April 8, 2009, 5:04 AM CT

Exercise for patients with chronic heart failure

Regular exercise is safe for heart failure patients and may slightly lower their risk of death or hospitalization, as per results from the largest and most comprehensive clinical trial to examine the effects of exercise in chronic heart failure patients. Supported by the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health, the study also observed that heart failure patients who add regular, moderate physical activity to standard medical treatment report a higher quality of life in comparison to similar patients who receive medical treatment only.

Scientists with HF-ACTION (Heart Failure A Controlled Trial Investigating Outcomes of exercise TraiNing) have published two papers in the April 8, 2009, issue of the Journal of the American Medical Association The study was conducted at 82 centers in the United States, Canada, and France.

"A number of patients and health care providers have continued to be concerned about the safety of aerobic exercise for heart failure," said NHLBI Director Elizabeth G. Nabel, M.D. "With the results of this robust clinical trial, we can now reassure heart failure patients that, with appropriate medical supervision, regular aerobic exercise is not only safe but it can also improve their lives in really meaningful ways."........ Posted by: April      Read more         Source

April 7, 2009, 5:20 AM CT

Reduce depression after heart surgery

Two non-pharmacological interventionscognitive behavior treatment and supportive stress managementappear more effective than usual care for treating depression after coronary artery bypass surgery, as per a report in the recent issue of Archives of General Psychiatry, one of the JAMA/Archives journals.

About one in every five patients experiences a major depressive episode following coronary artery bypass graft (CABG) surgery and at least that a number of develop milder forms of depression, as per background information in the article. "Depression around the time of surgery predicts postoperative complications, longer physical and emotional recovery, worse quality of life and increased rates of cardiac events and mortality [death]," the authors write, and may also be associated with problems with thinking, learning and memory.

Kenneth E. Freedland, Ph.D., of the Washington University School of Medicine, St. Louis, and his colleagues conducted a randomized clinical trial involving 123 patients who had major or minor depression within one year after CABG surgery. Of these, 40 were randomly assigned to usual care as determined by primary care or other physicians and the other patients were assigned to one of two therapy groups.

This included 41 patients who underwent 12 weeks of cognitive behavior treatment, shown to be an effective therapy for depression in other populations. The individual, 50- to 60-minute sessions with a psychology expert or social worker involved identifying problems and developing cognitive techniques for overcoming them, including challenging distressing automatic thoughts and changing dysfunctional attitudes. The other 42 patients received 12 weeks of supportive stress management, in which a social worker or psychology expert counseled the patient about improving his or her ability to cope with stressful life events. Depressive symptoms were assessed at the beginning of the study and again after three, six and nine months......... Posted by: April      Read more         Source

March 31, 2009, 3:40 PM CT

Why that patient is in heart failure

A failing heart makes a lot of a hormone needed to eliminate the excess salt and water bloating the body but not enough of the enzyme needed to activate it, scientists say.

Using novel assays they developed, Medical College of Georgia scientists found people in heart failure have less of the enzyme corin needed to activate pro-ANP, or pro-atrial natriuretic peptide, a hormone made by heart muscle cells that, when active, helps reduce extra sodium and fluid that tax the cardiovascular system.

Low corin levels help explain why the heart's natural attempt to save itself is often thwarted in heart failure and scientists hope the new tests they developed can help identify those people.

"The question is always: If you have so much of this hormone that is supposed to increase diuresis, why are patients still in heart failure with all this fluid in their lungs?" says Dr. Uzoma Ibebuogu, cardiology fellow at the Medical College of Georgia.

Dr. Ibebuogu presented the findings at the American College of Cardiology Congress March 28-31 in Orlando where he was among five finalists for the Young Investigator Award.

When he and his colleagues Drs. Guy Reed and Inna Gladysheva compared 14 patients in heart failure to 16 people with healthy hearts, they found those in heart failure had about 80 percent less corin. Their assays enabled measurement of corin as well as active ANP levels instead of only the total pro-ANP levels measured by current technology......... Posted by: April      Read more         Source

March 22, 2009, 9:39 PM CT

Genes associated with sudden cardiac death

You're sitting at your desk and suddenly your heart is beating in overdrive or worse, lurching along like a car on fumes. It is a shocking, uncomfortable and frightening sensation.

Irregular heart rhythms are a common cause of sudden cardiac death or SCD, a condition that accounts for 450,000 deaths annually in the United States. Researchers are now closer to understanding what causes SCD and who it may strike, said Gonalo Abecasis, associate professor of biostatistics at the University of Michigan School of Public Health.

Abecasis co-led on an international study aiming to identify genetic defects linked to sudden cardiac death. Aravinda Chakravarti of Johns Hopkins and Arne Pfeufer of the Institute for Human Genetics in Gera number of also co-led the study. Serena Sanna, formerly at the U-M School of Public Health and now a researcher at the National Research Center in Cagliari, Italy, was joint first author.

The team identified 10 genes linked to changes in the so-called QT interval duration. The QT interval duration measures the length of time the heart takes to contract. A QT interval that's too long or too short can cause serious problems, including arrhythmias and sudden cardiac death. The QT interval can be seen on an electrocardiogram monitor; it's a certain portion of the line that waves or spikes up and down when the heart contracts......... Posted by: April      Read more         Source

February 9, 2009, 6:21 AM CT

Gene associated with early heart attack

The largest study ever completed of genetic factors linked to heart attacks has identified nine genetic regions three not previously described that appear to increase the risk for early-onset myocardial infarction. The report from the Myocardial Infarction Genetics Consortium, based on information from a total of 26,000 inviduals in 10 countries, will appear in Nature Genetics and is receiving early online release.

"For several decades, it has been known that the risk for heart attack the leading cause of death and disability in the U.S. clusters in families and that some of this familial clustering is due to differences in DNA sequence," says Sekar Kathiresan, MD, director of Preventive Cardiology at Massachusetts General Hospital (MGH) and corresponding author of the Nature Genetics report. "We set out to find specific, single-letter differences in the genome, what are called single-nucleotide polomorphisms (SNPs), that appears to be responsible for an increased familial risk for heart attack."

Groundwork for the current study was laid more than 10 years ago when co-author Christopher O'Donnell, MD, now based at the Framingham Heart Study, began to gather data on patients treated at the MGH for early-onset heart attack men under 50 and women under 60. Kathiresan soon joined the project, and in 2006 they formed the Myocardial Infarction Genetics Consortium along with David Altshuler, MD, PhD, of the MGH Center for Human Genetic Research and the Broad Institute of MIT and Harvard, eventually involving six groups around the world that had collected samples on a total of about 3,000 early-onset heart attack patients and 3,000 healthy controls......... Posted by: April      Read more         Source

January 6, 2009, 7:01 PM CT

New risk assessment tools need to predict Coronary Heart Disease

The Framingham and National Cholesterol Education Program tools, NCEP, do not accurately predict coronary heart disease, according to a study performed at the Yale University School of Medicine in New Haven, CT.

The study included 1,653 patients who had no history of coronary heart disease; although 738 patients were taking statins (cholesterol lowering drugs like Lipitor) because of increased risk of developing coronary heart disease. All 1,653 patients underwent a coronary CT angiogram and doctors compared their risk of coronary heart disease, determined by the Framingham and NCEP risk assessment tools, to the amount of plaque actually found in their arteries as a result of the scan. Results showed that 21% of the patients who were thought to need statin drugs before the scan (because of the Framingham and NCEP assessment tools) did not require them; "26% of the patients who were already taking statins (because of the risk factor assessment tools) had no detectable plaque at all," said Kevin M. Johnson, MD, lead author of the study.

"Risk assessment tools are used by physicians implicitly. Physicians use them as a way to separate and treat patients accordingly. Ultimately, the Framingham influences what every doctor does, but I feel it is not good enough to show what is happening with each individual patient," said Dr. Johnson......... Posted by: April      Read more         Source

December 6, 2008, 4:34 PM CT

A little wine boosts omega-3 in the body

Results from the European study IMMIDIET show that moderate wine intake is associated with higher levels of omega-3 fatty acids considered as protective against coronary heart disease.

Moderate alcohol intake is associated with higher levels of omega-3 fatty acids in plasma and red blood cells. This is the major finding of the European study IMMIDIET that would be published in the recent issue of the American Journal of Clinical Nutrition, an official publication of the American Society for Nutrition and is already available on line (www.ajcn.org ). The study suggests that wine does better than other alcoholic drinks. This effect could be ascribed to compounds other than alcohol itself, representing a key to understand the mechanism lying behind the heart protection observed in moderate wine drinkers.

The IMMIDIET study examined 1,604 citizens from three geographical areas: south-west London in England, Limburg in Belgium and Abruzzo in Italy. Thanks to a close cooperation with General Practitioners of these areas, all participants underwent a comprehensive medical examination, including a one year recall food frequency questionnaire to assess their dietary intake, alcohol consumption included.

Omega-3 fatty acids, mainly derived from fish, are considered as protective against coronary heart disease and sudden cardiac death, thus their high blood concentration is definitely good for our health......... Posted by: April      Read more         Source

November 24, 2008, 9:32 PM CT

Gasping helps cardiac arrest victims survive

People who witness an individual collapse suddenly and unexpectedly should perform uninterrupted chest compressions even if the patient gasps or breathes in a funny way, research from the Resuscitation Research Group at The University of Arizona Sarver Heart Center shows. The study is set to publish in the Nov. 24 online issue of Circulation, the official journal of the American Heart Association, http://circ.ahajournals.org.

When an individual breathes abnormally or gasps after collapsing from sudden cardiac arrest there is a greater chance of surviving, the scientists report. Gasping can be thought of as a survival reflex triggered by the brain.

Each day, about 500 Americans collapse because their hearts suddenly stop beating. Data collected by Sarver Heart Center scientists show that in more than half of witnessed cardiac arrest cases, the patient gasped.

"Gasping is an indication that the brain is still alive, and it tells you that if you start and continue uninterrupted chest compressions, the person has a high chance of surviving," said Gordon A. Ewy, MD, corresponding author of the study, professor and chief of cardiology at the UA and director of its Sarver Heart Center. "We need people to promptly recognize sudden cardiac arrest, to call 9-1-1 and to start chest compressions right away"......... Posted by: April      Read more         Source

November 12, 2008, 10:39 PM CT

Sex differences narrow in death after heart attack

In recent years, women, especially younger women, experienced larger improvements in hospital mortality after myocardial infarction than men, as per a new study.

Over the last decade some studies showed that younger women, but not older ones, are more likely to die in the hospital after MI than age-matched men. A team of scientists led by Emory University examined whether such mortality differences have declined in recent years.

"We observed that the number of younger women who die in the hospital after a heart attack, compared with men has narrowed over the last few years," says study leader Viola Vaccarino, MD, PhD, professor of medicine (cardiology), Emory University School of Medicine.

Vaccarino says changes in patient characteristics and therapys over time accounted in part for the changing mortality trends. The findings were presented Nov. 12 at the American Heart Association Scientific Sessions conference in New Orleans.

Often referred to as a heart attack, MI occurs when the blood supply to part of the heart is interrupted. This decreased blood supply is usually due to blockage of a coronary artery and if left untreated can cause damage and/or death (infarction) of heart muscle tissue.

The scientists investigated MI mortality trends as per sex and age in five age groups during a 12-year period from 1994 to 2006. The study population included 916,380 MI patients from the National Registry of Myocardial Infarction (NRMI) who had a confirmed diagnosis of MI......... Posted by: April      Read more         Source

November 12, 2008, 10:35 PM CT

New theory that may lead to effective heart failure treatments

Do the biological underpinnings of heart failure share more in common with malignant tumors than other cardiovascular diseases?

Research presented at American Heart Association meeting may show why heart failure therapys fail.

A team of Medical University of South Carolina (MUSC) scientists and heart specialists are presenting many studies at the American Heart Association conference that point toward new therapys for heart failure patients.

As per the American Heart Association, more than 5 million Americans are living with heart failure, and 550,000 new cases are diagnosed each year. It is a chronic disease that has no cure and typically worsens rapidly.

Dr. Francis G. Spinale and several other scientists from MUSC have put together scientific clues resulting in more than a dozen research studies on patients and mice that strongly suggest that a family of proteins called matrix metalloprotienase (MMP) play a crucial role in why the supporting tissue surrounding the heart, called the myocardium, goes through significant and deleterious effects in heart failure patients.

The conclusions reached by the team have already led to the development of a blood test for these MMPs. But more significantly, as per MUSC cardiac specialist Francis G. Spinale, MD, PhD, this research may demonstrate why current therapys for heart failure are failing and point to novel therapy methods for heart failure patients, reduce the number of people on the heart transplant list and help prioritize those heart failure patients currently on the list......... Posted by: April      Read more         Source