New gene therapy to effectively treat severe heart failure

June 4, 2010 By Leave a Comment

Washington, June 4 (ANI): American researches have unveiled a new gene therapy that effectively treats severe heart failure.

The SERCA2a (produced as MYDICAR), developed by researchers at Mount Sinai School of Medicine, is designed to stimulate production of an enzyme that enables the failing heart to pump more effectively.

In a Phase II study, SERCA2a injection through a routine minimally invasive cardiac catheterization was safe and showed clinical benefit in treating this patient population and decreasing the severity of heart failure.

The data were recently presented at the Heart Failure Congress of the European Society of Cardiology in Berlin.

Trial investigator Jill Kalman, Associate Professor, Medicine, Cardiology, Director of the Cardiomyopathy Program, Mount Sinai School of Medicine, said: “SERCA2a met the primary endpoints and appears to be safe and effective in people with advanced heart failure.

“There is a significant unmet need for treatments in this patient population, and these data indicate that SERCA2a is a promising option for them.”

The CUPID (Calcium Up-regulation by Percutaneous administration of gene therapy In cardiac Disease) trial is a randomized, double-blind, placebo-controlled study, which enrolled 39 patients with advanced heart failure to study the safety and efficacy of SERCA2a.

Patients were randomized to receive SERCA2a gene delivery in one of three doses or placebo and were evaluated over six months.

The treatment is delivered directly to the patient”s heart during a routine outpatient catheterization procedure.

Patients in the SERCA2a group demonstrated improvement or stabilization in symptoms, heart function, and severity of heart failure.

They also saw an increase in time between cardiovascular events and a decrease in frequency of events.

SERCA2a was found to be safe, with no increases in adverse events, disease-related events, laboratory abnormalities, or arrhythmias compared to placebo. (ANI)

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‘Good’ cholesterol is not always good for health: Study

May 26, 2010 By Leave a Comment

The so-called “good” cholesterol, or HDL is not always a good thing, at least for a certain group of patients, says a new study.

It is widely known that raising HDL, or “good” cholesterol, and lowering LDL, or “bad” cholesterol, improves heart health.

The new study, has for the first time found that a high level of the supposedly good cholesterol places a subgroup of patients at high risk for recurrent coronary events, such as chest pain, heart attack, and death.

The findings could help explain disappointing results from a high-profile Pfizer clinical trial testing torcetrapib, an experimental drug designed to increase levels of HDL cholesterol, that some predicted would become a blockbuster medicine.

The trial was halted in 2006 due to a surprisingly excessive number of cardiovascular events and death.

As in the current study, cardiovascular events in the torcetrapib trial were associated with higher levels of “good” HDL cholesterol, though the reasons were unclear.

“It seems counterintuitive that increasing good cholesterol, which we’ve always thought of as protective, leads to negative consequences in some people.

We’ve confirmed that high HDL cholesterol is in fact associated with risk in a certain group of patients,” said Dr. James Corsetti, professor of Pathology and Laboratory Medicine at the University of Rochester Medical Center and lead author of the study.

Using a novel graphical data mapping tool – outcome event mapping – Corsetti and his team identified a group of patients in which elevated levels of HDL cholesterol place them in a high-risk category for coronary events.

“The ability to identify patients who will not benefit from efforts to increase HDL cholesterol is important because they can be excluded from trials testing medications that aim to raise HDL cholesterol. With these patients excluded, researchers may find that raising HDL cholesterol in the remaining population is effective in reducing cardiovascular disease risk,” said Dr. Charles Sparks.

Study authors believe genetics and environmental factors, particularly inflammation, influence whether high levels of HDL cholesterol are protective or if they increase cardiovascular risk in individual patients.

Given an inflammatory environment, an individual’s unique set of genes helps determine whether HDL cholesterol transforms from a good actor to a bad actor in the heart disease process.

In the high-risk subgroup of patients with elevated HDL cholesterol and CRP, researchers also identified two genetic factors associated with recurrent coronary events.

The activity of cholesterol ester transfer protein (CETP), which moves cholesterol away from the vascular system and is associated with HDL cholesterol, and p22phox, which influences inflammation-related processes and is associated with CRP, are both risk predictors in this subgroup of patients.

“Our research is oriented around the ability to better identify patients at high risk. Identifying these patients and determining what puts them at high risk may be useful in choosing treatments tailored to the specific needs of particular patient subgroups. This gets us another step closer to achieving the goal of personalized medicine,” said Corsetti.

The study was published in Arteriosclerosis, Thrombosis, and Vascular Biology, a journal of the American Heart Association.

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Post-transplant patients off steroids have fewer cardiovascular events

May 8, 2010 By Leave a Comment

Washington, May 8 (ANI): Post-transplant patients, who have given up corticosteroid regimen, have fewer cardiovascular events than those on steroids, increasing their graft survival rates and reducing early mortality, University of Cincinnati (UC) transplantation researchers have found.

Corticosteroids are commonly given to post-transplant patients as part of an immunosuppressive regime to promote graft survival.

But the steroids also cause harmful cardiovascular side effects such as increased blood pressure, cholesterol and weight gain, said Dr Rita Alloway.

The researchers have largely focused on reducing patient exposure to corticosteroids during post-transplantation treatment.

“Ten years ago, almost 80 percent of post-transplant kidney patients were discharged from the hospital on steroids. Now, according to United Network for Organ Sharing (UNOS) reports, less than 20 percent are discharged from the hospital on steroids. We’ve effectively removed chronic steroids from the immunosuppressive regimen while maintaining similar graft survival outcomes,” said Alloway.

In the study, led by Dr. Adele Rike Shields, researchers are now able to show patients removed from a steroid treatment have decreased cardiovascular events after transplant, in addition to their lowered side effects.

Shields evaluated acute graft rejection and graft loss in 630 kidney transplant patients withdrawn from corticosteroids.

She found the risk factors in the corticosteroid-withdrawn kidney transplant population are similar to those traditionally defined under conventional immunosuppression with steroids.

“With the summation of 10 years of work, we’ve been able to show that patients off corticosteroids have the same graft-function outcomes as patients on corticosteroids. In addition, the patients off corticosteroids benefit from fewer cardiovascular events,” said Alloway.

The researchers are presenting the study at the American Transplant Congress (ATC), the annual meeting of the American Society of Transplantation. (ANI)

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Orange juice suppresses oxidative stress from high-fat, high-carb meal

March 31, 2010 By Leave a Comment

Washington, Mar 31 (ANI): Flavonoids in orange juice neutralize the oxidative and inflammatory stress generated by high-fat, high-carb meals and help prevent blood vessel damage, claims a new study.

Free radicals, or reactive oxygen species, are known to induce inflammation in blood vessel linings and contribute to the risk of heart attack and stroke. In the new study, University at Buffalo endocrinologists say the potent preventative effect of orange juice likely is linked to its heavy load of the flavonoids naringenin and hesperidin, which are major antioxidants.

“Our data show, for the first time to our knowledge, that drinking orange juice with a meal high in fat and carbohydrates prevented the marked increases in reactive oxygen species and other inflammatory agents,” says UB”s Husam Ghanim, PhD, first author on the study.

“This did not happen when participants drank water or a sugary drink with the meal,” he says. “These issues of inflammation following a meal are important because the resultant high glucose and high triglycerides are known to be related to the development of cardiovascular events.”

The study appears in the March issue of the American Journal of Clinical Nutrition and appeared online ahead of print.

The study involved three groups of 10 normal-weight healthy men and women between the ages of 20 and 40. After an overnight fast, participants ate a 900-calorie breakfast composed of an egg “muffin” sandwich, a sausage “muffin” sandwich and a serving of hash browns. The meal contained 81 grams of carbohydrates, 51 grams of fat and 32 grams protein.

Along with the breakfast, one group drank 300 calories of “not-from-concentrate” orange juice, a second group drank a 300-calorie glucose drink and the third group drank an equal amount of water. All participants were given 15 minutes to finish their food and drink. Blood samples were collected before the meal and at 1, 3 and 5 hours afterwards. There was no significant difference in inflammatory mediators among the groups before the meal.

Analysis of the samples after the meal showed that oxygen free radicals increased an average of 62 percent with water, 63 percent with the glucose and 47 percent with orange juice. There also was an increase in blood components known as toll-like receptors, which play an important role in the development of inflammation, atherosclerosis, obesity, insulin resistance, and injury to cardiac cells than can occur after a blocked vessel is reopened.

Orange juice also prevented a significant increase in SOCS-3, an important mediator of insulin resistance, which contributes to development of type 2 diabetes.

“These data emphasize that a high-fat, high-carbohydrate meal is profoundly and rapidly proinflammatory, and that this process occurs at the cellular and molecular level,” says Paresh Dandona, MD, UB distinguished professor of medicine, director of the Diabetes-Endocrinology Center of Western New York at Kaleida Health and senior author on the study.

“In addition, specific proinflammatory genes are activated after the intake of glucose and a high-fat, high-carbohydrate meal, and these changes are observed in mononuclear cells that participate in vascular inflammation and insulin resistance,” he says. (ANI)

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Lowering BP to normal levels doesn’t help diabetics

March 15, 2010 By Leave a Comment

London, Mar 15 (ANI): Lowering blood pressure to normal levels does not reduce the combined risk of fatal or nonfatal cardiovascular disease events in type 2 diabetes patients prone to such events, according to new results from the landmark Action to Control Cardiovascular Risk in Diabetes (ACCORD) clinical trial.

Similarly, treating multiple blood lipids with combination drug therapy of a fibrate and a statin did not reduce the combined risk of cardiovascular disease events more than treatment with statin alone.

ACCORD, the study of more than 10,000 participants, is one of the largest studies ever conducted in adults with type 2 diabetes who were at especially high risk of cardiovascular events, such as heart attacks, stroke, or death from cardiovascular disease.

The multicenter clinical trial tested three potential strategies to lower the risk of major cardiovascular events—intensive control of blood sugar, intensive control of blood pressure, and treatment of multiple blood lipids.

The lipids targeted for intensive treatment were high density lipoprotein (HDL) cholesterol and triglycerides, in addition to standard therapy of lowering low density lipoprotein (LDL) cholesterol.

“ACCORD provides important evidence to help guide treatment recommendations for adults with type 2 diabetes who have had a heart attack or stroke or who are otherwise at especially high risk for cardiovascular disease. This information provides guidance to avoid unnecessarily increasing treatment that provides limited benefit and potentially increases the risk of adverse effects,” said Dr. Susan B. Shurin.

For the study, the researchers randomly assigned 4,733 participants with elevated blood pressure to a target systolic blood pressure of either less than 120 mmHg (the intensive group) or to less than 140 mmHg (the standard group).

A variety of FDA-approved blood pressure medications was used to reach blood pressure goals.

After an average follow-up of about five years, the researchers found no significant differences between the intensive group and the standard group in rates of a combined endpoint including nonfatal heart attack, nonfatal stroke, or cardiovascular death.

Lowering blood pressure to below the standard level significantly cut the risk of stroke by about 40 percent.

The intensive blood pressure group had 36 strokes, compared to 62 strokes in the standard group.

However, the researchers warned that participants in the intensive blood pressure group were more likely to have complications such as abnormally low blood pressure or high levels of blood potassium.

“Our results provide no conclusive evidence that targeting a normal systolic blood pressure compared with targeting a systolic blood pressure of less than 140 mmHg lowers the overall risk of major cardiovascular events in high risk adults with type 2 diabetes. However, the study suggests that lower blood pressure levels in patients like those in ACCORD may reduce the risk of stroke. This finding is consistent with other blood pressure trials,” said Dr. William C. Cushman, lead author of the study.

“Our results also showed a higher risk of serious adverse events with more intensive blood pressure control. Diabetic patients should discuss their systolic blood pressure goal with their health care provider and, as with any treatment, weigh the risks and benefits of various treatments to lower blood pressure,” added Cushman.

The results of the ACCORD clinical trials appear online in the New England Journal of Medicine (NEJM). (ANI)

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Soon, simple blood test to identify stroke survivors at risk of another cardiovascular event

August 28, 2009 By Leave a Comment

Washington, Aug 28 (ANI): A simple blood test would soon help identify stroke survivors at risk of another cardiovascular event, say researchers.

The research team from University of North Carolina, Chapel Hill suggests that measuring blood flow in the ankle may identify stroke survivors at risk of subsequent events such as asymptomatic peripheral artery disease (PAD) and transient ischemic attack (TIA).

In the test, the ankle brachial index, compares blood flow in the ankle to blood flow in the arm to detect poor circulation caused by fatty plaque buildup in the lower body, a condition known as peripheral artery disease (PAD).

The findings revealed that 26 percent of the survivors had asymptomatic PAD, and they had three times more subsequent cardiovascular events – stroke, heart attacks or death – in the following two years compared to those without PAD.

Furthermore 50 percent with asymptomatic PAD suffered subsequent events, compared with 16 percent of those without the disease. PAD was significantly associated with future vascular events, especially strokes.

PAD occurs when arteries in the extremities become obstructed by plaque. Leg pain, cramping, weakness and limping during physical exertion are the primary symptom.

“ABI measurement may be appropriate for screening stroke/TIA patients who may be at high risk for vascular events,” said lead researcher Dr Souvik Sen, M.P.H., director of the Stroke Centre at the University of North Carolina, Chapel Hill.

“The test is easily performed in less than 15 minutes at the physician’s office or at bed-side in hospitalized patients,” he added.

The study is published in Stroke: Journal of the American Heart Association. (ANI)

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Biomarkers’ ability to improve prediction of heart risk minimal, say experts

July 1, 2009 By Leave a Comment

Washington, July 1 (ANI): Researchers from Massachusetts General Hospital have revealed that measuring the known biomarkers modestly improves the prediction of future heart attack, but not enough to change preventive therapies.

Although conventional risk factors – like as smoking, hypertension, cholesterol levels and age – can identify individuals at the highest risk for heart attack or stroke, many people without these factors still experience these potentially devastating events.

“While there currently does not appear to be a role for routine use of biomarkers in screening for cardiovascular risk, our data do not exclude a role for biomarkers in selected patients,” said Dr. Thomas Wang, of the MGH Heart Centre, the study’s senior and co-corresponding author.

“We’re still optimistic that new technologies will lead to the discovery of biomarkers that could help us move toward offering truly personalized cardiovascular risk prediction,” he added.

The current study was focused on two biomarkers that have been extensively studied in cardiovascular disease – C-reactive protein (CRP) and N-terminal pro-B-type natriuretic peptide (N-BNP) – and four that recently have been identified as relating to cardiovascular risk – Cystatin C, Lp-PLA2, MR-proADM and MR-proANP.

The researchers found that two of the studied biomarkers – N-BNP and MR-proADM – did significantly improve the prediction of coronary events, defined as a heart attack or death from ischemic heart disease.

N-BNP and C-reactive protein improved the prediction of cardiovascular events, which are coronary events plus strokes.

But when the ability of biomarkers to move individual patients into higher- or lower-risk categories was analysed, the potential impact on treatment decisions was minimal.

“Since choice of therapies may depend on the risk category a patient falls into, moving patients between risk categories could lead to a change in therapy,” said co-author Dr. Christopher Newton-Cheh, of MGH Heart Centre.

“While there was more category movement among participants initially classified as intermediate-risk, that resulted primarily from movement to lower risk levels, so we still need to find biomarkers that can make a clinically significant difference in predicting cardiovascular risk” he added.

The study appears in the Journal of the American Medical Association. (ANI)

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Statins ‘cut heart attack risk by 30pct’

July 1, 2009 By Leave a Comment

London, July 1 (ANI): Cholesterol lowering drugs Statins could decrease the risk of heart attacks in healthy people by 30 per cent, according to a new study.

In the study of more than 70,000 patients, scientists also found that drugs could slashed the chance of having a stroke by 19 per cent and reduced mortality by 12 per cent in patients without heart disease.

Scientists have called for people without heart disease but with risk factors such as high blood pressure and diabetes, to be given statins.

“Statin use was associated with ­significantly improved survival and large reductions in the risk of major cardiovascular events,” the Daily Express quoted cardiologist Dr. Jasper Brugts from Erasmus Medical Centre in Rotterdam, who led the study, as saying.

The findings have been published in the British Medical Journal. (ANI)

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Drug-eluting stents found to be superior in efficacy to bare metal stents

May 27, 2009 By Leave a Comment

London, May 7 (ANI): A study suggests that the use of drug-eluting stents on heart attack patients undergoing angioplasty is more effective and as safe as that of bare-metal stents.

Lead researcher Dr. Gregg W. Stone, a professor of medicine at Columbia University Medical Center/New York-Presbyterian Hospital, has revealed that in patients undergoing angioplasty, the use of paclitaxel-eluting stents has been found to reduce rates of target lesion revascularization (TLR) and binary angiographic restenosis when compared to the use of bare-metal stents after 1 year.

The study also revealed that the primary safety measure of major adverse cardiovascular events (MACE)-including death, reinfarction, stent thrombosis and stroke-established the non-inferiority of drug-eluting stents with respect to safety through 1 year.

The trial enrolled 3,602 heart attack patients at 123 centers in 11 countries, 3,006 of whom were randomised to paclitaxel-eluting stents versus otherwise identical bare metal stents.

During the trial, the use of paclitaxel-eluting stents resulted in a significant reduction of ischemia-driven target-lesion revascularization (TLR)-the rate at which a particular lesion re-narrows following stent implantation severely enough to require either a repeat angioplasty or bypass surgery operation-at 12 months.

The use of paclitaxel-eluting stents also resulted in a significant reduction in binary restenosis after 13 months, which is the rate at which the artery re-narrows at least 50 per cent following implantation of the stent, and was the secondary efficacy endpoint of the trial. The paclitaxel-eluting stent had a rate of 10 per cent and the bare metal stent had a rate of 22.9 per cent.

“Outcomes from prior registry and randomised trials of drug-eluting stents compared to bare metal stents in heart attack patients have been conflicting. These results now provide definitive evidence that paclitaxel-eluting stents are superior in efficacy to bare metal stents and have a comparable safety profile at 1 year,” said Dr. Stone.

The researchers believe that the findings of their study will have a major impact on how decisions are made regarding drug-eluting and bare metal stents in the highest risk patients, those in the early hours of a heart attack.

“This study removes much of the uncertainty and concern about the efficacy and safety of drug-eluting stents in this clinical setting. Moreover, all of the patients in this trial will be followed long-term to ensure that these favorable results are maintained,” said Dr. Stone.

A research article on the trial has been published in The New England Journal of Medicine. (ANI)

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Big waistline could surprisingly be a lifeline for heart disease sufferers

May 19, 2009 By Leave a Comment

Washington, May 19 (ANI): Despite being a leading contributor to heart disease, obesity appears to play a protective role in a range of cardiovascular problems, says a new study.

Researchers found that obese heart patients respond better to strokes and heart attacks compared to normal or underweight patients.

Although obesity is a leading cause of heart disease, paradoxically scientists say fat and even high cholesterol may have protective benefits.
However, researchers say, losing weight is still best because obesity triggers more heart attacks and strokes.

The study has been published in the May 26, 2009, issue of the Journal of the American College of Cardiology.

“Obese patients with heart disease respond well to treatment and have paradoxically better outcomes and survival than thinner patients,” said Carl Lavie, M.D., F.A.C.C., medical director of Cardiac Rehabilitation and Prevention, Ochsner Medical Center, New Orleans, LA and lead author of the article.

“Although these patients have a more favorable short- and long-term prognosis, we don’t yet understand the mechanisms for why this might be the case,” the expert added.

The obesity paradox in patients with cardiovascular disease (CVD), which was first noticed earlier this decade, is complex. It is likely due to a combination of obesity’s impact on fat cells and other metabolic processes (e.g., insulin resistance, glucose metabolism, metabolic syndrome), as well as other consequences of being obese.

Dr. Lavie speculates that excess weight may be somewhat protective because these patients have more reserves to fight disease than thinner patients. Another explanation might be that obese patients present with problems earlier due to physical deconditioning (being out of shape) and other non-cardiovascular symptoms and, therefore, have the opportunity to be diagnosed with milder disease.

Although obese patients appear to experience fewer cardiovascular events and have better survival rates, Dr. Lavie is quick to caution that patients with heart disease shouldn’t incorrectly assume that gaining weight is the answer.

“Obesity is often what’s causing high blood pressure, blockages in arteries, and increased risk of sudden death in the first place. Such excess weight has adverse effects on all of the major cardiovascular risk factors and has increased the prevalence of heart disease,” he said.

“Taken together, most studies are supportive of purposeful weight loss for preventing and treating cardiovascular disease,” he added.

Health-promoting behaviors to stay active and lose weight can also confer benefits beyond initial heart disease. (ANI)

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Short-term sleep aid course ups treatment adherence in sleep apnea patients

May 18, 2009 By 1 Comment

Washington, May 18 (ANI): A new study has revealed that patients with obstructive sleep apnea, who use a short-course of the sleep aid, eszopiclone, when beginning continuous positive airway pressure (CPAP) therapy are likely to adhere to the treatment for a longer time.

CPAP is recommended as the first-line therapy for most patients with OSA, and has been shown to improve sleep quality, reduce daytime sleepiness and enhance quality of life.

However, despite many benefits compliance to CPAP is extremely poor.

“We know that non-benzodiazepine sedative hypnotics promote sleep onset and continuity. Additionally, they can be safely used in patients with OSA, especially those already using CPAP,” said Anita Shah, D.O., author of the study.

“To date, the only consistently reliable predictor of long-term use has been compliance with CPAP at treatment initiation. Studies suggest that long-term adherence patterns may be established very early in the course of therapy,” she added.

During the study, the researchers examined whether eszopiclone would improve early CPAP adherence.

They conducted a prospective, double-blind, randomised, placebo-controlled trial involving 154 patients newly diagnosed with OSA who were beginning CPAP therapy.

The participants either received eszopiclone or placebo for their first 14 days of CPAP therapy.

They found significant differences between the eszopiclone group and the placebo group.

On average, patients who received eszopiclone used their CPAP devices more nights per week, and for an hour longer per night and the adherence was sustained six-months.

“Because we know that CPAP therapy improves sleep quality, reduces daytime sleepiness, enhances quality of life and may mitigate the excessive risk for cardiovascular events associated with this disorder, this small intervention could represent a profound clinical benefit to these patients,” said Dr Christopher Lettieri, principal investigator.

“Given the poor adherence to CPAP therapy in many patients, any simple intervention that can reliably improve adherence should be strongly considered,” he added.

The findings were presented at the American Thoracic Society’s International Conference in San Diego. (ANI)

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Aspirin ‘cuts stroke risk in patients with peripheral artery disease’

May 13, 2009 By Leave a Comment

Washington, May 13 (ANI): Aspirin is likely to reduce the risk of stroke in patients with peripheral artery disease, suggests a new study.

Although aspirin is effective in the prevention of cardiovascular events in patients with symptomatic coronary heart disease and cerebrovascular disease, its effect in patients with peripheral artery disease (PAD) has been uncertain.

To determine the effect of aspirin on cardiovascular event rates in patients with PAD, lead researcher Dr Jeffrey S. Berger, of the University of Pennsylvania, Philadelphia conducted a meta-analysis to evaluate available evidence from randomized controlled trials of aspirin therapy, with or without dipyridamole (an antiplatelet agent), that reported cardiovascular event rates.

“Results of this meta-analysis demonstrated that for patients with PAD, aspirin therapy alone or in combination with dipyridamole did not significantly decrease the primary end point of cardiovascular events, results that may reflect limited statistical power,” wrote the authors.

Even though aspirin use is associated with a statistically nonsignificant decrease in the risk of a group of combined cardiovascular events but is associated with a significant reduction in the risk of one of these events, nonfatal stroke.

“Larger prospective studies of aspirin and other antiplatelet agents are warranted among patients with PAD in order to draw firm conclusions about clinical benefit and risks,” the authors added.

The study appears in the issue of JAMA. (ANI)

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Drug-eluting stents found to be superior in efficacy to bare metal stents

May 7, 2009 By Leave a Comment

Washington, May 7 (ANI): A study suggests that the use of drug-eluting stents on heart attack patients undergoing angioplasty is more effective and as safe as that of bare-metal stents.

Lead researcher Dr. Gregg W. Stone, a professor of medicine at Columbia University Medical Center/New York-Presbyterian Hospital, has revealed that in patients undergoing angioplasty, the use of paclitaxel-eluting stents has been found to reduce rates of target lesion revascularization (TLR) and binary angiographic restenosis when compared to the use of bare-metal stents after 1 year.

The study also revealed that the primary safety measure of major adverse cardiovascular events (MACE)-including death, reinfarction, stent thrombosis and stroke-established the non-inferiority of drug-eluting stents with respect to safety through 1 year.

The trial enrolled 3,602 heart attack patients at 123 centers in 11 countries, 3,006 of whom were randomised to paclitaxel-eluting stents versus otherwise identical bare metal stents.

During the trial, the use of paclitaxel-eluting stents resulted in a significant reduction of ischemia-driven target-lesion revascularization (TLR)-the rate at which a particular lesion re-narrows following stent implantation severely enough to require either a repeat angioplasty or bypass surgery operation-at 12 months.

The use of paclitaxel-eluting stents also resulted in a significant reduction in binary restenosis after 13 months, which is the rate at which the artery re-narrows at least 50 per cent following implantation of the stent, and was the secondary efficacy endpoint of the trial. The paclitaxel-eluting stent had a rate of 10 per cent and the bare metal stent had a rate of 22.9 per cent.

“Outcomes from prior registry and randomised trials of drug-eluting stents compared to bare metal stents in heart attack patients have been conflicting. These results now provide definitive evidence that paclitaxel-eluting stents are superior in efficacy to bare metal stents and have a comparable safety profile at 1 year,” said Dr. Stone.

The researchers believe that the findings of their study will have a major impact on how decisions are made regarding drug-eluting and bare metal stents in the highest risk patients, those in the early hours of a heart attack.

“This study removes much of the uncertainty and concern about the efficacy and safety of drug-eluting stents in this clinical setting. Moreover, all of the patients in this trial will be followed long-term to ensure that these favorable results are maintained,” said Dr. Stone.

A research article on the trial has been published in The New England Journal of Medicine. (ANI)

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Common heartburn drugs may reduce anti-clotting medications’ benefits

May 7, 2009 By Leave a Comment

Washington, May 7 (ANI): Scientists have found that the medicines used for the treatment of heartburn and ulcers can reduce the anti-clotting action of the medication clopidogrel, thereby resulting in about 50 per cent increase in the combined risk of hospitalisation for heart attack, stroke, and other serious cardiovascular illnesses.

This finding is based on a new study that was presented on May 6 at the Society for Cardiovascular Angiography and Interventions (SCAI) 32nd Annual Scientific Sessions.

The study specifically focused on the effects of proton pump inhibitors (PPI) omeprazole (Prilosec), esomeprazole (Nexium), pantoprazole (Protonix), and lansoprazole (Prevacid), which together accounted for about 96 per cent of PPI use in the study.

“Given the large number of patients who undergo coronary stent procedures each year, and the recommended and wide use of clopidogrel following this procedure, our findings have implications for many thousands of patients across the United States,” said Eric J. Stanek, PharmD, senior director of research, personalized medicine research and development, Medco Health Solutions, Franklin Lakes, NJ, and the study’s principal investigator.

“Clopidogrel should continue to be taken as prescribed, and the need for PPI therapy should be carefully evaluated to ensure that it is prescribed only when clearly indicated,” the researcher added.

The research team analysed integrated data on pharmacy and medical claims from more than 10 million patients, including 16,690 patients taking clopidogrel for a full year following coronary stenting. On average, 41 per cent of those patients also took a PPI for more than nine months of the year.

Over the 12-month period when patients took clopidogrel, the researchers evaluated the risk of hospitalisation for major adverse cardiovascular events (MACE), which they defined as a combination of heart attack, unstable angina, stroke or temporary stroke-like symptoms, repeat coronary procedures, or cardiovascular death.

The researchers observed that the overall MACE risk was 51 per cent higher among patients taking any PPI.

According to them, the findings were equally concerning when the effects of individual PPIs were analysed.

Omeprazole correlated with a 39 per cent increased risk of MACE, esomeprazole to a 57 per cent increased risk, pantoprazole to a 61 per cent increased risk, and lansoprazole to a 39 per cent increased risk.

Overall, the incidence of hospitalisation for upper gastrointestinal bleeding was only 1.1 per cent among patients taking a PPI and 0.07 per cent among those not taking a PPI.

However, the researchers concede that further studies are required to determine whether newer, less widely used PPIs-such as rabeprazole (Aciphex) and dexlansoprazole (Kapidex)-are also associated with increased cardiovascular risk in patients taking clopidogrel.

They also have plans to study how genetic variations in the liver enzymes that activate clopidogrel might alter the impact of PPIs on clopidogrel effectiveness, the potential influence of the timing of PPI administration, the effect of alternate dosing of clopidogrel, and the comparative effectiveness of other anti-clotting medications. (ANI)

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Wearing mask in traffic reduces heart attack risk

March 13, 2009 By Leave a Comment

Washington, Mar 13 (ANI): Facemasks can help prevent adverse cardiovascular effects caused by pollution, scientists have shown.

Researchers discovered that pollution from car exhausts caused arteries to stiffen, resulting in higher blood pressure and reduced blood flow to the heart, reports BioMed Central’s open access journal Particle and Fibre Toxicology.

Nicholas Mills from the University of Edinburgh worked with a team of researchers to investigate the cardiovascular damage that can be caused by inhaling diesel smoke.

He said, “Acute exposure to diesel exhaust is associated with an immediate and transient increase in arterial stiffness. This may, in part, explain the increased risk for cardiovascular disease associated with air pollution exposure”.

To reach the conclusion, the researchers invited a group of 12 non-smoking young men to cycle on exercise bikes while breathing air that had either been filtered or been contaminated with smoke from a diesel engine.

They found that when the subjects were exposed to the polluted air, the blood vessels in their wrists temporarily lost the ability to expand and contract.

In a separate article also published in Particle and Fibre Toxicology, researchers report how wearing a facemask reduces exposure to airborne pollution particles and leads to a reduction blood pressure and improved heart rate control during exercise in a city centre environment.

Jeremy Langrish from the University of Edinburgh said, “We tested a range of facemasks that differed widely in their efficiency as particle filters. In general, those masks designed to reduce occupational exposure to dusts in the workplace were more efficient than those marketed to cyclists and pedestrians.”

The authors say, “This simple intervention has the potential to protect susceptible individuals and reduce cardiovascular events in cities with high concentrations of ambient air pollution.” (ANI)

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Aspirin ‘improves survival in postmenopausal women with heart disease’

March 13, 2009 By Leave a Comment

Washington, Mar 13 (ANI): Aspirin may reduce the risk of death in postmenopausal women who have heart disease or who have had a stroke, according to a new study.

The Women’s Health Initiative (WHI) Observational Study also provides new insight into aspirin dosing for women, suggesting that a lower dose of aspirin (81 milligrams, or mg) is as effective as a higher dose (325 mg).

This is good news for women who might be concerned with internal bleeding, a well-known risk of aspirin that may be more likely with higher doses of aspirin, according to other studies. However, randomized clinical trials are needed to determine the optimal doses of aspirin in women with cardiovascular disease.

Scientific evidence indicates that, in general, aspirin lowers the risk of death and incidence of heart attack and stroke in patients with a history of cardiovascular disease; however, the benefits of aspirin in women with stable cardiovascular disease in particular are unknown.

In this study, researchers analyzed data from 8,928 postmenopausal women who had previously had a heart attack, stroke or transient ischemic attack (TIA, or mini-stroke), angina, or angioplasty or coronary bypass surgery to improve blood flow. Participants were followed for an average of 6.5 years.

The researchers found that as compared to those who did not report taking aspirin, regular aspirin users had a 25 percent lower risk of death from cardiovascular disease and a 14 percent lower risk of death from any cause.

They found that overall, aspirin use did not significantly decrease the risk of heart attack, stroke, or other cardiovascular events, except among women in their seventies.

There were no significant differences in death rates or other outcomes between women taking 81 mg of aspirin compared to those taking 325 mg.

The study appears in the March issue of the journal Circulation: Cardiovascular Quality and Outcomes and was published online March 5, 2009. (ANI)

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Soybeans And Legumes Can Improve Artery Function

September 26, 2008 By Leave a Comment

Soybeans And Legumes Can Improve Artery FunctionA recent study has shown intake of soybeans and legumes can improve artery Soybeans And Legumes Can Improve Artery Functionfunction in people who have suffered a stroke. The study has shown that isoflavone, a chemical found in soybeans, chickpeas, legumes and clovers is highly beneficial in working of arteries in stroke patients. This study was conducted by Professor Hung-Fat Tse, William MW Mong Professor in Cardiology and Academic Chief of the Cardiology Division in the Department of Medicine, Queen Mary Hospital, The University of Hong Kong and his team.

The present study was the first randomised controlled trial to find out the effects of isoflavone supplement on the way the brachial artery (the main artery in the arm) dilates in response to an increase in blood flow, a phenomenon known as flow-mediated dilation (FMD), in patients with established cardiovascular disease.

Researchers analyzed the data collected from 50 patients taking the isoflavone supplement and 52 who were taking a placebo pill. The first group of patients received a daily dose of 80mg of the supplement for 12 weeks. In the beginning of the study 80 per cent of the patients had an impaired FMD of less than 3.7 percent. Researchers found that there was an improvement of one percent in the isoflavone-treated patients.

Tse said, “Although the absolute increase in brachial diameter – one percent – is small, the relative increase actually amounted to about 50 percent because the mean average FMD in these stroke patients was about two per cent. In fact, in patients with severe endothelial dysfunction, there might not be dilatation of brachial diameter at all”.

Researchers found that the prevalence of impaired FMD after 12 weeks became significantly lower in isoflavone-treated patients than in the controls. There was also a greater effect in patients with more severe endothelial dysfunction.

Tse added that the patients who had a lower initial FMD were found, in general, to respond with a larger absolute increase in FMD after receiving 12 weeks of isoflavone intervention, compared to patients who had a better baseline FMD in the first place.

Researchers concluded that these findings suggest that isoflavone reverses endothelial dysfunction in this group of patients with cardiovascular disease. This has important clinical implications, as the benefit of the treatment is conferred to the group of patients with the highest risks for cardiovascular events, and this effect persists, even at this rather late stage of the cardiovascular continuum.

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