotic core of dying cells and fats. A thin cap and a necrotic core are features that may make the plaque more vulnerable to rupture.

A companion poster presentation (also Tuesday) has data showing that low shear stress is associated with greater necrotic core and dense calcium, while high shear stress is associated with greater plaque burden overall. Shear stress was not connected to the amount of fibrous tissue in the plaque.

Our findings suggest that both low and high shear stress may be implicated in different stages of atherosclerosis and that for a given degree of plaque, low shear stress is associated with more plaque vulnerability, as defined by ultrasound, Eshtehardi says.

To collect the data, doctors examined 27 patients in Emory University Hospital's catheterization laboratory because they had abnormal exercise EKGs or stable chest pain. The patients' coronary arteries were examined by intracoronary ultrasound and Doppler guide wire before and after six months of therapy with atorvastatin (Lipitor).

To model shear stress, Samady and Eshtehardi teamed up with assistant professor Michael McDaniel, MD, and Jin Suo and Don Giddens, experts in fluid mechanics at Georgia Tech. The patients' arteries were divided into more than 100 segments each, and the shear stress was calculated for each one.

New heart cells increase by 30 percent after stem cell infusion

Tue, 15 Nov 2011 05:00:00 PST

( from http://www.rxpgnews.com ) ORLANDO, Fla. -- Healthy, new heart cells have been generated by animals with chronic ischemic heart disease after receiving stem cells derived from cardiac biopsies or cardiospheres, according to research conducted at the University at Buffalo School of Medicine and Biomedical Sciences.

The research is being presented today (Nov. 15) at the Scientific Sessions of the American Heart Association in Orlando.

The UB research demonstrated a 30 percent increase in healthy heart muscle cells within a month after receiving cardiosphere-derived cells (or CDCs). This finding is contrary to conventional wisdom which has held that heart cells are terminally differentiated and thus, are unable to divide.

Ischemic heart disease from coronary artery narrowing and prior heart attacks is the most common cause of heart failure, the UB researchers explain. While other investigators have largely focused on regenerating muscle in scarred tissue, the UB group has shown that cardiac repair could be brought about by infusing the CDCs slowly into coronary arteries of the diseased as well as normal areas of the heart.

Whereas most research has focused upon irreversible damage and scarring following a heart attack, we have shown that a single CDC infusion is capable of improving heart function in areas of the heart that are viable but not functioning normally, explains study co-author John M. Canty Jr., MD, the Albert and Elizabeth Rekate Professor of Medicine in the UB medical school and UB's chief of cardiovascular medicine.

He explains that areas of myocardial dysfunction without fibrotic scarring are common in patients with heart failure from coronary artery disease and that they arise from remodeling in response to a heart attack, as well as adaptations that develop from periods of inadequate blood flow, sometimes called hibernating myocardium.

The rationale for our approach is somewhat analogous to planting seeds in fertile soil versus trying to grow plants in sand, Canty comments.

We have shown that cells derived from heart biopsies can be expanded outside of the body and slowly infused back into the coronary arteries of animals with chronic dysfunction from restricted blood flow or hibernating myocardium, says Gen Suzuki, MD, research assistant professor of medicine in the UB medical school and lead author on the research. The new cardiac muscle cells are small and function more normally than diseased large, hypertrophied myocytes.

Canty adds that infusing stem cell formulations directly into coronary arteries also delivers the cells throughout the heart and is much simpler than injecting cells directly into heart muscle which requires equipment that is not widely available.

The research currently is in a preclinical phase but the UB researchers expect that translation to determine effectiveness in patients could take place within two to three years or possibly even sooner.

Stem cell study helps clarify the best time for therapy to aid heart attack survivors

Mon, 14 Nov 2011 05:00:00 PST

( from http://www.rxpgnews.com ) ORLANDO, Fla. -- A research network led by a Mayo Clinic physician found that stem cells obtained from bone marrow delivered two to three weeks after a person has a heart attack did not improve heart function. This is the first study to systematically examine the timing and method of stem cell delivery and provides vital information for the field of cell therapy.

The results were presented this morning at the 2011 Scientific Sessions of the American Heart Association Meeting in Orlando, Fla. They also will be published online in JAMA to coincide with the presentation.

Some data suggests that stem cell therapy is helpful within the first week after a heart attack, says Robert Simari, M.D., cardiologist at Mayo Clinic and chairman of the Cardiovascular Cell Therapy Research Network (CCTRN). The network includes five clinics and other sites supported by the National Heart, Lung, and Blood Institute, part of the National Institutes of Health. Our study helps identify the limits of when stem cell therapy might be beneficial. We now know that this therapy should not be extended two to three weeks after a heart attack. While it is safe to do so, we did not find any benefit to heart function after six months.

Between July 2008 and February 2011, 87 people with heart attacks and moderate to severe left ventricular dysfunction received their own bone marrow mononuclear stem cells (BMCs) or placebo. The study, called LateTIME, developed a standardized method of processing the BMCs and was the first such trial to provide a uniform dose to each participant.

The researchers assessed heart function through a cardiac MRI by measuring the ejection fraction, or what percentage of blood is pumped out of the left ventricle during each contraction. No significant differences were found in the cardiac function readings between baseline and six months in the BMC group (from 48.7 percent to 49.2 percent) or the placebo group (from 45.3 percent to 48.8 percent).

Dr. Simari says that earlier studies suggest patients with severe heart attacks benefit most from stem cell therapy. The researchers were interested in studying the two- to three-week period because many people who have severe heart attacks are not well enough or stable enough to receive cells right after their heart attacks. Many are on life support or other systems, and we didn't think that studying them that early was the best way to assess the benefits to the sickest patients, Dr. Simari says.

The LateTIME study offers a cautionary lesson for people who have had heart attacks and are considering going overseas to seek stem cell treatment. We would suggest that individuals not seek treatment outside of the U.S. for therapies that aren't proven effective, Dr. Simari says. The researchers think that the heart may be less receptive to such therapies two to three weeks after a heart attack, or that a person's stem cells are less potent at that time.

Jay Traverse, M.D., lead author of the study and a cardiologist at the Minneapolis Heart Institute at Abbott Northwestern Hospital, says patients will be followed clinically for two years in the LateTIME study.

There may still be other benefits to stem cell therapy that may be uncovered over time, Dr. Traverse says. We observed that patients who received the cell therapy had fewer adverse events such as placement of defibrillators or repeat revascularization compared to patients who got the placebo, consistent with observations in some of the European trials. This therapy may provide hidden safety measures that reduce adverse events and that's something we will follow closely.

LateTIME is one of three heart stem cell trials being conducted by CCTRN. The other trials will explore the effectiveness of stem cell therapy delivered at three days and seven days following a heart attack, and the usefulness of stem cell therapy in people with chronic heart failure.

Patients fare just as well if their nonemergency angioplasty is performed at hospitals

Mon, 14 Nov 2011 05:00:00 PST

( from http://www.rxpgnews.com ) Hospitals that do not have cardiac surgery capability can perform nonemergency angioplasty and stent implantation as safely as hospitals that do offer cardiac surgery. That is the finding of the nation's first large, randomized study to assess whether patients do just as well having nonemergency angioplasty performed at smaller, community hospitals that do not offer cardiac surgery.

Results of the study, called the Cardiovascular Patient Outcomes Research Team Elective Angioplasty Study (C-PORT-E), are being presented on Nov. 14, at the American Heart Association's Scientific Sessions 2011. The study, led by Johns Hopkins cardiologist Thomas Aversano, evaluated the outcomes of more than 18,500 patients who were randomly assigned to have heart artery-opening angioplasty or stenting at hospitals with or without cardiac surgery capability.

The study included 60 hospitals in nine states without cardiac surgery backup. In order to participate in the study, those hospitals had to perform a minimum of 200 angioplasty procedures each year and complete a formal angioplasty development program.

Emergency angioplasty is performed during a heart attack, when a vessel needs to be opened right away to restore blood flow in the heart. Nonemergency procedures are offered to patients with blockages that may be causing chest pain.

Historically, angioplasty has been performed at hospitals that had cardiac surgery backup in case complications from the procedure required emergency surgical intervention. Initially, in the late 1970s, the rate of complications requiring emergency surgery was as high as 15 percent, says Aversano, who is an associate professor of medicine at the Johns Hopkins University School of Medicine. Today, however, the rate of complications from angioplasty is very low.

During angioplasty, a tiny balloon is inflated within a coronary artery to push away plaque that is causing a blockage in the vessel. Stents, which act like tiny scaffolds, also can be put in place to keep the artery open. In rare cases, the procedure can cause a tear in the vessel or closing of the artery, requiring open-heart surgery to repair the problem.

Data from the study indicated that emergency surgery was rarely needed, and patients in neither group were more likely to have such a complication. Also, the researchers found that the death rate within six weeks for any cause was less than one percent among patients in both groups.

The American Heart Association and the American College of Cardiologists currently recommend that nonemergency angioplasty only be performed within hospitals that offer open-heart surgery.

Hospitals with cardiac surgery usually have a higher volume of heart-related cases overall, and that's one reason why those hospitals have been thought to offer better quality of care for nonemergency procedures, says Aversano, who adds that until this study, there was a lack of good outcomes data.

The researchers do not believe that every hospital should be performing angioplasty. However, they wanted to know if hospitals that offer emergency angioplasty to open blocked coronary arteries in heart attack patients can also safely perform elective angioplasty.

It is not reasonable to have doctors, nurses and technicians who are specially trained in performing angioplasty on hand 24/7 just to handle emergency cases, says Aversano. Also, having the ability to perform elective cases, as well as emergency ones, increases quality that comes with more experience.

About 850,000 angioplasties are performed in the United States each year. Many states restrict hospitals that don't offer cardiac surgery from performing angioplasty, which is a minimally invasive procedure performed by specially trained cardiologists rather than cardiac surgeons. As a result, hospitals feel pressured to create costly cardiac surgery programs so that they can offer angioplasty.

The goal of our study, says Aversano, is to give health care planners the best possible information on which to base their decisions about the allocation of resources, so that patients can have access to the highest quality of care.

More data from the CPORT study, focusing on the quality of procedures, are expected to be released early in 2012. Those data will reveal patient outcomes nine months after their angioplasty in terms of death, heart attack, and whether the vessel that was opened by angioplasty or stenting became blocked again, requiring another procedure.

Low vitamin C levels may raise heart failure patients' risk

Sun, 13 Nov 2011 05:00:00 PST

( from http://www.rxpgnews.com ) Low levels of vitamin C were associated with higher levels of high sensitivity C-Reactive protein (hsCRP) and shorter intervals without major cardiac issues or death for heart failure patients, in research presented at the American Heart Association's Scientific Sessions 2011.

Compared to those with high vitamin C intake from food, heart failure patients in the study who had low vitamin C intake were 2.4 times more likely to have higher levels of hsCRP, a marker for inflammation and a risk factor for heart disease.

The study is the first to demonstrate that low vitamin C intake is associated with worse outcomes for heart failure patients.

Study participants with low vitamin C intake and hsCRP over 3 milligrams per liter (mg/L) were also nearly twice as likely to die from cardiovascular disease within one year of follow-up.

We found that adequate intake of vitamin C was associated with longer survival in patients with heart failure, said Eun Kyeung Song, Ph.D., R.N., lead author of the study and assistant professor at the Department of Nursing, College of Medicine, in the University of Ulsan in Korea.

The average age among the 212 patients in the study was 61, and about one-third were women. Approximately 45 percent of the participants had moderate to severe heart failure.

Participants completed a four-day food diary verified by a registered dietitian and a software program calculated their vitamin C intake. Bloods tests measured hsCRP.

Researchers divided participants into one group with levels over 3 mg/L of hsCRP and another with lower levels. Patients were followed for one year to determine the length of time to their first visit to the emergency department due to cardiac problems or death.

Researchers found that 82 patients (39 percent) had inadequate vitamin C intake, according to criteria set by the Institute of Medicine. These criteria allowed the researchers to estimate the likelihood that the patient's diet was habitually deficient in vitamin C based on a four day food diary. After a year follow-up, 61 patients (29 percent) had cardiac events, which included an emergency department visit or hospitalization due to cardiac problems, or cardiac death.

The researchers found that 98 patients (46 percent) had hsCRP over 3 mg/L, according to Song.

Inflammatory pathways in heart failure patients may be why vitamin C deficiency contributed to poor health outcomes, the data suggests.

Increased levels of high-sensitivity C-reactive protein means a worsening of heart failure, Song said. An adequate level of vitamin C is associated with lower levels of high-sensitivity C-reactive protein. This results in a longer cardiac event-free survival in patients.

The use of diuretics may also play a role because vitamin C is water soluble and diuretics increase the amount of water excreted from the kidneys, said Terry Lennie, Ph.D., R.N., study author and associate dean of Ph.D. studies in the College of Nursing at the University of Kentucky in Lexington, Kentucky.

Diet is the best source of vitamin C, Lennie said. Eating the recommended five servings of fruits and vegetables a day provides an adequate amount.

More randomized controlled trials and longitudinal prospective studies are needed to determine the impact of other micronutrients on survival or rehospitalization, Song said.

White pediatric heart transplant patients more likely than non-whites to survive long term

Sun, 13 Nov 2011 05:00:00 PST

( from http://www.rxpgnews.com ) White heart transplant patients under the age of 18 are more than twice as likely to be alive a decade after surgery as their African-American counterparts, new Johns Hopkins research suggests.

The findings, part of a large-scale review of factors that appear to significantly influence long-term survival among pediatric heart transplant patients, will be presented this week at the American Heart Association's annual Scientific Sessions in Orlando.

It's unclear whether these racial disparities are due to biological differences or socio-economic differences that have an impact on access to care, or some combination of the two, says Arman Kilic, M.D., a surgical resident at The Johns Hopkins Hospital in Baltimore who is scheduled to make the AHA presentation. That's been hotly debated, but these data tell us we need to do a lot more research to figure out why those disparities exist and how we can narrow the gap.

Kilic analyzed United Network of Organ Sharing (UNOS) data from the 2,721 pediatric heart transplants performed in the United States between 1987 and 1999. Forty-two percent of patients (1,143) were alive 10 years or more after transplant. The average age of the recipients at the time of transplant was less than six years.

In addition to racial disparities in longterm survival, the analysis also showed that boys are 26 percent more likely than girls to survive a decade after their transplants; and children who had their surgeries at hospitals where large numbers of transplants are done annually were more likely to be alive 10 years later. For every 10 additional pediatric heart transplants conducted at a hospital each year, the chance of 10-year survival for patients transplanted there increased 36 percent. Patients at high-volume centers do better not only because their surgeons likely have more experience with heart transplants, Kilic says, but also because the staff and facilities are likely better equipped to manage the complex post-operative care of these patients.

The findings also show that patients transplanted later in the study period and those who got their hearts from younger donors were also significantly more likely to survive long term. Those who were on mechanical ventilation prior to their transplant were less likely to live a decade than those who were breathing on their own before surgery.

Children are potentially a group of patients whose survival after transplantation could be several decades, so it's especially important to better understand why some do well and others do not, Kilic says.

ASE-EAE to issue guidelines for the echocardiographic evaluation of cancer patients

Thu, 20 Oct 2011 04:00:00 PST

( from http://www.rxpgnews.com ) Considering that the early detection of cardio toxicity is a critical issue for patients undergoing chemotherapy, the ASE and the EAE have come together to write guidelines which will highlight the technical advantages of echocardiography in identifying cardio toxicity early, explained Prof Juan Carlos Plana, Co-Director of the Cardio-oncology Center, Cleveland Clinic, from the ASE. This would help select patients who would benefit from cardio protective regimens, so that heart failure does not become an obstacle to the oncologist during therapy, and to the patient during his/her survival.

In the last decade cancer therapy has had an enormous progress leading to an important reduction of morbidity and mortality of several types of cancer. The therapeutic management of patients with cancer includes a combination of drugs, radiation therapy, and surgery. Several of these therapies, mainly anthracyclines, produce potential adverse cardiac reactions which can negatively impact the quality of life as well as the prognosis of oncologic patients. The new generation of targeted therapies (i.e. trastuzumab in breast cancer) has also been associated with unexpected unfavorable side effects on myocardial function. Currently, 17% of patients have to stop cancer therapy due to heart involvement.

Detecting cardio toxicity is a critical issue in the clinical setting, in order to appropriately modulate and, hopefully, not interrupt cancer therapy. The traditional screening of patients with cancer includes a cardiac examination, and both an electrocardiogram (EKG) and a 2D echocardiogram with Doppler at baseline. The monitoring of cardiovascular toxicity might be more accurate using endomyocardial biopsy. However, the test is highly invasive and not free from complications, stated Dr Maurizio Galderisi, from the Federico II University in Naples, Italy and chairperson of the EAE task force.

Echocardiography has emerged as the modality of choice for noninvasive evaluation of cardiac disease in the cancer patient. This tool is essential for the evaluation of left ventricular systolic and diastolic dysfunction, pericardial and valvular heart disease. However, echocardiograms are only routinely performed at the beginning of cancer therapy, in order to document a normal left ventricular systolic function. Further echocardiographic follow up during cancer therapy is performed only as a consequence of the onset of cardiac symptoms and/or signs, in particular following the administration of recognized cardiotoxic drugs or radiation therapy.

Dr Rosa Sicari, FESC, from the CNR Institute of Clinical Physiology, Pisa, Italy and chairperson of the EAE Scientific Committee adds that the assessment of cardiac toxicity remains a critical issue in oncology. Ejection fraction, the time honored parameter of function is not useful for the detection of early and subtle forms of cardiac dysfunction. New tools are needed and the evidence should be built in the near future with appropriately designed studies and with the common efforts of oncologists, cardiologists and pharmacologists. This document is not meant to fill the gap of knowledge but to provide the state of the art of ultrasound in this field and indicate new research pathways.

On these premises, the upcoming joint recommendations of the American Society of Echocardiography and European Association of Echocardiography will present the need and clinical usefulness of serial echocardiographic evaluations, and the potential impact of more advanced ultrasound technologies in patients undergoing cancer therapy.

Stroke rate 25 percent higher for Metis

Tue, 04 Oct 2011 04:00:00 PST

( from http://www.rxpgnews.com ) OTTAWA, Oct. 4, 2011 -- The stroke rate among Manitoba Metis is nearly 25 percent higher than for other Manitobans, according to a study by the University of Manitoba and the Manitoba Metis Federation (MMF) presented today at the Canadian Stroke Congress.

The higher stroke rate is driven by a 53 percent higher smoking rate, 34 percent higher rate of diabetes, and 13 percent higher rate of high blood pressure among Metis aged 40 years and older, compared to all other Manitobans. High blood pressure, smoking and diabetes are leading risk factors for stroke.

Being historically of both First Nation and European ancestries, but not really identifying as either one, Metis are a very unique people, but little research has been done on this population, says Dr. Judith Bartlett of the University of Manitoba and the MMF. It's really difficult for a health system to put in place Metis-specific programs if they don't understand what that means. Our job through this study is to link the health authorities with the Metis to bridge that knowledge gap.

The study linked the MMF membership list and several Canadian Community Health Survey cycles with Manitoba Health's hospital records throughout the province to create the Metis Population Data-Base, a one-of-a-kind registry of the 73,000 Metis in the province.

Despite universal health care, it is clear that stroke and related conditions are even more significant issues for Manitoba Metis than for all other residents in the province, the study says.

What are called knowledge networks of Metis and provincial Regional Health Authority (RHA) staff have now been established in each of the Manitoba Metis Federation's seven regions to look at the information from the study and interpret it within a local context, says Julianne Sanguins, Ph.D, of the Faculty of Medicine at the University of Manitoba and the MMF.

During the first few meetings of these knowledge networks, Metis Regions learned about available resources and the health-care providers discovered the strength of the Metis presence in their community, Dr. Sanguins says.

The ultimate purpose of these networks is to raise awareness about existing health services and then to make any necessary changes to the programs in each of the MMF/RHA regions to better meet the cultural needs of the Metis citizens.

It is important to learn more about the unique health challenges of Canada's Metis population in order to control risk factors and prevent stroke, says Dr. Antoine Hakim, CEO and Scientific Director of the Canadian Stroke Network. This study provides valuable information to create targeted education and outreach initiatives.''

Aboriginal people are twice as likely to die from stroke than the general Canadian population, says Heart and Stroke Foundation spokesperson Dr. Michael Hill. They are more likely to have high blood pressure and type 2 diabetes, putting First Nations, Inuit and Metis people at an even greater risk of stroke than the general population.

He says that culturally appropriate prevention strategies and novel health-care solutions will improve outcomes. Awareness of how to control risk factors such as high blood pressure, obesity, physical activity, diabetes, and smoking is essential.

Telestroke the next best thing

Tue, 04 Oct 2011 04:00:00 PST

( from http://www.rxpgnews.com ) OTTAWA, Oct. 4, 2011 -- The use of long-distance video and data hookups to link remote community hospitals with stroke neurologists in large centres provides the same level of care as having everyone in the same room, according to a new study presented today at the Canadian Stroke Congress.

The study found that rural patients examined with the aid of a technology called Telestroke received an important stroke drug, tPA, at the same rate as patients treated in specialized urban centres, says Dr. Thomas Jeerakathil, a neurologist at the University of Alberta Hospital. The drug tPA (tissue plasminogen activator) is used to break up blood clots. It can help reverse stroke damage if administered within 4.5 hours of the onset of symptoms.

Besides providing better care to remote communities, early projections show that Telestroke resulted in more than $1 million in health-care savings over four years, Dr. Jeerakathil says.

Telestroke is a way to bring the expert out to the rural centre to provide treatment that wouldn't otherwise be available, Dr. Jeerakathil says. And there is no delay in treatment despite the time required to set up video conferencing equipment and examine CT scans and blood work.

In the study, an initiative of the Alberta Provincial Stroke Strategy, University of Alberta Hospital neurologists observed the use of Telestroke in 10 primary stroke centres throughout remote parts of Northern Alberta over a four-year period.

During this time, tPA was administered to more than 500 people and, of those, 119 patients were treated with the help of Telestroke. Without access to the technology, these patients would have gone without treatment or been transferred to a bigger hospital and faced delays, says Dr. Jeerakathil.

Effective Telestroke treatment in remote areas contributed to a 50-per-cent decrease in emergency room transfers from rural areas to the University Hospital in Edmonton, says Dr. Jeerakathil. Some remote hospitals reported a decrease in transfers as high as 92 per cent.

Cost savings are occurring while outcomes are improving and stroke mortality is decreasing in the province, says Dr. Jeerakathil.

Telestroke allows small hospitals to be designated as primary stroke centres with many of the services of a major stroke unit. These primary stroke centres have a small sectioned off area with staff specially trained in stroke care, 24-hour access to a CT scan and the ability to give tPA.

Telestroke is severely under-utilized in Canada, says Dr. Antoine Hakim, CEO and Scientific Director of the Canadian Stroke Network. An audit of stroke care in Canada showed that fewer than 1 per cent of stroke patients received a Telestroke consultation. This study undeniably proves that Telestroke saves both lives and money.

Providing stroke patients fast and seamless access to stroke services regardless of where one lives in Canada will save lives and reduce disability, says Heart and Stroke Foundation spokesperson Dr. Michael Hill. Telestroke is another way that technology allows for an easy, cost-effective way to bridge geographic barriers to smoothly link stroke specialists with communities where on- site stroke care does not exist.

There are about 50,000 new strokes in Canada each year and 315,000 Canadians living with the after-effects of a stroke.

Undetected strokes increase risk

Tue, 04 Oct 2011 04:00:00 PST

( from http://www.rxpgnews.com ) OTTAWA, Oct. 4, 2011 -- Everyday, 1,000 people in Canada turn 65, entering a stage of life that has increasing risk of stroke and Alzheimer's disease.

Recent national and international imaging studies on the brains of people aged 65 and older show that 95 per cent have brain small vessel disease seen as white spots and patches on magnetic resonance images, says Dr. Sandra Black, director of the Brain Sciences Research Program at Sunnybrook Research Institute at the University of Toronto.

These studies also show that a quarter of healthy senior volunteers, average age 70, living in the community, have evidence of small silent strokes. Even in younger people (average age 60), this number may be as high as 14 per cent, according to preliminary results of the Canadian PURE MIND study, presented at the Canadian Stroke Congress in Ottawa, where Dr. Black addressed more than 900 researchers and clinicians.

Microbleeds, another type of small vessel disease, are associated with high blood pressure and with Alzheimer's disease, she says. Unlike major stroke events, these types of small vessel disease gradually build up and increase the risk of clinical stroke events, depression, falls and Alzheimer's dementia.

Alzheimer's and small vessel disease often live together in the brains of the elderly in a way that is very disabling, says Dr. Black. People become depressed, off balance when walking, have trouble thinking and often cannot live on their own. Unfortunately, so far there is no cure for either disease but there are actions we can all take to delay onset or progression.

The time is now for the brain to be the top priority for Canada's health research community, says Dr. Black. In the next 20 years the number of people with dementia and Alzheimer's disease is expected to reach more than one million in Canada alone, increasing ten-fold the current health care costs of$15 billion/year, she says.

Stroke is adding to the increasing incidence of dementia: 65 per cent of stroke patients experience difficulty with thinking, memory, goal setting and motivation after a stroke and 20 to 30 per cent become clinically demented within three months post-stroke, says Dr. Black.

Research for a cure is being actively pursued but, in the meantime, there are important counter measures people can take to delay and prevent these devastating diseases. This is because stroke and Alzheimer's share the same vascular risk factors, such as high blood pressure, obesity, diabetes, high cholesterol, smoking and a lifestyle of physical inactivity.

It turns out protecting the blood vessels in your heart and body also helps to protect your brain and its blood vessels. This can delay the onset of dementia, says Dr. Black.For example, regular aerobic exercise throughout the lifespan can help delay the onset of late life dementia, even more so in people who may be genetically prone to dementia.

Researchers from all fields are going to need to work together, says Dr. Antoine Hakim, CEO and Scientific Director of the Canadian Stroke Network

Lifestyle choices will have the biggest impact in protecting the hearts and brains of our aging population, says Heart and Stroke Foundation spokesperson Dr. Michael Hill.

ACCF/AHA release updated guideline to promote better management of peripheral artery disease

Thu, 29 Sep 2011 04:00:00 PST

( from http://www.rxpgnews.com ) Peripheral artery disease, or PAD, is a common and dangerous condition that affects tens of millions of Americans -- often unknowingly -- and can restrict blood flow to the legs, kidneys or other vital organs. PAD, which remains underdiagnosed, is often a sign of a more widespread accumulation of fatty deposits in the heart, brain or legs and, if untreated, it is one of the most common causes of preventable heart attack, stroke, leg amputations and death.

To help guide clinical decision-making related to PAD and improve patient outcomes, the American College of Cardiology Foundation (ACCF), and the American Heart Association (AHA), along with collaborating societies, today released an updated guideline for its diagnosis and management. This guideline includes expanded criteria for using the ankle-brachial index (ABI) for earlier diagnosis, increased efforts to ensure all patients have access to smoking cessation services, improved use of clot-preventing medications, as well as a more focused definition of effective interventions for avoiding limb amputations and treating aortic aneurysms.

PAD restricts blood flow to the extremities, especially the legs and feet. When blood flow is reduced to the legs, walking may become difficult and painful, and amputation can occur. Decreased kidney blood flow can cause high blood pressure or kidney failure. Aneurysms of the aorta, the largest artery, can rupture and lead to death. Yet, for many, PAD is asymptomatic and therefore may not lead to recognizable symptoms, delaying a prompt diagnosis.

This document provides agreed upon approaches and treatments for PAD that vascular surgeons, vascular medicine specialists, cardiologists, pulmonologists, interventional radiologists and primary care clinicians can apply to help improve patient care, said Thom Rooke, MD, Krehbiel Professor of Vascular Medicine, Mayo Clinic, Rochester, MN, and chair of the writing group. This guideline is especially important for PAD, which is often still treated less aggressively than heart disease, and we know that many patients do not yet receive ideal care.

Of note, the guideline includes a recommendation to lower the age at which ABI diagnostic testing should be performed in the practice setting from 70 years of age or older to 65 years of age or older. This decision was based on mounting evidence demonstrating that people 65 and older have a one in five chance of having either symptomatic or asymptomatic PAD.

Age alone appears to define a patient population at such a high risk of PAD that we can justify using a cost-effective and risk-free test like the ABI, said Dr. Rooke. It's important to remember, when we check ABI to detect PAD in a patient without clear-cut leg symptoms, it is known that we are effectively assessing overall heart and vascular health. If PAD is detected, effective risk reduction medications are available to lower this risk.

Some of the other recommendations set forth by the writing group include:

Postcode lotteries in preventative health care -- not necessarily all bad news

Tue, 27 Sep 2011 04:00:00 PST

( from http://www.rxpgnews.com ) There is much interest in the unequal health care caused by postcode lotteries. The area you live in can impact the treatment you receive for cancer treatment, surgery or GP care. Research published in BioMed Central's open access journal BMC Public Health shows that there are also geographic differences in the implementation of public health programs.

In 2009, the government introduced 'Health Checks' a national public health program with the aim of reducing the incidence of cardiovascular disease (CVD). This program is open to all 40-74 year olds with no prior history of CVD and aims to assess each person's risk of a cardiovascular event within the next 10 years and provide them with advice and medication if necessary.

Using an example of eight primary care trusts (PCTs) in North West London, researchers examined the amount of money each PCT spent on the program, how they recruited eligible people onto the program, what parameters they tested (including blood glucose levels, blood pressure, weight, alcohol intake, smoking and exercise) and what information and treatment was provided after the examination.

The results showed considerable variation across the PCTs including the amount of money spent per person. However, apart from one PCT, there was a general trend that PCTs responsible for more deprived areas, which traditionally have a higher burden of CVD, spent more per eligible person than PCTs responsible for more affluent areas.

For most PCTs, 'Health Checks' are carried out in GP practices. But flexibility in the scheme meant that the 'Health Checks' could also be carried out at local pharmacies, or at community events to include high-risk individuals who typically do not visit their GPs. This included football stadiums and job centers, to catch middle aged men in manual jobs, and people out of work.

Dr David McCoy from the Public Health Directorate said that, This study shows both good and bad in the way in the 'Health Checks' Program is implemented. Better coordination and sharing of information between PCTs could help iron out inequalities, reduce costs and PCTs would be able to learn from the experience of others.

Dr McCoy continued, A more serious problem we found was the lack of a common approach to evaluating the impact of 'Health Checks'. While we can count the number of health checks done, we currently don't know if this has a positive effect on unhealthy behavior or prevents CVD. Also there was no way of knowing whether uptake and impact of the program was the same for all sections of the population. The main point is to ensure that regardless of interpretation of guidelines, 'Health Checks' results in a real reduction in CVD risk.

Signs of aging may be linked to undetected blocked brain blood vessels

Thu, 01 Sep 2011 04:00:00 PST

( from http://www.rxpgnews.com ) Many common signs of aging, such as shaking hands, stooped posture and walking slower, may be due to tiny blocked vessels in the brain that can't be detected by current technology.

"This is very surprising," said Aron S. Buchman, M.D., lead author of the study and associate professor of neurological sciences at Rush University Medical Center in Chicago. "There is a very big public health consequence because we're not capturing this 30 percent who have undiagnosed small vessel disease that is not picked up by current technology. How would you even get them on your radar? We need additional tools in our toolkit."

In 1994, the researchers began conducting annual exams of 1,100 older nuns and priests for signs of aging. The participants also donated their brains for examination after death. This study provides results on the first 418 brain autopsies (61 percent women, average 88 years old at death).

Although Parkinson's disease occurs in only 5 percent of older people, at least half of people 85 and older have mild symptoms associated with the disease.

Before the study, researchers believed that something more common, such as microscopic blocked vessels, might be causing the physical decline. The study's autopsies found the small lesions could only be seen under a microscope after participants died.

The lesions couldn't be detected by current scans.

During the annual exams of the nuns and priests, researchers used the motor skills portion of a Parkinson's disease survey to assess their physical abilities.

"Often the mild motor symptoms are considered an expected part of aging," said Buchman, who is also a member of the Rush Alzheimer's Disease Center. "We shouldn't accept this as normal aging. We should try to fix it and understand it.

If there is an underlying cause, we can intervene and perhaps lessen the impact."

Registry: Do medications which reduce angina

Tue, 30 Aug 2011 04:00:00 PST

( from http://www.rxpgnews.com ) Although medication which decreases the risk of angina attacks (chest pain caused by blockage of the arteries that supply the heart), are frequently prescribed in patients who have sustained a myocardial infarction, the possible influence of medication on long-term survival is not known, with the exception of beta-blocking agents, which have been shown to decrease mortality in clinical trials performed 30 years ago. Because antianginal drugs also protect the myocardium against ischemia (insufficient oxygen delivery to the heart muscle), there is a possibility that they may improve the prognosis of patients having suffered a heart attack. There are several classes of antianginal medications, which act through different mechanisms and therefore may have different effects on the clinical prognosis of patients.

The French registry of Acute ST-elevation and non-ST-elevation Myocardial Infarction (FAST-MI), is a nationwide survey of patients hospitalised for acute myocardial infarction in France over a one-month period, at the end of 2005. Patients included will be followed for a period of 10 years after the initial heart attack. At three years, fewer than 5% of the patients have been lost to follow-up.

Of a population of 3,670 patients included in the registry, 3,262 survived the initial hospitalisation and had a complete prescription at discharge. Among them, 1266 (39%) received antianginal agents other than beta-blockers. Calcium-channel blockers were prescribed to 16% (dihydropyridines 10.5%, diltiazem 2% or verapamil 3%), nitrates to 19%, molsidomine to 3%, nicorandil to 9% and trimetazidine to 4.5% of patients. In addition, beta-blockers were prescribed to 77% of the patients. Patients who received antianginal agents were older and had more severe infarctions than those who did not receive such medications.

Three-year survival was 77% in patients treated with antianginal agents, compared with 86% in those who were not. After taking into account the initial profile of the patients and the severity of their heart attacks, prescription of antianginal medications was associated with a small (7%), non significant increase in the risk of dying in the 3 years following the heart attack.

When the different antianginal agents were analysed individually, none was associated with either a decreased or an increased risk of dying, except for molsidomine. Prescription of nitrates, the most ancient antianginal medication available, was associated with a trend to increased risk of death (+ 22%) which was not statistically significant; molsidomine was prescribed in a small number of patients (n=111) and was associated with a significant excess of deaths (+ 57%).

There was no evidence of any benefit or harm with respect to long-term mortality with most antianginal agents prescribed in patients having sustained a heart attack. The findings of possible increased hazard associated with use of nitrates, and more importantly of molsidomine, are intriguing and deserve further studies.

Evidence in the field of CVD in pregnancy is sparse, but the condition remains a concern:

Tue, 30 Aug 2011 04:00:00 PST

( from http://www.rxpgnews.com ) Pre-existing heart disease in pregnancy remains a concern. Complications are frequent and in some cases may be life-threatening for both the mother and her child. In Europe maternal heart disease has now become the major cause of maternal death during pregnancy.

As interim data from the ESC's special registry on pregnancy in cardiac disease suggests, the numbers of women at risk is not in decline, mainly because of today's older age at first pregnancy and with it a concomitant increase in risks of diabetes, hypertension and obesity.

Professor Jolien Roos-Hesselink, joint chairman of the ESC registry together with Professor Roger Hall (Norwich, UK), reported that the most frequently diagnosed condition in the registry population was congenital heart disease, found in around 60% of subjects. More than 1300 women have been enrolled into the registry so far - from 28 countries and 60 centres; they consist of 869 women with congenital heart disease, 333 with valvular heart disease patients, 79 with cardiomyopathy and 24 with ischaemic heart disease.

Professor Roos-Hesselink said that evidence in this field is sparse, with randomised trials impossible to perform: So the only way to improve our knowledge of the factors which determine outcome in pregnant women with heart disease is to gather data on a large number of pregnancies and try to find patterns of outcome which correlate with management strategies. In this way we might determine the areas of danger for both mother and child and the best forms of treatment.

It was because of the need to generate relevant data in areas such as this, that the concept of European registries was developed in 2006. Data collection in the pregnancy and CVD registry began in 2008, with information recorded on CVD diagnosis, medication, cardiac complications, obstetric complications, and pregnancy outcome at six months.

An interim analysis of these pregnancies was presented at the ESC Congress but, said Professor Roos-Hesselink, data collection continues and it is clear larger numbers will be required to obtain meaningful conclusions.

However, results so far reflect a very high hospitalisation rate during pregnancy: 338 patients (26% of all pregnancies) were hospitalised, 203 of cardiac cause. Maternal death occurred in 13 patients (1%) and fetal death in 59 cases (4.5%). These death rates, said Professor Roos-Hesselink, are significantly higher than normal; maternal mortality is in the order of 100 times higher and fetal mortality 10 times higher. There was also a high rate of delivery by Caesarean section of around 40%.

She added that no single cause for the high mortality rate is as yet clear, but the further analysis and larger numbers of the study should provide stringer evidence. We are analysing patterns of therapy as well trying to identify the particular underlying cardiac conditions associated with mortality, she said.

ESC pilot registry in heart failure reflects improvement in chronic disease

Tue, 30 Aug 2011 04:00:00 PST

( from http://www.rxpgnews.com ) With the increased prevalence of chronic heart failure (HF), there is a concomitant increase in the number of related hospitalisations; as chronic HF progresses, the risk of acute exacerbation increases.

Registries and surveys of HF have been generally conducted in patients with either chronic or acute conditions, but a description of the whole clinical history of patients with HF, including the acute episodes, consequent changes in clinical conditions and management strategies, have not been available.

The final results of the Heart Failure Pilot Study, a general registry of the ESC's ongoing EurObservational Research Programme (EORP), now provide improved information on the epidemiology and outcomes of real world patients with this clinical condition.

The HF pilot study was a prospective observational survey conducted in 136 cardiology centers in 12 European countries selected to represent the different health systems and care attitudes across Europe. From October 2009 to May 2010, 5118 patients were included, 1892 (37%) admitted for acute HF, and 3226 (63%) with chronic HF. All were followed-up for the subsequent year, and the study was terminated at the end of May 2011. Just 5% of the patients were lost to follow-up.

Results showed that, while the mortality rate of patients with chronic HF seems to be improving (7% after one year of follow-up), outcomes of acute HF patients are still unacceptably poor at one year - an all-cause mortality rate of nearly 17% and a combined outcome measure of all-cause mortality or hospitalisation of 35%.

The outcome improvement in ambulatory patients with chronic HF could be explained by the fact that European cardiologists prescribe a high rate of guideline-recommended pharmacological treatments, such as the blockers of the renin-angiotensin-aldosterone system and beta-blockers. The study showed that these treatments were not only prescribed appropriately but were maintained over the whole one-year follow-up period.

Unlike patients with chronic HF, those admitted for acute HF were still treated more anecdotally than according to evidence-based medicine. This may be, explained Professor Aldo Maggioni from the Centro Studi ANMCO in Florence, Italy, because of a lack, in this specific clinical context, of specific controlled studies demonstrating effective treatment strategies for improving outcomes. And this could be the reason for the still high observed mortality and morbidity rates in acute HF patients.

As expected, the great majority of the causes of death, both in acute and chronic HF was cardiovascular, and sudden in 40% of cases; the most frequent cause of hospitalisation or re-hospitalisation was HF.

Professor Maggioni added: The study has also allowed us to identify several independent predictors of outcome, which will be useful for implementing ad hoc strategies in very high risk patients with this severe clinical condition.

The pilot study has paved the way for implementation of a pan-ESC long-term registry which began data collection in May 2011 with the participation of 32 European countries.

Assessing the most appropriate duration of dual antiplatelet therapy after coronary stenting

Tue, 30 Aug 2011 04:00:00 PST

( from http://www.rxpgnews.com ) A randomised multicentre open-label study evaluating the efficacy and safety of prolonged antiplatelet therapy in patients with coronary disease has found that 24 months' duration of dual therapy is no better than six months DAPT in preventing adverse cardiac events.

However, the PROlonging Dual antiplatelet treatment after Grading stent-induced Intimal hyperplasia studY (PRODIGY) also found a consistently greater risk of haemorrhage in the 24-month dual therapy group according to all prespecified bleeding definitions, including the recently proposed Bleeding Academic Research Consortium classification. The need for transfusion was also increased in the longer treatment group.

The results, said investigator Dr Marco Valgimigli from the University Hospital of Ferrara, Italy, question the validity of current guideline recommendations - which were based on registry data - that at least 12 months' dual antiplatelet therapy should be pursued after implantation of a drug-eluting stent.

While we cannot exclude the possibility that a smaller than previously anticipated benefit may still exist in prolonging therapy with clopidogrel for several months after coronary stenting, our study clearly shows that the benefit to risk ratio of prolonged therapy has been over-emphasised.

The PRODIGY study was a 4-by-2 randomised, three-centre open-label clinical trial designed to assess the efficacy and safety of prolonged clopidogrel therapy for up to 24 months in all-comer patients receiving a balanced combination of drug-eluting stents (with various anti-intimal hyperplasia potency and belonging to both first and second generation). Patients were 18 years or older with chronic stable coronary artery disease or acute coronary syndromes, including non-ST-elevation and ST-elevation myocardial infarction.

More than 2000 patients scheduled for elective, urgent or emergency coronary angioplasty were randomly assigned in a 1:1:1:1 fashion to one of four stent types: everolimus-eluting stent, paclitaxel-eluting stent, zotarolimus-eluting stent or third-generation thin-strut bare metal stent. Randomisation to the four different types, said Dr Valgimigli, was justified by the different safety profile of each, which was meant to ensure that patients in the two main study groups (six versus 24 month dual antiplatelet therapy) received exactly the same stent types. At 30 days, patients in each stent group were then further randomised to either six or 24 months of dual antiplatelet treatment.

The primary objective of the study was to assess whether 24-month dual antiplatelet treatment, consisting of clopidogrel and aspirin after coronary stenting, was associated with a lower cumulative incidence of all-cause mortality, non-fatal myocardial infarction or cerebrovascular accident (the primary outcome) than six-month dual therapy.

Results showed that the cumulative risk of the primary outcome at two years was 10.1% with the 24-month treatment, and 10.0% with the six-month (HR 0.98; 95% CI 0.74-1.29; P=0.91). The individual risks of death, myocardial infarction, cerebrovascular accident or stent thrombosis did not differ between the two groups.

Among the patients receiving long-term dual antiplatelet therapy, there was a roughly two-fold greater risk of type 5, 3 or 2 bleeding events (HR 2.17, 95% CI 1.44-3.22; p=0.00018) as well as type 5 or 3 bleeding events (HR 1.78, 95% CI 1.02-3.13; p=0.037) according to the Bleeding Academic Research Consortium classification. The risks of TIMI-defined major bleeding and red blood cell transfusion were also increased in the 24-month clopidogrel group.

Commenting on the implications of the results, Dr Valgimigli said: While a formal economic analysis will follow, the results of this study have important implications for heathcare expenditure - for this study shows that prolonging therapy with clopidogrel beyond six months is not only associated with no clinical benefit but also with a significant increase in actionable bleeding events requiring re-hospitalisations and multiple diagnostic and therapeutic resources.

The CRISP AMI trial

Tue, 30 Aug 2011 04:00:00 PST

( from http://www.rxpgnews.com ) Intra-aortic balloon pump counterpulsation prior to PCI in patients with ST segment elevation MI does not reduce infarct size as measured by MRI, according to results from the Counterpulsation Reduces Infarct Size Acute Myocardial Infarction (CRISP AMI) trial.

Intra-aortic balloon counterpulsation is a procedure in which a balloon inserted in the aorta is timed to inflate at the start of diastole and to deflate before the start of systole. This increases diastolic pressure, which increases coronary perfusion and oxygen delivery to the myocardium, and facilitates ejection of blood from the left ventricle. There is evidence that LV unloading before reperfusion can reduce the extent of the infarct; infarct size has been shown to predict LV function after AMI.

Principal investigator Dr Manesh Patel from the Duke Clinical Research Institute of Duke University, Durham, USA, explained: Animal studies had suggested that inserting a balloon pump before opening the vessel would reduce the heart's workload and, by doing so, could potentially reduce infarct size. However, having tested this observation in humans, we did not show similar results.

CRISP AMI was a multicentre, prospective, randomised trial in patients with acute ST segment elevation MI without shock. They were recruited within six hours of chest pain onset and planned primary PCI. Of the 337 patients enrolled, 161 were randomised to receive intra-aortic balloon counterpulsation (IABC) prior to primary PCI, and 176 to standard care (SOC, primary PCI without IABC support).

The primary efficacy endpoint of the trial was infarct size measured by cardiac MRI at 3-5 days post-PCI. The secondary clinical endpoint was the composite of major adverse clinical events including death, reinfarction, and heart failure at six months.

Results showed that mean infarct size was not significantly different between the IABC and SOC groups (42.1% vs. 37.5%, representing the percentage of left ventricle affected). At 30 days, major bleeding or transfusion had occurred in five (3.1%) of IABC patients and three (1.7%) of SOC patients. Major vascular complications occurred in seven IABC (4.3%) and two SOC (1.1%) patients. By six months, death had occurred in three (1.9%) of the IABC and nine (5.2%) of the SOC group.

While the study did not meet its primary endpoint, and was not powered to draw significant conclusions on clinical events, Dr Patel says the results nevertheless offer an insight into the treatment of STEMI patients. The most striking observation is the excellent overall outcome for the highest risk patients within the context of this trial, he says. The IABC group had less than 5% mortality, and it's difficult to improve that. We've become very good at treating AMI patients. In the USA acute mortality risk in AMI is between 6% and 15%; one-year mortality is estimated at 38% for women and 25% for men.

Dr Patel adds that 15 of the patients in the SOC group crossed over to receive IABC, and five patients crossed over prior to PCI and ten patients after PCI. While this trial shows that the routine use of IABC cannot be recommended in STEMI, physicians should be vigilant about identifying those patients who are at risk for rapid deterioration and may benefit from counterpulsation, he says.

Lower achieved platelet reactivity associated with better cardiovascular

Tue, 30 Aug 2011 04:00:00 PST

( from http://www.rxpgnews.com ) Compared to patients who had persistently high platelet reactivity, those who achieved low platelet reactivity, according to the VerifyNow P2Y12 Test, had a reduced incidence of cardiovascular death, heart attack and stent thrombosis, as indicated by a clinical trial presented today at the ESC Congress 2011.

These findings were part of a secondary analysis of the Gauging Responsiveness with A VerifyNow P2Y12 Assay- Impact on Thrombosis and Safety (GRAVITAS) trial, the largest prospective trial to date to test the clinical efficacy of antiplatelet therapy modification, based on platelet reactivity testing. The GRAVITAS trial, published in the Journal of the American Medical Association in March 2011, was a randomized comparison of double-dose clopidogrel versus the standard 75mg dose in ~2200 patients receiving drug-eluting stents and who were identified as having high on-treatment platelet reactivity (ie., were non-responders) by the VerifyNow P2Y12 Test. The trial's primary results showed that there was no reduction in cardiovascular events with double-dose therapy, leading many to postulate that platelet reactivity may not be a modifiable risk factor for cardiovascular events.

In the current analysis, researchers looked at achievement of a different level of platelet reactivity than used in the original study design and determined the clinical importance of platelet reactivity over time. We looked at the cardiovascular risk in patients who achieved a level of platelet reactivity of less than 208 P2Y12 Reaction Units (PRU), the platelet reactivity result provided by the test used in the GRAVITAS trial, stated Dr. Matthew Price, the study's principal investigator. Patients who got below this level of platelet reactivity, whether at discharge or 30 days after PCI, had significantly better cardiovascular outcomes -- approximately half the risk of cardiovascular death, myocardial infarction or stent thrombosis.

This suggests that it may be important not only to know a patient's platelet reactivity at the time of discharge, but also to ensure that low platelet reactivity is achieved throughout the course of their treatment. Importantly, we saw this effect even after adjustment for other clinical risk factors, so our observation applies both to traditionally 'low-risk' patients such as those undergoing elective PCI as well as patients presenting with acute coronary syndromes.

These findings from this secondary analysis also help explain why we may not have seen a benefit of double-dose clopidogrel in the primary results of GRAVITAS concluded Dr. Price. It turns out that less than half the patients on the double-dose reached this 'safe' level of 208 PRU.

Dr. Price also indicated that this is still the tip of the iceberg as to what we may learn from GRAVITAS. Data from whole exome DNA sequencing are being analyzed to comprehensively investigate the influence of genetic variation on platelet reactivity in the GIFT Exome sub-study. Data are also being analyzed to determine the impact of aspirin responsiveness on clinical outcomes to further understand how physicians may be able to optimize the care of their patients receiving dual antiplatelet therapy.

Considerably lower risk of stent thrombosis and restenosis in 'new generation' drug-eluting stents

Tue, 30 Aug 2011 04:00:00 PST

( from http://www.rxpgnews.com ) Results from the SCAAR study, presented at the ESC Congress 2011 today, showed that Percutaneous Coronary Intervention (PCI) with new generation Drug Eluting Stents, was associated with a 38% lower risk of clinically meaningful restenosis and a 50% lower risk of stent thrombosis compared to old generation DES.

Although many trials and studies support the overall early and mid-term safety and efficacy of first-generation drug-eluting stents, there has been concern on their long-term safety, especially regarding the potential risk of late stent thrombosis as well as late restenosis.

New drug-eluting stents (n-DES) have been developed with the purpose of overcoming the current limitations of the older generation drug-eluting stents (o-DES).

The purpose of this study was to evaluate the long-term outcome in all patients who underwent stent implantation with bare metal stents (BMS), older generation drug eluting stents (o-DES), and new generation drug eluting stents (n-DES) in Sweden, using a national registry with complete consecutive enrolment, the Swedish Coronary Angiography and Angioplasty Registry (SCAAR).

The SCAAR holds data on consecutive patients from 29 centers that perform coronary angiography and percutaneous coronary intervention (PCI) in Sweden. The registry is sponsored by the Swedish Health Authorities and is independent of commercial funding. The technology is developed and administered by the Uppsala Clinical Research Center. Since 2001, SCAAR has been Internet-based, with recording of data online through an Internet interface in the catheterization laboratory; data are transferred in an encrypted format to a central server at the Uppsala Clinical Research Center.

All consecutive patients undergoing coronary angiography or PCI are included. Information with respect to restenosis and stent thrombosis has been registered for patients undergoing any subsequent coronary angiography for a clinical reason since the beginning of 2004.

Our study included 94384 stent implantations in Sweden (BMS, n=64631; o-DES, n= 19202; n-DES, n=10551), from November 2006 to October 2010. Follow-up was performed up to two years post-intervention.

The performance up to two years of different types n-DES was evaluated in an unselected large real-world population- including patients with myocardial infarction, three-vessel and/or left main disease, bifurcation lesions, graft disease, restenotic lesions and chronic total occlusions.

The main findings of this study are that PCI with new generation DES was associated with a 38% lower risk of clinically meaningful restenosis and a 50% lower risk of stent thrombosis compared to old generation DES.

Further studies are needed in order to attempt to discriminate whether one of the three components of the new generation DES- the polymer, the stent alloy, the eluting-drug- is mainly involved in decreasing the incidence of stent thrombosis and restenosis.

Improved stent designs with thinner struts, more biocompatible polymers may have an important impact on drug elution profiles, endothelial coverage, and functional recovery.

In conclusion, we showed that patients treated with PCI with new generation DES have a considerably lower risk of restenosis and stent thrombosis at 2 years compared to older generation DES in a large real world population.

These findings can be useful for the management of patients with high risk profile that could benefit more from these new devices.

New study shows patients with coronary artery disease

Tue, 30 Aug 2011 04:00:00 PST

( from http://www.rxpgnews.com ) Thrombotic (clotting) and bleeding events are complications that may occur after surgery. With the aging population in the western world, there are more patients undergoing orthopedic surgery than ever before. This makes understanding the risk of complications from orthopedic surgery exceedingly important. However, there is a lack of data investigating the incidence of thrombotic and bleeding complications in orthopedic surgery.

The new study by investigators at NYU School of Medicine was comprised of 3,082 patients undergoing orthopedic surgery of the hip, knee, and spine. The study shows that thrombotic and bleeding complications occurred in 5.8% and 5.4% of all subjects, respectively. Coronary artery disease, cancer, and peripheral artery disease were independent predictors of both thrombotic and bleeding events. Increasing age and kidney disease were strong predictors of thrombotic events, while female sex was a significant predictor of major bleeding.

Thrombotic and bleeding complications can occur in the setting of orthopedic surgery, said Brandon S. Oberweis, MD, lead author and medical resident at NYU School of Medicine. Our findings help elucidate specific risk factors for these perioperative complications, helping to provide physicians with the ability to properly risk stratify patients when undergoing orthopedic surgery.

To properly assess the potential benefit/risk trade-off during the perioperative period, one must know the true incidence of thrombotic and bleeding events following any surgery. Previous research has shown an increase in short- and long-term cardiovascular events and all-cause mortality in patients with a perioperative thrombosis (heart attack).

On the opposite end of the clinical spectrum, major bleeding is an important consideration during the perioperative setting. Surgeons are very cognisant of the bleeding risk and great emphasis is placed to prevent perioperative bleeding.

The trade-off between thrombotic and bleeding risk is exemplified regarding the use of antiplatelet drugs (such as aspirin), which may lower the risk of thrombotic events while increasing the risk of bleeding events.

In addition, our data shows a subgroup of patients undergoing orthopedic surgery with established coronary artery disease, who were more than four times as likely to suffer from a thrombotic event and twice as likely to suffer from a bleeding event as those patients without coronary artery disease, said Dr. Oberweis.

Despite the increased risk of thrombotic events, only 8% of subjects with coronary artery disease were on aspirin preoperatively. Interestingly, among patients on aspirin, there was a lowering of the risk of thrombotic events (7.1% versus 12.1%); however, this finding did not reach statistical significance. No significant impact on bleeding was observed with the use of aspirin.

Our data is suggestive of a potential role of aspirin in the perioperative setting which may help lower the risk of perioperative complications, said senior author, Jeffrey S. Berger, MD, assistant professor of Medicine and director of Cardiovascular Thrombosis at NYU School of Medicine. Even though this was a small study population of patients on aspirin, future studies targeting high-risk individuals for the reduction of thrombotic events with aspirin are certainly warranted, said Berger.

Results of the EXAMINATION trial

Tue, 30 Aug 2011 04:00:00 PST

( from http://www.rxpgnews.com ) The second generation drug-eluting stent Xience V performs well in patients having primary PCI for ST elevation myocardial infarction, and has a better safety profile than that of bare metal stents, according to results of the EXAMINATION (Evaluation of Xience-V stent in Acute Myocardial INfArcTION) trial.

The study was a randomised controlled trial with an all-comers design to evaluate the Xience V stent in the complex setting of STEMI and to provide data that may be applicable to the real world population.

Dr Sabate said that the first generation drug-eluting stents (DES) had been evaluated in randomised controlled trials in the setting of STEMI, with positive results overall. However, he added, most of these trials lacked good generalisability to real world circumstances because of their highly selected inclusion/exclusion criteria. Moreover, no safety and efficacy data exist for the new generation of DES in this high risk group of patients with STEMI. The all-comers design of the EXAMINATION trial applied wide inclusion and few exclusion criteria, which may result in a more representative sample of the target population.

The study was an investigator-initiated, multicentre, multinational trial involving 1498 STEMI patients randomised to either a Xience V stent (everolimus-eluting) or cobalt chromium bare metal stent. The primary endpoint was a composite of all-cause death, any recurrent myocardial infarction and any repeat revascularisation at one-year follow-up. Individual components of the primary endpoint and stent thrombosis were the main secondary endpoints. Patients included in the trial represented up to 70% of all STEMI patients being attended in the centres during the recruitment period, reflecting the real world nature of the design.

Results presented during the Hot Line session in Paris included 98% of patients with one-year follow-up data. In terms of primary endpoint, there was a non-significant trend towards benefit with the Xience-V stent by virtue of a lower rate of new revascularisations during follow-up as compared to the bare metal stents.

In terms of safety, the rates of definite and definite/probable stent thrombosis at one-year follow-up were significantly lower with the Xience V stent as compared to the bare metal stent, accounting for 0.5% (definite) and 0.9% (definite or probable) at one year with Xience V and 1.9% and 2.6% with the bare metal stent (both p=0.01).

These are the first 'real world' results we have from a randomised trial about the performance of the new generation drug-eluting stents in the high-risk context of STEMI, said Dr Sabate, and I think we can be reassured over any concerns about stent thrombosis.

Discontinuation of smokeless tobacco after myocardial infarction linked to improved survival

Mon, 29 Aug 2011 04:00:00 PST

( from http://www.rxpgnews.com ) In this prospective cohort study, presented today at the ESC Congress 2011, discontinuation of smokeless tobacco after a myocardial infarction (MI) is associated with a lower risk of subsequent mortality. Investigators found that post MI snus quitters had a 44 % lower risk of total mortality.

The association seems to be independent of smoking habits, but partly explained by concomitant changes in other lifestyle variables.

Smokeless tobacco in the form of Swedish snus (oral moist snuff) has been advocated as a safer alternative to smoking. Snus takes the form of a finely ground and moistened tobacco, a bolus of which is placed under the upper lip for around an hour, with daily exposure times estimated to be around 10 to 12 hours. Different formulations exist from loose tobacco to sachets. In Sweden, 20% of adult males and 4% of adult females are estimated to be daily users. The sale of snus is illegal in the rest of the European Union, but widespread and increasing in the United States.

While cigarettes are indeed associated with more negative health effects, smokeless tobacco can't be regarded as harmless, said Gabriel Arefalk from Uppsala University (Uppsala, Sweden), the first author of the study. In Sweden every time we discharge an MI patient who's a snus user, we're faced with the clinically important question of whether they should discontinue use.

Of concern, he added, has been a meta-analysis suggesting that use of smokeless tobacco results in an increased risk for fatal MIs, indicating that snus use may predispose people to arrhythmic or other serious complications of MIs.

In the current prospective cohort study, 20,911 consecutive patients aged 75 years or less who had been admitted between 2005 and 2009 to coronary care units for an MI in Sweden, were followed. Two months post discharge, information about risk factors such as past and present tobacco exposure, diabetes, hypertension, body mass index and waist circumference was recorded, as well as more specific potential confounding factors such as type of MI (STEMI/NSTEMI), participation in cardiac rehabilitation programs, level of physical activity and occupation status.

During a mean follow-up of 2.1 years, 812 of the participants died. Among the 1799 current snus users, 69 died (incidence rate 18.7 per 1000 person-years-at-risk); versus 14 among the 675 post MI snus quitters (incidence rate 9.7 per 1000 person-years-at-risk).

In a model adjusted for age, gender and present and past smoking status, the investigators found that post MI snus quitters had a 44 % lower risk of total mortality (hazard ratio 0.56; 95% confidence interval [CI] 0.31-0.99) relative to current snus users. While in a model that was further adjusted for diabetes, hypertension, systolic and diastolic blood pressures, body mass index, waist circumference, type of MI, participation in cardiac rehabilitation programs, level of physical activity and occupational status, snus quitters had a non-significant 32 % lower risk than current users (hazard ratio 0.68; 95% CI 0.38-1.21).

The reduced risk in snus quitters seemed to be independent of smoking habits but may be partly related to changes in other life style behaviors, such as level of physical activity and participation in cardiac rehabilitation programs, said Arefalk. Ideally the effects of quitting snus post-MI should be studied in a randomised clinical trial, he added.

Clinical outcomes in PCI patients given sirolimus-eluting and everolimus-eluting stents

Mon, 29 Aug 2011 04:00:00 PST

( from http://www.rxpgnews.com ) The second generation drug-eluting stent, everolimus-eluting stent (EES), has consistently demonstrated superior clinical outcomes in randomised controlled trials over the first generation drug-eluting stent, paclitaxel-eluting stent. However, other earlier studies comparing EES with another first generation drug-eluting stent, sirolimus-eluting stent (SES), have only demonstrated the non-inferiority of EES; the superiority of EES relative to SES in terms of target-lesion revascularisation has not yet been investigated in adequately powered randomised controlled trials.

This has now been addressed in the Randomised Evaluation of Sirolimus-eluting versus Everolimus-eluting stent Trial (RESET), a prospective randomised multicentre open label trial comparing EES with SES in daily clinical practice in Japan. The trial was performed in patients scheduled for percutaneous coronary intervention with drug-eluting stents, who were enrolled without any exclusion criteria. The primary efficacy endpoint was defined as any target-lesion revascularisation. The trial was a sequential non-inferiority and superiority study, which was powered for non-inferiority on the primary efficacy endpoint at one year after the index procedure.

Between February and July 2010, a total of 3206 patients were enrolled in the trial among 100 participating centres. Excluding nine patients who withdrew consent, 3197 patients were randomly assigned to receive either of the twp investigation stents.

An angiographic sub-study evaluating in-segment late lumen loss and angiographic restenosis rate at eight months included 571 patients. The study population included large proportions of patients with advanced age, diabetes and prior PCI. The two groups of patients were well balanced in terms of baseline clinical, angiographic and procedural characteristics.

Results of this large randomised trial comparing showed EES to be non-inferior to SES in terms of target-lesion revascularisation rate at one year and angiographic in-segment late loss at 8-12 months.

One-year clinical outcome after both EES and SES use was excellent, said investigator Dr Takeshi Kimura from Kyoto University Hospital, Kyoto, Japan, with low rate of target-lesion revascularisation and very low rate of stent thrombosis.

However, Dr Kimura cautioned about several limitations to the study. First, he said, although SES was not widely used at the time of the trial, it was the most widely used and most extensively studied first generation DES. Clinical outcome after SES implantation should be regarded as the benchmark for the current and future generation drug-eluting stents.

Second, despite the all-comers trial design, the study population actually enrolled seemed to represent relatively low-risk patients, resulting in event rates lower than anticipated. Future stent trials, he suggested, might focus more on complex patients, in whom coronary artery bypass grafting could be a reasonable alternative.

Dr Kimura also added that longer-term follow-up is important to address whether EES might affect the late adverse events beyond one year such as late restenosis and very late stent thrombosis.

Elite cross-country skiing linked to increased risk of subsequent arrhythmias

Mon, 29 Aug 2011 04:00:00 PST

( from http://www.rxpgnews.com ) A Swedish study presented at the ESC Congress 2011 today, found a higher incidence of arrhythmias in cross-country skiers with a long history of endurance training. Compared to those who had completed one single race, those who had completed 7 or more races had 29% higher risk of a subsequent arrhythmia. Further, elite athletes finishing at 100-160% of the winning time had 37% higher risk of arrhythmias than recreational athletes finishing at more than 241% of the winning time.

Although it is well established that physical training significantly reduces the risk of cardiovascular disease, earlier reports have indicated a higher incidence of arrhythmias (heart rhythm disorders) among elite athletes committed to endurance sports. Different types of arrhythmias have different severity, but the most feared situation is when a young athlete suffers a sudden death caused by a ventricular tachycardia (fast heart rhythm originating from the large chambers). This tragic event is most often seen in athletes with an unknown pre-existing heart disease. Other types of arrhythmias are less serious but most uncomfortable for the athlete. Atrial fibrillation (fast irregular heart rhythm) is the most frequent, and athletes suffering from atrial fibrillation have an unpleasant feeling in the chest, decreased performance and higher risk of suffering from stroke. Earlier small studies have reported a higher incidence of atrial fibrillation and bradyarrhythmias (slow heart rhythm) among endurance sport athletes but no large scale studies have been presented. This study's aim is to investigate the risk of arrhythmias in a large group of endurance-trained athletes.

Every year the first Sunday of March, around 15,000 participants in the Swedish skiing event Vasaloppet endure 90 strenuous kilometres of cross-country skiing. The participants are ranging from elite to recreational athletes, and their training status (measured as maximal oxygen consumption) is closely correlated to their finishing time. It is important to stress that participants in the Vasaloppet are generally healthy, have higher than average socioeconomic status and lower mortality compared to the general population.

This study includes all Swedish citizens completing the race during the period 1989-98 (47,477 persons) and investigates two cross-country skiing-related exposures; 1) the participants finishing time, as a proportion of the winning time that year (a measure of whether the athlete is trained at an elite or recreational level); and 2) number of races completed by the participant (a measure of the duration of the training).

Accounting for age, socioeconomic status and education, we observed a higher incidence of arrhythmias in cross-country skiers with a long history of endurance training. Compared to those who had completed one single race, those who had completed 7 or more races had 29% higher risk of a subsequent arrhythmia. Further, elite athletes finishing at 100-160% of the winning time had 37% higher risk of arrhythmias than recreational athletes finishing at more than 241% of the winning time. This association was more prominent among younger (less than 45 years) than older athletes. The associations were mainly driven by the most common type of arrhythmia, atrial fibrillation, and bradyarrhythmias. We did not find any significantly increased incidence of the potential lethal ventricular arrhythmias with any of the exposures.

Dr. Andersen summarizes: Basically, this study shows, that even though physical activity is generally healthy, athletes committed to endurance sports at elite level have higher risk of suffering from a heart rhythm disorder. There seems to be a relation with the duration of the sport commitment and at which level the athletes competed. We emphasize that we do not find any increased incidence of potential lethal heart rhythm disorders. However, this study only compares athletes at different levels and a future large scale study comparing athletes against the normal population would be very interesting.

Potential benefits of remote follow-up of ICD patients

Mon, 29 Aug 2011 04:00:00 PST

( from http://www.rxpgnews.com ) Results from the EVATEL (EVAluation of TELe follow-up) trial are the first in Europe to demonstrate potential safety and efficacy benefits from the remote follow-up of ICD patients. The trial was conducted in France, with the financial support of the French Ministry for Health and independent of any manufacturer grants.

ICDs (implantable cardioverter defibrillators) are devices routinely implanted in patients at risk of sudden cardiac death as a result of rhythm disturbances. The expending indications for ICDs are expected to have an impact on follow-up strategy, as the number of patients with ICDs is increasing rapidly.

Currently, explains investigator Dr Philippe Mabo form the University Hospital of Rennes, France, regular in-clinic follow-up must be performed every three months, according to manufacturer guidelines. But there are two drawbacks to the in-clinic follow-up - they're time-constrained for both the patient and the clinic, and there's no link between the time of the appointment and the clinical event or device malfunction. So there's a clinical need to consider new follow-up strategy.

In response, several manufacturers have developed new technologies which allow the remote transmission of information from the device and on its therapeutic effect. Critical data can be transmitted at any time on system integrity or unexpected events - for example, lead integrity, battery status or ineffectively delivered therapy. Data stored in the device are transmitted by phone from the patient's home to the implant centre, with website access to the data.

In this context, said Dr Mabo, remote device follow-up seems to be a promising technique for device follow-up. But the technology needed clinical validation in terms of safety, efficacy and cost-efficiency, which were the objectives of the EVATEL trial.

The study included 1501 patients from 30 French centres enrolled between January 2008 and January 2010. They were each followed-up every three months for an overall period of one year. The last follow-up was performed in January 2011. The characteristics of the subjects were comparable to those of an ICD trial or registry, with a mean age of 59 years and the majority male (85%). Half the patient received conventional follow-up at the implant centre, the other half were followed remotely. The primary end-point of the trial was a clinical composite of death (all causes), cardiovascular hospitalisation, and ineffective or inappropriate therapy delivered by the device.

The primary endpoint was validated in 28.5% of the control group and 30.2% of the remote group, thus indicating no difference in outcome between the groups. In addition, there were no statistically significant differences between the two groups in time to occurrence of the first primary endpoint (p=0.71) and the one-year survival rate (p=0.31). The number of inappropriate therapies was lower in the remote group (4.7%) as compared to the control group (7.5%) (p=0.03).

Nevertheless, the non-inferiority hypothesis of the trial with a strict non-inferiority margin of 5% was not confirmed, as the event rate difference between the two groups was 1.7%, with a 95% confidence interval of -0.3 to 6.4.

Commenting on the results, Dr Mabo said: The remote follow-up of patients implanted with an ICD seems to be a safe alternative to conventional in-office follow-up. However, for the widespread uptake of this new strategy - at least in France - reimbursement from the healthcare system will be needed. We hope that it will be available soon in France.

How a cardiovascular prevention program in a Brazilian school reduced parent's CVD risk

Mon, 29 Aug 2011 04:00:00 PST

( from http://www.rxpgnews.com ) A multidisciplinary educational programme in cardiovascular prevention directed to children of school age can reduce their parents' cardiovascular risk. Cardiovascular prevention could have more success focusing on children first, inducing healthier lifestyle habits in the whole family, said investigator Luciana Fornari, from the University of Sao Paulo, Brazil. The inspiration for this study, presented today at the ESC Congress 2011 in Paris, came with her motherhood, and the perception that her children could efficiently modify the family's habits with concepts that they have learned at school.

For the study, 197 children aged 6 to 10 years from a private school in the city of Jundiai (located about 60 km from Sao Paulo), and their 323 parents were divided into two groups. Children in the control group (which assessed of 161 parents with a mean age of 39 years) were provided with written educational material at the beginning and middle 2010. The material included information about benefits of healthy life style, such as a fat and sugar free nutrition, more physical exercises and avoidance of tobacco. Children in the intervention group (which assessed 162 parents with a mean age of 38 years) were issued with the same material and also exposed to a weekly educational program about cardiovascular prevention that aimed to teach, in different ways adapted to their ages, concepts of healthy nutrition, tobacco avoidance and the importance of physical activity.

The programme included educational films and plays, and discussion about healthy lifestyles with the multidisciplinary team. The children were encouraged to write stories, draw and paint about what they had learned. Children also participated in practical cooking sessions where they learned to make and tasted healthy juices and sandwiches and could discuss with the nutritionists about the contents of different kinds of foods and how to make healthy choices. Parents and children could also take part in family bike rides and Olympic style events.

The programme was delivered by a multidisciplinary team from Anchieta University, and included nurses, physical education teachers, physiotherapists, nutritionists, psychologists and primary teachers.

In both groups, investigators collected data from parents and their children at the beginning and end of 2010, including nutritional and exercise survey, measures of weight, height, waist circumference, arterial blood pressure and laboratory exams. From this data, investigators calculated the risk of parents experiencing cardiovascular heart disease over the next 10 years, according to the National Heart, Lung and Blood Institute's (NHLBI) Framingham Heart study.

When the investigators analyzed the parents' Framingham cardiovascular risk, they found that 9.3% of the control group (15 parents) and 6.8% (11 parents) of the intervention group had more than 10% year risk of cardiovascular heart disease (CHD) in the next 10 years. After the children's educational programme, the intervention group had a reduction of 91% in the intermediate/high Framingham CVD risk group (1 parent with >10% year risk of CHD) compared with 13% reduction in the control group (13 patients with >10% year risk of CHD), p=0.0002.

So, prioritize children first seems to be the right way towards cardiovascular prevention today.

MitraClip Therapy demonstrates benefits for heart failure patients

Sun, 28 Aug 2011 04:00:00 PST

( from http://www.rxpgnews.com ) Results of an observational study presented at the European Society of Cardiology (ESC) meeting today in Paris demonstrate that the percutaneous catheter-based MitraClip treatment improves symptoms and promotes reverse left ventricular (LV) remodeling in patients with mitral regurgitation (MR), who do not respond to cardiac resynchronization therapy (CRT).

The trial, called PERMIT-CARE, is an investigator-led study evaluating the safety and efficacy of MitraClip treatment in 51 patients with clinically significant functional mitral regurgitation (FMR) at seven European centers. All patients had unchanged symptoms and unchanged left ventricular volumes after at least six months of CRT. Nearly all patients enrolled in the study were considered ineligible for mitral valve surgery due to a high estimated mortality risk.

Results of the study demonstrate that FMR reduction with MitraClip treatment is feasible, safe, and leads to substantial improvement in NYHA functional class and reverse LV remodeling in approximately 70 percent of patients.

Results of this study suggest that MitraClip treatment could offer, for the first time, a solution for heart failure patients who have severe MR and are unresponsive to CRT, said Angelo Auricchio, M.D., Ph.D., the study's lead investigator, of the division of Cardiology at the Fondazione Cardiocentro Ticino in Lugano, Switzerland. Surgery is not a good option for these patients because of their advanced left ventricular dysfunction and low ejection fraction. We have shown that they were significantly improved following treatment with the MitraClip device. I look forward to additional prospective studies to confirm our findings and to evaluate appropriate timing of MitraClip treatment in heart failure patients.

CRT is a treatment for congestive heart failure, a common problem with significant prevalence and mortality, both of which increase with advancing age. Severe FMR is common in heart failure patients, including approximately one-third of those indicated for CRT therapy. CRT often reduces MR; however, MR has been reported to persist in about 20-25 percent of CRT treated patients, and in an additional 10-15 percent MR may actually worsen after CRT treatment.

Results of the study will be published in an upcoming issue of the Journal of the American College of Cardiology.The MitraClip system is designed to reduce significant MR by clipping together the leaflets of the mitral valve, one of the four valves of the heart. The catheter-based MitraClip device is delivered to the heart through the femoral vein, a blood vessel in the leg. The heart beats normally during the procedure, and therefore does not require a heart-lung bypass machine. After treatment, patients are usually home within two to three days and have been observed to recover quickly. The safety and efficacy of the MitraClip system were evaluated in the EVEREST II randomized clinical trial.

Laughter has positive impact on vascular function

Sun, 28 Aug 2011 04:00:00 PST

( from http://www.rxpgnews.com ) Watching a funny movie or sitcom that produces laughter has a positive effect on vascular function and is opposite to that observed after watching a movie that causes mental stress according to research conducted at the University of Maryland School of Medicine in Baltimore, Maryland.

The idea to study positive emotions, such as laughter came about after studies had shown that mental stress caused blood vessels to constrict, says Dr. Michael Miller, Professor of Medicine and lead investigator.

In their initial study more than 10 years ago, 300 men and women with or without heart disease completed a questionnaire related to situational-humor. For example, if you went to a party and saw someone wearing the same clothes as you, on a scale of 1 to 5 (ranging from not funny at all to very funny) how would you respond? The volunteers with heart disease were 40% less likely to find these situations funny. Even though this study was unable to prove whether a humorous response to situations in daily life may protect against heart disease, (or the lack of such a response is more common after a heart attack), it led to the next series of studies testing whether laughter may directly affect vessel function.

In this manner, volunteers watched segments of a funny movie, such as There's something about Mary on one day and on another day watched the opening segment of the stressful movie Saving Private Ryan. Each volunteer served as his or her own control.

When study volunteers watched the stressful movie, their blood vessel lining developed a potentially unhealthy response called vasoconstriction, reducing blood flow. This finding confirms previous studies, which suggested there was a link between mental stress and the narrowing of blood vessels. However, after watching the funny movie, the blood vessel lining expanded.

Overall, more than 300 measurements were made with a 30-50% difference in blood vessel diameter between the laughter (blood vessel expansion) and mental stress (blood vessel constriction) phases. The magnitude of change we saw in the endothelium after laughing was consistent and similar to the benefit we might see with aerobic exercise or statin use says Dr. Miller.

The endothelium has a powerful effect on blood vessel tone and regulates blood flow, adjusts coagulation and blood thickening, and produces chemicals in response to injury and inflammation. It also plays an important role in the development of cardiovascular disease.

The endothelium is the first line in the development of atherosclerosis or hardening of the arteries, so it is very possible that laughing on a regular basis may be useful to incorporate as part of an overall healthy lifestyle to prevent heart disease. In other words, eat your veggies, exercise and get a good belly laugh every day says Dr. Miller.

Although the results of the brachial artery blood flow measurements appear to make a connection between laughter and vascular health, more studies are needed. What we really need is a randomized clinical trial to determine whether positive emotions reduce cardiovascular events above and beyond today's standard of care therapies, concluded Dr. Miller.

Anger predicts long-term mortality in patients with myocardial infarction

Sun, 28 Aug 2011 04:00:00 PST

( from http://www.rxpgnews.com ) There is a growing awareness that psychological factors play a major role in triggering and modulating the progression of ischemic heart disease. Negative emotions such as hostility, anger, depression, anxiety and social isolation are cardio-toxic, whereas positive feelings characterized by imagination, empathy, and spiritual interests are cardio-protective. A type D (for Distress) personality is described as someone with the tendency to live negative emotions and experience strong inhibitions to express them, and has been associated with a special vulnerability to ischemic heart disease.

Doctor Franco Bonaguidi, researcher and psychologist in a multidisciplinary team of cardiologists and epidemiologists at the IFC Institute, specialising in cardiovascular disease said: For a long time I have been interested in the important, but still largely elusive, relationship between personality traits, negative emotions and prognosis in cardiology. This is important in the group of patients recovering from an acute myocardial infarction, who have a special vulnerability (since they are at higher risk compared to patients with stable coronary artery disease). The good news is that these patients have the opportunity to change their behaviour, since they have recently experienced a life-threatening condition (such as acute myocardial infarction) which often leads people to reassess the whole of life balance and priorities. This is a suitable time for psychological intervention and behavioural therapy, when needed.

The overall aim of the study was to assess whether personality traits and, in particular anger-prone behavioural responses, may affect prognosis in patients who survived an acute myocardial infarction.

A total of 228 patients hospitalised in 13 Coronary Care Units of northern and central Italy from 1990 to 1995, with the diagnosis of acute myocardial infarction (AMI) were included in the study. Before their discharge, patients underwent a psychological evaluation by using Cattell's Sixteen Personality Factors Questionnaire and Psy Inventory. Cattell's questionnaire assesses secondary factors obtained from a factorial analysis of raw scores of 16 primary factors (Extraversion, Anxiety, Sensitivity, Self-control). The PSY inventory measures 6 psychological traits, only in part covered by the profile of type A personality (Responsibility, Energy, Obsessive behaviour, Anger, stress-related disturbances and time urgency).

After discharge the patients entered a programme of clinical follow-up for ten years, during which 51 cardiac events were recorded. To understand which factors were able to predict these events the authors used a statistical analysis known as the Cox model. Examining factors such as the age of patient, gender, psychological variables, clinical data (traditional risk factors, peak cardiac necrosis enzymes, left ventricular wall motion score index and heart rate variability), the results show that the only factors able to predict cardiac events in patients are the Anger and Stress-related disturbances, with a relative risk of 2.30 and 1.90 respectively. Patients who had reported a high score on the Anger scale had a higher risk of experiencing a new event, 2.30 times superior in comparison with those who had reported a low score on the same scale.

Expressing the results in terms of infarction-free survival with the Kaplan-Meier method ten years after infarction, the patients with high score of anger show a significantly lower ( 57,4%) infarction-free survival in comparison with the other set (78.5%).

The results of our study confirm the results of other important studies. Actually a recent meta-analysis of 25 studies of Chida and Steptoe (J Am Coll Cardiol. 2009) shows that anger and hostility are associated with coronary heart disease outcomes both in healthy and coronary heart disease population.

Anger is a recognized predictor of adverse outcome in patients with cardiovascular disease and can be specifically characterized by tailored questionnaires. Anger is a primitive emotion which cannot be switched off at will. It can have a constructive function when it serves to overcome obstacles and reach certain objectives. Beyond a certain level, or in presence of underlying vulnerability due to genetic or environmental factors, anger can trigger unfavourable hemodynamic, neural and endocrine changes through excessive sympathetic activation and can chronically contribute to self-destructive life habits, food and alcoholic addiction.

Anger becomes destructive when it is impotent, manifesting itself in grievance, resentment, irritability and frustration. At times, anger masks sorrow, a deeper and more painful emotion. Acknowledgement of inner states of mind can lead to psychological and spiritual growth which has a beneficial impact on spiritual well-being. As Shakespeare writes: Give sorrow words; the grief that does not speak, whispers the over- fraught heart and bids it break (Macbeth, act IV, scene III)

These results suggest the necessity of a multidimensional therapeutic approach which includes not only physical and pharmacological therapy, but also psychotherapy treatment targeted not only on anger but also toward a deeper suffering, of which anger is often an expression.

Results from the 17-country PURE study

Sun, 28 Aug 2011 04:00:00 PST

( from http://www.rxpgnews.com ) There is great under-use of proven therapies for the secondary prevention of cardiovascular disease, according to results presented today from the PURE (Prospective Urban Rural Epidemiological) study.

The study indicates a large gap in secondary prevention globally, said Dr Salim Yusuf, lead author and Executive Director of the Population Health Research Institute at McMaster University, Canada. We found extremely low rates of use of proven therapies in all countries, but these were more marked in middle and low income countries.

The study, which began recruitment in 2002, included 154,00 adults aged between 35 and 70 years living in 17 high, middle and low-income countries, and is the only multi-country study of its kind. All subjects had a history of heart disease or stroke. Among the huge amount of data collected (at the national, community and individual levels) were a record of each subject's use of medication along with information about their age, sex, education and key risk factors such as smoking, diabetes, hypertension and obesity.

Results showed that even the use of an inexpensive and commonly available treatment such as aspirin varied seven-fold in patients following a heart attack or stroke between low income and high income countries; the use of statins varied 20-fold between these countries. As a result Yusuf said there is an urgent need for systematic approaches to understand and solve the causes of the large treatment gap in secondary prevention in all communities.

The data are extremely disturbing, said Yusuf, and indicate a need for systematic efforts to understand why even inexpensive medications are substantially under-utilised worldwide. This is a global tragedy and represents a huge wasted opportunity to help millions of people with heart disease at very low cost.

There was no clear explanation for the results, which included a lower use of medications among women. Some reasons, the PURE investigators suggested, may be the limited availability of these drugs in low and middle income countries, the relatively high cost of even generic versions, side effects, difficulties in transportation, limited access to healthcare and a lack of awareness of the need for lifelong therapy among patients and their doctors.

However, the under-use of medication for secondary prevention was not confined to low and middle income countries. Even the three high income countries studied (Canada, Sweden and the United Arab Emirates) found significant numbers of post-MI and stroke patients not taking preventive treatment. Yet aspirin, statins and diuretics are of proven benefit, said Yusuf. They work, they are extremely safe and are very inexpensive.

Beating heart problems: How a combined group therapy helps depressed cardiac patients

Sun, 28 Aug 2011 04:00:00 PST

( from http://www.rxpgnews.com ) Researchers from the Heart Research Centre in Melbourne, Australia, have demonstrated the benefits of the 8-week 'Beating Heart Problems' group programme in a randomised controlled trial. According to Principal Research Fellow at the Centre, Dr Barbara Murphy, depressed participants appear to have benefited from the contact with their non-depressed peers: In groups for depressed patients, progress can be slow. With our programme, which involved depressed and non-depressed patients in a group together, we saw that the depressed patients improved dramatically. We believe that the 'well' patients were positive role models for the depressed patients, helping them to embrace healthy behaviours and a more positive mood.

After a heart attack or coronary bypass surgery, about one in four patients experience symptoms of depression. For some, these symptoms continue on for months and even years. Depressed patients are more likely to experience another acute event in the year after their heart attack, and have an increased likelihood of death in the years to follow. Treating depression is a key step in preventing disability and premature death.

The Beating Heart Problems program uses principles of cognitive behaviour therapy, which helps patients to identify 'unhelpful thoughts' and replace them with more helpful ones. Often it is not the actual events in our lives but the way we think about those events that causes low mood or depression says Dr Murphy. The Beating Heart Problems program helps patients to focus on their thoughts about their heart attack or heart condition, and come up with more helpful ways of thinking about it. In the same way, we can practise more helpful ways of thinking about physical activity, healthy eating and quitting smoking.

Another feature of our program is that it is very patient-centred. We don't tell people which behaviours to change or which thoughts to think. Patients in the group are encouraged to make the lifestyle changes that they want to make, and to work at their own pace.

The 8-week program covers eight topics including depression, anxiety and anger management, physical activity, healthy eating, and smoking cessation. Depressed patients who attended the 8-week program also significantly increased their physical activity levels, and had substantial improvements in the high-density lipoprotein levels, the 'good' cholesterols in the blood. Increased physical activity has long been known to improve symptoms of depression, in both cardiac patients and in the general population. Patients who did not attend the program did not obtain these benefits.

The study, funded by Australian Rotary Health, the Eirene Lucas Foundation and Perpetual Trustees, involved 275 patients from the Royal Melbourne Hospital and Melbourne Private Hospital, both in Victoria, Australia. All patients had been recently hospitalised after heart attack or for coronary bypass surgery.

Overall we are very excited about these findings says Dr Murphy. Depression is very debilitating for cardiac patients, and makes their recovery process more protracted and difficult. Our program helps to make the recovery process easier. And having non-depressed patients in the group certainly seems to be a strong point of the programme.

Hair-cell-derived patient-specific heart cells for disease modeling and drug screening

Sun, 28 Aug 2011 04:00:00 PST

( from http://www.rxpgnews.com ) The study presented by Dr. Katrin Streckfuss-Boemeke from Germany, won the ESC Basic Science Young Investigators Award.

Data gathered in this study demonstrates an easy and fast possibility to generate iPSCs from hair follicles of patients with genetic cardiac diseases and their further differentiation into functional cardiomyocytes. These cells will allow us to model the heart disease of these patients, to investigate the mechanisms of the disease, to perform drug screenings and to develop patient-specific therapeutic strategies, explained Dr Streckfuss-Boemeke.

Most iPSC described in previous studies were generated from skin fibroblasts or bone marrow cells which require surgical intervention. The aim of this study was to use an alternative cell source that could be readily and noninvasively isolated from patients and which shows a high proliferation rate for efficient reprogramming.

Heart disease is one of the leading causes of death in developed countries. Although the majority of cardiac death victims are elderly, many children and young adults under the age of 35 die each year due to various cardiac pathologies. Recent progress in the fields of molecular biology and human genetics have enabled identification of the genetic causes of many heart diseases, including multiple causes of sudden cardiac death (SCD).

Genetically determined cardiac diseases can be divided into two groups : diseases with a structural change of the heart, like hypertrophic cardiomyopathy (HCM) or arrhythmogenic right ventricular dysplasia (ARVD) and a second group, without structural changes, resulting in life-threatening cardiac arrhythmia. Examples are primary electric heart diseases (the channelopathies), as the long QT syndrome (LQTS), the short QT syndrome (SQTS), the Brugada syndrome (BrS) and the Catecholaminergic Polymorphic Ventricular Tachycardia (CPVT), which causes sudden unexpected cardiac death in apparently healthy young individuals.

Several genetic cardiac diseases are not rare, for example HCM (although it is most common cause of SCD in childhood), LQTS and BrS. However, several diseases are rare, for example, CPVT and ARVD, and are very often related to high mortality in children and young adults. The cumulative mortality of the CPVT cases is 30-50% by the age of 20-30 years.

Until now, most of studies of human cardiac developmental defects or adult diseases have been done in animal models, especially in mice. However, mice differ from humans in many ways; for example, a mouse heart beats at 500 beats per minute, while the human heart beats at 70 beats per min. Therefore, the use of pluripotent stem cells is a promising approach for studying cardiac diseases.

Pluripotent stem cells have two major properties: they can proliferate indefinitely and they can form about 220 different cell types present in the adult body, including functional cardiomyocytes. Lately, the reprogramming of somatic cells to induced pluripotent stem cells (so called iPSCs) has become very popular. For the pluripotency induction, proteins (e.g. the pluripotency factors Oct4, Sox2, Nanog, Lin28 Klf4, and cMyc) are introduced into the cells. Therefore, human iPSC cells offer the particularly attractive opportunity to convert somatic cells from patients with cardiac disease into iPSCs and differentiate these iPSCs into patient-specific cardiomyocytes. In this way we can establish a human heart disease model for analyzing molecular mechanisms and developing individual therapy strategies. This would not be possible by using heart biopsies from living patients, because of limitation regarding the procedure and the amount of the taken tissues.

However, most iPSC lines described in previous studies have been generated from skin fibroblasts or bone marrow cells that require surgical intervention on the patient for their isolation. Therefore, our aim was to use an alternative cell source that could be readily and noninvasively isolated from patients and shows a high proliferation rate for efficient reprogramming. We decided to use keratinocytes, which can be easily isolated from the hair of living human individuals.

Previous studies showed that hair-plucked keratinocytes are difficult to be cultivated with a low proliferation capacity. Therefore our first aim was the optimization of culture conditions for keratinocytes from human hair follicles. We plucked approximately 40 hairs from 41 individuals between 22-52 years, isolated and cultivated hair follicle keratinocytes with an efficiency of 90%. After 10 to 14 days we had a sufficient amount of keratinocytes in culture and started the induction of reprogramming of these hair cells into pluripotent stem cells. We introduced different combinations of pluripotency genes (Oct4, Sox2, Nanog, and Lin28 (OSNL) or Oct, Sox2, Klf4, and cMyc (OSKM) by using the lentiviral system. Oct4 and Sox2 are two transcription factors, which act as transcriptional activator of other pluripotency-associated genes. Nanog is more involved in the maintenance of pluripotency, and Lin28 for example has been used to enhance the efficiency of reprogramming. After 2-3 weeks we saw iPSC-colonies (Kera-iPSCs) in culture with a typical compact morphology of pluripotent human embryonic stem cells (hESCs).

We performed three sets of experiments for proving the pluripotency of the generated kera-iPSCs: First we analyzed the expression of typical pluripotency markers on gene and protein levels. We observed that the endogenous expression of OCT4 and SOX2 is very low in keratinocytes in contrast to a significantly increase in the keratinocyte-derived iPSCs. We detected no endogenous expression of NANOG and LIN28 in the keratinocytes but a highly induction in the iPSCs. These gene expression data were confirmed on the protein level. We were able to show that the kera-iPSCs were positive for markers common to pluripotent cells, including alkaline phosphatase, Nanog, Oct4, Sox2, Tra-1-60, and SSEA4.

The second proof of pluripotency of the generated iPSCs is their differentiation potential in vivo and therefore the ability to form teratomas. To test this, we injected the cells subcutaneously in immune-suppressed SCID-beige mice. After 8 weeks we observed the formation of teratomas, in which differentiating cells of all three germ layers were found, including cartilage, epithelium with intestinal differentiation and neural tissues.

In a last set of experiments we analysed the iPSC differentiation potential in vitro. Using the so-called embryoid body (EB) formation, we induced the cells to differentiate spontaneously into derivatives of all three embryonic germ layers in vitro.

During this time in vitro, tissue-specific genes were expressed in a developmentally controlled manner, including AFP-positive hepatic cells, tyrosine-hydroxylase positive neuronal cells and troponinT-positive cardiac cells. But the most exciting observation during this differentiation is the rhythmically beating clusters in EB outgrowths.

All these experiments show that the hair keratinocyte-derived iPSCs are really pluripotent and can be differentiated into beating cardiomyocytes.

These data demonstrate an easy and fast possibility to generate iPSCs from hair follicles of patients with genetic cardiac diseases and their further differentiation into functional cardiomyocytes. In comparison to hair-follicle-derived cardiomyocytes from healthy individuals we will be able to model the heart disease, to investigate the mechanisms of the disease, to perform drug screenings and to develop patient-specific therapeutic strategies (Fig.1). In conclusion, hair follicle keratinocytes offer a simple and accessible route to generate patient-specific iPSCs, and with minimum inconvenience for the patients.

The Homburg Cream and Sugar study

Sun, 28 Aug 2011 04:00:00 PST

( from http://www.rxpgnews.com ) The Homburg Cream and Sugar (HCS) study was designed to determine whether the measurement of postprandial triglyceride in addition to the assessment of glucose tolerance and traditional risk factors might improve the prediction of cardiovascular events.

To facilitate the study, an oral metabolic test protocol was developed to assess triglyceride and glucose tolerance prospectively. The test consisted of an oral fat load (250 ml cream drink containing 75 g fat) followed by a glucose drink (250 ml water with 75 g glucose) three hours later. (Patients with medical treatment for diabetes received only the cream drink.) Two sets of measurements were taken: first, fasting and postprandial triglyceride (TG) concentrations; and second, insulin concentrations and glucose tolerance.

This sequential testing was performed in 514 consecutive patients with stable coronary artery disease (CAD) undergoing coronary angiography. Eighteen months later they were followed-up for assessment of the primary composite endpoint of cardiovascular death or hospitalisation for cardiovascular events.

Results of the study showed that the combined testing of postprandial glucose and triglyceride tolerance is feasible in clinical practice. However, a number of specific conclusions emerged, notably that in the total cohort postprandial TG concentrations did not correlate with the number of primary endpoint events; fasting TG levels were found to be predictive, but this association was lost in multivariate analysis.

However, both fasting and postprandial TG levels were strongly correlated with glucose metabolism: patients with normal glucose tolerance had lower fasting TGs and a lower absolute postprandial TG increase than those with impaired glucose metabolism (although the mean relative TG increase was comparable). Thus, in patients with normal glucose tolerance both fasting and postprandial TG levels were identified as independent markers for cardiovascular outcomes. In those with impaired glucose tolerance, however, postprandial TG levels did not predict outcomes.

This is the first prospective study to assess postprandial triglycerides and glucose tolerance at the same time in a representative cohort of patients with coronary artery disease, said investigator Professor Ulrich Laufs from the from Saarland University Hospital, Homburg, Germany. While the combined sequential test protocol did allow the prediction of cardiovascular outcomes in the total cohort of patients with CAD, we did find that in CAD patients with diabetes and impaired glucose tolerance, absolute fasting and postprandial TG levels were high but not independently predictive of cardiovascular outcomes. In contrast, in patients with CAD and normal glucose tolerance, both fasting and - with superior risk prediction - postprandial TG concentrations were independent markers for cardiovascular outcomes.

Inhibition of microRNAs can stimulate the growth of new blood vessels

Sun, 28 Aug 2011 04:00:00 PST

( from http://www.rxpgnews.com ) This is the result of a recent experimental study carried out at the University Hospital Freiburg in Germany and funded by the German Research Foundation. In an animal model of peripheral artery disease, blood flow to the lower leg was significantly improved after treatment with the so-called antagomir-inhibitor.

MicroRNAs are a class of recently discovered molecules that can bind to other RNAs and thereby regulate the expression of several genes at once. More than 1000 microRNAs exist in humans and recent studies have shown an important function of these small regulators in many aspects of cardiovascular disease, from atherosclerosis to heart failure. It is estimated that more than 30% of all genes are affected by microRNAs.

Researchers from Freiburg describe for the first time the changes in microRNA-expression that occur if a major artery is occluded and new blood vessels develop as a compensatory mechanism. We then selected the microRNAs with highest change in expression for further analysis, research lead, Dr. Sebastian Grundmann, explains. The levels of microRNA-100, which is highly expressed in resting blood vessels, rapidly decreased if small vessels had to proliferate to compensate for the occluded artery. However, in patients this adaptive growth often remains insufficient to bring enough blood to the tissue at risk.

The additional pharmacologic inhibition of microRNA-100 with a new antagomir-inhibitor could be used to stimulate this natural adaptive mechanism. In the treatment group, blood flow increased by almost 30%, Dr. Grundmann summarizes the main result of the study, and we could show that an increase in the microRNA-100 target mTOR was responsible for this effect.

mTOR (mammalian target of rapamycin) is a central signal transduction molecule with an important function in cell proliferation, blood vessel growth and metabolic regulation. Inhibitors of mTOR are currently used for the prevention of in-stent re-stenosis and evaluated in several other cardiovascular and oncologic disease states. The discovery that microRNA-100 acts as an endogenous mTOR-modular extends the possible function of this small RNA beyond the regulation of blood vessel growth.

Since microRNA-100 and mTOR are not specific for blood vessels, potential side effects of its inhibition are also a concern. Indeed, first results from the Freiburg group demonstrate that the microRNA-100-inhbibitor also affects inflammatory processes, an unwanted effect in cardiovascular disease. Together with expert collaborators, we are currently investigating microRNA-100 and its inhibitor in several other disease models, where we already know that mTOR is critical, Dr. Grundmann explains. Our results on microRNA-100 in blood vessel show that microRNAs are attractive targets for future therapy of cardiovascular disease.

Pericytes from human leg veins may help with recovery after a myocardial infarction

Sat, 27 Aug 2011 19:15:09 PST

( from http://www.rxpgnews.com ) Stem cell therapies promise to regenerate the infarcted heart through the replacement of dead cardiac cells and stimulation of the growth of new vessels. New research has found the transplantation of stem cells that reside in human veins can help in the recovery of a heart attack. The findings could lead, in the next few years, to the first human clinical trial.

The study, led by Professor Paolo Madeddu, Chair of Experimental Cardiovascular Medicine in the School of Clinical Sciences at the University of Bristol and colleagues in the Bristol Heart Institute, is published online in Circulation Research: Journal of the American Heart Association.

The study, funded by the British Heart Foundation (BHF) and a National Institute for Health Research (NIHR) grant, looked at whether human mural cells, known to scientists as pericytes, cells that stay around, can stabilise blood vessels after a heart attack.

The researchers, using a mouse model, have demonstrated for the first time that pericytes expanded from redundant human leg veins are able to stimulate new blood vessels (neovascularization) and help with the recovery after a heart attack.

The study found that upon transplantation pericytes relocate around the vessels of the peri-infarct zone and establish with them physical contacts allowing the transfer of genetic material, microRNA-132 (miR-132). MicroRNAs are small non-coding RNA sequences that modulate the expression of genes by binding to messenger-RNA and inhibiting it. One microRNA can inhibit many genes simultaneously. The study shows that the transfer of miR-132 from pericytes to endothelial cells inhibits a gene that acts as a negative regulator of cell growth. This unlashes endothelial cell proliferation and the formation of new vessels.

Professor Madeddu said: "Although bone marrow cell therapies dominate today, continued research on other types of stem cells is mandatory to achieve optimal treatment of cardiovascular disease.

"Human pericytes could be an invaluable source for future applications of cardiovascular regenerative medicine."

The researchers demonstrated that transplanted pericytes relocate around and support the growth of blood vessels in the heart, suggesting an unusual growth of these cells is instrumental to therapeutic benefit. The physical contact between pericytes and resident endothelial cells may strengthen the nascent vascularization, thus reducing micro-vascular permeability and myocardial oedema, which are acknowledged to have a negative impact on cardiac function.

The discovery that pericytes use microRNAs to communicate with neighbouring cells reveals a new mechanism used by these cells to influence vascular function. Likewise, pericytes can sense signals from the endothelium and communicate biochemical information to surrounding tissue.

Dr Helene Wilson, Research Advisor at the BHF, which co-funded the study, said: "This exciting discovery is one more step towards mending broken hearts. It shows that 'one man's trash could be another's treasure' – using cells from leftover vein normally binned after heart bypass surgery, to try to repair heart damage in mice.

"While it's early days, the study shows that pericytes may have potential to help repair the heart after a heart attack. This is a vital goal for preventing heart failure, which currently affects more than 750,000 people in the UK and has a worse prognosis than many cancers."

Study raises doubts about value of heart ultrasound before elective surgery

Thu, 18 Aug 2011 04:00:00 PST

( from http://www.rxpgnews.com ) TORONTO, Ont., Aug. 18, 2011_A new study has found no evidence that patients who had a heart ultrasound known as an echocardiogram before major surgery had improved survival rates one month or one year after their operation.

Some groups of patients actually had worse survival rates, according to Dr. Duminda Wijeysundera, a scientist at the Li Ka Shing Knowledge Institute of St. Michael's Hospital and the Institute for Clinical Evaluative Sciences.

His study, published in the British Medical Journal, adds to a growing body of evidence that echocardiograms may not be helpful in predicting which patients are likely to have complications after major surgery and therefore require more specialized care.

These findings have important implications, especially since thousands of people undergo surgery around the world every day, said Dr. Wijeysundera, who is also an anesthesiologist at Toronto General Hospital.

Given that echocardiography may actually cause harm, physicians should reconsider its role for patients undergoing elective surgery. This study also highlights the importance of rigorously evaluating how tests are used in medicine and the fact that more testing is not always better.

An echocardiogram (ECHO) uses sound waves to create a picture of the heart, showing the shape, texture and movement of heart valves as well as the size of the heart chambers and how well they are working.

Dr. Wijeysundera found that 15 per cent of the almost 265,000 Ontario residents who underwent major surgery between 1999 and 2008 had echocardiograms beforehand. That makes the echocardiogram one of the most commonly ordered pre-operative tests.

Despite its common use, there was no evidence that the patients who had echocardiograms had improved survival at one month or one year after surgery.

Some groups of patients appear to do worse if they had undergone echocardiography. If a patient had two or fewer risk factors for postoperative cardiac complications and had not undergone cardiac stress testing, having an echocardiogram was associated with a higher chance of dying within one year after surgery. Risk factors could include such conditions as diabetes, kidney disease or a history of heart disease.

Dr. Wijeysundera and his colleagues have previously shown that if patients had at least one risk factor for postoperative cardiac complications, they had better survival after surgery if they had undergone stress testing before their operation. Despite these better outcomes with stress testing, physicians in Ontario are 50 per cent more likely to order an echocardiogram before surgery, perhaps because they are often easier to order quickly.

Dr. Wijeysundera said there are some potential reasons for these findings. Since echocardiograms do not perform that well in distinguishing between high-risk and low-risk patients, physicians may have been incorrectly reassured that some high-risk patients could safely undergo surgery with no additional specialized care.

In addition, some physicians may have incorrectly thought that some low-risk patients needed specialized care and therefore given them unnecessary and potentially harmful interventions.

If echocardiography results in patients having a better chance of surviving after major surgery, its increased use is justified, Dr. Wijeysundera said. If it does not, the relatively common use of echocardiography represents an unnecessary healthcare cost that may also unnecessarily delay scheduled surgeries.

Mount Sinai receives $3.4 million for largest study of personalized medicine in the clinical setting

Thu, 18 Aug 2011 04:00:00 PST

( from http://www.rxpgnews.com ) Mount Sinai School of Medicine has been awarded a $3.4 million grant over four years from the National Human Genome Research Institute (NHGRI) of the National Institutes of Health (NIH) to begin the largest study of its kind, in which a patient's genomic risk for disease is revealed in a lab, and then entered into an electronic medical record for use in determining treatment in the clinical care setting.

Using DNA and plasma samples provided by patients, Mount Sinai researchers from the Charles R. Bronfman Institute for Personalized Medicine (IPM) will identify genetic markers of disease for each patient enrolled in the study and input them into Mount Sinai's new electronic medical records system in a safe and secure way. Physicians who are treating these patients in the clinical setting may then electronically access this genomic information and determine susceptibility for heart disease, responsiveness to certain medications, and a personalized course of treatment.

Discovering genetic disease risk markers of major diseases such as heart disease through genome-wide genotyping was a major advance toward personalized medicine, but thus far the genomic information of individual patients has been limited to the laboratory and research setting, said Erwin Bottinger, MD, Director of the Charles R. Bronfman Institute for Personalized Medicine, and the Irene and Dr. Arthur M. Fishberg Professor of Medicine at Mount Sinai School of Medicine. This will allow us for the first time to bring that critical individual genetic-disease risk information to the patient setting, which we believe will eventually have a tremendous impact on the practice of medicine.

The study, called the Biorepository for Genomic Medicine in Diverse Communities, is part of a consortium of seven leading genomic medicine institutions called Electronic Medical Records and Genomics (eMERGE). As a member of the consortium, the IPM team hopes to have enrolled up to 20,000 patients from the Mount Sinai Biobank, which consists of consented patients representing the diverse communities surrounding The Mount Sinai Medical Center.

This grant is a significant achievement for Mount Sinai, propelling us to the forefront of personalized medicine and its application in the clinical setting, said Dennis. S. Charney, MD, Anne and Joel Ehrenkranz Dean of Mount Sinai School of Medicine and Executive Vice President for Academic Affairs of The Mount Sinai Medical Center. The future of medicine lies in genomics research and translating it into a patient-care setting. Mount Sinai's commitment to translational research makes us uniquely poised to lead that revolution.

Mount Sinai Biobank patients have provided DNA and plasma samples to aid in genomic and personalized medicine research, allowing Dr. Bottinger's team to validate and customize 288 previously-reported single nucleotide polymorphisms (SNPs) as genetic risk markers of major diseases, including heart, kidney, and liver disease, for Mount Sinai's racially and ethnically diverse patient populations. The IPM team is committed to ensuring that this information is made available in culturally appropriate, easy to understand formats, and will have the potential to benefit all patients.

USF researchers get $2.6 million NIH grant to investigate new post-stroke therapy

Thu, 11 Aug 2011 04:00:00 PST

( from http://www.rxpgnews.com ) University of South Florida Department of Neurosurgery and Brain Repair faculty members have received a $2.6 million grant from the National Institutes of Health to investigate the potential for cells derived from human bone marrow to benefit post-stroke patients by repairing the blood-brain barrier (BBB). The BBB prevents harmful substances in circulating blood from entering the brain while allowing passage of needed substances.

According to the researchers, current treatment for ischemic stroke is limited to one FDA-approved drug, the serine protease tissue-type plasminogen activator (tPA) that to be effective must be administered during a three-hour window following a stroke.

Although there are almost 800,000 stroke cases yearly in the US, less than three percent of patients benefit from tPA treatment, said Dr. Svitlana Garbuzova-Davis, assistant professor in the Department of Neurosurgery and Brain Repair and co-principal investigator on the grant. Because of the drug's narrow three-hour therapeutic window, and its detrimental side effects that can exacerbate stroke injury and counteract the benefits provided by reperfusion of the occluded artery, new drugs are desperately needed.

According to Dr. Garbuzova-Davis, any treatment aimed at repairing stroke deficits should consider the pivotal role of BBB repair in order to maintain central nervous system (CNS) stability and enhance neuronal regeneration.

Permanent BBB damage can lead to harmful serum protein leakage into ischemic brain tissue and may result in the formation of severe brain swelling in the hours and days following a stroke, she explained. This damage could negatively influence CNS regenerative processes after a stroke.

Using animal models of stroke, the researchers will investigate how blood-brain barrier repair might mitigate the functional recovery in the stroke animals, and determine if BBB reconstitution can lead to positive therapeutic outcomes. Their research is aimed at discovering a potential mechanism underlying the BBB repair produced by stem cell transplantation.

We believe that a regenerative mechanism involving the repair of the damaged BBB by endothelial progenitor cells (EPCs) derived from bone marrow is critical to the successful outcome of cell therapy in stroke, explained Dr. Garbuzova-Davis. Whereas other cell-based technologies are largely designed to circumvent the BBB for delivery of cells or drugs from the periphery into the brain, we are taking a novel approach of repairing the BBB damage to lead to a therapeutic outcome for stroke victims.

According to the investigators, the site-specific EPC recruitment, followed by blood vessel repair processes, is important to exploiting BBB repair, a neglected therapeutic approach in stroke therapy. As these studies are designed to examine whether EPC transplantation extends the therapeutic window of tPA for stroke, the current research builds on the their long-standing goal of translating cell therapy from the laboratory to the clinic.

If BBB restoration via EPC transplantation alone or in combination with tPA is proven effective, the researchers believe that direct clinical application of this cell therapy could help a large population of ischemic stroke patients who may have missed the limited 3-hour tPA window, explained Dr. Paul R. Sanberg, director of USF's Center of Excellence for Aging and Brain Repair.

Trauma drama: K-State professor researches drama queen of immune system

Mon, 08 Aug 2011 04:00:00 PST

( from http://www.rxpgnews.com ) MANHATTAN, KAN. -- Kansas State University's Sherry Fleming is investigating the factor that initiates the immune system's drama queen: the one responsible for intestinal cell damage after hemorrhage.

Fleming, an associate professor in the Division of Biology, is using a $140,000 grant from the American Heart Association to identify the molecule responsible for the overreaction that can cause cell death in the intestines after trauma.

What's starting this drama queen situation? A 13-year-old girl doesn't usually become a drama queen without a reason. There's something that initiated the drama -- clothes, shoes, make-up, movies, etc., Fleming said. With hemorrhage, we're looking for the initiating factor in the drama which occurs after trauma.

After a traumatic event, such as the loss of a limb or severe bleeding, the body cuts off blood flow to the intestines, sending more blood to the vital organs like the heart, lungs and brain, Fleming said. During that time, cells in the gut release molecular markers to let the body know that they are not getting oxygen.

After the trauma is resolved, blood flow is returned to the gut and a protein in the blood -- known as beta2 glycoprotein 1 in mice and apolipoprotein H in humans -- binds to the molecular marker on the cell to notify antibodies that there is a problem. The antibodies then activate a cascade of proteins, known as complement, that normally help the immune system by killing bacteria and helping rid tissues of dying cells. However, after a trauma this system can overreact and unnecessarily kill healthy cells.

If you've been in a car accident and sever an arm or start hemorrhaging, you want complement there to protect you from bacteria. So we don't want to stop all complement action entirely, Fleming said.

But Fleming is looking for a way to interrupt the chain of events leading to the over activation of complement following a traumatic event, because trauma patients often develop further complications throughout their body due to the activation of complement, she said.

Many times trauma patients who have lost a lot of blood will end up with acute respiratory distress syndrome or multiple organ dysfunction syndrome, due to the complement system overreacting, Fleming said. So they not only have to deal with the trauma, but also with their immune system attacking things that it shouldn't.

As a possible solution, Fleming and her lab group have developed a peptide that takes the place of the beta2 protein in binding to the molecular marker on the cell's surface, thus preventing the activation of complement.

This treatment is a promising solution, Fleming said. The funding from the American Heart Association will give us the opportunity to make major progress in this research.

A research tale with a heart to match: Professor looks at cardiovascular disease in dogs

Wed, 03 Aug 2011 04:00:00 PST

( from http://www.rxpgnews.com ) MANHATTAN -- For more than 15 years, Kansas State University researcher Michele Borgarelli has studied heart diseases in man's best friend.

But there is an interesting twist in his work with mitral valve disease: chronic mitral valve disease in dogs is similar to the same disease affecting humans, making Borgarelli's research beneficial to dog's best friend, too.

Further proof of the bond between owner and dog? Perhaps.

But for Borgarelli, Kansas State University associate professor of cardiology, the heart-filled similarities motivate him to learn more about mitral valve disease, the most common acquired cardiovascular disease in dogs.

The disease is a heart condition where the mitral valve -- one of the four valves in the heart -- deteriorates. As the valve deteriorates, more blood backflows through the valve and can lead to congestive heart failure.

We know that the disease affects geriatric dogs very commonly, Borgarelli said. I'm interested to know why some dogs progress faster and die from the disease when other dogs do not.

Small breed dogs, such as Cavalier King Charles spaniels, cocker spaniels, dachshunds, miniature poodles and Yorkshire terriers are more prone to chronic mitral valve disease. But Borgarelli's research has shown that the disease can also affect large breed dogs, such as German shepherds. He wants to search a list of factors to identify dogs more likely to progress to a severe disease stage.

Although a lot of these patients never progress to heart failure, you don't want to wait until they get to an age where it is too late, Borgarelli said. You want to identify these patients as early as possible.

About 70 percent of the dogs that are affected by mitral valve disease are not affected from heart failure and do not die from the disease.

That's very similar to people, Borgarelli said. There are some people who don't progress to heart failure even without any treatment. Treatments options are also different between people and dogs. Severely afflicted humans can have their deteriorated valve repaired or replaced. You cannot do that with dogs, yet. But surgery is going to be an option in the future for dogs, and because not every dog will be affected by heart failure, it is important to be able to identify dogs at higher risk for progression of the disease.

During a period of five years, Borgarelli and his research team conducted two population studies that involve more than 300 dogs. One population study, which was published in 2008, involved dogs that had mitral valve disease at different stages, from mild to severe. Another study, which the researchers are preparing for publication, involves dogs with the mild form of the disease.

The researchers found that 70 percent of pre-clinical dogs that have symptoms of the disease are still alive after six years. The dogs that experience heart failure have a median survival time of nine months after severe heart failure to 33 months after moderate heart failure.

Using echocardiographic examination, which creates an ultrasound-like image of the heart, the researchers have already found some indicators for severe forms of the disease. One such indicator is an enlarged left atrium in the heart, while other indicators include biomarkers, which involve evaluating blood samples.

Borgarelli is leading an Italian study of another indicator, called Brain Natriuretic Peptide, or BNP. The study, which started last year and will last until 2015, has two major goals: to evaluate if treatment with a combination of two drugs can delay the onset of clinical signs of mitral valve disease and to evaluate if any biomarker, including the peptide, can be used to identify patient risk.

For a third study, Borgarelli is applying a new noninvasive technique called contrast echocardiography to evaluate noninvasive myocardial perfusion -- an imaging procedure that can evaluate many heart conditions.

The study, sponsored by pharmaceutical company Boehringer Ingelheim, has just begun at Kansas State University's College of Veterinary Medicine Teaching Hospital and will continue until 2012. Researchers plan additional studies using new 3D technology to further evaluate the mitral valve. Their work is evidence of the rapid progress made on the disease in recent years, Borgarelli said.

This disease was first described in the 1960s. What we knew about the disease in the 1960s was about the same as what we knew up until a few years ago, Borgarelli said. Many questions have been resolved in just a few years.

But unanswered questions still exist, Borgarelli said, such as whether the disease is genetic and why some dogs progress to a more severe disease while others do not.

Because it's such a common disease and because dogs are naturally models for studying the disease in humans -- those are reasons why I want to continue studying this disease, Borgarelli said.

Johns Hopkins scientists begin first-of-its-kind research to create blood platelets from stem cells

Wed, 03 Aug 2011 04:00:00 PST

( from http://www.rxpgnews.com ) Johns Hopkins scientists have launched a pioneering research program to create, for the first time, human platelet cells from stem cells in order to study inherited blood clotting abnormalities ranging from clots that cause heart attacks and stroke to bleeding disorders. The study is funded by a $9 million grant from the National Institutes of Health (NIH) as part of a nationwide initiative to examine how genetic variations cause heart, lung and blood diseases.

One goal of the Hopkins research is to increase understanding of how genes regulate the function of platelets, which are the sticky cells in blood that are important to stop excessive bleeding. The researchers will also investigate how genetic variations can affect a person's responsiveness to aspirin and other medications that are designed to prevent clotting, in order to find new ways to prevent and treat abnormal clotting. Current anticoagulants, or blood thinner medications that are essential to prevent life-threatening complications from some heart or vascular diseases, are not always effective for individuals with certain genetic variations.

The other key aspect of the research will be to develop the technical capacity to produce large numbers of blood platelets from a single individual's blood sample. That way, patients who need platelet transfusions, such as those whose platelets were wiped out following chemotherapy, would be able to be transfused with their own platelets without the risk of rejection that comes with receiving platelets donated from others.

We will work to develop a completely new approach to generating blood cells for people who are desperately in need of chronic infusions, says Lewis Becker, M.D., professor of medicine and cardiologist at the Johns Hopkins University School of Medicine, who is the co-principal investigator of the study, called Functional Genomics of Platelet Aggregation Using iPS and Derived Megakaryocites.

To begin the research, small blood samples will be taken from 400 adult study volunteers. White blood cells from those donated samples will be transformed into immortal induced pluripotent stems cells, or iPS cells. Those iPS cells can be reprogramed into any type of human tissue. In this case, they will be converted into megakaryocytes, which are few in number, reside in bone marrow and produce platelets.

We are essentially turning back the clock, transforming these adults cells back to their origins into an embryonic-like state, says Linzhao Cheng, Ph.D., professor of medicine and associate director for basic research in the Division of Hematology. He is also a member of the Johns Hopkins Institute for Cell Engineering and a co-principal investigator of the study.

The techniques we will use for this study will also be applied to increase understanding of other human diseases. For the first time, we will have a laboratory system to study how human gene variants affect the function of cells, Cheng adds.

The blood samples will come from a large group of people who previously participated in the Johns Hopkins GeneSTAR study, a genetic research initiative with a database of 4,000 people who have family members with early heart disease. That study, which was the largest platelet function study in the world, uncovered an important genetic region related to platelet function and the effect of aspirin on blood clotting.

From GeneSTAR, we already know that these individuals have inherited genetic variants that affect their platelet function. We will ask some of them to come back to give a small blood sample to help us with this new study, says Diane Becker, Sc.D, M.P.H, professor of medicine and director of the GeneSTAR genetic research program in the Division of General Internal Medicine, who is also an investigator on the study.

The five-year study is one of nine new stem cell projects funded by the NIH to examine how gene variants cause disease. These studies will illuminate how specific genes behave in different tissues and should clarify the mechanisms by which a gene associated with a disease affects the biology of different tissues, says Susan B. Shurin, M.D., acting director of the NIH's National Heart, Lung and Blood Institute. Understanding the cellular and tissue biology will allow us to develop and test new therapies and prevention methods. These approaches, using iPS cells on a large scale, could improve the predictive value of preclinical testing, benefit regenerative medicine and reduce the need for animal models of disease, she says.

Cutting down on salt doesn't reduce your chance of dying

Tue, 05 Jul 2011 04:00:00 PST

( from http://www.rxpgnews.com ) Moderate reductions in the amount of salt people eat doesn't reduce their likelihood of dying or experiencing cardiovascular disease. This is the main conclusion from a systematic review published in the latest edition of The Cochrane Library.

There is lots of evidence that reducing dietary salt intake reduces blood pressure and the researchers did see some indication of this occurring. Intensive support and encouragement to reduce salt intake did lead to a reduction in salt eaten and a small reduction in blood pressure after more than six months, says lead author Professor Rod Taylor who works at the Peninsula College of Medicine and Dentistry at the University of Exeter.

What we wanted to see was whether this dietary change also reduced a person's risk of dying or suffering from cardiovascular events, says Taylor.

An earlier Cochrane review of dietary advice published in 2004 could not find enough evidence to allow the researchers to draw any conclusions about the effects of reducing salt intake on mortality or cardiovascular events. In Taylor's newly published research, however, the team managed to locate seven studies that together included 6,489 participants. This gave a sufficiently large set of data to be able to start drawing conclusions. Even so, Taylor believes he would need to have data from at least 18,000 individuals before he could expect to reveal any clear health benefits.

Most experts are agreed that consuming too much salt is not good for you and that salt reduction is beneficial in people with normal and high blood pressure. We believe that we didn't see big benefits in this study because the people in the trials we analyzed only reduced their salt intake by a moderate amount, so the effect on blood pressure and heart disease was not large, says Taylor. He believes that health practitioners need to find more effective ways of reducing salt intake that are both practicable and inexpensive.

Many countries have government-sanctioned recommendations that call for reduced dietary sodium. In the UK, the National Institute of Health and Clinical Guidance (NICE) has recently called for an acceleration of the reduction in salt in the general population from a maximum intake of 6g per day per adult by 2015 to 3g by 2025.

With governments setting ever lower targets for salt intake, and food manufacturers working to remove it from their products, it's really important that we do some large research trials to get a full understanding of the benefits and risks of reducing salt intake, says Taylor.

EHRA Europace and Cardiostim agree to develop common scientific programs

Thu, 30 Jun 2011 04:00:00 PST

( from http://www.rxpgnews.com ) Madrid, 28 June 2011 - EHRA-Europace and Cardiostim, Europe's leading congresses in electrophysiology and the treatment of heart rhythm disorders (such as atrial fibrillation) have formed a strategic alliance to ensure the development from year to year of a homogeneous congress programme devised under the direction of a common scientific committee.

The EHRA (European Heart Rhythm Association) and Cardiostim have had an agreement since 2006 whereby each organisation held their respective congresses in alternating years - Cardiostim in even years, and Europace in odd. That arrangement will continue under the new agreement, but now with further scope for consistency, integration and homogeneity. Both organisations share a wish to avoid fragmentation and create a common vision and objective - to promote the field of electrophysiology in terms of training and accreditation, research, the exchange of clinical skills and co-operation with allied professionals and manufacturers.

Under today's agreement, both congresses will retain their independence in terms of brand, ownership and finance, but will join forces in the planning and preparation of scientific content. The agreement, therefore, which was signed by representatives of EHRA-Europace and Cardiostim on 26 June 2011, aims to reinforce the quality of each congress and provide a scientific continuum from one event to the next. Currently, each congress attracts almost 6000 participants.

The agreement between the two organisations is for six years, from 2012 to 2017 inclusive; years 2012 and 2013 are seen as transition years in which EHRA-Europace and Cardiostim will retain their respective congress rules and structures. However, from 2014 a single common scientific committee, composed of and chaired by members of each organisation, will develop the scientific programme and the two congresses will aggregate their names.

Each programme will be built around four main themes: electrophysiology and catheter ablation (one important approach to the treatment of cardiac arrhythmias), devices for the management of heart rhythm and heart failure, non-invasive approaches to rhythm disturbances, and basic science. Abstracts selected for inclusion will be published in the Europace-EHRA journal.

Commenting on the agreement, Professor Panos Vardas, President of the European Heart Rhythm Association, said: The EHRA is the indisputable European leader in the management of cardiac arrhythmias and we have entered this agreement with Cardiostim in the belief that together we can create a highly successful congress driven by a common programme committee. We believe that this strategic decision - which took two years of discussion to reach - will be welcomed by the majority of European arrhythmologists.

Dr Philippe Ritter, Chairman of Cardiostim, said: This agreement is an historic event for the European electrophysiology community. Highly supported by the industry, this strategic alliance is the continuation of a rapprochement which started in 2006. Respectful of both organisations, it should now allow us to jointly accelerate the development of our congresses, as international congresses open to doctors and scientists from all over the world.

Genetic testing for inherited cardiac conditions is 'patchy' in Europe

Sun, 26 Jun 2011 04:00:00 PST

( from http://www.rxpgnews.com ) While genetic inheritance is known to play a role in the multifactorial development of most diseases of the heart, there are also a number of clearly diagnosed cardiac conditions which owe their development to quite specific genetic abnormalities. When these genetic disorders affect the integrity of the heart's muscle they are known as a cardiomyopathy; when the disorder affects the heart's excitability, it is known as a channelopathy.

Both conditions predispose to arrhythmias and sudden cardiac death - often in the young. A reliable genetic test for the presence of DNA changes in the genes which encode for ion channels and relevant proteins would not only help identify affected patients and reduce these serious risks, but also provide information for personalised treatment.

An expert consensus statement on the value of diagnostic genetic testing for these inherited cardiac conditions will be unveiled today at the EHRA EUROPACE 2011 congress in Madrid. The report, the HRS/EHRA Expert Consensus Statement on the State of Genetic Testing for the Channelopathies and Cardiomyopathies, is a joint development of the Heart Rhythm Society and the European Heart Rhythm Association (EHRA). The latter is the organiser of EHRA EUROPACE 2011.

According to Dr Silvia Priori, who will present details of the consensus statement today, its aim is to provide recommendations on how each of 13 inherited conditions might be tested for and diagnosed using genetic analysis. The guidance makes clear that these recommendations deal with uncommon diseases and are based on the results of studies which are much smaller than those available for more common diseases, such as myocardial infarction or heart failure. But, says Dr Priori, the field is evolving rapidly. In deed, the genetics of inherited arrythmogenic diseases is a recent sub-specialty of cardiology and it's only in the past 25 years that the first causative genes for channelopathies and cardiomyopathies were discovered.

Dr Priori, who is director of Molecular Cardiology at the Fondazione Salvatore Maugeri and University in Pavia, and Director of Cardiovascular Genetics at New York University, describes the penetration of use of genetic testing in Europe as patchy, with some countries still without even a limited framework for their application.

The document is intended to provide guidance to cardiologists in the use of genetic testing among patients and family members, she explains. Results may be useful for both the diagnosis and treatment of affected individuals. The appropriate use of these tests, she adds, is critical because they are expensive, and should, therefore, be used in patients with a clinical diagnosis (or high suspicion) of these diseases.

The recommendations focus on testing for 13 inherited conditions, including hypertrophic cardiomyopathy, long QT syndrome, Brugada syndrome, and dilated cardiomyopathy. In addition, the statement includes guidance on the use of genetic testing for out-of-hospital cardiac arrest survivors and post-mortem testing in cases of sudden death, the most dramatic consequence of these conditions.

Dr Priori describes the prevalence of these conditions among the general population as ranging from one in 500 to one in 10,000 - with an average prevalence of around one in 2000. Based on current knowledge, it is still not possible to find genetic abnormalities in all patients affected by these conditions; however, in some - such as hypertrophic cardiomyopathy or long QT syndrome - genetic testing may identify a causative mutation in as many as 70% of cases. In other diseases, however, the yield of testing is much lower, and improvements will depend on the discovery of more genes.

So genetic testing cannot be viewed as a one-size fits all solution, but its contribution to family screening and management in affected patients should be defined for each disease, says Dr Priori, and results should defined in the context of a comprehensive clinical evaluation. Counselling, particularly among family members, is essential for reassurance about disease risk and surveillance.

The consensus provides an assessment of the strength of indication for genetic testing in different conditions. In some diseases, such as hypertrophic cardiomyopathy or long QT syndrome, the recommendations to test all individuals with a clinical diagnosis are strong. In other diseases, such as Brugada syndrome or dilated cardiomyopathy, there is a value in performing the test, but the strength of recommendation is lower. And there are some instances - such as atrial fibrillation - where genetic testing cannot yet be indicated.

Similarly, the report does not recommend genetic testing in all cases of out-of-hospital cardiac arrest, but recommends that testing should be performed if there is a clinical sign or suspicion of an inherited arrythmogenic disease. However, genetic testing may be considered in all cases of sudden unexpected death, including sudden infant deaths (SIDS), where autopsy yields negative results. Studies suggest that genetic mutations can explain an underlying cause of sudden unexpected death in up to 35% of cases. Even events such as drowning or motor accidents in the young may in fact be attributed to cardiac arrhythmias of genetic cause.

Ultimately, says Dr Priori, the report hopes to lower the risk of sudden cardiac death by promoting the appropriate use of genetic testing - and to ensure their reimbursement from insurance and health care systems.

Teens with type 2 diabetes already show possible signs of impaired heart function

Tue, 07 Jun 2011 04:00:00 PST

( from http://www.rxpgnews.com ) Heart function may be affected in people with Type 2 diabetes as early as adolescence, according to a new study that will be presented Sunday at The Endocrine Society's 93rd Annual Meeting in Boston.

Past studies in adults with Type 2 diabetes show that their heart and blood vessels' ability to adapt to exercise may be impaired. Our study shows that these changes in heart function may begin to happen very early after Type 2 diabetes occurs, said the study's lead author, Teresa Pinto, MD, a pediatric endocrinologist at the Dalhousie University IWK Health Centre in Halifax, Nova Scotia, Canada.

Pinto performed the research while at the University of Auckland in New Zealand. The researchers studied how the heart and blood vessels of 13 teenagers with Type 2 diabetes adapted to exercise, compared with 27 overweight or obese subjects who did not have diabetes and 19 nondiabetic and nonobese control subjects. The subjects were ages 12 to 20 and from New Zealand. Their body composition, including percentage of body fat, was determined using dual-energy x-ray absorptiometry (DEXA) scans.

All subjects performed an exercise test on a stationary bicycle designed for use in a magnetic resonance imaging (MRI) machine. With MRI, images were taken of each subject's heart and femoral artery, a large blood vessel in the leg that supplies the leg with blood. MRI took place while the subjects were at rest and during or immediately after exercise on the cycle.

The images of the heart showed that the hearts of subjects with Type 2 diabetes did not expand and fill up with blood between heart beats as well as the hearts of subjects in the other two groups. This occurred during exercise only, the authors found. With exercise, the amount of blood pumped out with each heart beat (the cardiac output) was normal in all three groups, although still lower in the diabetic group.

We showed that the heart's pumping function is strong, but it is not filling as well as normal between heart beats. This is known as diastolic dysfunction, Pinto said. Although this study did not determine the reason for this, we know that with diabetes, the heart can become stiffer, limiting its ability to stretch and expand.

In addition, images of the femoral artery showed that the flow of blood through the artery was significantly less in the diabetic group during exercise compared with the other two groups.

It appears that irrespective of weight, Type 2 diabetes seems to have a negative effect on the heart and blood vessels in adolescents, Pinto said. This impaired exercise capacity may be reversible with exercise training however, as some literature in adults suggests, but further studies are required to determine this.

Low-carb, higher-fat diets add no arterial health risks to obese people seeking to lose weight

Wed, 01 Jun 2011 04:00:00 PST

( from http://www.rxpgnews.com ) Overweight and obese people looking to drop some pounds and considering one of the popular low-carbohydrate diets, along with moderate exercise, need not worry that the higher proportion of fat in such a program compared to a low-fat, high-carb diet may harm their arteries, suggests a pair of new studies by heart and vascular researchers at Johns Hopkins.

Overweight and obese people appear to really have options when choosing a weight-loss program, including a low-carb diet, and even if it means eating more fat, says the studies' lead investigator exercise physiologist Kerry Stewart, Ed.D.

Stewart, a professor of medicine and director of clinical and research exercise physiology at the Johns Hopkins University School of Medicine and its Heart and Vascular Institute, says his team's latest analysis is believed to be the first direct comparison of either kind of diet on the effects to vascular health, using the real-life context of 46 people trying to lose weight through diet and moderate exercise. The research was prompted by concerns from people who wanted to include one of the low-carb, high-fat diets, such as Atkins, South Beach and Zone, as part of their weight-loss program, but were wary of the diets' higher fat content.

In the first study, scheduled to be presented June 3 at the annual meeting of the American College of Sports Medicine in Denver, the Hopkins team studied 23 men and women, weighing on average 218 pounds and participating in a six-month weight-loss program that consisted of moderate aerobic exercise and lifting weights, plus a diet made up of no more than 30 percent of calories from carbs, such as pastas, breads and sugary fruits. As much as 40 percent of their diet was made up of fats coming from meat, dairy products and nuts. This low-carb group showed no change after shedding 10 pounds in two key measures of vascular health: finger tip tests of how fast the inner vessel lining in the arteries in the lower arm relaxes after blood flow has been constrained and restored in the upper arm (the so-called reactive hyperemia index of endothelial function), and the augmentation index, a pulse-wave analysis of arterial stiffness.

Low-carb dieters showed no harmful vascular changes, but also on average dropped 10 pounds in 45 days, compared to an equal number of study participants randomly assigned to a low-fat diet. The low-fat group, whose diets consisted of no more than 30 percent from fat and 55 percent from carbs, took on average nearly a month longer, or 70 days, to lose the same amount of weight.

Our study should help allay the concerns that many people who need to lose weight have about choosing a low-carb diet instead of a low-fat one, and provide re-assurance that both types of diet are effective at weight loss and that a low-carb approach does not seem to pose any immediate risk to vascular health, says Stewart. More people should be considering a low-carb diet as a good option, he adds.

Because the study findings were obtained within three months, Stewart says the effects of eating low-carb, higher-fat diets versus low-fat, high-carb options over a longer period of time remain unknown.

However, Stewart does contend that an over-emphasis on low-fat diets has likely contributed to the obesity epidemic in the United States by encouraging an over-consumption of foods high in carbohydrates. He says high-carb foods are, in general, less filling, and people tend to get carried away with how much low-fat food they can eat. More than half of all American adults are estimated to be overweight, with a body mass index, or BMI, of 26 or higher; a third are considered to be obese, with a BMI of 30 or higher.

NIH stops clinical trial on combination cholesterol treatment

Thu, 26 May 2011 04:00:00 PST

( from http://www.rxpgnews.com ) The National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health has stopped a clinical trial studying a blood lipid treatment 18 months earlier than planned. The trial found that adding high dose, extended-release niacin to statin treatment in people with heart and vascular disease, did not reduce the risk of cardiovascular events, including heart attacks and stroke.

Participants were selected for AIM-HIGH because they were at risk for cardiovascular events despite well-controlled low-density lipoprotein (LDL or bad cholesterol). Their increased risk was due to a history of cardiovascular disease and a combination of low high-density lipoprotein (HDL or good cholesterol) and high triglycerides, another form of fat in the blood. Low HDL and elevated triglycerides are associated with an increased risk of cardiovascular events. While lowering LDL decreases the risk of cardiovascular events, it has not been shown that raising HDL similarly reduces the risk of cardiovascular events.

During the study's 32 months of follow-up, participants who took high dose, extended-release niacin and statin treatment had increased HDL cholesterol and lowered triglyceride levels compared to participants who took a statin alone. However, the combination treatment did not reduce fatal or non-fatal heart attacks, strokes, hospitalizations for acute coronary syndrome, or revascularization procedures to improve blood flow in the arteries of the heart and brain.

Seeking new and improved ways to manage cholesterol levels is vital in the battle against cardiovascular disease, said Susan B. Shurin, M.D., acting director of the NHLBI. This study sought to confirm earlier and smaller studies. Although we did not see the expected clinical benefit, we have answered an important scientific question about treatment for cardiovascular disease. We thank the research volunteers whose participation is key in advancing our knowledge in this critical public health area, and the dedicated investigators who conducted the study.

The AIM-HIGH trial, which stands for Atherothrombosis Intervention in Metabolic Syndrome with Low HDL/High Triglycerides: Impact on Global Health, enrolled 3,414 participants in the United States and Canada with a history of cardiovascular disease who were taking a statin drug to keep their LDL cholesterol low. Study participants also had low HDL cholesterol and high triglycerides, which meant that they were at significant risk of experiencing future cardiovascular events. Niacin, also known as Vitamin B3, has long been known to raise HDL and lower triglycerides. Eligible participants were randomly assigned to either high dose, extended-release niacin (Niaspan) in gradually increasing doses up to 2,000 mg per day (1,718 people) or a placebo treatment (1,696 people). All participants were prescribed simvastatin (Zocor), and 515 participants were given a second LDL cholesterol-lowering drug, ezetimibe (Zetia), in order to maintain LDL cholesterol levels at the target range between 40-80 mg/dL.

The NHLBI funded the AIM-HIGH study with additional support from Abbott Laboratories, a pharmaceutical company based in Abbott Park, Ill. Abbott also provided Niaspan and Merck Pharmaceuticals, based in Whitehouse Station, N.J., provided Zocor. All drugs used in the study were approved for marketing in the United States and Canada and have been on the market for many years.

Researchers began recruiting participants in early 2006. The study was scheduled to finish in 2012. The average age of the participants was 64 years. Pre-existing medical conditions included coronary artery disease (92 percent); metabolic syndrome, which is a cluster of risk factors for heart disease (81 percent); high blood pressure (71 percent); and diabetes (34 percent). More than half of participants reported having a heart attack prior to entering the study.

The rationale for the AIM-HIGH study was based in part on a large number of observational studies that consistently showed that low HDL cholesterol increases the risk of cardiovascular events in men and women, independent of high LDL cholesterol. In addition, previous small clinical studies showed that relatively high residual cardiovascular risk exists among patients with cardiovascular disease, low HDL cholesterol, and high triglycerides despite intensive management of LDL cholesterol.

However, efforts to find HDL-raising treatments that actually reduce this residual risk have thus far proved disappointing. Fenofibrate, an HDL-raising drug, failed to reduce the rate of cardiovascular events in patients with diabetes in the Action to Control Cardiovascular Risk in Diabetes (ACCORD trial) despite favorable effects on HDL and triglycerides. Another HDL-raising drug, torcetrapib, actually increased the rate of cardiovascular events in the Investigation of Lipid Level Management to Understand its Impact in Atherosclerotic Events (ILLUMINATE) trial despite lowering LDL and triglycerides and raising HDL levels, as intended.

Earlier studies of niacin had shown more favorable results. Unlike AIM-HIGH, the earlier studies were not designed specifically to evaluate the impact of raising HDL on the risk of cardiovascular events while maintaining excellent LDL control. Several other trials testing this hypothesis, including a large international trial of high dose, extended-release niacin, are still ongoing.

As is customary in clinical trials, the NHLBI established an independent data and safety monitoring board (DSMB) to monitor trial progress and participant safety. At a regularly scheduled meeting on April 25, 2011, the study's DSMB concluded that high dose, extended-release niacin offered no benefits beyond statin therapy alone in reducing cardiovascular-related complications in this trial. The rate of clinical events was the same in both treatment groups, and there was no evidence that this would change by continuing the trial. For this reason, the DSMB recommended that the NHLBI end the study.

The DSMB also noted a small and unexplained increase in ischemic stroke rates in the high dose, extended-release niacin group. This contributed to the NHLBI acting director's decision to stop the trial before its planned conclusion. During the 32-month follow-up period, there were 28 strokes (1.6 percent) reported during the trial among participants taking high dose, extended-release niacin versus 12 strokes (0.7 percent) reported in the control group. Nine of the 28 strokes in the niacin group occurred in participants who had discontinued the drug at least two months and up to four years before their stroke. Previous studies do not suggest that stroke is a potential complication of niacin, and it remains unclear whether this trend in AIM-HIGH arose by chance, was related to niacin administration or some other issue.

All AIM-HIGH study participants have been informed of the results and will be scheduled for clinic visits within the next 2.5 months. Participants will be followed for an additional 12 to 18 months.

Patients who were not in the AIM-HIGH trial should not stop taking high dose, extended-release niacin without talking to their doctor first, said Shurin.

The lack of effect on cardiovascular events is unexpected and a striking contrast to the results of previous trials and observational studies, said Jeffrey Probstfield, M.D., AIM-HIGH co-principal investigator and professor of medicine and epidemiology at the University of Washington, Seattle. The AIM-HIGH findings do not support the trial's hypothesis that, in the population studied, adding extended-release niacin to simvastatin in participants with well-controlled LDL cholesterol can provide additional clinical benefit.

The results from AIM-HIGH should not be extrapolated to apply to potentially higher-risk patients such as those with acute heart attack or acute coronary syndromes, or in patients whose LDL cholesterol is not as well-controlled as those in AIM-HIGH, said William E. Boden, M.D., AIM-HIGH co-principal investigator and professor of medicine and preventive medicine at the University at Buffalo, N.Y.

The niacin tested in the study is a proprietary formulation used in doses of 500-2,000 milligrams (mg), manufactured by Abbott Laboratories and approved and regulated by the U.S. Food and Drug Administration. Low doses of niacin, typically 20 to 100 mg, can be found in multivitamin formulations available without a prescription. The FDA regulates the use of high doses of niacin (over 500 mg), which is approved by prescription for helping treat low HDL cholesterol and/or high triglycerides. At prescription-level doses, some people experience flushing. The extended-release formulation of niacin tested in AIM-HIGH was intended to help reduce the likelihood of flushing.

An estimated 1 in 7 Americans has high blood cholesterol. It is a major risk factor for cardiovascular disease, which kills 800,000 Americans a year. Cholesterol can build up in the walls of arteries and cause them to narrow, a condition known as atherosclerosis.

As we continue to search for new approaches to treating cholesterol problems, it is important to remember the value of existing treatments. The key to treating high cholesterol so patients can reduce their risk of cardiovascular disease is to lower the level of LDL cholesterol, through well-established drug treatments such as statins and lifestyle changes, said Patrice Desvigne-Nickens, M.D., NHLBI project officer for the AIM-HIGH trial.

The AIM-HIGH investigators will now focus on completing data collection and analysis. The preliminary outcomes of the study are expected to be reported at scientific meetings in the fall of 2011.

Halving the radiation dose in cardiac perfusion imaging is now 'feasible'

Tue, 17 May 2011 04:00:00 PST

( from http://www.rxpgnews.com ) 17 May 2011 -- A reduction by half in the radiation dose to which cardiac patients are exposed during diagnostic perfusion imaging is now feasible, according to an Israeli study.

Results from the study will be presented as a late-breaking trial at the International Conference of Non-Invasive Cardiovascular Imaging (ICNC) in Amsterdam (15-18 May). ICNC is now one of the world's major scientific events in nuclear cardiology and cardiac CT imaging.

The various modalities of modern perfusion imaging - such as single photon emission computed tomography (SPECT) - allow the non-invasive assessment of myocardial blood flow and thus the detection of coronary artery disease. The cardiac imaging test is usually performed twice to provide a comparison between at rest and at exercise (rest-stress, and vice-vera). Blood flow can be scanned and visualised because of an injection of radioisotope tracer (technetium sestamibi) which enters through the coronary blood vessels and is distributed into the myocardium (perfusion); the images are based on gamma rays given off by the tracer substance. Healthy functional myocardial tissue will absorb the radioactive material. However, in cases of reduced blood flow (because of coronary artery narrowing) perfusion defects will be seen. This denotes myocardial ischaemia, which occurs following exercise. When there is damaged tissue (infarct), fixed defects will also be seen at rest imaging.

According to Professor Nili Zafrir, Director of Nuclear Cardiology at the Rabin Medical Center in Petah Tikva, Israel, and first author of this late-breaking study, the current application of standard myocardial perfusion diagnosis is limited because of high radiation dose in the tracer substance with which each patient is injected. She agrees that the radiation dose is within acceptable limits, but insists that the level of radiation exposure (and its consequent cancer risk) is still a matter of great debate. The present study was designed to test whether radiation dose could be reduced without loss of resolution in the diagnostic images.

Radiation effective dose is measured in millisieverts, and, with conventional protocols, each investigation exposes the patient to a radiation dose of between 8 and 25 mSv. This study compared outcome from two protocols, a conventional full dose injection of tracer substance and a half-dose injection. Each group comprised 109 patients, who were investigated with stress-only, rest-and-stress and stress-and rest imaging. The full dose protocol was applied with dosages ranging between 12 and 32 milicurries (mCi) (depending on patient weight); in the half dose protocol dosages ranged between 5 and 17 mSCi. These were converted to radiation effective dose (in mSv).

Professor Zafrir explains that the study only became possible because of the introduction of new image processing software, which was originally designed to reduce the time it takes to acquire a full diagnostic image. The aim of our study, she says, was to use the same software but to assess the feasibility of reducing the tracer dose instead of reducing the acquisition time.

Results showed that 94% of the images from the half-dose protocol were assessed as excellent to good, suggesting no loss of image quality or diagnostic accuracy when the radiation dose of the perfusion was halved.

Professor Zafrir also reports that 35% of the patients in the half-dose group had only a single stress-only investigation, and they were exposed to a mean of just 1.9 mSv. The total effective dose for stress-rest investigation was 7.19 mSv in the half dose protocol compared to 14.4 mSv in the conventional dose protocol.

So it's our view that myocardial perfusion imaging is feasible with significant radiation dose reduction, says Professor Zafrir. We found that image quality using the new processing software was similar to that in conventional protocols. Indeed, the clinical results identified with the half-does protocol were equivalent to those determined by full dose imaging. But significantly, the half dose protocol reduced radiation exposure to a minimum of 1.9 mSv in one-third of our patients, far below the dose range we see in conventional perfusion scanning.

Clearly, we cannot be certain what the long-term benefit of reducing radiation exposure might be, but theoretically it would seem important.

Egyptian princess was first person with diagnosed coronary artery disease

Tue, 17 May 2011 04:00:00 PST

( from http://www.rxpgnews.com ) Embargo: 17 May 2011 18:00 CET-- The coronary arteries of Princess Ahmose-Meryet-Amon - as visualised by whole body computerised tomography (CT) scanning - will feature in two presentations at the International Conference of Non-Invasive Cardiovascular Imaging (ICNC) this week in Amsterdam (15-18 May). ICNC is now one of the world's major scientific event in nuclear cardiology and cardiac CT imaging.

The Egyptian princess Ahmose-Meryet-Amon, who lived in Thebes (Luxor) between 1580 and 1550 BC and who is now known to be first person in human history with diagnosed coronary artery disease, lived on a diet rich in vegetables, fruit and a limited amount of meat from domesticated (but not fattened) animals. Wheat and barley were grown along the banks of the Nile, making bread and beer the dietary staples of this period of ancient Egypt. Tobacco and trans-fats were unknown, and lifestyle was likely to have been active.

The coronary arteries of Princess Ahmose-Meryet-Amon - as visualised by whole body computerised tomography (CT) scanning - will feature in two presentations at the International Conference of Non-Invasive Cardiovascular Imaging (ICNC) currently taking place in Amsterdam (15-18 May). ICNC is now one of the world's major scientific event in nuclear cardiology and cardiac CT imaging.

Both presentations will be based on findings from the Horus study, in which arterial atherosclerosis was investigated in 52 ancient Egyptian mummies. Results have shown that recognisable arteries were present in 44 of the mummies, with an identifiable heart present in 16. Arterial calcification (as a marker of atherosclerosis) was evident at a variety of sites in almost half the mummies scanned, prompting the investigators to note that the condition was common in this group of middle aged or older ancient Egyptians; the 20 mummies with definite atherosclerosis were older (mean 45.years) than those with intact vascular tissue but no atherosclerosis (34.5 years).

Although relatively common at other vascular sites, atherosclerosis in the coronary arteries was evident in only three of the mummies investigated, but was clearly visualised in Princess Ahmose-Meryet-Amon (in whom calcification was present in every vascular bed visualised).

The CT scan image below shows that the princess, who died in her 40s, had atherosclerosis in two of her three main coronary arteries. Today, said Dr Gregory S Thomas, director of Nuclear Cardiology Education at the University of California, Irvine, USA, and co-principal investigator of the Horus study, she would have needed by-pass surgery.

Overall, it was striking how much atherosclerosis we found, said Dr Thomas. We think of atherosclerosis as a disease of modern lifestyle, but it's clear that it also existed 3500 years ago. Our findings certainly call into question the perception of atherosclerosis as a modern disease.

If, however, the princess enjoyed a diet deemed to be healthy and pursued a lifestyle probably active, how could this disease of modern life affect her so visibly? Dr Thomas and his co-principal investigator Dr Adel Allam of Al Azhar University, Cairo, suggest three possibilities.

First, that there is still some unknown risk factor for cardiovascular disease, or at least a missing link in our understanding of it. Dr Allam noted a likely effect of genetic inheritance, pointing out that much of the human predisposition to atherosclerosis could be secondary to their genes. He similarly raised the possibility that an inflammatory response to the frequent parasitic infections common to ancient Egyptians might predispose to coronary disease - in much the same way that immunocompromised HIV cases seem also predisposed to early coronary disease. Nor can a dietary effect be excluded, despite what we know of life in ancient Egypt. Princess Ahmose-Meryet-Amon was from a noble family, her father, Seqenenre Tao II, the last pharaoh of the 17th Dynasty.

So it's likely that her diet was not that of the common Egyptian. As a royal, she would have eaten more luxury foods - more meat, butter and cheese. Moreover, foods were preserved in salt, which may also have had an adverse effect.

Despite the suggestion of a genetic, inflammatory or unknown effect, Drs Thomas and Allam were keen not to discount those risk factors for heart disease which we do know about. Indeed, even in the study's apparent association of atheroma with increasing age, there was a pattern of prevalence consistent with our own epidemiology today. Recent studies have shown that by not smoking, having a lower blood pressure and a lower cholesterol level, calcification of our arteries is delayed, said co-investigator Dr Randall C Thompson of the St Luke's Mid-America Heart Institute in Kansas City, USA. On the other hand, from what we can tell from this study, humans are predisposed to atherosclerosis, so it behoves us to take the proper measures necessary to delay it as long as we can.

Results from study of 8,000 older people in Ireland launched

Wed, 11 May 2011 04:00:00 PST

( from http://www.rxpgnews.com ) The first results from The Irish Longitudinal Study on Ageing (TILDA), a national study of 8,000 older people aged 50 and over in Ireland, were launched this week by the Minister for Health and Children, Dr James Reilly.

TILDA is the most comprehensive study ever conducted on ageing in Ireland. Between 2009- 2011, over 8,000 people aged 50 and over were randomly selected across the country and interviewed about many aspects of their lives including issues such as health, financial circumstances and quality of life. Almost 85 per cent of the participants also underwent a rigorous health assessment. The same group will be interviewed every two years until 2018. Further health assessments will be undertaken on the participants in 2014 and 2018. This report, Fifty Plus in Ireland 2011: First Results from the Irish Longitudinal Study on Ageing, contains initial findings from the study. TILDA is funded by the Department of Health and Children, Irish Life and The Atlantic Philanthropies.

Commenting on the significance of the study, Principal Investigator of TILDA and Professor of Medical Gerontology, Professor Rose Anne Kenny said: The importance of this study cannot be understated. By collecting and analysing this data, we will be able to develop a much deeper understanding of the lives and circumstances of older people and of the factors which lead to good health and good quality of life in older ages. This will mean that Ireland will be better placed to plan for the ageing of our population and to help policy makers ensure that limited resources are correctly targeted to those in need. TILDA provides exciting opportunities for Research and Development and new models of service delivery to create employment in this rapidly developing demographic. We are deeply grateful to our participants. Because of their generosity in taking the time to provide us with this crucial information, Ireland now and in the future will greatly benefit.

When launching the report, the Minister said that the Study's high quality objective and subjective measurements of health coupled with its longitudinal design will provide a truly unique knowledge base that will inform policies for older people in the years ahead.

The findings in the report cover many topics and show that there is considerable diversity across older adults in terms of the various dimensions of their lives. A selection of findings is highlighted below.

When the participants were asked about their quality of life, the following emerged.

CHOP partners with Vascular Magnetics, Inc. to pursue commercial potential of blood vessel research

Mon, 09 May 2011 04:00:00 PST

( from http://www.rxpgnews.com ) Building on its extensive laboratory research using magnetically guided nanoparticles to deliver drugs to diseased blood vessels, The Children's Hospital of Philadelphia has just spun off its first startup company, Vascular Magnetics, Inc. (VMI).

By licensing its technology to VMI, a new company formed to develop the lab findings into a commercially viable therapy, the Hospital aims to create a novel, greatly needed treatment for peripheral artery disease (PAD). Characterized by blocked arteries, primarily in the legs, PAD affects more than 27 million older adults in North America and Europe, with diabetes patients and smokers at particularly high risk. Current treatments for PAD, including drug-eluting stents, are ineffective, with re-blockage of the arteries occurring at a high rate.

In addition to being the Hospital's first startup company, the program targets patients outside the Hospital's usual pediatric age group. While our first target group is adult patients, the technique represents a new platform technology, potentially adaptable to delivering a variety of therapies to children as well as adults, says the technology's inventor, Robert J. Levy, M.D., the William J. Rashkind Endowed Chair in Pediatric Cardiology at The Children's Hospital of Philadelphia.

Levy co-founded VMI with Richard S. Woodward, Ph.D., the company's Chief Executive Officer. The two first joined forces through the QED Proof-of-Concept Program sponsored by the University City Science Center in West Philadelphia. The goal of the QED Program, the nation's first multi-institutional proof-of-concept program for life sciences technologies, is to accelerate research from academic laboratories into the marketplace. A unique feature of this program is that academic scientists such as Levy are partnered with experienced business advisors such as Woodward, who has a background that includes developing nanoparticles and polymeric coatings.

The Science Center is proud to have played a role in the launch of Vascular Magnetics, said Stephen S. Tang, Ph.D., MBA, president and CEO of the University City Science Center. VMI's launch is helping to prove our concept that the early addition of business advice is a key element of the tech transfer puzzle.

In a series of animal studies over the past decade, Levy and his team at Children's Hospital have investigated his new approach to stent-based therapy. They have developed nanoparticles, extremely tiny spheres made of a biodegradable polymer impregnated with iron oxide. Under a low-power, uniform magnetic field, much lower than that produced by existing MRI machines, magnetic forces drive the nanoparticles into metal stents and the surrounding artery. The nanoparticles carry a therapeutic payload of the drug paclitaxel, which is released into the surrounding blood vessel tissue in order to slow arterial re-blockage. In 2008, Forbes magazine named Levy's work a promising disruptive technology, one that might eventually supplant conventional technology, in this case, drug-eluting stents.

As they advance the technique to human trials, Levy and Woodward envision a future therapy called Vascular Magnetic InterventionTM which would serve as an adjunct to artery stenting. A physician would open and stent the blocked artery and then insert a catheter tipped with an expandable magnetic targeting device. The targeting device would be expanded against the walls of the artery.

A magnetic field is then applied to the leg, and paclitaxel-containing magnetic nanoparticles would be administered through the catheter. The targeting device develops strong magnetic gradients that force the nanoparticles into the wall of the artery. After treatment and removal of the catheter, the wall of the artery is uniformly coated with the nanoparticles, which slowly biodegrade and release the drug. The uniform coating provides a higher dose of drug than is achievable with a drug-eluting stent. In addition, the technique could be used to re-treat arteries where the stents have become re-blocked.

The technology, said Levy, is highly adaptable. Instead of paclitaxel, it could deliver other therapeutic compounds, DNA for site-specific gene therapy, therapeutic cells, or other treatments. In addition to treating PAD, the technique might carry paclitaxel to narrowed coronary arteries, chemotherapy drugs to a tumor, or other medications to a bile duct or a urinary tract. Eventually, said Levy, the technology could be applied to types of pediatric heart disease, such as primary pulmonary hypertension or heart defects.

As its lab research continues, Vascular Magnetics is moving ahead to attract venture capital. Our plan is to prove the efficacy of this therapy in humans by late 2015, said Woodward. The revenue projections for the company suggest sales of over a billion dollars per year within about four years after commercial launch.

Heart failure treatment options have come a long way

Thu, 05 May 2011 04:00:00 PST

( from http://www.rxpgnews.com ) This year the Heart Failure Congress 2011, organised by the Heart Failure Association of the European Society of Cardiology (ESC), offers a strong scientific programme featuring 11 late breaking trials and clinical updates, over 1000 original abstracts (submitted by delegates from 61 countries), 14 industry sponsored satellites and mini satellites and over 70 separate sessions.

The presentations will demonstrate the fantastic improvements we've seen in both treatment options for heart failure and understanding of the mechanisms behind the disease. The field has come an awfully long way since the ESC first started holding dedicated heart failure meetings in 1995, said Professor Karl Swedberg, Scientific Chairperson of the Congress programme.

Highlights of the late breaking trials and clinical updates programme will include the SHIFT trial with ivadrabine, EMPHASIS-HF with eplerenone, an update on the MADIT CRT trial on how to predict optimal benefits from CRT, Northstar, and two telemonitoring trials - The TEHAF study and TIM-HF.

The Heart Failure Congress, which represents the largest meeting on heart failure in the world, offers the opportunity for everyone in the heart failure community to come together. It will help get delegates up to speed on the core topics and associated technologies that they need in their daily clinical practice, said Professor Piotr Ponikowski, President of the Heart Failure Association.

Delegates attending the Heart Failure meeting, which expects to attract around 2500 attendees, will include cardiologists, internists, general physicians, basic scientists, epidemiologists, nurses, and industry affiliates.

The overall theme of the congress will be co-morbidities, with sessions focusing on heart failure and diabetes, lung disease, renal impairment, hypertension, cancer, cardio-renal syndrome and anaemia. More and more patients with heart failure are suffering from co-morbidities. The problem heart failure clinicians face on a daily basis is how best to integrate the different medications and approaches to treatments, said Swedberg.

Other important topics that will be covered in depth are devices and technologies, including ICDs, CRT and LVAD, with sessions exploring how to apply the new findings in clinical practice.

One event likely to attract high attendance is an over view of the Surgical Treatment for Ischemic Heart Failure (STICH) trial, which will be presented by Christopher O'Connor (Durham, US) in a debate session at 14.15 on Monday in the Stockholm Lecture Room. The STICH trial, comparing CABG therapy and medical therapy in patients with left ventricular ejection fractions less than 35%, was first presented at the American College of Cardiology meeting in April. This session will provide a good opportunity for delegates to get to grips with how to interpret the results of this really important trial, with opportunities to ask the presenters questions, said Swedberg.

A highlight on Saturday will be the presidential debate that is being held as a joint session with the Heart Failure Society of America, to explore two controversial issues in heart failure treatment. One debate will feature whether ICDs are being over used in Europe, and the other will explore the controversy over whether heart rate reduction beyond beta blockers is effective in heart failure. Other joint sessions that will be held include Imaging heart failure, with the European Association of Echocardiography on Saturday, and the impact of new atrial fibrillation guidelines on heart failure management on Sunday with the European Heart Rhythm Association (EHRA).

For the first time the meeting will not offer a dedicated nursing tract. This was a conscious decision because we want to emphasize the team spirit that goes on in the management of heart failure patients. The work of physicians and nurses in heart failure should be properly integrated, explained Swedberg. Sessions that may be of particular interest to nurses will include palliative care for patients with end-stage heart failure, and how to talk to your patients.

In the opening ceremony a life time achievement award will be presented for the first time to Professor John Kjekshus, from the University of Oslo, Norway, who over the past 40 years has been involved in many trials in the development of treatments for heart failure, including the TIMOLOL trial, CONSENSUS trial, the 4 S trial, the MERIT trial and the CORONA trial.

To recognise the contribution of young researchers the Heart Failure Association Board are inviting delegates under 35 years to a special reception with faculty members that will be held on Monday evening. We want to emphasise the importance that we place on young researchers because they represent our new blood, said Ponikowski. The idea is to provide them with a clear picture of our aims, mission and on-going initiatives in the hope that we can inspire them to get more involved.

On Sunday a poster session providing updates from industry on the latest ongoing trials will be co chaired by John McMurray (Glasgow, GB) and Stefan Anker (Berlin, DE). The objective is to provide industry with an opportunity to present their ongoing trials and the audience to ask questions. It will be a real opportunity for delegates to get a feel for what's in the pipeline, said Ponikowski.

The city of Gothenburg provides an ideal venue for the congress. The many advantages include close proximity between hotels and the congress centre, together with many cultural and social attractions said Swedberg, adding that the closeness to the sea makes Gothenburg particularly special with a half-hour tram ride taking you straight into the southern archipelago.

Unique AED pads give hearts a second chance

Tue, 26 Apr 2011 04:00:00 PST

( from http://www.rxpgnews.com ) An invention by Rice University bioengineering students in collaboration with the Texas Heart Institute (THI) is geared toward giving immediate second chances to arrhythmia victims headed toward cardiac arrest.

For their capstone design project, a team of Rice seniors created a unique pad system for automated external defibrillators (AEDs), common devices that can shock a victim's heart back into a proper rhythm in an emergency.

Often, the first shock doesn't reset a heart and the procedure must be repeated, but the sticky pads on the chest must first be repositioned. The pads need to be in the right location to send current through the heart, and someone with no experience who tries to provide aid might miss the first time.

The Second-Chance AED Pads let rescuers try again without losing valuable time to remove the pads from the victim's chest. The pads incorporate three electrodes, two in a single pad with an A/B switch attached, and a third in its own pad.

If one shock doesn't restart the patient's heart, flipping the switch will change the jolt's path, just a little bit, for the second attempt.

The pads were developed by students on the DefibTaskForce -- Lisa Jiang, Joanna Nathan, Justin Lin, Carl Nelson and Brad Otto -- in tandem with Mehdi Razavi, director of electrophysiology clinical research at THI, and their adviser, Renata Ramos, a Rice lecturer in bioengineering.

The potential for their project was clear from the beginning. We did some calculations that suggested we could save at least 13,000 lives per year, Otto said. Cardiac defibrillation is very time-sensitive. Thirty seconds can be the difference between life and death in a lot of situations. The time it takes to flip the switch is negligible compared with the time it takes to remove the pads, shave and prep a new area on the body, reapply the pads and administer another shock. And a layman might not even know to try a second position.

Rather than try to build a new type of AED, the team decided early on that it was enough to simply design new pads that would fit devices that are already in use. Manufacturers generally require AED pads be replaced every two years, which provides a ready market for the students' invention. But well over 100,000 AED units are produced every year, so even if our pads are only paired with new AEDs, we have a significant market, Lin said.

Getting the instructions right turned out to be just as important as the device itself and required a lot of illustrative trial and error. In tests for the final version at Rice's Oshman Engineering Design Kitchen, the team recruited students with no experience using an AED to shock a medical mannequin back to life. We had 100 percent of the testers place the pads correctly, showing it was very intuitive to use, Jiang said.

All five team members, along with Razavi and Ramos, are listed on the provisional patent. They hope an AED manufacturer will pick up the rights to the Second-Chance pads for clinical trials and ultimately FDA approval.

Heart drugs could cut blood pressure risks in pregnancy

Wed, 20 Apr 2011 04:00:00 PST

( from http://www.rxpgnews.com ) Pregnant women could benefit from a pioneering trial that will test whether heart disease drugs can be used to treat pre-eclampsia.

Researchers are investigating if a class of drugs - known as statins - can prevent the potentially fatal condition, which affects up to eight per cent of pregnant women in the UK.

The world's first trial on statins in pregnancy follows on from research showing that statins, which are prescribed to lower heart disease, could also help to decrease amounts of two proteins linked to inducing pre-eclampsia.

Statins act on an enzyme that suppresses the production of these proteins - soluble FLt-1 and soluble endoglin.

The trial, funded by the Medical Research Council and led by the University of Edinburgh, will involve pregnant women in the UK diagnosed with very early-onset pre-eclampsia, which occurs in women who are less than 32 weeks pregnant.

It will also involve researchers from the University of Birmingham, University College London Hospital and Queen Mary, University of London.

The study follows on from previous research that shows the enzyme involved - heme oxygenase 1 - produces carbon monoxide within cells. This could explain why female smokers, who have higher levels of carbon monoxide in their blood, have a lower risk of pre-eclampsia.

The condition, which is responsible for around four million premature births worldwide each year, causes high blood pressure, inflammation of the lining of blood vessels and can also cause kidney and liver damage. In extreme cases, when unmanaged, it can also lead to convulsions and death.

Early onset pre-eclampsia affects one in 100 expectant mothers in Britain. The condition carries greater risk than pre-eclampsia occurring later in the pregnancy because the only treatment for the condition is to deliver babies prematurely.

Professor Asif Ahmed, who is leading the study, stressed that until the results were available, pregnant women who think they may be susceptible to pre-eclampsia should not ask their doctor to prescribe statins.

Professor Asif Ahmed, of the University of Edinburgh's Centre for Cardiovascular Science, said: This is the first stage, but we are confident that taking a scientific approach to find a way to alleviate pre-eclampsia would enable us to prolong affected pregnancies, improving the outcome for both the baby and the expectant mother. If successful this could help provide cheap, widely available therapy against pre-eclampsia which could help reduce maternal and infant deaths across the world.

The study is known as StAmP - statins to ameliorate early onset pre-eclampsia.

Professor Max Parmar, Director of the Medical Research Council's Clinical Trials Unit, said: The MRC supports trials which drive the translation of discoveries made in the lab into real benefits for public health. The design of the StAmP study means that it should provide important evidence on whether statins, which are already widely used in other conditions, could be exploited even further. Pre-eclampsia is a major problem area in women's health, so it would be a key step forward if this trial provides a positive outcome.

Rice wins $1.2 million for heart-valve tissue research

Wed, 20 Apr 2011 04:00:00 PST

( from http://www.rxpgnews.com ) A team of bioengineers from Rice University is bringing a promising new strategy for growing replacement heart valves closer to reality, thanks to a four-year, $1.2 million grant from the National Institutes of Health. The team hopes to use gel-like materials to generate three-dimensional patterns called scaffolds that can simultaneously mimic the complex structural and physical properties of heart-valve tissues and guide the behavior of tissue-forming cells.

Tissue-engineering researcher Jane Grande-Allen, the lead investigator on the grant, said researchers once believed that replacement heart valves would be one of the easiest and first tissues that could be grown in the laboratory. At just a millimeter thick, the rugged flaps of tissue in heart valves seemed simple enough when researchers first started trying to engineer them in the mid-1990s.

It's ironic because they turned out to be one of the most difficult and complex tissues of all, said Grande-Allen, associate professor in bioengineering at Rice.

Grande-Allen said it's been difficult for engineers to find synthetic materials that truly mimic the complex structure and mechanical properties of heart-valve leaflets, the tough yet flexible flaps of tissue that form a tight seal to prevent blood from flowing backward each time the heart pumps. Having materials that can both mimic the leaflets' microscopic structure and act as a pattern for tissue-forming stem cells has been a missing link in growing replacement heart valves.

Each aortic or pulmonary heart valve contains a trio of leaflets. Prior to each heartbeat, the leaflets open, like the petals of a blooming flower, allowing blood to flow into one of the heart's chambers. Then the leaflets fold back, interlocking with one another to form a tight seal that prevents blood from flowing backward. In cases of heart-valve disease, the valves don't seal properly, and the heart must pump much harder to deliver sufficient amounts of blood.

More than 90,000 Americans are hospitalized each year for heart-valve disease, and with too few human valves available for transplant, the most common surgical options are mechanical valves, which are noisy and require patients to stay on anticlotting medications for life, and artificial valves made of biological material, usually from pigs, which wear out after about 15 years.

Ideally, tissue engineers would like to grow living valves that use a patient's own cells to eliminate the risk of tissue rejection. But engineers have struggled to find nontoxic, biodegradable materials that can act as a scaffold to guide the cells' behavior. The ideal scaffold will have the same mechanical properties of a valve so that it can be surgically implanted and function as a valve, even as cells grow new tissue to replace it.

Grande-Allen said the fact that valve leaflets have three distinct layers has presented serious complications to creating scaffolds. Leaflets have a soft, malleable layer sandwiched between denser outer layers. The soft layer adds flexibility and sits between outer layers that have subtly different properties. The upshot is that to truly mimic the valves, engineers must design a multilayered scaffold.

That hasn't been done before, but we have a real shot at success with some of the new methods that have been developed here at Rice in recent months that will allow us to cross-link, layer and reinforce hydrogel scaffolds to have spatially varying mechanical behavior, Grande-Allen said.

Grande-Allen and co-principal investigator Jennifer West, department chair and the Isabel C. Cameron Professor of Bioengineering at Rice, will work with several graduate students to create a multilayered, patterned scaffold with new techniques initially developed by West's team and then further refined in collaboration with Grande-Allen's laboratory. The key technique is one that allows researchers to selectively reinforce soft, nontoxic polymer scaffolds so that they'll mimic the various leaflet layers and won't peel apart.

We're taking a very pragmatic approach, Grande-Allen said. We have the tools to make a lot of headway in designing appropriate patterns, but we want to make certain the class of materials that we're planning to work with will ultimately be translatable to create functional valves.

Grande-Allen's and West's laboratories are located in Rice's BioScience Research Collaborative (BRC), an innovative space where scientists and educators from Rice and other Texas Medical Center institutions work together to conduct research that benefits human medicine and health.

New study identifies possible cause of salt-induced hypertension

Thu, 14 Apr 2011 04:00:00 PST

( from http://www.rxpgnews.com ) New research from Case Western Reserve University School of Medicine and Kent State University shows that salt intake raises blood pressure because it makes it harder for the cardiovascular system to simultaneously juggle the regulation of blood pressure and body temperature.

For decades, medical researchers have sought to understand how salt causes salt-induced high blood pressure to no avail. Some individuals, described as salt sensitive, experience an increase in blood pressure following the ingestion of salt, whereas others, termed salt resistant, do not. Until now, scientists have been unable to explain why some individuals are salt sensitive and others are salt resistant. This inability to explain why salt raises blood pressure in some individuals but not others has hampered the development of a comprehensive theory as to what causes most cases of high blood pressure.

Since the cardiovascular system is responsible for maintaining normal blood pressure and also helps control body temperature by conducting heat from the muscles and internal organs to the skin's surface, a team of researchers led by Robert P. Blankfield, MD, MS, clinical professor of family medicine at Case Western Reserve University School of Medicine, and a member of the Department of Family Medicine at University Hospitals Case Medical Center and Ellen L. Glickman, PhD, professor of exercise science at Kent State University, tested whether these dual roles of the cardiovascular system might help explain how salt ingestion leads to salt-sensitive hypertension.

The researchers examined the effect of salt and water consumption versus just water upon a group of 22 healthy men without high blood pressure. The study participants' blood pressure, rectal temperature, cardiac index (the volume of blood pumped by the heart per minute), and urine output were monitored at one, two, and three hours after the men ingested either salt and water or water alone. Changes in rectal temperature were compared between the men identified as salt sensitive versus those who were salt resistant.

The study found that the ingestion of salt and water lowered body temperature more than the ingestion of water by itself. In addition, body temperature decreased more in individuals who are salt resistant than in individuals who are salt sensitive.

It appears that salt sensitive individuals maintain core body temperature equilibrium more effectively than salt resistant individuals, but experience increased blood pressure in the process, Dr. Blankfield says. Conversely, salt resistant individuals maintain blood pressure equilibrium more effectively than salt sensitive individuals following salt and water intake, but experience a greater temperature reduction in the process.

Matthew D. Muller, PhD, postdoctoral research fellow at the Penn State College of Medicine, and the paper's first author explains, If our results are generalizable, it would be possible to account for the role of salt in the development of salt-sensitive hypertension: salt and water loading raises blood pressure in salt sensitive individuals, and the elevated blood pressure persists for a finite period of time during and after the salt and water intake. These transient blood pressure elevations, whether brief or prolonged, might initiate the complex changes within the walls of the arteries and arterioles that characterize individuals with essential hypertension.

Dr. Muller adds, Nowadays, physicians tell their patients that no one knows what causes high blood pressure. Since we can now explain why salt-sensitive hypertension develops, a theory that will explain all hypertension may be possible. Thus, physicians may one day be able to tell their patients that the cause of high blood pressure is understood, and physicians may also be able to explain to their patients what must be done to avoid developing this chronic medical condition. Dr. Muller conducted this research as a doctoral student at Kent State University.

International organizations join forces to promote cardiovascular health

Wed, 06 Apr 2011 04:00:00 PST

( from http://www.rxpgnews.com ) This year's EuroPRevent meeting, 14 -16 April, is taking full advantage of its Geneva location and the close proximity to the European Headquarters of the World Health Organisation (WHO), the World Heart Federation (WHF), the United European Football Association (UEFA), and the International Olympics Committee (IOC).

On Thursday 14 April the European Association for Cardiovascular Prevention and Rehabilitation (EACPR) will host joint sessions including a session looking at the medical, legal and ethical aspects of eligibility screening for competitive sport with the IOC, a session looking at Cardiovascular prevention in Russia with WHO and WHF, a session looking at the Global challenges in CVD with the WHO and WHF, and a session looking at competitive sports in high risk patients with the IOC. It's a marvelous opportunity to be able to bring together all these organisations that are engaged in prevention and rehabilitation to fight heart disease and to provide science and practical tools to improve cardiovascular health both in Europe and also around the world, says Hugo Saner, the local organizer of the Congress.

EuroPRevent 2011, which represents the biggest meeting in Europe on cardiovascular prevention and rehabilitation, expects to attract over 1,500 delegates including epidemiologists, clinical cardiologists, sports physiologists, basic scientists, nutrition counsellors, physical therapists, nurses, sports teachers and psychologists. The field of cardiovascular prevention is currently gaining real momentum, says Volker Adams, chair person of the EuroPRevent Congress Programme Committee. For a while we've had the scientific knowledge, but now big strides are being made in improving the diagnostic technology and we're starting to see real political will power to bring about change. EuroPRevent 2011 brings all these aspects of prevention together.

The congress will be arranged around four main tracks: global challenges in prevention, new strategies and developments, sports cardiology and corporate health and prevention programmes.

This year, explains Adams, the sessions have been put together in a completely novel way with the intention of making them more inclusive and attractive to wider audiences. We've taken a topic and got different professionals to talk about them from different perspectives. The idea is that viewing topics from different angles will allow delegates to gain greater insights, says Volker Adams.

Sports cardiology is a major theme of the meeting with sports sessions running continually throughout the programme in room 2. Sport is really important for prevention because it helps promote healthy lifestyles across all age groups whether children or middle aged adults, says Hugo Saner.

Highlights of the meeting include two sessions on corporate health. Industry is beginning to appreciate that with an ageing population there's a real danger that they'll lose good employees to health problems and that this could lead to a lack of skilled workers. Companies are starting to appreciate that they need to take preventive measures to avert disaster, says Saner.

Distinguished speakers at EuroPRevent include Klaus Schwab, the founder of the World Economic Forum who is looking to promote a good attitude towards corporate health; Salim Yusuf from McMaster's University, Canada, who will be giving a personal view of what is needed in cardiac prevention; and Srinath Reddy, president of the Public Health Foundation of India, who will talk about the cardiovascular challenges facing India.

For the first time this year EuroPRevent will feature one late breaking session with six presentations of new research. In addition, 420 abstracts have been selected including 270 on prevention and epidemiology, 152 on rehabilitation and implementation, 45 on sports cardiology and 61 on exercise and translational science. Abstracts are really important because they give the young people starting out in the field a platform to showcase their work, says Adams.

Religious young adults become obese by middle age

Wed, 23 Mar 2011 04:00:00 PST

( from http://www.rxpgnews.com ) CHICAGO --- Could it be the potato salad? Young adults who frequently attend religious activities are 50 percent more likely to become obese by middle age as young adults with no religious involvement, according to new Northwestern Medicine research. This is the first longitudinal study to examine the development of obesity in people with various degrees of religious involvement.

We don't know why frequent religious participation is associated with development of obesity, but the upshot is these findings highlight a group that could benefit from targeted efforts at obesity prevention, said Matthew Feinstein, the study's lead investigator and a fourth-year student at Northwestern University Feinberg School of Medicine. It'spossible that getting together once a week and associating good works and happiness with eating unhealthy foods could lead to the development of habits that are associated with greater body weight and obesity.

Previous Northwestern Medicine research established a correlation between religious involvement and obesity in middle-age and older adults at a single point in time. By tracking participants' weight gain over time, the new study makes it clear that normal weight younger adults with high religious involvement became obese, rather than obese adults becoming more religious.

The research is being presented at the American Heart Association's Nutrition, Physical Activity and Metabolism/Cardiovascular Disease Epidemiology and Prevention Scientific Sessions 2011 in Atlanta, Georgia.

The study, which tracked 2,433 men and women for 18 years, found normal weight young adults ages 20 to 32 years with a high frequency of religious participation were 50 percent more likely to be obese by middle age after adjusting for differences in age, race, sex, education, income and baseline body mass index. High frequency of religious participation was defined as attending a religious function at least once a week.

Obesity is defined as having a body mass index of 30 or higher. A woman who is 5'5 and 180 pounds has a BMI of 30, for example.

The men and women in the study were part of the Coronary Artery Risk Development in Young Adults (CARDIA) multi-center study, supported by the National Heart, Lung and Blood Institute.

Obesity is the major epidemic that is facing the U.S. population right now, said senior study author Donald Lloyd-Jones, M.D., chair of preventive medicine at Northwestern University Feinberg School of Medicine and a cardiologist at Northwestern Memorial Hospital. We know that people with obesity have substantial risks for developing diabetes, heart disease and certain types of cancer, and of dying much younger. So, we need to use all of the tools at our disposal to identify groups at risk and to provide education and support to prevent the development of obesity in the first place. Once the weight is on, it is much harder to lose it.

The authors caution that their findings should only be taken to mean people with frequent religious involvement are more likely to become obese, and not that they have worse overall health status than those who are non-religious. In fact, previous studies have shown religious people tend to live longer than those who aren't religious in part because they tend to smoke less.

Here's an opportunity for religious organizations to initiate programs to help their congregations live even longer, Feinstein said. The organizations already have groups of people getting together and infrastructures in place that could be leveraged to initiate programs that prevent people from becoming obese and treat existing obesity.

Feinstein noted Northwestern is leading such an educational intervention in a church on Chicago's West Side where members are taught how dietary changes and increased physical activity can lower cardiovascular disease risk factors such as obesity, cholesterol and high blood pressure. Church-based interventions have shown promising results, he said.

Load up on fiber now, avoid heart disease later

Tue, 22 Mar 2011 04:00:00 PST

( from http://www.rxpgnews.com ) CHICAGO --- A new study from Northwestern Medicine shows a high-fiber diet could be a critical heart-healthy lifestyle change young and middle-aged adults can make. The study found adults between 20 and 59 years old with the highest fiber intake had a significantly lower estimated lifetime risk for cardiovascular disease compared to those with the lowest fiber intake.

The study will be presented March 23 at the American Heart Association's Nutrition, Physical Activity and Metabolism/Cardiovascular Disease Epidemiology and Prevention Scientific Sessions 2011 in Atlanta, Ga. This is the first known study to show the influence of fiber consumption on the lifetime risk for cardiovascular disease.

It's long been known that high-fiber diets can help people lose weight, lower cholesterol and improve hypertension, said Donald M. Lloyd-Jones, corresponding author of the study and chair of the department of preventive medicine at Northwestern University Feinberg School of Medicine and a cardiologist at Northwestern Memorial Hospital. The results of this study make a lot of sense because weight, cholesterol and hypertension are major determinants of your long-term risk for cardiovascular disease.

A high-fiber diet falls into the American Heart Association's recommendation of 25 grams of dietary fiber or more a day. Lloyd-Jones said you should strive to get this daily fiber intake from whole foods, not processed fiber bars, supplements and drinks.

A processed food may be high in fiber, but it also tends to be pretty high in sodium and likely higher in calories than an apple, for example, which provides the same amount of fiber, Lloyd-Jones said.

For the study, Hongyan Ning, M.D., lead author and a statistical analyst in the department of preventive medicine at Feinberg, examined data from the National Health and Nutrition Examination Survey, a nationally representative sample of about 11,000 adults.

Ning considered diet, blood pressure, total cholesterol, smoking status and history of diabetes in survey participants and then used a formula to predict lifetime risk for cardiovascular disease.

The results are pretty amazing, Ning said. Younger (20 to 39 years) and middle-aged (40 to 59 years) adults with the highest fiber intake, compared to those with the lowest fiber intake, showed a statistically significant lower lifetime risk for cardiovascular disease.

In adults 60 to 79 years, dietary fiber intake was not significantly associated with a reduction in lifetime risk of cardiovascular disease. It's possible that the beneficial effect of dietary fiber may require a long period of time to achieve, and older adults may have already developed significant risk for heart disease before starting a high-fiber diet, Ning said.

As for young and middle-aged adults, now is the time to start making fiber a big part of your daily diet, Ning said.

The study suggests that starting a high-fiber diet now may help improve your long-term risk, Ning said.

Diabetes drug can raise heart disease risk by 25 percent

Sun, 20 Mar 2011 15:11:07 PST

( from http://www.rxpgnews.com ) Diabetes drug Avandia, which has been used by at least 50,000 people in Britain, increases the risk of heart disease by 23 percent and the risk of death by 14 percent.

A study of 810,000 people found that those taking Avandia were 23 percent more likely to suffer congestive heart failure and 14 percent more likely to die, compared to a similar medication.

In addition, they were 16 percent more likely to have a heart attack, the British Medical Journal reports.

Last September, the European Medicines Agency - suspended the licence for the drug after 10 years on the market, saying the evidence of its harmful effects had tipped the balance against it being prescribed, according to the Telegraph.

The latest study is further evidence supporting that decision. It analysed the results of 16 separate studies in 810,000 patients, of which 429,000 were on Avandia -- also known by its generic name rosiglitazone, and 381,000 who were on Actos -- also known as pioglitazone. Most were over the age of 60.

The drugs belong to a class that help control blood sugar levels in patients with Type 2 diabetes.

It found that Avandia could have led to an extra 431 deaths per 100,000 people, an extra 170 heart attacks and an extra 649 cases of heart failure.

University of East Anglia pharmacology lecturer Yoon Kong Loke, who led the study, warned that although the drug had been withdrawn in Britain, patients could still be affected by it.

Study reinforces link between obesity, high-fat meals and heart disease

Thu, 17 Feb 2011 05:00:00 PST

( from http://www.rxpgnews.com ) The effect of a high-fat meal on blood vessel walls can vary among individuals depending on factors such as their waist size and triglyceride levels, suggests new research at UC Davis.

The new research reinforces the link between belly fat, inflammation and thickening of the arterial linings that can lead to heart disease and strokes.

Triglycerides are types of fat molecules, commonly associated with bad cholesterol, known to increase risk of inflammation of the endothelium, the layer of cells that lines arteries.

The new study shows that eating a common fast food meal can affect inflammatory responses in the blood vessels, said Anthony Passerini, assistant professor of biomedical engineering at UC Davis, who led the project.

Our techniques allowed us to measure the inflammatory potential of an individual's lipids outside of the body and to correlate that with easily measured characteristics that could be used to help better understand a person's risk for vascular disease, Passerini said.

Passerini collaborated with Scott Simon, professor of biomedical engineering at UC Davis, to develop cell culture models to mimic the properties of blood vessels. They wanted to learn how triglyceride levels can cause endothelial inflammation, and find a way to assess an individual's inflammatory potential.

They recruited 61 volunteers with high and normal fasting triglyceride levels and a range of waist sizes, then measured levels of triglyceride particles in their blood after they ate a typical fast food breakfast from a major fast food franchise: two breakfast sandwiches, hash browns and orange juice.

Passerini's team found that after eating the high-fat meal, the size of a type of a particle called triglyceride-rich lipoprotein (TGRL) varied directly with the individual's waist size and preexisting blood triglyceride level. These particles can bind to the endothelium, triggering inflammation and an immune response that brings white blood cells to repair the damage. Over time, this leads to atherosclerosis.

The researchers tested whether TGRL particles from the volunteers' blood could cause cultured endothelial cells in the laboratory to express markers for inflammation.

There was a mixed response: individuals with both a waist size over 32 inches (not terribly large by most standards) and high triglyceride levels had large lipoprotein particles that bound easily to the endothelial cells and caused inflammation in response to an immune chemical trigger.

The TGRLs only caused inflammation when exposed to this immune molecule, which suggests that people with existing low-grade inflammation may be more susceptible to endothelial dysfunction related to triglyceride spikes that occur after eating high-fat meals, Passerini said.

In people who are predisposed, repeated episodes of inflammation could lead to atherosclerosis. Passerini's lab is continuing to investigate how abdominal obesity, high triglyceride levels and inflammation can lead to atherosclerosis.

Moderate-to-heavy alcohol intake may increase risk of atrial fibrillation

Mon, 14 Feb 2011 05:00:00 PST

( from http://www.rxpgnews.com ) Atrial Fibrillation (AF) is the most common cardiac arrhythmia (abnormal heart rhythm). Its name comes from the fibrillating (i.e., quivering) of the heart muscles of the atria, instead of a coordinated contraction. The result is an irregular heartbeat, which may occur in episodes lasting from minutes to weeks, or it could occur all the time for years. Atrial fibrillation alone is not in itself generally life-threatening, but it may result in palpitations, fainting, chest pain, or congestive heart failure.

There is no doubt that heavy alcohol intake and binge drinking can lead to cardiac arrhythmias, with the Holiday Heart Syndrome being known for more than three decades. This syndrome often includes atrial fibrillation; the syndrome is usually not associated with long-standing heart disease and the arrhythmia tends to resolve when drinking stops.

Members of The international Scientific Forum on Alcohol Research comment 'This paper, Alcohol consumption and risk of atrial fibrillation. A meta-analysis. J Am Coll Cardiol 2011;57:427-436. analyzing the results of 14 papers suggests that even moderate drinking can lead to this syndrome, but others find no effect for moderate alcohol intake, only for heavy drinking. One of the best studies on alcohol consumption and risk of atrial fibrillation is a Danish cohort study (the Danish Diet, Cancer and Health Study) examining the issue among 22,528 men and 25,421 women followed over 6 years. The study included a large number of cases with atrial fibrillation, detailed information on potential confounding factors, and complete follow up through nationwide population-based registries. The results included a modest increase in risk of atrial fibrillation in men drinking more that 2 drinks/day and no association between alcohol consumption and risk of atrial fibrillation in women.

There is much evidence that heavy alcohol consumption is associated with an increased incidence of atrial fibrillation, among other health risks. The pattern of consumption (speed, time frame and without food), not often addressed, affects risk too - we know that binge drinking is associated with a greater incidence of arrhythmias, especially atrial fibrillation.

A weakness of this paper, and of essentially all meta-analyses, is that there were varying definitions for categories of alcohol consumption, and the highest category of alcohol intake included alcoholics and 6 or more drinks/day for some studies, while the highest category of alcohol intake was = 1-2 drinks/day in other studies.

The consistent message is that there is a difference between heavy and moderate use of alcohol, between binge drinking and a healthy pattern of drinking, and inherent health risk. The most important question would be: Does light to moderate drinking increase the risk of AF? The conclusion of the authors of this paper seems to be yes, while many other studies find little effect of such drinking'.

Overall, the scientific evidence from many studies suggests that heavy drinking may increase the risk of atrial fibrillation, although whether light-to-moderate intake increases the risk seems unlikely. Previous basic scientific data of mechanisms of atrial fibrillation have suggested that alcohol has little effect on this arrhythmia.

University Hospitals system-approach to stroke care increases the use of tPA therapy by 13.5-fold

Fri, 11 Feb 2011 05:00:00 PST

( from http://www.rxpgnews.com ) University Hospitals (UH) Stroke and Cerebrovascular Center recently reported that it has increased the use of tPA or clot busting therapy for ischemic stroke by 13.5 times throughout UH system hospitals since implementing the System Stroke Program (SSP). Launched in 2008, SSP sought to increase access to the lifesaving treatment for acute (urgent) ischemic stroke patients in the 15 counties surrounding Cleveland.

tPA is Tissue Plasminogen Activator, a drug that dissolves blood clots and must be administered intravenously within 4.5 hours of the onset of stroke symptoms to be effective. tPA is the only drug approved by the U.S. Food and Drug Administration for the acute treatment of stroke and although tPA was approved for use in 1995, many hospitals did not have systems in place to evaluate or treat patients with this therapy.

Nationally, administration for stroke has increased in recent years through the development of Stroke Centers. However, the overall rate of use remains very low. According to a recently published study, the use of tPA increased nationally from less than 1 percent in 2001 to 2.4 percent in 2006.

When UH launched the SSP, the rate among UH hospitals was similar to the national rate, about 2 percent. Through the SSP efforts, that rate has increased dramatically to 27 percent.

According to Dr. Cathy Sila, director of the UH Stroke and Cerebrovascular Center, UH used its hub and spoke model, with UH Case Medical Center at the center offering stroke specialty teams around the clock, and the community hospitals acting as spokes off that hub. The stroke specialist doctors and nurses provided community hospital staff in the UH health system with education to accurately identify, assess, and treat patients who present with stroke symptoms and standard protocols to ensure that any patient coming to any UH hospital would receive the same high quality, evidence-based stroke care. Community hospital emergency medicine teams were trained to evaluate stroke patients for tPA eligibility, conduct urgent brain imaging scans and consult with the UH Case Medical Center stroke service to coordinate appropriate treatment plans.

As rapid tPA treatment is associated with better patient outcomes, patients need to receive treatment as soon as possible. Empowered by training and supported by the stroke specialists at UH Case Medical Center, our community hospitals have done a tremendous job in identifying eligible patients for tPA treatment and initiating that treatment without delay, said Dr. Sila. Patients are then transferred to UH Case Medical Center with trained critical care transport which is called 'drip and ship' therapy. The stroke team is waiting for them on arrival and if the patient has not responded to the tPA therapy, they are rapidly evaluated for other treatment options such as angiography.

The success of the SSP program was recently presented at the International Stroke Conference in Los Angeles.

Acute anemia linked to silent strokes in children

Fri, 11 Feb 2011 05:00:00 PST

( from http://www.rxpgnews.com ) Silent strokes, which have no immediate symptoms but could cause long-term cognitive and learning deficits, occur in a significant number of severely anemic children, especially those with sickle cell disease, according to research presented at the American Stroke Association's International Stroke Conference 2011.

One-quarter to one-third of children with sickle cell disease have evidence of silent strokes in their brains, according to Michael M. Dowling, M.D., Ph.D., lead author of the study and assistant professor of pediatrics and neurology at the University of Texas Southwestern Medical Center in Dallas.

These are 5- to 10-year-old children who have brains that look like the brains of 80-year-olds, Dowling said. These strokes are called 'silent' because they don't cause you to be weak on one side or have any obvious neurologic symptoms. But they can lead to poor academic performance and severe cognitive impairments.

Sickle cell disease is a blood disorder characterized by low levels of hemoglobin, the iron-containing component of red blood cells that carries oxygen. Low hemoglobin causes anemia. In sickle cell disease, the blood cells are misshapen (sickle-shaped) and may form clots or block blood vessels. About 10 percent of children with sickle cell disease suffer a stroke. Blood transfusions can reduce the high risk of repeat strokes.

Dowling and colleagues hypothesized that silent strokes occur during severe anemia and may be detectable by MRI. They used MRI on the brains of 52 hospitalized children 2- to 19-years-old at Children's Medical Center Dallas with hemoglobin concentrations dropping below 5.5 g/dL. They compared severely anemic children with sickle cell disease to a group of children without sickle cell disease who had hemoglobin levels below 5.5 g/dL.

They identified silent strokes in about 20 percent of the children with sickle cell disease who were experiencing acute anemia. They also saw evidence of silent strokes, though not as often, in severely anemic children who didn't have sickle cell disease.

The many reasons, besides sickle cell disease, why children could have anemia include trauma, surgery, iron deficiency or cancer such as leukemia.

These are brain injuries that go unnoticed by doctors, unless the children have testing with a special MRI, he said. We looked at every child who went to the hospital for a 30-month period and identified about 400 children that came in with hemoglobin below 5.5 g/dL. That represented about 12 percent of the admissions for sickle cell disease and about 1 percent of the total admissions to Children's Medical Center.

The findings suggest that children with or without sickle cell disease who have acute anemia could be suffering undetected brain damage. The researchers suggest that all children with severe anemia need careful examination for silent strokes.

Improved recognition and timely transfusion to increase blood hemoglobin levels could prevent permanent brain damage in children with silent strokes, according to the study.

Future studies should look at larger groups of children for longer periods to better understand the impact of acute anemia on children, Dowling said.

Final data show experimental agent better than aspirin at preventing stroke

Thu, 10 Feb 2011 05:00:00 PST

( from http://www.rxpgnews.com ) A new anti-clotting agent is vastly superior to aspirin at reducing stroke risk (1.6 percent per year versus 3.6 percent per year) in atrial fibrillation (AF) patients unable to take stronger drugs, according to final data reported today at the American Stroke Association's International Stroke Conference 2011. Researchers found the drug also works better in people with a history of stroke or a warning stroke.

Atrial fibrillation is a heartbeat abnormality that can cause blood clots which raise the risk of stroke, particularly in the elderly.

The AVERROES: Apixaban Versus Acetylsalicylic Acid (ASA) to Prevent Strokes trial is a randomized trial of 5,600 AF patients at moderate to high risk of stroke who were not willing or able to take oral vitamin-K antagonists like warfarin, a drug commonly prescribed to prevent blood clots in people with AF. They were treated at 520 medical centers worldwide. A May 2010 interim analysis found evidence that the investigational oral drug apixaban was so much more superior to aspirin that the researchers were advised to end the trial early, said Hans-Christoph Diener, M.D., professor and chairman, Department of Neurology and Stroke Center, University Hospital Essen, Essen, Germany.

In releasing the study's final results, he reported that apixaban was far superior to aspirin at preventing stroke or systemic embolism (blood clot) and was also very safe. The drug blocks factor Xa, a crucial step in blood clot formation, said Diener, co-chair of the study's adjudication committee.

Apixaban was highly superior to aspirin. We had not anticipated that apixaban would show such a big difference compared with aspirin while showing no significant increase in major bleeds, he said. Everyone had expected that a more powerful drug like apixaban would be associated with more severe bleeding complications compared to aspirin, but it wasn't.

The study's primary endpoint was the reduction of ischemic stroke (stroke caused by blockages in the brain's circulation), hemorrhagic stroke (stroke due to bleeding in the brain) and systemic embolism (blockages due to blood clots elsewhere in the body), he said. The primary safety endpoint was major bleeding incidents.

Up to 50 percent of all AF patients with moderate or high stroke risk are unsuitable for the most effective class of anti-clotting treatment known as vitamin K antagonists (VKA). That class includes the well-known drug warfarin.

All of the AVERROES patients were unsuitable for VKA therapy, which carries an increased risk of hemorrhage and requires frequent blood testing to monitor its effectiveness. For such patients the only alternate treatment is aspirin, which is just modestly effective, Diener said.

The patients in this study, all over age 50, were at moderate to high risk because they had at least one stroke risk factor in addition to AF, such as being age 75 or older, having high blood pressure, heart failure, diabetes or having a history of stroke or transient ischemic attack (a possible precursor of stroke), he explained.

Patients were randomized to receive either apixaban at 5 milligrams (mg) twice a day (2.5 mg twice a day in selected patients) or between 81 mg and 324 mg of aspirin per day. The study's double-dummy design mandated that patients randomized to receive apixaban took an aspirin-placebo and those randomized to receive aspirin got an apixaban-placebo, he explained.

During an average of 1.1 years of follow up, the researchers found 51 strokes or systemic embolism events in the 2,808 patients taking apixaban compared to 113 strokes and systemic embolic events in the 2,791 patients taking aspirin. That represents an annual rate of 1.6 percent for apixaban vs. 3.6 percent for aspirin, meaning apixaban carries about half the relative risk of stroke or systemic embolism compared to aspirin. Although bleeding events were slightly higher with apixaban, the difference fell short of statistical significance.

The researchers will also report on a subgroup of patients with a history of stroke or transient ischemic attack (TIA), often a precursor to stroke.

If validated by future studies I think this is the end of aspirin as a drug to prevent stroke in patients with AF, he added.

Diener said the study's major limitation is the limited time period of observation, shortened further by the study's early conclusion. AF patients need anticoagulation for the rest of their lives and we would have liked to see a much longer duration of the trial, he said.

By evaluating the use of apixaban as a replacement for aspirin in AF patients who are unsuitable for VKA therapy, the AVERROES study is addressing an important unmet clinical need.

Robot therapy can improve arm, shoulder mobility after stroke

Thu, 10 Feb 2011 05:00:00 PST

( from http://www.rxpgnews.com ) Therapy in which robots manipulate paralyzed arms, combined with standard rehabilitation, can improve arm and shoulder mobility in patients after stroke, according to research presented at the American Stroke Association's International Stroke Conference 2011.

Patients on robotic therapy showed marked improvement in two measures of upper extremity function: the Fugl-Meyer flexor synergy score, a 0 to 12 scale with higher numbers reflecting recovery of voluntary arm movement; and the Fugl-Meyer shoulder/elbow/forearm score, a 0 to 36 scale with higher numbers reflecting recovery of motor function in the shoulder, elbow and forearm.

Combining robotic exercise with regular rehabilitation may be the key to successful intervention, said Kayoko Takahashi, Sc.D., O.T.R., lead author of the study and clinician and research associate in the Department of Occupational Therapy in Kitasato University East Hospital in Kanagawa, Japan. Robots could allow therapists to focus on helping patients master daily activities while maintaining repetitive training, Takahashi said.

The new study involved 60 stroke survivors with hemiplegia (paralysis on one side of the body) treated at six rehabilitation centers in Japan. The patients, average age 65, had suffered a stroke in the previous four to eight weeks. All received standard rehabilitation therapy from an occupational therapist.

Half the group received robotic therapy every day for six weeks, in sessions lasting 40 minutes. The other half spent the same amount of time working through a standard self-training program for hemiplegic patients, performing stretches and passive-to-active exercises of their affected arm.

With a recent trend in helping patients function with one arm, many post-stroke patients have given up hope of recovery of their affected arms. Takahashi said. Participating in such robotic exercise is therefore expected to give patients insights about their future ability and a more positive image regarding their affected arm, increasing their self-efficacy and motivation toward rehabilitation.

The group assigned to robotic therapy used a Reo Therapy System by Motorika Ltd. in Israel. For the therapy, the patient's forearm, either resting on or strapped to a platform, is moved in multiple directions based on pre-programmed exercise movements.

Researchers selected five such pre-programmed movements. For instance, in one of the movements, forward reach, the robot helps patients extend their arms forward as if reaching for something in front of them.

Therapists also selected from five levels of robotic assistance according to what was most appropriate for the patient, from movement entirely guided by the robot and passive on the patient's part, to movement actively performed by the patient.

The successful test of robots adds a new wrinkle to stroke rehabilitation strategies, Takahashi said. While repetitive movement is an essential therapy, physical and occupational therapists aren't always available to provide care, and self-training, if not done correctly, can result in pain and disability.

Robots, on the other hand, can carry out the repetitive movement exercise with exactly the right movement pattern to prevent misuse, Takahashi said.

WSU study finds younger stroke victims benefit from earlier MRIs, ambulance rides to ER

Thu, 10 Feb 2011 05:00:00 PST

( from http://www.rxpgnews.com ) Detroit - While the American Stroke Association reports that stroke is the third leading cause of death and one of the top causes of disability in the United States, young adults showing signs of suffering a stroke are sometimes misdiagnosed in hospital emergency rooms, preventing them from receiving early effective treatment that can prevent serious damage.

Performing magnetic resonance imaging sooner on younger stroke patients entering emergency rooms can lower the rate of misdiagnosis and lead to faster appropriate treatment, according to a team of Wayne State University School of Medicine and Wayne State University Physician Group neurologists.

The Wayne State University-Detroit Medical Center Stroke Program team presented its findings Thursday during the American Heart Association/American Stroke Association's International Stroke Conference 2011 in Los Angeles, Calif.

In Early Performance of MRI is Associated with Lower Rate of Stroke Misdiagnosis in Young Adults, the team examined the cases of 77 patients with a mean age of 37.9 years who reported to an emergency room displaying stroke symptoms. Of those cases, 14.5 percent of the patients were initially misdiagnosed.

The chances of a misdiagnosis decreased if physicians performed an MRI of the patient within 48 hours. The likelihood of a misdiagnosis increased as the age of the patients decreased. The study concluded that early performance of an MRI leads to greater accuracy of a stroke diagnosis in young adults brought to emergency rooms, and patients younger than 35 years of age are at greater risk of being misdiagnosed when exhibiting stroke symptoms. However, if a patient demonstrating stroke symptoms arrived via ambulance, there was a lower rate of misdiagnosis. The team hypothesized that arrival by ambulance may increase an emergency room staff's perception of the gravity of the patient's condition.

Accurate diagnosis of stroke on initial presentation in young adults can reduce the number of patients who have continued paralysis and continued speech problems, said Seemant Chaturvedi, M.D., professor of Neurology and director of the WSU-DMC Stroke Program. We have seen several young patients who presented to emergency rooms with stroke-like symptoms within three to six hours of symptom onset, and these patients did not get proper treatment due to misdiagnosis. The first hours are really critical.

Part of the problem is that the emergency room staff may not be thinking 'stroke' when the patient is younger, Dr. Chaturvedi said. Physicians must realize that a stroke is the sudden onset of these symptoms. Patients arriving with seemingly trivial symptoms like vertigo and nausea should be assessed meticulously, he said.

Delay can be costly. After 48 to 72 hours, there are no major interventions available to improve stroke outcome, he said.

Intravenous delivery of the clot-dissolving agent tissue plasminogen activator is the only U.S. government-approved treatment for acute stroke. The drug must be administered within three hours of symptom onset to reduce permanent disability.

The findings build on the team's 2009 study in which members reviewed seven years worth of data covering 57 patients between the ages of 16 and 50. The patients were enrolled in the Young Stroke Registry at the Comprehensive Stroke Center at the WSU School of Medicine. Four males and three females (average age 34) in the study were misdiagnosed with migraine headaches, vertigo, alcohol intoxication or other conditions. They were discharged from the emergency room, but later were found to have suffered a stroke.

Advanced macular degeneration is associated with an increased risk

Wed, 09 Feb 2011 05:00:00 PST

( from http://www.rxpgnews.com ) Older people with late-stage, age-related macular degeneration (AMD) appear to be at increased risk of brain hemorrhage (bleeding stroke), but not stroke caused by brain infarction (blood clot), according to research presented at the American Stroke Association's International Stroke Conference 2011.

Other studies have found there are more strokes in older individuals with late AMD, but ours is the first to look at the specific types of strokes, said Renske G. Wieberdink, M.D., study researcher and epidemiologist at Erasmus Medical Center in Rotterdam, the Netherlands. We found the association is with brain hemorrhage, but not brain infarction.

AMD is degeneration of the macula, which is the part of the retina responsible for the sharp, central vision needed to read or drive. Because the macula primarily is affected in AMD, central vision loss may occur. Age-related macular degeneration usually produces a slow, painless loss of vision. Early signs of vision loss from AMD include shadowy areas in your central vision or unusually fuzzy or distorted vision.

Because the number of brain hemorrhages observed in the study was small, the findings will need to be corroborated in a larger group, Wieberdink said.

These findings should be considered preliminary, she said. Patients and physicians must be very careful not to over-interpret them. We don't know why there are more brain hemorrhages in these patients or what the relationship with AMD might be. This does not mean that all patients with late-stage AMD will develop brain hemorrhage.

Beginning in 1990, the Rotterdam Study is a prospective, population-based cohort investigation into factors that determine the occurrence of cardiovascular, neurological, ophthalmological, endocrinological and psychiatric diseases in older people.

The researchers tallied stroke incidence among 6,207 participants 55 years and older. All of the participants were stroke-free at the study's outset. AMD was assessed during scheduled eye examinations, and participants with the condition were divided into five different stages of AMD, and whether their condition was wet AMD or dry AMD. Participants were tracked for an average of 13 years. Of the 726 persons who suffered a stroke in that time, 397 were brain infarctions, 59 were brain hemorrhages and the stroke type was not available for 270.

Late AMD (stage 4) was associated with a 56 percent increased risk of any type of stroke. Late AMD, both the dry and the wet form, was strongly associated with more than six times the risk of brain hemorrhage, but not with brain infarction. Early AMD (stages 1-3) did not increase the risk of any stroke. Associations were adjusted for possible confounders, such as diabetes, blood pressure, anti-hypertensive medications, smoking status, body mass index, alcohol use and C-reactive protein levels.

New study to use smart phones to track air pollution exposure

Tue, 08 Feb 2011 05:00:00 PST

( from http://www.rxpgnews.com ) BUFFALO, N.Y. -- University at Buffalo researchers are creating a new and unusual app for the smart phone: tracking air pollution.

Carole Rudra, PhD, UB assistant professor of social and preventive medicine, has received a grant to assess a person's exposure over time to pollutants in an urban area -- in this case, the City of Buffalo.

The study is funded by a two-year $440,247 grant from the National Institutes of Health (NIH).

A city's air pollution varies from downtown to playground to kitchen table, making it essential to be able to track study participants' location and collect data throughout the day. Smart phones equipped with GPS can do this very well.

There are many ways to estimate air pollution exposures among humans, says Rudra. Many current methods are based on participants' home addresses. These methods don't take into account the fact that people don't spend all day inside their homes. In an urban area, exposure changes significantly as people go about their daily activities.

To overcome this limitation in a way that is convenient for study participants and feasible for future large studies, we will use smart phones to track study participants' locations over 24 hours. Their location registers automatically, so they don't have to call in or do anything else.

The 40 participants in the two-year study will use their own GPS-equipped smart phones, such as iPhones or Androids, which will record their location several times a day during a three-month study period. Volunteers from Buffalo and surrounding areas will be recruited in two waves -- summer 2011 and winter 2011-12.

Location will be defined by geographical coordinates, a system that enables every location on earth to be specified by a set of numbers. The researchers will check air pollution monitoring sites in various locations to determine participants' exposure to a number of pollutants.

Air pollution is associated with a variety of health problems, such as asthma, heart disease, lung cancer, COPD and other conditions, notes Rudra.

An earlier study conducted by Rudra around Seattle, Wash., on the health risks of air pollution in pregnancy found that it does not increase the risk of preeclampsia or early delivery.

This project will develop a method that will improve our ability to estimate human exposures to air pollutants, and will improve public health by allowing researchers to more accurately measure human exposures and relate these exposures to health outcomes.

Osmoreceptors in liver help increase blood pressure

Thu, 27 Jan 2011 06:17:04 PST

( from http://www.rxpgnews.com ) For 60 years, scientists have puzzled over the possibility of a hepatic osmoreceptor that influences blood pressure regulation. Now, researchers of the Max Delbrück Center for Molecular Medicine (MDC) Berlin-Buch, the Experimental and Clinical Research Center (ECRC) of the MDC and Charité and the Hannover Medical School (MHH) appear to have made a breakthrough discovery. Dr. Stefan Lechner and Professor Gary R. Lewin (both of MDC), Professor Friedrich C. Luft (ECRC) and Professor Jens Jordan (ECRC; now MHH) have discovered a new group of sensory neurons in the mouse liver which mediates the regulation of blood pressure and metabolism. This peripheral control center outside of the brain is triggered simply by drinking water and leads to an elevation of blood pressure in sick and elderly people. (Neuron, No. 69 (2) pp. 332-344)

More than ten years ago Professor Jens Jordan, MD, then a research fellow at Vanderbilt University in Nashville, Tennessee, observed a phenomenon together with his colleagues, more or less by accident. Later, at the former Franz Volhard Clinic of the Charité in Berlin-Buch, Jens Jordan again observed that in patients with a damaged nervous system, blood pressure readings rose by as much as 50 mm Hg if the patients drank a half liter of water all at once. "In young people whose sympathetic nervous system was stimulated by drugs, water intake also caused blood pressure levels to rise," said Professor Friedrich C. Luft of the ECRC. "Even in healthy older people, water drinking triggers a regulator for blood pressure." The two clinicians invited neuroscientists at MDC to collaborate with them and started a joint research project.

For 60 years researchers have suspected that there must also be a control center for the body's self-regulation located outside of the brain. Motivated by findings of recent studies, the researchers in Berlin-Buch therefore looked for sensory neurons specifically in organs peripheral to the central nervous system that would detect body changes caused by water intake and would thus be able to activate a regulator which in old and sick people causes blood pressure to rise and which stimulates metabolism in healthy young people.

"In this entire process, osmolality plays a key role," explained Dr. Stefan Lechner, a member of Professor Lewin's research group. "It is the measure of the body's water balance. And it indicates how many molecules are dissolved in a liter of fluid. Each species has a characteristic set point for osmolality, which depends to a great extent on the immediate living conditions. We wanted to know how deviations of osmolality are able to activate a regulator."

The researchers observed in the mouse model that specific neurons in the liver react actively to water intake. The water the mice drink is absorbed in the small intestine and reaches the blood system via the liver. Due to the sudden water intake, the osmolality in the blood vessels of the liver falls under its set-point value. This deviation is registered by sensory neurons in the liver, the so-called osmoreceptors, as the researchers could now demonstrate. They found that the osmoreceptors transform the information into an electrical signal, which in turn triggers a reflex and stimulates the hepatic blood vessels to raise blood pressure.

Ion Currents Help to Elucidate the Mechanisms

To study the activation of the osmoreceptors under realistic physiological conditions, the researchers stained this newly discovered group of osmoreceptors in the liver with a dye. In their experiments they could thus show that after drinking water, even the slightest shifts of osmolality in the blood flowing through the liver activate nerve fibers in the liver and cause ion currents to flow. The ion currents were similar to those that can be measured in an ion channel located both in the central nervous system and in the internal organs (heart, liver, kidney, testicles, pancreas). This ion channel, abbreviated TRPV4, reacts very sensitively to changes and functions quasi as an osmoreceptor.

"The TRPV4 ion channel opens in just a few hundred milliseconds like the lens of a camera, letting the electrical signal through and thus activating a regulator," explained Dr. Stefan Lechner. "We were now interested in whether the TRPV4 ion channel is acting alone or whether it needs subunits to aid it, and we wanted to know how the whole thing works mechanically."

In further experiments, to elucidate the role and function of TRPV4 in this regulation process, the researchers studied mice in which the gene for the TRPV4 ion channel had been inactivated. After giving these knockout mice water to drink, they did not observe any activation of the osmoreceptors in the liver. No ion currents flowed and as a consequence, no reflex was triggered. The researchers concluded that the elevation of the blood pressure due to water intake must be associated with the presence of the TRPV4 ion channel.

Consequences for therapy

"We are now able to describe the characteristics of a completely new group of hepatic osmoreceptors on the molecular level, which in humans are possibly an extension of a very important regulating reflex," said Professor Lewin. "The research findings not only improve our understanding of the physiological role of osmoreceptors in mediating blood pressure, metabolism and osmolalic self-regulation, over the long term they could also lead to new strategies in the treatment of diseases caused by the absence of the gene encoding the TRPV4 channel protein."

"The effect of drinking water on blood pressure regulation is already leading to therapeutic consequences in the daily routine of the hospital," Professor Jordan added. "We tell patients to drink water who, due to blood pressure regulation disorders, suffer from fainting attacks when standing. This alleviates the symptoms and at the same time we are able to reduce the amount of medication. Healthy people can also suffer fainting attacks when they stand for a long time or are otherwise under strain, e.g. when they donate blood. In many cases these can be avoided by drinking water. Our decade-long persistence in investigating osmolalic self-regulation has really paid off!"

Certain strains of Listeria monocytogenes target heart tissue

Tue, 25 Jan 2011 19:07:14 PST

( from http://www.rxpgnews.com ) Certain strains of the food pathogen Listeria are uniquely adapted to infect heart tissues and may put people at a higher risk from serious cardiac disease, according to a new study published in the Journal of Medical Microbiology. Developing new diagnostic tests to identify these potentially fatal strains could protect those most at risk, such as those with heart valve replacements.

Researchers from the University of Illinois, Chicago have shown that a sub-population of the bacterium Listeria monocytogenes display an enhanced ability to infect cardiac tissue. They found that mice infected with certain strains of L. monocytogenes had 10-15-fold more bacteria in their heart tissues than mice infected with other strains.

L. monocytogenes is a serious food-borne pathogen which may be found in soft cheeses and chilled ready-to-eat products. Less severe infections lead to gastroenteritis. Serious infections are most commonly associated with the central nervous system or with the developing fetus in pregnant women. Dr Nancy Freitag who led the study explained how a subset of infections progress differently. "A significant number - about 10% - of L. monocytogenes infections involve the heart. In these cases death rate from cardiac illness is estimated to be up to 35% yet very little is known about how these bacteria infect heart tissues."

The results of the study suggest that these cardiac-associated strains display modified proteins on their surface that enable the bacteria to target the heart, leading to bacterial infection. "We found distinct genetic similarities between the cardioinvasive Listeria versus the other strains that we compared. These similarities all related to the surface proteins on the bacteria," said Dr Freitag.

The group are hoping to develop diagnostic tests based on bacterial genetic markers. "These tests could be used to distinguish strains of Listeria isolated from food outbreaks, food processing plants, or from clinical infections that place patients at increased risk of cardiac disease," suggested Dr Freitag. "This would allow health care workers and food safety officials to closely monitor exposed individuals."

The ability to identify cardiac-targeting strains of Listeria could improve infection outcomes and help protect vulnerable groups. "Patients with heart valve replacements or prior cardiac illness are believed to be more susceptible to Listeria cardiac infections. It is not clear exactly why this is so, but it could be that damaged tissue provides an additional entry way for infection," explained Dr Freitag. "We believe that this risk may be increased if the individuals are exposed to cardiac-targeting strains," she said.

Statins: Benefits questionable in low-risk patients

Tue, 18 Jan 2011 05:00:00 PST

( from http://www.rxpgnews.com ) There is not enough evidence to recommend the widespread use of statins in people with no previous history of heart disease, according to a new Cochrane Systematic Review. Researchers say statins should be prescribed with caution in those at low risk of cardiovascular disease (CVD).

CVD is the most common cause of death, accounting for nearly a third of all deaths worldwide. Cholesterol-lowering statins are first line treatments for heart patients and the benefits are well established. However, there is less evidence that statins are beneficial for preventing heart problems in those who have no history of CVD. Given that low cholesterol has been shown to increase the risk of death from other causes, statins may do more harm than good in some patients.

The researchers reviewed data from 14 trials involving 34,272 patients. Outcomes in patients given statins were compared to outcomes in patients given placebos or usual care. Combined data from eight trials involving 28,161 patients that provided data on deaths from all causes showed that statins reduced the risk of dying from 9 to 8 deaths for every 1000 people treated with statins each year. Statins reduced fatal and non-fatal events, including heart attack, stroke and revascularization surgery, as well as blood cholesterol levels.

However, the researchers say that the conclusions of their review are limited by unclear, selective and potentially biased reporting and that careful consideration should be given to patients' individual risk profiles before prescribing statins.

It is not as simple as just extrapolating the effects from studies in people who have a history of heart disease, said lead researcher Fiona Taylor, from the Cochrane Heart Group at the London School of Hygiene and Tropical Medicine in London, UK. This review highlights important shortcomings in our knowledge about the effects of statins in people who have no previous history of CVD. The decision to prescribe statins in this group should not be taken lightly.

The researchers point out that all but one of the trials they reviewed were industry-sponsored. We know that industry-sponsored trials are more likely to report favourable results for drugs versus placebos, so we have to be cautious about interpreting these results, said Taylor. The numbers eligible for treatment with statins are potentially great so there might be motivations, for instance, to stop trials earlier if interim results support their use.

A separate Cochrane Systematic Review, conducted by some of the same authors, considered the effects of combined approaches to reducing the risk of heart disease, including using education and counselling to encourage people to change their diets and stop smoking. The authors concluded that combined interventions had little or no impact on deaths or disease caused by CVD. In an editorial accompanying the reviews, Carl Heneghan, University of Oxford, concluded that, Although various multiple prevention strategies exist, the most effective and cost-effective intervention for primary prevention in adults at low risk currently remains unclear.

Candesartan has less all-cause mortality compared to losartan

Fri, 14 Jan 2011 10:55:34 PST

( from http://www.rxpgnews.com ) In a comparison of the angiotensin II receptor blockers (ARBs) candesartan and losartan, used by patients with heart failure, candesartan was associated with a lower risk of death at 1 and 5 years, according to a study in the January 12 issue of JAMA.

Angiotensin II receptor blockers reduce cardiovascular mortality and heart failure (HF) hospitalization in patients with HF with reduced left ventricular ejection fraction (LVEF; a measure of how well the left ventricle of the heart pumps with each contraction). Despite variable effects of different ARBs, they have not been tested head to head, and there are reasons to believe they may differ in efficacy, according to background information in the article. Previous research found that in elderly patients with HF, losartan was associated with higher mortality than other ARBs.

Maria Eklind-Cervenka, M.D., of the Department of Cardiology, South Hospital, Stockholm, and colleagues conducted a study to determine whether candesartan is associated with less all-cause mortality than losartan in patients with HF. The study included analysis of data from an HF registry (the Swedish Heart Failure Registry) of 30,254 patients registered from 62 hospitals and 60 outpatient clinics between 2000 and 2009. A total of 5,139 patients (average age, 74; 39 percent women) were treated with candesartan (n = 2,639) or losartan (n = 2,500).

In overall survival between the 2 groups, the researchers found that one-year survival was 90 percent for patients receiving candesartan and 83 percent for patients receiving losartan, and 5-year survival was 61 percent for patients receiving candesartan and 44 percent for patients receiving losartan. The results persisted in stratified analyses.

The researchers add that there are mechanistic reasons to believe candesartan may be more effective than losartan and that studies of candesartan have been larger and more conclusively positive than studies of losartan.

"In conclusion, our findings suggest that candesartan is associated with less all-cause mortality than losartan. However, clinical decision making should await supportive evidence of this observed association. Ideally, different ARB agents should be tested against each other in randomized controlled trials. It would also be important and perhaps more feasible to confirm our findings in other large HF registries," the authors write.

No difference in graft patency between radial and saphenous vein grafts in CABG procedures

Tue, 11 Jan 2011 18:03:21 PST

( from http://www.rxpgnews.com ) Use of a radial artery graft compared with a saphenous vein graft for coronary artery bypass grafting did not result in improved angiographic patency one year after the procedure, according to a study in the January 12 issue of JAMA.

Coronary artery bypass grafting (CABG) is one of the most common operations performed, with a database indicating that in the United States, 163,048 patients had CABG surgery in 2008. The success of CABG depends on the long-term patency of the arterial and venous grafts. Arterial grafts are thought to be better conduits than saphenous vein grafts for CABG based on experience with using the left internal mammary (breast) artery to bypass the left anterior descending coronary artery, according to background information in the article. The efficacy of the radial artery graft, which is easier to harvest than other arteries, is less clear. A database shows that more than 10,000 patients in the United States received radial artery grafts in 2008, suggesting that about 6 percent of patients undergoing CABG have radial artery grafts.

Steven Goldman, M.D., of the Southern Arizona VA Health Care System and the University of Arizona Sarver Heart Center, Tucson, and colleagues compared 1-year angiographic patency of radial artery grafts vs. saphenous vein grafts in 757 participants (99 percent men) undergoing elective first-time CABG. The randomized controlled trial was conducted from February 2003 to February 2009 at 11 Veterans Affairs medical centers. The left internal mammary artery was used to preferentially graft the left anterior descending coronary artery whenever possible; the best remaining recipient vessel was randomized to radial artery vs. saphenous vein graft. The primary outcome measured was angiographic graft patency at 1 year after CABG. Secondary outcomes included angiographic graft patency at 1 week after CABG, heart attack, stroke, repeat revascularization and death.

The analysis included 733 patients (366 in the radial artery group, 367 in the saphenous vein group). The researchers found that there was no significant difference in 1-year graft patency between radial artery (238/266; 89 percent) and saphenous vein grafts (239/269; 89 percent). Also, there was no significant difference in 1-week patency between patients who received radial artery grafts (285/288; 99 percent) vs. saphenous vein grafts (260/267; 97 percent), or in the other secondary outcomes. There was no difference in the number and types of adverse events, including serious adverse events.

"Although most clinicians assume that compared with vein grafts, arterial grafts have an improved patency rate, there are little multi-institutional prospective data on radial artery graft vs. saphenous vein graft patency," the authors write.

Because the important question is long-term patency, the researchers note that there will be a 5-year angiographic follow-up of these patients to define chronic graft patency in this population.

Coronary artery bypass grafting (CABG) is one of the most common operations performed, with a database indicating that in the United States, 163,048 patients had CABG surgery in 2008. The success of CABG depends on the long-term patency of the arterial and venous grafts. Arterial grafts are thought to be better conduits than saphenous vein grafts for CABG based on experience with using the left internal mammary (breast) artery to bypass the left anterior descending coronary artery, according to background information in the article. The efficacy of the radial artery graft, which is easier to harvest than other arteries, is less clear. A database shows that more than 10,000 patients in the United States received radial artery grafts in 2008, suggesting that about 6 percent of patients undergoing CABG have radial artery grafts.

Steven Goldman, M.D., of the Southern Arizona VA Health Care System and the University of Arizona Sarver Heart Center, Tucson, and colleagues compared 1-year angiographic patency of radial artery grafts vs. saphenous vein grafts in 757 participants (99 percent men) undergoing elective first-time CABG. The randomized controlled trial was conducted from February 2003 to February 2009 at 11 Veterans Affairs medical centers. The left internal mammary artery was used to preferentially graft the left anterior descending coronary artery whenever possible; the best remaining recipient vessel was randomized to radial artery vs. saphenous vein graft. The primary outcome measured was angiographic graft patency at 1 year after CABG. Secondary outcomes included angiographic graft patency at 1 week after CABG, heart attack, stroke, repeat revascularization and death.

The analysis included 733 patients (366 in the radial artery group, 367 in the saphenous vein group). The researchers found that there was no significant difference in 1-year graft patency between radial artery (238/266; 89 percent) and saphenous vein grafts (239/269; 89 percent). Also, there was no significant difference in 1-week patency between patients who received radial artery grafts (285/288; 99 percent) vs. saphenous vein grafts (260/267; 97 percent), or in the other secondary outcomes. There was no difference in the number and types of adverse events, including serious adverse events.

"Although most clinicians assume that compared with vein grafts, arterial grafts have an improved patency rate, there are little multi-institutional prospective data on radial artery graft vs. saphenous vein graft patency," the authors write.

Because the important question is long-term patency, the researchers note that there will be a 5-year angiographic follow-up of these patients to define chronic graft patency in this population.

Doubled risk of anxiety for 18 month-old children with congenital heart defects

Wed, 17 Nov 2010 05:00:00 PST

( from http://www.rxpgnews.com ) Research from the Norwegian Institute of Public Health (NIPH) shows that children with severe congenital heart defects have twice the risk of anxiety at 18 months of age compared to healthy children. Children with mild and moderate heart defects, on the other hand, did not show an increased risk of anxiety.

- These findings suggest that children with severe forms of congenital heart defects are prone to emotional problems at a very young age. The increased risk of anxiety could be related to the number of medical procedures and hospital admissions that characterise the first years of life for these children, said PhD student Kim Stene-Larsen at the NIPH.

Part of the HEARTKIDS project

The NIPH is collaborating with the Department of Paediatric Cardiology at Oslo University Hospital on a major research project, HEARTKIDS.

In this follow-up study the researchers examined whether children with congenital heart defects had an increased risk of internalising problems such as anxiety or sleep problems at 18 months of age.

Out of 198 eighteen month old children with a congenital heart defect who were studied, 58 had a severe heart defect. Analysis showed that the children with a severe heart defect had a doubled risk of anxiety compared to healthy children.

In addition to the severity of the heart defect, maternal anxiety and depression explained some of the anxiety in these children. Children with mild or moderate heart defects, however, showed no signs of anxiety or other internalising problems.

The HEARTKIDS project is a sub-study of the Norwegian Mother and Child Cohort Study (MoBa). The project is funded by the Norwegian Research Council. This longitudinal study aims to explore the psychological and developmental consequences of congenital heart defects in infants and toddlers. Through a merge of the MoBa and the Oslo University Hospital's nationwide register of congenital heart defects, which provides accurate diagnostic information about heart defects, it is possible to compare children with varying severity of heart defects with healthy children.

Previous findings from the HEARTKIDS project have shown that 6-month-old children with moderate or severe congenital heart defects show a higher risk of emotional reactivity (irritability, frequent and powerful crying).

Need for more knowledge about children with congenital heart defects

Approximately one percent of all newborn children have a congenital heart defect. The severity of the heart defects varies widely from minor defects to complex conditions that require a series of operations throughout the child's first year.

Several studies have shown that children with congenital heart defects down to 3 years of age are more prone to emotional problems like anxiety and depression. However, there is little knowledge about the emotional problems in infancy and early childhood, which is the phase of life where most of the medical treatment is carried out. The HEARTKIDS project is focusing on the phase from birth to child age 3 years of age.

Regenerative stem cell therapy offers new hope for treating cardiovascular disease

Wed, 17 Nov 2010 05:00:00 PST

( from http://www.rxpgnews.com ) Northwestern Medicine physician researchers are revolutionizing treatment of cardiovascular disease by utilizing patients' own stem cells to regenerate heart and vascular tissue. Northwestern Medicine is the lead site for a study examining stem cell transplantation as treatment for critical limb ischemia. Chief investigator Douglas Losordo, MD, director of the Program in Cardiovascular Regenerative Medicine at Northwestern Memorial Hospital and the Eileen M. Foell Professor of Heart Research of Northwestern University's Feinberg School of Medicine, will present the findings of this study at the American Heart Association's Scientific Sessions in Chicago, on Wednesday, November 17.

Traditionally, cardiovascular medicine has focused on repairing damaged tissues with medication or surgery, said Losordo, also director of the Feinberg Cardiovascular Research Institute. For some patients, their cardiovascular disease is advanced to the point that standard treatment options are not effective. Regenerative cardiovascular medicine strives to redevelop cardiac and vascular tissue and stimulate new blood supply to areas like the heart and legs by using stem cells already present in the patient's body.

Losordo's limb preservation study examined the effectiveness of stem cell therapy in limb preservation for patients with critical limb ischemia (CLI). CLI develops in patients with severe obstruction of the arteries which limits blood flow to the extremities. CLI results in more than 100,000 amputations annually in the United States. The trial tested the ability of CD34+ cells to stimulate new blood vessel formation in ischemic limbs, which can improve perfusion and salvage function.

The phase II, double-blind placebo controlled trial had a total of 28 patients randomized at 18 U.S. sites. The patients enrolled in this study were Rutherford class 4 and 5, meaning they were in the later stages of peripheral artery disease and at heightened risk for amputation. Patients in the randomized group had CD34 injected at eight locations in the ischemic limb and were followed for 12 months.

Stem cell treatment was associated with a significant reduction in amputation rate, said Losordo. Treatment was associated with a 50 percent reduction in the total amputation rate compared to control. Although further study is needed, these results provide evidence that CD34 cell therapy is an effective treatment for critical limb ischemia.

Losordo and his Northwestern Medicine team are leading the field of stem cell therapy for cardiovascular conditions and bringing it to the forefront of medicine. The results of this study are encouraging and provide evidence for that stem cell therapy can significantly repair cardiac and vascular tissues, said Losordo. As study of stem cells continues, I believe we're on the verge of a rebirth in the practice of medicine. Using a patient's own cells to regenerate their body has enormous potential to treat conditions that have previously been considered irreversible.

Statin RX may be overprescribed in healthy people without evidence of diseased arteries

Tue, 16 Nov 2010 05:00:00 PST

( from http://www.rxpgnews.com ) Rolling back suggestions from previous studies, a Johns Hopkins study of 950 healthy men and women has shown that taking daily doses of a cholesterol-lowering statin medication to protect coronary arteries and ward off heart attack or stroke may not be needed for everyone.

In a study to be presented Nov. 16 at the American Heart Association's (AHA) annual Scientific Sessions in Chicago, the Johns Hopkins team found that nearly 95 percent of all heart attacks, strokes or heart-related deaths occurred in the half of study participants with some measureable buildup of artery-hardening calcium in the blood vessels; hence, only this subgroup might have benefited from preventive drug therapy. Seventy-five percent of all heart emergencies occurred in the quarter with the highest calcium scores.

The 47 percent of study participants with no detectable levels of calcium buildup in their blood vessels suffered about 5 percent of heart-disease related events during the six-year study, meaning that drug therapy may not have offered any coronary protection.

Our results tell us that only those with calcium buildup in their arteries have a clear benefit from statin therapy, and those who are otherwise healthy and have no significant calcification should with their physician focus on aggressive lifestyle improvements instead of early initiation of statin medications, says study lead investigator Michael Blaha, M.D., M.P.H.

While statin therapy can benefit healthy men and women with normal or even low cholesterol levels, adds Blaha, a cardiology fellow at the Johns Hopkins University School of Medicine and its Heart and Vascular Institute, it certainly is not the case that all adults should be taking it to prevent heart attack and stroke, because half are at negligible risk of a sudden coronary event in the next five to 10 years.

Results of the study underscore the importance of measuring coronary artery calcium deposits, Blaha says, in predicting who is really at risk of suffering a heart attack. High levels of C-reactive protein in the blood, a CRP score at or above 2 milligrams per liter, offered no predictive value after established risk factors are taken into account, including age, gender, ethnicity, hypertension, blood cholesterol levels, obesity, diabetes, smoking and a family history of heart disease. Study participants in the new analysis had varying blood levels of the inflammatory byproduct, believed by some to be a predictor of all kinds of coronary disease.

The latest findings from the Johns Hopkins-led Multi-Ethnic Study on Atherosclerosis, or MESA, are believed to be the first to pinpoint precisely who among the more than 6 million healthy American adults with normal blood-cholesterol levels and, thus, potential candidates for preventive statin therapy, would benefit from a statin's cardio-protective effects. Rosuvastatin, marketed as Crestor, is one particular statin drug effective in preventing heart attack and stroke in some individuals, according to results of the landmark JUPITER trial published in 2008.

In the JUPITER trial, short for the Justification for the Use of Statins in Primary Prevention: An Interventional Tool Evaluating Rosuvastin, daily doses of 20 milligrams per liter of blood per day halved the number of potentially fatal coronary blockages in some 18,000 adults, all with high CRP levels.

Patients receiving dialysis are at a heightened risk for sudden cardiac death

Sun, 14 Nov 2010 05:00:00 PST

( from http://www.rxpgnews.com ) Approximately 500,000 Americans require dialysis to treat kidney disease; of that population nearly half of the deaths that occur are caused by cardiovascular disease. Dialysis patients are at elevated risk for sudden cardiac death, but physicians are unclear why these deaths occur because little research has been done to examine how to best manage heart disease in this high-risk population.

Northwestern Medicine cardiologist Rod Passman, MD, medical director for the Center for Atrial Fibrillation at the Bluhm Cardiovascular Institute of Northwestern Memorial Hospital will present a paper at the American Heart Association's Scientific Sessions being held November 13 through 17 in Chicago about sudden cardiac death in dialysis patients. Passman is working to increase understanding within the medical community about this heightened mortality risk and how to prevent sudden cardiac death among this rapidly growing patient population.

Dialysis patients have extraordinarily high mortality rates with cardiac disease accounting for 43 percent of deaths in this population; data indicates that approximately 27 percent of the mortalities are due to sudden cardiac death, said Passman, who is also an associate professor of cardiology at Northwestern University's Feinberg School of Medicine. Patients on dialysis are excluded from clinical trials examining sudden cardiac death because of their kidney disease. The lack of research complicates clinicians' ability to understand the connection between renal disease and cardiovascular disease. The medical community needs to stop neglecting this community of patients because it is a rapidly growing group.

Sudden cardiac death is unexpected natural death from a cardiac cause within a short time period, generally less than an hour from the onset of symptoms in a person without prior condition that would appear fatal. In most cases, sudden cardiac death occurs because of ventricular arrhythmias (abnormal heart rhythms), including ventricular tachycardia (VT) or ventricular fibrillation (VF).

Risk of cardiac arrest in dialysis patients is related to age and dialysis duration, said Passman. A study by the United States Renal Disease Data System (USRDS) indicates longer dialysis duration is associated with higher mortality. This data also leads us to believe that end-stage renal disease is a primary promoter of cardiac disease and increased risk for sudden cardiac death.

By analyzing USRDS data, Passman and other researchers are beginning to better understand how cardiovascular disease affects renal patients and developing plans for preventing sudden cardiac death. The more understanding we gain in regards to why these patients are dying from sudden cardiac death, the better chance we have to save them, Passman explained. The best methods for prevention are medicinal options, including beta-adrenergic blockers, angiotensin converting enzyme (ACE) inhibitors and angiotensin type II receptor blockers (ARB), or both external and implantable defibrillators.

Data also indicates a connection between potassium levels in a patient's dialysate prescription and sudden cardiac death. Patients who suffered a cardiac arrest during dialysis were twice as likely to be on low-potassium dialysate versus higher levels of potassium, which were associated with the best survival rates. According to Passman, clinicians should evaluate and modify dialysate prescription on an ongoing basis in an effort to minimize risk of sudden cardiac death.

By highlighting the issue of sudden cardiac death in dialysis patients, Passman hopes that he and other physicians will be able to better understand this unique patient population. There is very little research related to prevention of sudden cardiac death in dialysis patient; this group remains a mystery in terms of medical research, even though their numbers are growing, said Passman. The lack of research and study of cardiovascular disease in kidney patients is a problem that must be addressed. By understanding why dialysis patients are at such great risk for sudden cardiac death, we can begin to develop better standards for prevention.

Vitamin D deficit doubles risk of stroke in whites, but not in blacks

Sun, 14 Nov 2010 05:00:00 PST

( from http://www.rxpgnews.com ) Low levels of vitamin D, the essential nutrient obtained from milk, fortified cereals and exposure to sunlight, doubles the risk of stroke in whites, but not in blacks, according to a new report by researchers at Johns Hopkins.

Stroke is the nation's third leading cause of death, killing more than 140,000 Americans annually and temporarily or permanently disabling over half a million when there is a loss of blood flow to the brain.

Researchers say their findings, to be presented Nov. 15 at the American Heart Association's (AHA) annual Scientific Sessions in Chicago, back up evidence from earlier work at Johns Hopkins linking vitamin D deficiency to higher rates of death, heart disease and peripheral artery disease in adults.

The Hopkins team says its results fail to explain why African Americans, who are more likely to be vitamin D deficient due to their darker skin pigmentation's ability to block the sun's rays, also suffer from higher rates of stroke. Of the 176 study participants known to have died from stroke within a 14-year period, 116 were white and 60 were black. Still, African Americans had a 65 percent greater likelihood of suffering such a severe bleeding in or interruption of blood flow to the brain than whites, when age, other risk factors for stroke, and vitamin D deficiency were factored into their analysis.

Higher numbers for hypertension and diabetes definitely explain some of the excess risk for stroke in blacks compared to whites, but not this much risk, says study co-lead investigator and preventive cardiologist Erin Michos, M.D., M.H.S., an assistant professor at the Johns Hopkins University School of Medicine and its Heart and Vascular Institute. Something else is surely behind this problem. However, don't blame vitamin D deficits for the higher number of strokes in blacks.

Nearly 8,000 initially healthy men and women of both races were involved in the latest analysis, part of a larger, ongoing national health survey, in which the researchers compared the risk of death from stroke between those with the lowest blood levels of vitamin D to those with higher amounts. Among them, 6.6 percent of whites and 32.3 percent of blacks had severely low blood levels of vitamin D, which the experts say is less than 15 nanograms per milliliter.

It may be that blacks have adapted over the generations to vitamin D deficiency, so we are not going to see any compounding effects with stroke, says Michos, who notes that African Americans have adapted elsewhere to low levels of the bone-strengthening vitamin, with fewer incidents of bone fracture and greater overall bone density than seen in Caucasians.

In blacks, we may not need to raise vitamin D levels to the same level as in whites to minimize their risk of stroke says Michos, who emphasizes that clinical trials are needed to verify that supplements actually do prevent heart attacks and stroke. In her practice, she says, she monitors her patients' levels of the key nutrient as part of routine blood work while also testing for other known risk factors for heart disease and stroke, including blood pressure, glucose and lipid levels.

Michos cautions that the number of fatal strokes recorded in blacks may not have been statistically sufficient to find a relationship with vitamin D deficits. And she points out that the study only assessed information on deaths from stroke, not the more common brain incidents of stroke, which are usually non-fatal, or even mini-strokes, whose symptoms typically dissipate in a day or so. She says the team's next steps will be to evaluate cognitive brain function as well as non-fatal and transient strokes and any possible tie-ins to nutrient deficiency.

Besides helping to keep bones healthy, vitamin D plays an essential role in preventing abnormal cell growth, and in bolstering the body's immune system. The hormone-like nutrient also controls blood levels of calcium and phosphorus, essential chemicals in the body. Shortages of vitamin D have also been tied to increased rates of breast cancer and depression in the elderly.

Michos recommends that people maintain good vitamin D levels by eating diets rich in such fish as salmon and tuna, consuming vitamin-D fortified dairy products, and taking vitamin D supplements. She also promotes brief exposure daily to the sun's vitamin D-producing ultraviolet light. And to those concerned about the cancer risks linked to too much time spent in the sun, she says as little as 10 to 15 minutes of daily exposure is enough during the summer months.

If vitamin supplements are used, Michos says that daily doses between 1,000 and 2,000 international units are generally safe and beneficial for most people, but that people with the severe vitamin D deficits may need higher doses under close supervision by their physician to avoid possible risk of toxicity.

The U.S. Institute of Medicine (IOM) previously suggested that an adequate daily intake of vitamin D is between 200 and 600 international units. However, Michos argues that this may be woefully inadequate for most people to raise their vitamin D blood levels to a healthy 30 nanograms per milliliter. The IOM has set up an expert panel to review its vitamin D guidelines, with new recommendations expected by the end of the year. Previous results from the same nationwide survey showed that 41 percent of men and 53 percent of women have unhealthy amounts of vitamin D, with nutrient levels below 28 nanograms per milliliter.

Researchers led by St. Michael's Hospital receive grant to teach new method of CPR

Wed, 03 Nov 2010 04:00:00 PST

( from http://www.rxpgnews.com ) TORONTO, Ont., Nov. 3, 2010 -- Researchers led by St. Michael's Hospital will be teaching a quick, inexpensive method of cardio-pulmonary resuscitation to some Toronto-area high school students this fall.

Rescu, a research group headed by Dr. Laurie Morrison, received $50,000 from the American Heart Association and Norway's Laerdal Foundation for Acute Medicine to teach an innovative CPR course that takes only 22 minutes, uses an instructional DVD and a small inflatable mannequin and can be taught almost anywhere. Students will also learn how to use an automated external defibrillator.

The researchers hope the pilot program will be expanded to all high schools in Ontario and that students will teach this CPR method to friends and relatives, thereby raising survival rates of people who suffer heart attacks outside of hospitals.

CPR can quadruple survival rates from out-of-hospital cardiac arrests and the use of an AED can save even more lives, Despite this, the bystander CPR rate has remained low and unchanged for the past decade. Toronto has one of the lowest rates in the world of bystanders willing and able to perform cardio-pulmonary resuscitation. It also has one of the lowest rates of AED use in Canada.

Only 51 per cent of Toronto high schools teach CPR, even though it is part of the Grade 9 curriculum. Only 6 per cent of high schools train students to use an AED, which is found in less than half the schools.

It is clear that the current CPR and AED training strategies need to be evaluated and changed in order for students to become the next generation of responsible citizens willing and ready to perform bystander CPR, Morrison said.

She said the low CPR training rates in schools may reflect the fact that the four hours of instruction competes for time in the busy curriculum. In addition, private schools do not have any funding to provide instruction. The Heart and Stroke Foundation's CPR Anytime kit costs only $35 each.

The pilot project initially involves about 250 students at six schools in Toronto, Burlington and Oakville. The first session will take place on Nov. 23. Rescu is partnering in this project with researchers from the University of Toronto and a number of not-for-profit organizations including The Hospital for Sick Children, Sunnybrook-Osler Centre for Prehospital Care, Safe Communities Canada, the Toronto Paramedics Association, Halton Region Emergency Medical Services, the Heart and Stroke Foundation of Canada and the Heart and Stroke Foundation of Ontario.

Rescu is part of the Rescue Outcomes Consortium, a large, multinational research collaboration of 10 sites across the United States and Canada, studying how promising new tools and treatments can improve survival rates among people who suffer cardiac arrest or life-threatening traumatic injury.

$12 million grant to probe root causes of heart failure

Tue, 02 Nov 2010 04:00:00 PST

( from http://www.rxpgnews.com ) Researchers at the University of Illinois at Chicago have been awarded more than $12 million by the National Heart, Lung, and Blood Institute to investigate both the acquired and familial causes of heart failure -- with the aim of identifying markers for diagnosis and targets for cures.

The five years of new funding supports an ongoing program-project grant led by R. John Solaro, distinguished university professor and head of physiology and biophysics at UIC, that looks at one of the leading causes of death, disability and hospitalization in the western world. Heart failure occurs when the heart cannot pump effectively and is unable to meet the body's need for blood and oxygen. More than 5.5 million Americans suffer from heart failure, and 670,000 new cases are diagnosed each year, according to the American Heart Association.

We're looking at the overarching problem of the maladaptive changes the heart undergoes that lead into a vicious cycle of failure, says Solaro.

His program, like other program-project grants, links the unique expertise of each investigator to those of the others. The sum is greater than the individual parts, he said.

His collaborators are Brenda Russell, professor in physiology and biophysics; E. Douglas Lewandowski, professor in physiology and biophysics; and Pieter de Tombe, chair of physiology at Loyola University, Chicago. The projects expand the program that Solaro has led for 10 years.

Those 10 years have been extraordinarily productive, resulting in dozens of papers in top-tier journals, said Russell, who is executive associate vice chancellor for research at UIC. A decisive factor for the NIH to extend a project grant is the productivity of the program, she said.

Projects led by Solaro and de Tombe investigate energy consumption by the molecular motors of the cardiac muscle, called sarcomeres, which generate the pressure to pump blood through the arteries. Pilot studies have identified possible therapies for common familial cardiac disorders for which there is presently no cure.

The project headed by Russell addresses the mechanisms for growth of the heart-muscle cells and the assembly of the sarcomeres during growth.

Lewandowski focuses on the metabolic pathways that supply energy to the molecular motors and on the coordination of energy supply and demand, which he says brings a slightly new perspective to the program. Cellular metabolism is a topic of intense interest now, he said, because scientists think the interplay between protein function and expression in the heart, and metabolic processes in the cell, can either make or break the contractile function of the heart.

Genetic variations linked with worse outcomes with use of antiplatelet drug for cardiac procedures

Tue, 26 Oct 2010 04:00:00 PST

( from http://www.rxpgnews.com ) An analysis of data from previously published studies indicates that use of the antiplatelet drug clopidogrel for patients who have common genetic variants of a certain gene and are undergoing a procedure such as coronary stent placement have an associated increased risk for major adverse cardiovascular events, particularly development of blood clots in stents, according to a study in the October 27 issue of JAMA.

Clopidogrel, one of the most commonly prescribed medications, has been shown to reduce cardiovascular events in patients undergoing percutaneous coronary intervention (PCI; procedures such as balloon angioplasty or stent placement used to open narrowed coronary arteries). However, there is a large degree of interindividual variability in the pharmaco-dynamic response to clopidogrel, the authors write. Data suggest its pharmacologic effect varies based on variations of the gene CYP2C19, but there is uncertainty regarding the clinical risk given by certain variations.

Jessica L. Mega, M.D., M.P.H., of Brigham and Women's Hospital and Harvard Medical School, Boston, and colleagues conducted a meta-analysis to determine the risk of major adverse cardiovascular outcomes among carriers of 1 or 2 reduced-function CYP2C19 genetic variants in patients treated with clopidogrel. The analysis included data from 9 studies and 9,685 patients (of whom 91.3 percent underwent PCI and 54.5 percent had an acute coronary syndrome), 863 experienced the composite outcome of cardiovascular death, heart attack, or stroke; and 84 patients had stent thrombosis (blood clot) among the 5,894 evaluated for such.

There were 6,923 patients (71.5 percent) with no CYP2C19 reduced-function alleles (an alternative form of a gene), 2,544 (26.3 percent) with 1 reduced-function CYP2C19 allele, and 218 (2.2 percent) with 2 reduced-function CYP2C19 alleles. Compared with CYP2C19 noncarriers, there was a significantly increased risk of cardiovascular death, myocardial infarction, or stroke in the 26.3 percent of the overall study population who carried only 1 reduced-function CYP2C19 allele. Similarly, there was a significantly increased risk of cardiovascular death, myocardial infarction, or stroke in the 2.2 percent of the overall study population who carried 2 reduced-function CYP2C19 alleles, the researchers write.

The authors also found that both carriers of only 1 reduced-function CYP2C19 allele and carriers of 2 alleles were at significantly increased risk of stent thrombosis when compared with CYP2C19 noncarriers.

In conclusion, the findings of this collaborative meta-analysis demonstrate that common genetic variants in the CYP2C19 gene are associated with almost 1 in 3 patients not receiving ideal protection from ischemic events when treated with standard doses of clopidogrel for PCI. Given how widely clopidogrel is used to treat patients with cardiovascular disease, determination of the optimal antiplatelet treatment doses or regimens for individual patients is needed to tailor therapy appropriately, the authors write.

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Studies show everolimus-eluting stent implantation reduces restenosis and repeat revasculariztion

Thu, 21 Oct 2010 04:00:00 PST

( from http://www.rxpgnews.com ) Two new studies have determined that everolimus-eluting stent (EES) implantation reduced the incidence of restenosis and repeat revascularization in patients with calcified culprit lesions, and had fewer clinical events. Results show the rate of major cardiac adverse events in EES-treated patients with calcified lesions were higher than in those for noncalcified lesions, but remained lower than the results of previously reported stent studies. Details of both studies are published in the November issue of Catheterization and Cardiovascular Intervention, a peer-reviewed journal from The Society for Cardiovascular Angiography and Interventions.

The treatment of calcified coronary stenosis is associated with a high frequency of restenosis and target lesion revascularization (TLR). Drug-eluting stents (DES), known to reduce the rates of restenosis and TLR in patients with relatively simple coronary artery lesions when compared with bare metal stents (BMS), are now successfully being used for more advanced lesions such as calcified coronary stenoses.

The XIENCE V EES emerged in 2008 as a new option in DES. Following favorable results with this device in the SPIRIT FIRST randomized study, the SPIRIT II and III trials were performed to evaluate the EES in comparison with the widely used TAXUS paclitaxel-eluting stent (PES) in the treatment of patients with coronary artery disease. The SPIRIT studies suggested positive outcomes for EES implantation in calcified culprit lesions, with the aim of the current analysis to confirm its safety and efficacy in patients with calcified and noncalcified culprit lesions.

In the first study, researchers from the Erasmus Medical Center in the Netherlands identified 212 patients with 247 lesions, who were treated with EES alone. Target lesions were angiographically classified as none/mild, moderate, or severe grades of calcification. The population was divided into two groups: those with at least one target lesion moderately or severely calcified (the calcified group: 68 patients with 75 calcified lesions) and those with all target lesions having mild or no calcification (the noncalcified group: 144 patients). Six-month and 2-year angiographic follow-up and clinical follow-up to 3 years were completed.

At the 6-month and 2-year follow-ups, the calcified group (compared with the noncalcified group) had significantly higher rates of in-stent angiographic binary restenosis (ABR) and ischemia-driven (ID) TLR, resulting in numerically higher major cardiac adverse events (MACE). While at 3 years, only ID-TLR tended to be higher in the calcified group than in the noncalcified group, resulting in numerically higher MACE.

The geometry and rigidity of calcified culprit lesions often prevent optimal device delivery, deployment, and conformability, explained study leader Patrick Serruys, M.D., Ph.D. Consequently, the treatment of this lesion subset with percutaneous coronary intervention (PCI) is associated with a high frequency of acute complications and a low-success rate. Our study showed high-clinical device success (98.7%), excellent clinical procedural success (100%), and the absence of MACE during the acute phase (up to 30 days after stent implantation) in the calcified group.

Additionally, no patient in the calcified group suffered from stent thrombosis up to 3 years after PCI, while two thrombotic complications occurred in the noncalcified group. Although large population studies with long-term follow-up are mandatory, the authors concluded that EES implantation for calcified culprit lesions appears to be safe up to 3 years. This study also demonstrated that the rates of in-stent ABR (4.3%) and ID-TLR (5.9%) at 6 months for calcified culprit lesions are remarkably lower than that in previous BMS studies, in which these rates ranged from 12 to 23% and from 18 to 23%, respectively, suggesting that EES implantation is more effective for calcified culprit lesions than BMS implantation.

In a related study, researchers from the Wake Forrest University School of Medicine in North Carolina analyzed data from SPIRIT III clinical trial to evaluate whether EES, with thinner stent struts and polymer, results in less adverse outcomes. Findings from the SPIRIT III trial indicated that the newer generation of DES, the EES, was associated with fewer clinical events than the first generation PES. In an effort to determine whether this benefit extended to all patient subgroups, Robert Applegate, MD, FSCAI, and colleagues assessed the impact of jailed side branches on clinical outcomes and periprocedural myonecrosis within each stent treatment group.

The Wake Forest researchers identified 113 patients in the EES group and 63 patients in the PES group who met the criteria of having a lesion with a jailed side branch (less than 2 mm diameter, and less than 50% stenosis). Two-year clinical outcomes were evaluated, revealing that MACE (cardiac death, myocardial infarctions (MI), or TLR) occurred in 6.8% of EES and 19.0% of PES jailed side branch patients, with numerically lower rates of MI and TLR in the EES group, with comparable rates of cardiac death.

Use of a PES was associated with an increase in rates of periprocedural creatine kinase-MB fraction (CK-MB) elevation, which was most prevalent in those patients with a jailed side branch. In contrast, rates of CK-MB elevation were similar in those patients receiving an EES, and lower when compared to PES, regardless of the presence or absence of a jailed side branch. The clinical outcomes at 1 and 2 years were similar in the EES treated patients with and without a jailed side branch, but were numerically higher in the PES treated patients with a jailed side branch compared to those without a jailed side branch.

Dr. Applegate concluded, Our observations confirm previous studies demonstrating a relative increase in the incidence of periprocedural elevation of biomarkers with PES use, and demonstrate the absence of this phenomenon with EES.

Key to blood-brain barrier opens way for treating Alzheimer's and stroke

Thu, 14 Oct 2010 04:00:00 PST

( from http://www.rxpgnews.com ) While the blood-brain barrier (BBB) protects the brain from harmful chemicals occurring naturally in the blood, it also obstructs the transport of drugs to the brain. In an article in Nature scientists at the Swedish medical university Karolinska Institutet now present a potential solution to the problem. The key to the BBB is a cell-type in the blood vessel walls called pericytes, and the researchers hope that their findings will one day contribute to new therapies for diseases like Alzheimer's and stroke.

Our new results show that the blood-brain barrier is regulated by pericytes, and can be opened in a way that allows the passage of molecules of different sizes while keeping the brain's basic functions operating properly, says Christer Betsholtz, professor of vascular biology at the Department of Medical Biochemistry, who has led the study.

The blood-brain barrier is a term denoting the separation of blood from tissue by blood vessels that are extremely tight? Impermeable?. In other organs, the capillary walls let certain substances carried by the blood, such as the plasma proteins albumin and immunoglobulin, out into the surrounding tissue. In the brain, however, this pathway is closed off. This is essential for many reasons, one being that the plasma proteins are harmful to nerve cells.

In recent time, capillary permeability in the brain has been discussed as a factor of potential significance to neurodegenerative diseases, such as Alzheimer's, Parkinson's and ALS.

Our new knowledge of how the BBB is regulated could be used in two ways, says Professor Betsholtz. To protect the brain under conditions such as stroke and inflammation that lead to the opening of the BBB and the release of neurodamaging substances; and to open the barrier temporarily to allow the transport of drugs against neurodegenerative and other diseases of the brain.

In the study, which is now published in Nature, Professor Betsholtz and his research group show how this would be possible. The pericytes normally maintain the barrier function through an as-yet unknown molecular mechanism; in their absence, a special transport process called transcytosis opens a path through the capillary walls so that molecules of different sizes, including large plasma proteins, can pass from the blood into the brain. The pericytes also regulate another type of brain cell known as an astrocyte. Astrocytes contribute to the BBB through special extensions called end-feet which envelop the capillaries and regulate water and ion flows.

Another interesting find is that the cancer drug Imatinib, which inhibits certain signal proteins for cell growth, has a similar effect in the presence of pericytes in that they also close the capillary wall transport paths, says Professor Christer Betsholtz.

First phase II trial of heart disease treatment for Duchenne muscular dystrophy launched

Tue, 12 Oct 2010 04:00:00 PST

( from http://www.rxpgnews.com ) Baltimore, Md. -- Kennedy Krieger Institute announced today the launch of a first-of-its-kind, phase II clinical trial to investigate a treatment for heart disease in individuals with Duchenne muscular dystrophy (DMD). Made possible by a $545,000 grant from Pilot Trials Now, an innovative DMD initiative organized and managed by Charley's Fund Inc. and The Nash Avery Foundation, with additional support from Pfizer Inc., the study will examine whether Revatio (sildenafil) improves cardiac function for those affected by the most common fatal genetic disorder in the world.

DMD affects approximately 1 in 3,500 boys worldwide. Errors in the gene that codes for dystrophin, a protein that plays a key role in muscle fiber function, result in progressive muscle-wasting that eventually spreads throughout the body, affecting both the heart and lung muscles, ultimately resulting in paralysis and death by early adulthood. With no cure for DMD, researchers hope that preserving the function of key muscles such as the heart and lungs can contribute to increased life expectancy.

The Kennedy Krieger Institute research team, working collaboratively with the Division of Cardiology in the Johns Hopkins University School of Medicine, will investigate whether Revatio (sildenafil), the same drug in Viagra which is best known for its efficacy in treating male erectile dysfunction, can improve cardiac function by preventing pathologic left ventricular hypertrophy, an unhealthy increase of the heart's muscle mass that outpaces the heart's pumping ability. In research first pioneered by co-investigator David Kass, Johns Hopkins' Abraham and Virginia Weiss Professor of Cardiology, sildenafil was shown to suppress and even reverse heart muscle dysfunction and hypertrophy in experimental animal models. Recently, research supported by Charley's Fund Inc, The Nash Avery Foundation and the Parent Project Muscular Dystrophy revealed cardiac benefits of sildenafil in mouse models of muscular dystrophy.

We are very excited to be offering a clinical trial to this older Duchenne muscular dystrophy population with this promising drug, said Dr. Kathryn Wagner, Director of the Center for Genetic Muscle Disorders at Kennedy Krieger. For the first time in decades, there are promising therapies in development that I believe should give families a real sense of hope for the future.

Thirty males, aged 15 years and older, who have been diagnosed with DMD and cardiac dysfunction, are being recruited to participate in this randomized, double-blind, placebo-controlled study for six months. An open-label period during which all enrolled subjects will receive Revatio (sildenafil) will follow for an additional six months. Dr. Daniel Judge, Medical Director for the Johns Hopkins Center for Inherited Heart Diseases, will co-direct the trial.

HHS agencies partner with PEPFAR to transform African medical education

Thu, 07 Oct 2010 04:00:00 PST

( from http://www.rxpgnews.com ) The U.S. Department of Health and Human Services is partnering with the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) with a plan to invest $130 million over five years to transform African medical education and dramatically increase the number of health care workers.

Through the Medical Education Partnership Initiative (MEPI), grants are being awarded directly to African institutions in a dozen countries, working in partnership with U.S. medical schools and universities. The initiative will form a network including about 30 regional partners, country health and education ministries, and more than 20 U.S. collaborators.

The program is designed to support PEPFAR's goals to train and retain 140,000 new health care workers and improve the capacity of partner countries to deliver primary health care.

We must dramatically transform African medical education to increase the number of qualified care providers available and develop the scientific expertise needed for research and innovation, said Ambassador Eric Goosby, U.S. Global AIDS Coordinator at the Department of State. By engaging country health and education ministries, MEPI will strengthen national plans to improve medical instruction and bolster the overall health care delivery systems. As we transition PEPFAR-supported HIV efforts from an emergency response to a more sustainable effort, we need to develop the expertise necessary for evidence-based decision making on the local level. This expertise will empower countries to lead health programs and fulfill their responsibility for the health of their people.

Several components of the National Institutes of Health joined PEPFAR in funding the initiative, which will be administered by Fogarty International Center of the NIH and the HIV/AIDS Bureau of the Health Resources and Services Administration (HRSA).

Eleven programmatic awards, largely funded by PEPFAR, will expand and enhance medical education and research training in the field of HIV/AIDS. Eight smaller non-HIV/AIDS awards, funded by the NIH Director's Common Fund, with additional support from several NIH institutes, will encourage the development of expertise in topics such as maternal and child health, cardiovascular diseases, cancer, mental health, surgery and emergency medicine. Over a five-year period, MEPI intends to provide up to $10 million for each programmatic award, up to $2.5 million for each linked project and up to $1.25 million for each pilot grant.

Non-communicable diseases, such as maternal-child health issues, cardiovascular disease, cancer, and mental illness, represent the fastest growing causes of morbidity and mortality in sub-Saharan Africa, said NIH Director Francis S. Collins, M.D., Ph.D. We at NIH are delighted to join hands with our colleagues in PEPFAR to help build research and clinical capacity in these important areas of human health.

A coordinating center is being established to link the African sites and their U.S. partners, leverage shared resources and provide technical expertise. A Web-based platform will be developed to allow all partners to share data and outcomes. The platform will facilitate evaluation and provide a gateway to maximize the initiative's global impact. MEPI will enable participating institutions to strengthen their information technology infrastructure, support distance education and data sharing, and encourage the establishment of clinical registries to inform research and health care decision making on national levels. The coordinating center will also form an African leadership network to guide and advocate for the initiative.

HRSA's decades of experience working in HIV/AIDS through the Ryan White HIV/AIDS Program have highlighted the critical need for enhanced medical education and training to provide quality care to people affected by HIV/AIDS in rural and underserved communities. We are proud to collaborate with PEPFAR and NIH to advance medical education in Africa through this initiative, as well as continue supporting the on-going care and treatment and health system strengthening activities, said Mary K. Wakefield, Ph.D., R.N., HRSA administrator.

NIH funding is being provided by the Common Fund, Office of AIDS Research, Office of Research on Women's Health, National Heart, Lung and Blood Institute, National Human Genome Research Institute, National Institute of Mental Health, National Institute of Neurological Disorders and Stroke, and National Institute of Nursing Research.

Here is the complete list of MEPI awards and collaborating partners:

Programmatic Awards:

Botswana: University of Botswana, in partnership with Harvard School of Public Health and the University of Pennsylvania

Heart, kidney, diabetes and cancer MEP groups league against chronic disease to seek European commitment

Tue, 05 Oct 2010 04:00:00 PST

( from http://www.rxpgnews.com ) In an unprecedented effort to bring prevention of chronic diseases to the top of the EU agenda, the MEP Heart Group , the MEP Group for Kidney Health , the EU Diabetes Working Group and MEPs Against Cancer organise a joint meeting today in the European Parliament, together with representatives of health professionals and health activists at European level.

If we don't address these chronic diseases urgently, they threaten the Europe 2020 strategy, especially the goal to have 75% of the working population employed and productive says Linda McAvan, MEP and co-chair of the MEP Heart Group. Most of these chronic diseases are treatable but not curable, which explains why they generate an enormous financial burden due to treatment and care costs and loss of economic productivity.

Chronic diseases are largely preventable and in this respect the European Parliament has a major role to play says Frieda Brepoels, chair of the MEP Group for Kidney Health.

In a joint statement issued at the end of the meeting, MEPs call upon the competent authorities in the member states to urgently develop and improve policies aiming at tackling chronic diseases. A higher investment in prevention is needed, continues Frieda Brepoels, in particular by raising awareness about common risk factors and promoting healthy lifestyles.

Four major health determinants - tobacco, poor diet, alcohol and lack of physical activity - account for most chronic illness and death in Europe. Addressing chronic diseases will allow Europeans to live longer and healthier lives, stay longer in the workforce and contribute to reversing the alarming negative labour force growth which is predicted for 2020.

High tobacco and alcohol taxes, smoke free environment, good nutrition labelling which helps consumers make healthy choices and measures to prioritise the needs of pedestrians and cyclists over those of motorists in urban areas are but some of the few measures that politicians should put in place.

Alojz Peterle, Member of the European Parliament and President of MEPs Against Cancer (MAC), one of the co-organisers of the event said: 'We urge MEPs, the European Commission, the Council of Ministers and national governments to work together to tackle the problem of chronic diseases. It is only by working in partnership that we will be able to put in place effective Europe-wide policies aimed at preventing these conditions that cause so much suffering and death each year. Prevention is undoubtedly cheaper than disease management and treatment and, therefore, it makes economic sense to pursue these policies now at a time when many national governments are having to curb their expenditure.'