Heart Disease: Overview, Causes, Risk Factors, Treatment, Prevention
What’s good or bad for the heart, may be the same for the brain
It has been known for years that eating too many foods containing “bad” fats, such as saturated fats or trans fats, isn’t healthy for your heart. However, according to new research from Brigham and Women’s Hospital (BWH), one “bad” fat - saturated fat - was found to be associated with worse overall cognitive function and memory in women over time. By contrast, a “good” fat - mono-unsaturated fat was associated with better overall cognitive function and memory.
This study is published online by Annals of Neurology, a journal of the American Neurological Association and Child Neurology Society, on May 18, 2012.
The research team analyzed data from the Women’s Health Study - originally a cohort of nearly 40,000 women, 45 years and older. The researchers focused on data from a subset of 6,000 women, all over the age of 65. The women participated in three cognitive function tests, which were spaced out every two years for an average testing span of four years. These women filled out very detailed food frequency surveys at the start of the Women’s Health Study, prior to the cognitive testing.
“When looking at changes in cognitive function, what we found is that the total amount of fat intake did not really matter, but the type of fat did,” explained Olivia Okereke, MD, MS, BWH Department of Psychiatry.
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Warfarin in Heart Failure
Despite major advances in the management of heart failure with angiotensin-converting–enzyme inhibitors, beta-blockers, and resynchronization therapy, there are more than 1 million hospitalizations for heart failure in the United States each year, and mortality remains high. As compared with the general population, patients with heart failure have an increased risk of stroke and of systemic thromboembolic events, which are believed to arise from within the heart as a result of left ventricular stasis, endocardial dysfunction, and a systemic hypercoagulable state. Heart failure is a risk factor for atrial fibrillation, which, even if asymptomatic, further increases the risk of stroke. Consequently, one would expect that patients with heart failure could benefit from oral anticoagulant therapy. However, until now, the hypothesis that patients with heart failure benefit from long-term anticoagulant therapy has been tested only in modest-sized randomized, controlled trials.
In the Warfarin versus Aspirin in Reduced Cardiac Ejection Fraction (WARCEF) trial reported by Homma et al., 2305 patients (mean age, 61 years - relatively young for a population with heart failure) who had severe left ventricular dysfunction (mean left ventricular ejection fraction of 25%) were randomly assigned to receive warfarin (with a target international normalized ratio [INR] of 2.0 to 3.5) or aspirin (at a dose of 325 mg per day), with treatment continued for a mean of 3.5 years. Only 43% of patients had evidence of underlying ischemic heart disease. This, together with the exclusion of patients with known atrial fibrillation, meant that the trial was primarily testing whether anticoagulant therapy for the prevention of an embolism emanating from the left ventricle or caused by subclinical atrial fibrillation would lead to a reduction in the composite end point of stroke or death.
The careful conduct of this blinded trial, in which patients in the warfarin group had good control of INR levels (mean time in the therapeutic range after a 6-week period of dose adjustment, 62.6%) and which included more than 600 primary outcome events, has provided clinicians with clear answers. As compared with aspirin, warfarin did not significantly reduce the rate of the primary composite outcome of stroke (ischemic or hemorrhagic) or death.
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Increased Sudden Cardiac Death Rate Among HIV Patients
Patients with HIV/AIDS have a significantly increased risk of sudden cardiac death (SCD), according to a study published in the May 22 issue of the Journal of the American College of Cardiology.
Zian H. Tseng, M.D., of the University of California in San Francisco, and associates conducted a retrospective study of 2,860 HIV patients treated at a public HIV clinic in San Francisco from April 2000 to August 2009. Data were collected on deaths, cause of death, and clinical characteristics, and the link between HIV/AIDS and SCD was investigated.
During a median follow-up of 3.7 years, the researchers identified 230 deaths. Of these, 57 percent were due to AIDS; 14 percent met the criteria for SCD; 11 percent were due to natural causes; and 19 percent were due to overdoses, suicides, and unknown causes. Eighty-six percent of the cardiac deaths (30 of 35) were due to SCD. The mean SCD rate was 4.5-fold higher than expected, at 2.6 per 1,000 person-years. Compared with AIDS deaths, SCD occurred in older patients (49.0 versus 44.9 years; P = 0.02). SCDs had a significantly higher prevalence of prior myocardial infarction, cardiomyopathy, heart failure, and arrhythmia than AIDS and natural deaths combined.
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Air pollution level changes in Beijing linked with biomarkers of cardiovascular disease
During the 2008 Beijing Olympics, changes in air pollution were associated with changes in biomarkers of systemic inflammation and thrombosis (formation of blood clot) as well as measures of cardiovascular physiology in healthy young persons, according to a study in the May 16 issue of JAMA, a theme issue on Global Health.
“Air pollution is a risk factor for cardiovascular diseases (CVD), but the mechanisms by which air pollution leads to CVD is not well understood. Hypothesized mechanisms with associated biomarkers include systemic inflammation and thrombosis or endothelial [thin layer of cells that line the heart and certain vessels and cavities within the body] dysfunction,” according to background information in the article. “As a condition for hosting the 2008 Olympic Games, the Chinese government agreed to temporarily and substantially improve air quality in Beijing for the Olympics and subsequent Paralympics. This provided a unique opportunity to use a quasi-experimental design in which exposures and biomarkers were measured at baseline (pre-Olympics), following a change in pollution (during-Olympics), and then repeated after an expected return to baseline (post-Olympics).”
David Q. Rich, Sc.D., of the University of Rochester, New York, and colleagues conducted a study to determine whether markers related to CVD pathophysiological pathways (biomarkers for systemic inflammation and thrombosis, heart rate, and blood pressure) are sensitive to changes in air pollution. The researchers measured environmental air pollutants daily and also measured various biomarkers and other measures (heart rate, blood pressure) in 125 healthy young adults before, during, and after the 2008 Olympics (June 2-October 30). The biomarkers measured included those associated with systemic inflammation (fibrinogen, C-reactive protein [CRP], white blood cell [WBC] count) and thrombosis or endothelial dysfunction (platelet activation markers P-selectin [sCD62P] and soluble CD40 ligand [sCD40L] as well as the adhesive endothelial glycoprotein von Willebrand factor).
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Lack of basic evidence hampering prevention of sudden heart attacks in sport
Big gaps in basic knowledge about the numbers and causes of apparently inexplicable heart attacks among young sportsmen and women are seriously hampering our ability to prevent them, says a sport and exercise medicine specialist in the British Journal of Sports Medicine.
At the very least, we need to start building reliable databases of all such events across sport, in a bid to start plugging these knowledge gaps, say Dr Richard Weiler and colleagues.
His comments come in the wake of the recent high profile case of premier league footballer, Fabrice Muamba, who collapsed on pitch, in front of a stadium packed with spectators, after sustaining a sudden heart attack.
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Blacks Less Likely to Get Help on Scene After Cardiac Arrest: Study
Black Americans who suffer cardiac arrest in public places are less likely than whites to receive CPR and treatment with automated external defibrillators, a new study has found.
Cardiac arrest occurs when an abnormal heart rhythm causes the heart to stop beating. CPR and automated external defibrillators (AEDs)—devices that use electrical shocks to restore the heart to a normal rhythm—can help a cardiac arrest victim survive until emergency medical crews arrive on the scene.
The study also found that black cardiac arrest patients’ hearts were much less likely to have been restarted by the time they arrived at a hospital, which is an important indicator for whether cardiac arrest patients ultimately survive, said the University of Pennsylvania School of Medicine researchers.
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Heart attack patients taken to PCI hospitals first treated faster
Heart attack patients in North Carolina who were rushed directly to hospitals equipped to do percutaneous coronary intervention (PCI) received treatment significantly faster than patients first taken to hospitals unequipped to perform PCI and then later transferred for treatment, according to research reported at the American Heart Association’s Quality of Care and Outcomes Research 2012 Scientific Sessions.
The study focused on the most serious form of heart attack, ST-elevation myocardial infarction (STEMI). A STEMI typically involves complete blockage of the blood flow to the heart. Opening the blocked artery as quickly as possible is crucial to improving survival.
Physicians often use PCI, also known as angioplasty, to open blocked coronary arteries. A tiny balloon is inserted through a catheter, or tube, into the affected area. The balloon is inflated to widen the blocked areas. Physicians often combine the procedure with the insertion of a stent to help prop the artery open and decrease the chance of another blockage.
Opening the blockage with clot-busting drugs is used when timely access to PCI is not an option.
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Cameron Health’s under-skin ICD safe, effective
Cameron Health Inc, which agreed in March to be acquired by Boston Scientific Corp, said on Thursday its implantable heart defibrillator proved safe and effective for treating patients at risk for sudden cardiac arrest in a 330-patient clinical trial.
Cameron’s implantable cardioverter defibrillator (ICD) is the first such device that does not use intravenous leads, or electric wires, to transmit electricity from the device to the heart. Leads are often the weak link of the defibrillator system and can cause serious complications.
“Conventional ICDs are a proven therapy with a long clinical track record; however, complications related to transvenous leads, or wires placed in the heart, can be quite serious for patients,” said Dr Martin Burke, professor of medicine and director of the Heart Rhythm Center at the University of Chicago.
“We did not observe the typical lead-related complications with the S-ICD System, so having an alternative treatment for patients that can virtually eliminate transvenous lead complications is an important step forward for ICD therapy,” he said.
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Heart patients with a distressed personality reported worse health
People with a distressed (Type D) personality reported worse health than other patients after having devices implanted to ensure proper heart rhythm, according to new research in Circulation: Cardiovascular Quality and Outcomes, an American Heart Association journal.
Those reporting worse health within a year of having the internal defibrillators implanted were assessed before the procedure and found to have “Type D” personality traits, meaning they tend toward increased negative emotions but don’t share them with others due to fear of rejection.
In a study of 383 patients in the Netherlands, researchers also found that all implantable cardioverter defibrillator (ICD) patients whose devices shocked their hearts back into normal rhythm within a year of the procedure reported poorer health status. ICDs monitor heart rhythms and deliver electrical shocks to restore normal rhythm when life-threatening irregular heartbeats occur.
Patients who had both a Type D personality and whose defibrillators delivered a shock within the first year reported the worst health of all.
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Discovery may lead to targeted heart disease treatments
University of Guelph researchers have found the location and effect of abnormal heart proteins that can cause cardiac failure, a discovery that points to potential new ways to treat the most costly health problem in the world.
The study appears today in PLoS ONE, a peer-reviewed international journal published by the Public Library of Science.
“In order to cure heart disease, you have to understand its fundamental properties,” said study author John Dawson, a molecular and cellular biology professor.
“So we looked at variants of naturally occurring proteins that are found in people with heart disease.”
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