March 3, 2008, 8:33 PM CT

Depression And Heart Attack Patients

Depressed heart attack patients have a higher risk for sudden death in the months following a heart attack. Now a team led by scientists from Washington University School of Medicine in St. Louis has observed that the risk continues for a number of years.

"There's a two- to four-fold increase in a person's risk of dying following a heart attack if they also happen to be depressed," says Robert. M. Carney, Ph.D., lead author of the new study and professor of psychiatry at Washington University. "Previously we thought the impact of depression was strongest for the first three to six months following a heart attack and then gradually dropped off within a couple of years. Instead, we observed that the effect lasts for at least five years."

Carney, with colleagues from Duke University Medical Center, Harvard University, Yale University, the National Heart, Lung and Blood Institute (NIH) and the Mayo Clinic, followed more than 750 heart attack patients for five years. The findings will appear in an upcoming issue of the Journal of Affective Disorders and are currently available online.

Patients followed in the study had participated in the NIH-funded project Enhancing Recovery in Coronary Heart Disease Patients (ENRICHD). A little less than half were diagnosed with depression......... Posted by: April      Read more         Source

March 2, 2008, 9:03 PM CT

Low-fat diets to reduce risk of heart disease

Low-fat diets are more effective in preserving and promoting a healthy cardiovascular system than low-carbohydrate, Atkins-like diets, as per a new study by scientists at the Medical College of Wisconsin in Milwaukee.

The study, reported in the February edition of the scientific journal Hypertension, was led by David D. Gutterman, M.D., Northwestern Mutual Professor of Cardiology, professor of medicine and physiology, and senior associate dean of research at the Medical College. Shane Phillips, M.D., a former Cardiology faculty member at the Medical College, and now assistant professor in the department of physical treatment at the University of Illinois - Chicago, was the lead author.

Public awareness of the obesity epidemic has resulted in various dietary weight loss strategies. In America, it is estimated that 45 percent of women and 30 percent of men diet to lose weight.

The nutrient-specific effects of these diets on cardiovascular health are largely unknown, says Dr. Gutterman.

Low-carbohydrate diets are significantly higher in total grams of fat, protein, dietary cholesterol and saturated fats than are low-fat diets. While a low-carbohydrate diet may result in weight loss and improvement in blood pressure, similar to a low-fat diet, the higher fat content is ultimately more detrimental to heart health than is the low-fat diet suggested by the American Heart Association, points out Dr. Phillips......... Posted by: April      Read more         Source

February 11, 2008, 8:29 PM CT

Swift System For Heart Attack Care Improves Treatment

Heart attack patients received lifesaving care up to an hour sooner after an Indiana hospital implemented a novel protocol to rapidly activate the cardiac catheterization lab, scientists reported in Circulation: Journal of the American Heart Association.

In comparison to the traditional protocol, patients arrived at the cardiac catheterization lab ("cath lab") sooner for artery-opening procedures, had less heart damage and shorter hospital stays. The new protocol also reduced the cost of care.

Patients in the study had a type of heart attack called ST-segment elevation myocardial infarction, or STEMI, which is caused by a completely blocked artery. The quicker a patient with this heart attack has the artery opened, the better the chances are for survival and less permanent damage to the heart.

Currently, the preferred therapy for this type of heart attack is emergency angioplasty, which is also called percutaneous coronary intervention (PCI). In this procedure, which is performed in a cath lab, a thin wire with a tiny balloon on the end is threaded through an artery to the blockage. When the balloon is inflated, it clears the blockage and restores blood flow to the heart. A number of times a wire mesh tube, called a stent, also is placed to help prop the artery open and prevent re-blockage......... Posted by: April      Read more         Source

February 11, 2008, 8:16 PM CT

Uncertain About Care for Heart Failure Patients

Less than one fourth of physicians specializing in geriatrics, internal or family medicine or cardiology believe they can accurately predict the whether patients with heart failure are at risk of dying, new Saint Louis University research found.

The ability to determine whether patients are within six months of death is crucial to clinical care, impacting key patient-care decisions such as therapeutic approaches and referral for palliative care, which is focused on symptom relief rather than cure.

"Our findings are important not only in light of the increasing prevalence of heart failure in the United States but because the data show that there are considerable gaps in knowledge regarding end-stage heart failure that ultimately affect a patient's experience with their illness," says Paul Hauptman, M.D., professor of internal medicine at Saint Louis University School of Medicine and the study's lead author.

"Palliative measures can be adopted to ease the pain of patients with terminal heart failure, but these measures are not always utilized because of uncertainty about the patient's prognosis. Unlike cancer, for example, predicting death is not always clear with end-stage heart failure."

Across the board, physicians reported that they were unlikely to refer a patient with end-stage heart failure for hospice care. Their reluctance was due in part to uncertainty about timing and patient acceptance of the recommendation......... Posted by: April      Read more         Source

February 7, 2008, 10:08 PM CT

Woman is first in region to receive new heart valve

A 78-year-old St. Louis woman was the first patient in this region to receive an experimental device to replace her defective aortic valve without opening the chest wall or using a heart-lung machine. This procedure waccording toformed by Washington University cardiologists at Barnes-Jewish Hospital on Jan. 15.

The woman is an initial participant in a national multicenter trial to evaluate the effectiveness of the new device. If proven effective, this new device holds enormous hope for patients who are unable to undergo the standard open-heart surgery for aortic valve replacement because they are too old or too sick to qualify for the surgery.

The patient, a retired registered nurse, longtime girl scout volunteer and mother of five, is expected to be discharged from the hospital as early as Friday.

Washington University School of Medicine/Barnes-Jewish Hospital is one of only 10 heart centers selected by the U.S. Food and Drug Administration (FDA) to evaluate this technique, which uses a catheter to thread a replacement aortic valve into the heart. Mounted on a catheter, the valve can be guided through the patient's circulatory system from the leg or inserted between the ribs into the heart and expanded at the site of the patient's diseased valve. The technique is called transcatheter valve replacement......... Posted by: April      Read more         Source

January 17, 2008, 10:23 PM CT

Increased risk of heart attack for who are resistant to aspirin

Being resistant to aspirin makes patients four times more likely to suffer a heart attack, stroke or even die from a pre-existing heart condition, as per a research studypublished on bmj.com today.

The study relates to patients who are prescribed aspirin long term as a way of preventing clots from forming in the blood.

Patients who are labelled aspirin resistant have blood cells (platelets) that are not affected in the same way as those of patients who are responsive to the drug, ie people who are aspirin sensitive.

There is currently no agreed method of accurately determining who is and isnt aspirin resistant and the reasons why someone might be aspirin resistant are currently a cause of controversy.

Relatively few studies have looked at whether aspirin resistance has any impact on clinical outcome so the Canadian authors carried out a review of all the available data to better understand the relationship between the two.

They identified 20 studies, involving 2,930 patients with cardiovascular disease, all of whom had been prescribed aspirin as a way of preventing clots from forming in the blood. 28% were classified as aspirin resistant.

They observed that all aspirin resistant patients, regardless of their underlying clinical condition, were at greater risk of suffering a heart attack, stroke or even dying. In particular they observed that 39% of aspirin resistant patients in comparison to 16% of aspirin sensitive patients suffered some sort of cardiovascular event......... Posted by: April      Read more         Source

January 10, 2008, 11:05 PM CT

High Blood Pressure In Older Adults

Researchers have identified the gene that sets off a sequence of events in the blood vessels of otherwise healthy adults that can lead to high blood pressure. The disease process eventually makes conditions in vessels ripe for the creation of blockages that can cause heart attacks, strokes and circulatory problems.

The finding in a study led by Ohio State University scientists might lead to new therapeutic options for high blood pressure, particularly high blood pressure linked to aging. Obesity and aging contribute to increasing cases of high blood pressure, which currently affects an estimated 50 million Americans.

Despite more intensive therapys available for hypertension, little has been done to prevent it. A change in the structure of the blood vessels, called vascular remodeling, increases with age and triggers the onset of the disease. When remodeling occurs, blood vessel walls increase in thickness, decreasing the diameter of the channel through which blood normally flows.

The gene, called profilin 1, has been traced to a series of interactions within the smooth muscle cells of blood vessels that causes those cells to increase in size. This in turn narrows the channel through which blood flows, causing stress on vessel walls, injuring the lining of the vessel walls and making it easier for blockages to develop. By identifying this pathway, scientists hope to pinpoint the most effective therapeutic target to interfere with the disease process......... Posted by: April      Read more         Source

January 8, 2008, 9:43 PM CT

A healthy smile may promote a healthy heart

Each year, cardiovascular disease kills more Americans than cancer. And while most people are aware that lifestyle choices such as eating right, getting enough exercise and quitting smoking can help prevent cardiovascular disease, they may not know that by just brushing and flossing their teeth each day, they might also be avoiding this potentially lethal condition.

An article reported in the recent issue of the Journal of Periodontology (JOP), the official publication of the American Academy of Periodontology (AAP), suggests that periodontal patients whose bodies show evidence of a reaction to the bacteria linked to periodontitis may have an increased risk of developing cardiovascular disease.

Eventhough there have been a number of studies associating gum disease with heart disease, what we have not known is exactly why this happens and under what circumstances, said JOP editor Kenneth Kornman, DDS, PhD. The findings of this new analysis of previously published studies suggest that the long-term effect of chronic periodontitis, such as extended bacterial exposure, may be what ultimately leads to cardiovascular disease.

Scientists at Howard University identified 11 studies that had previously examined clinically-diagnosed periodontal disease and cardiovascular disease. The team then analyzed the participants level of systemic bacterial exposure, specifically looking for the presence of the bacteria linked to periodontal disease, as well as measuring various biological indicators of bacterial exposure. They observed that individuals with periodontal disease whose biomarkers showed increased bacterial exposure were more likely to develop coronary heart disease or atherogenesis (plaque formation in the arteries)......... Posted by: April      Read more         Source

January 7, 2008, 11:08 PM CT

Congestive heart failure leads to greater disability

Medical breakthroughs in recent decades have allowed heart attack survivors and other heart-disease patients to live longer. But as their hearts decline into congestive heart failure, an increasing number will experience disability and the need for nursing-home care.

A new study from the University of Michigan Health System and the VA Ann Arbor Healthcare System sheds light on the degree of disability among people with CHF, as well as the implications for the health care system, community care facilities, families and the patients themselves.

In particular, the study observed that CHF patients were much more likely to be disabled than people without the condition. They were found to be much more likely to have difficulties with activities of daily living, such as grocery shopping and walking across the room. And they were more likely to require care from nursing homes and family members.

The prevalence of congestive heart failure imposes a substantial burden on patients, families and the long-term care system, says lead author Tanya Gure, M.D., a lecturer in the Division of Geriatric Medicine at the U-M Health System. The degree of disability in this group is quite high, and their caregiving needs are extensive. We need to make sure, in the medical community and society in general, that we are adequately meeting their health and social needs......... Posted by: April      Read more         Source

December 20, 2007, 9:55 PM CT

New insights into deadly heart rhythm disorder

Every year, 300,000 Americans die suddenly when, out of the blue, a storm of electrical activity arises within their heart muscle so violent and so abrupt that their hearts just stop beating. These tragic and dramatic sudden cardiac deaths strike people young and old, often without warning.

But despite this, researchers still dont understand just what causes a hearts electrical system to suddenly go so berserk. They have a name for the rhythm disturbance that causes most sudden cardiac deaths ventricular fibrillation, or VF but not a full understanding of what makes one person more vulnerable to it than another.

And eventhough research on VF in animals is yielding important clues, it hasnt been clear if lessons learned from the hearts of laboratory mice can be applied to people.

Now, a new paper by a group of scientists published online in the Proceedings of the National Academy of Sciences sheds new light on the origins of VF and the ability of research in animals to be translated into humans. The paper, and other research by the team, may help lead to better ways to identify which people are at risk of sudden cardiac death, and to develop therapys to help them reduce their risk.

The paper, which will be in the December 26 print edition of PNAS, is by a group of scientists from the United States, Canada and Spain. Most of them are from a State University of New York Upstate Medical University group that is in the process of moving its research laboratory to the University of Michigan Medical School......... Posted by: April      Read more         Source