| Tweet |
Updates, advancements and bottom lines on heart disease.
In the United States, one person dies every 35 seconds from heart disease. The disease has remained the number one cause of premature death since 1900 and does not show any sign of slowing up. Currently, 1 in every 2.5 Americans has some form of cardiovascular disease (statistics from the American Heart Association).
With such widespread prevalence, it is not surprising that research studies are always going on to try to find out what can be done to ward off this killer. Yet despite having knowledge on how to reduce risk factors readily available in media, textbooks, and the World Wide Web, obesity has become an epidemic in both adults and children. February is Heart Month. Maybe it can provide a second chance to get on track, and raise the awareness of the part of the body that really needs focus - our hearts.
Good news in exercise research has shown that moderate aerobic types of activity on a regular basis actually preferentially select the fat in the mid-section. Based on this sort of exercise research, Wake Forest University School of Medicine researchers are studying over 6,500 people throughout the country, in all types of cultures and socioeconomic status. Their hope is to find out whether fat around the heart may increase the development of heart disease, similar to the way fat around the middle increases incidence of diabetes and high cholesterol values.
UPDATES ON HEART PROCEDURES:
Results of a study funded by the National Heart, Lung and Blood Institute (NHLBI) raised the question whether blocked arteries in heart attack victims three to 28 days after the heart event are better to be treated with medications (such as cholesterol lowering agents) or to undergo a procedure called angioplasty and stenting. This procedure involves a balloon-like tool that is inserted into the blocked artery and then fitted with a metal device called a stent to help keep the artery open. Results showed that patients who had the blocked arteries opened with angioplasty and stent were no better off than those who only took drug therapy. The study was called the Occluded Artery Trial and results were drawn from researching over 200 patients. This study was not aimed at patients who were currently undergoing a heart attack, who may benefit with early (within 48 hours) intervention, and also did not include the newer stents that are drug-coated, to help prevent re-occlusion in that same area of the artery. It also did not include people who had blockages receiving stents to prevent the onset of a heart attack.
As many may be aware, researchers and those in charge of compliance questioned the safety of drug-coated stents. The drug coated stents were heralded as the newer solution to a big problem, without having to do bypass surgery. Coated stents contain a slow dissolving medication that helps to prevent scar tissue that has historically been the downfall of non-coated stents in terms of re-stenosis. The recent fears towards drug-coated stents was the incidence of over 2,000 patients per year who developed life threatening blood clots once the stent was placed and up to two years later. However, many supporting physicians will continue to use the drug-coated stents for their ability to ward off re-occlusion of the artery. The newer recommendation is to prescribe anticoagulant therapy or blood thinning medication for longer than was initially determined as necessary for preventing blood clots from the stents.
Wisconsin researchers feel they may have found the reason for the increase in blood clot formation with drug-coated stents (currently 0.6-2.6% of patients, about 1 million Americans who get these types of stents implanted). The scientists at Medical College of Wisconsin observed that the medicine used to keep plaque and scar tissue around the stents from re-occluding (the whole benefit behind the drug-coated stent) may actually interfere with the hearts generation of collateral blood vessels. The production of new blood vessels helps to form a sort of bypass around a clogged artery. These findings have spawned other studies that wish to look further into the body’s capability to form these blood vessels. The hope is that a gene will be discovered that can perhaps be administered to potential stent patients who lack the gene, but would benefit from the opening of coronary arteries with stent placement.
NON-INVASIVE DIAGNOSTIC OPTIONS:
The newer non-invasive techniques, such as CT scanning and MRI, have gained acclaim in the medical industry. Cardiac catheterization and angiogram, where a probe is fed through an artery in the groin and up into the coronary vessels to detect blockages with imaging techniques, has been the most used diagnostic process. Unfortunately, people have shown clean reports on catheterizations and still had serious or even fatal heart attacks. The procedure carries risk to the arteries and requires at least an overnight stay in the hospital, costing anywhere from $10,000 to $20,000.
Cardiac CT scanning has shown a 90% accuracy rate in detecting blockages in the heart. CT scans use x-ray machines that produce many “slices” or pictures of the heart and the coronary arteries. The end result is a 3-D image of the heart and its vascular system. These newer, ultra-fast CT scans also detect a calcium score, or whether any calcification has taken place within the heart or arteries scanned.
Since the heart moves when it beats, this technology divides the heart into many slices that increases the resolution and now can get clear images within a short time. The scan could help with emergency room patients who come in with discomfort in the chest area or other symptoms that sound heart-related. Without having to go through a whole catheterization procedure, a doctor could determine if the person has some blockages in a coronary artery, or whether the discomfort stems from a muscular problem, or heartburn, or even a lung problem, for example. Downsides of CT scans are that calcium buildup may distort the ability to tell if a narrowing in the artery is causing complete or only a partial lack of blood flow. Also, radiation exposure projects a downside for the proponents of cardiac CT scans.
Bottom line: CT scans have a purpose in emergency rooms, to help rule in or rule out heart, lung, or major blood vessel involvement when a patient comes in with chest discomfort. The CT scan can detect obstructive lesions and higher-risk non-obstructive lesions, and thus can help in determining which patients should undergo intervention through angioplasty, surgery or medical management.
Another non-invasive procedure, Magnetic Resonance Imaging (MRI), does not need radiation, as it uses the concepts of electromagnets that detect hydrogen, present in any of the body tissues that contain water, such as soft tissues like muscle and organs. MRI can show which segments of the heart are lacking blood flow during heart attacks. They can determine the health of the muscular walls of the heart as well as the valves that control blood flow through the heart. The downside of MRI is that they take a lot of training for physicians to interpret them, so it is not easily made into an “everybody has one” situation. Insurance companies have yet to embrace them fully as well, in terms of taking place of the gold standard cardiac cath-eterization technique. The biggest choice seems to be deciding which patient needs which procedure done.
More current research has revealed that not all blockages equate into a heart attack. For example, some people have a large blockage, but have the ability to generate blood vessels around that blockage – called angiogenesis. Other plaques are not as large in terms of reducing blood flow, but may have a lot of inflammatory properties and are more likely to cause problems. However, knowing that a blockage is there may mean that the cardiologist can better make a call on prescribing statins and other medications to reduce heart-related risk factors for a patient. The additional benefit is finding a blockage well before a heart attack ever happens and taking action to prevent risks, without invasive procedure and high costs.
OTHER HEART-RELATED NEWS:
The leading study that in the 1970’s helped identify the initial risk factors for developing heart disease, the Framingham Heart Study, has now conducted a project that researched some newer emerging heart disease risk factors such as C-reactive protein and homocysteine (and eight other substances). Some of the predictors studied in the blood and urine samples did show an increase in likelihood of cardiovascular event, such as heart attack or stroke. However, the risk factors that have been used for decades showed just as much accuracy in predicting cardiovascular events. These standard risk factors include: high blood pressure, high cholesterol, smoking, age, being sedentary, diabetes, and family history of cardiovascular disease.
In response to the Framingham project, a big study is set to start on over 6,000 people with heart disease risk factors. The company, BG Medicine, is developing partnerships with drug companies and a health insurer, Humana, Inc. to try to identify a combination of risk factors or blood substances that seems to signal the likelihood of heart attacks. President of BG Medicine, Dr. Pieter Muntendam, has noted the prevalence of heart attacks that occur in someone who has not had a lot of buildup in arteries, but seem to occur because of something in the vessel wall. This same question has led to many studies on inflammation and its role in heart attacks, but BG Medicine and its co-researchers wish to find a better prediction for heart risk.
When it comes to risk factors, CT scans or MRI studies may come into play. For example, when a patient presents with discomfort in the chest or with another well-known heart symptom, but shows normal cholesterol values, no high blood pressure history and perhaps none of the other risk factors, doctors began to wonder what else could be going on. This was the reason for interest in other risk factors that may could be out there, such as inflammatory marker C-reactive Protein (CRP). A CT scan or MRI could non-invasively help determine whether the symptom had a potential heart-related cause by seeing what the heart and its vessels look like in addition to determining the patient’s risk factors from thorough medical history, physical exam and blood/urine samples.
In terms of psychological effects on heart disease, a study at Duke University Medical Center in Durham, North Carolina analyzed information gathered on over 2,000 Air Force Veterans studied over 17 years for incidence of heart disease. Those veterans with the highest levels of negative personality traits in combination were the ones with the most incidence of heart disease. Negative personality traits include depression, anger, hostility, and anxiety. Usually, people have a combination of these traits if they have one, so the researchers feel it is better to look at overall disposition rather than tweaking out individual negative traits.
UPDATES ON STEM CELLS (AND BEYOND):
Harvard researchers have found a “master” embryonic cardiac stem cell that, in mice, was able to generate cardiac cells. Not only was it able to generate heart cells, but the three different types of cells that make up the heart organ—the heart muscle itself, the smooth muscle cells, and the pacemaker cells that cause the heart to beat. Embryonic cells, though still controversial in some federal funding, has been shown to develop into basically any kind of body tissue cell. Plus, heart formation in a fetus is generated by embryonic cells. The hope is that the findings of these “master” cells can be applied in human subjects. As with all preliminary research, more study must take place prior to ensuring it is safe to try this with human subjects.
Meanwhile, Boston researchers at Hydra Biosciences in conjunction with Harvard are hoping that their findings may be the beginning of helping damaged body organs repair themselves. For someone who has suffered a heart attack, this means the regeneration of heart tissue so that a person may be able to go back to normal physical activity and prevent a downgrade into congestive heart failure, the inability of the heart muscle to work properly and leading to a backup of fluid in body tissues. The key is in inhibiting an enzyme in heart muscle that limits tissue growth. The method would involve administration of a regenerative protein into the bloodstream via inhalation or with a drug gun (no needles!). With the enzyme turned off, heart cells are able to replicate themselves into new heart muscle, taking the place of old, dead tissue.
PREVENTION:
Preventive measures, though not well-covered by the majority of U.S. insurance companies, are the best weapon against heart disease. Many people have turned to other cultures with lower incidence of heart disease for answers. Mediterranean diets have gathered a large audience, with many recipes and cookbooks available. Olive oil was thought to be one of the biggest helpful ingredients in the diet, but recent study published in the Journal of the American College of Cardiology (October 2006) seems to give walnuts more of the credit. Both olive oil and walnuts contain what is called Omega-3 fatty acids, which reduce inflammation and oxidation within arteries, but walnuts go one step further by maintaining the elasticity of arteries. The research even showed that eating approximately a hand full of the nuts along with foods that contain high saturated fat levels may reduce the fat’s harmful effects. However, people cannot expect to reap health benefits if they continue to eat horrible diets and just add a bit of walnuts along with their poor diet choices. It is best to try to eat as many fresh foods as possible, including choices that add walnuts throughout the day.
A British study found that something called procyanidins found in red wine help protect blood vessels. We already have heard how polyphenols in wine are beneficial to the heart, but procyanidins are certain kinds of polyphenols found only in red wines of southwest France and Sardinia (an island off the coast of Italy and Spain). The populations in these areas tend to live long life spans and red wine consumed there is made more traditionally, which increases the tannins. Of course, other experts caution us on taking the news to mean wine is a cure-all. The study merely shows correlation between procyanidins and longevity, but does not mean all people will respond the same way.
Meanwhile, Canadian researchers have shown what our epidemiologists feared with the rise in childhood obesity and diabetes – indications of plaque build-up in children’s coronary arteries. Prevention is the key, starting with good habits early in life. Again, convenience for busy lifestyles leads many parents, even those who know better, to lean on the wrong food choices for their kids. The study revealed the importance of knowing children’s cholesterol and blood pressure values early in life, and to make sure they are within ideal levels. Trying to make sure all children engage in regular exercise is also key. Parents need to pose as positive role models, living up to the recommendations they suggest for their kids. If a parent makes exercise an important part of everyday life, it becomes part of his or her child’s routine too.
BOTTOM LINE:
This year, make the right food choices and get moving as much as possible. Get help if you have no idea where to start – find a reputable registered dietitian and follow his or her advice. Prevention remains a priority in heart disease. For every person, it means making changes that prevent not only our own health from deteriorating, but the next generation’s too. Take necessary action against the things you can do something about, and try not to let history repeat itself if your family had poor luck with heart problems. Armed with the right set of tools and staying on top of most recent findings, Americans can make a dent in the upward trend of the nation’s number one killer. It just takes dedication.
