The US Cardiovascular Arena - In Brief An Authoritative Round-up of Trends, Statistics and Clinical Research

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HRT Linked to Heart Attack Reduction in Women Under 60 Years

Hormone replacement therapy (HRT) could reduce heart attacks in women under the age of 60 by up to one-third.

A study, conducted by researchers from Stanford and Cornell universities, analyzed statistical data for over 39,000 women. It uncovered that, for women who began HRT treatment to relieve menopausal symptoms whilst in their 50s, the chance of cardiac death reduced significantly by over 32%compared witho those who received no treatment.

The study did note, however that, for women over the age of 60 years, results were not so conclusive. Indeed, for this age group, HRT increased the risk of heart attacks for the first year of treatment. After two years of treatment, however, the risk of heart attacks reduced below the level of women on either the placebo or on no treatment at all.

The results of this study further support a meta-analysis, conducted by the same researchers in 2004, that concluded 39% fewer deaths among woman who started HRT treatment prior to the age of 60 years, compared to those not on HRT treatment.

The Women's Health Initiative has previously reported a positive correlation between HRT treatment and the number of heart attacks. However, this research was based on a study group with a mean age of 63 years, and did not further examine age as a factor. These latest findings may prove important not only in indicating the cardiovascular benefits of HRT treatment in younger women, but also in helping to eradicate confusion among women, ignited by previous trial results.

American Heart Association Publishes New Diet and 'Lifestyle Guidelines

The American Heart Association (AHA) has released new lifestyle and dietary guidelines aimed at reducing risk of cardiovascular disease.

In the first major update of the guidelines since 2000, the AHA has introduced the term 'lifestyle', a move designed to cover factors such as smoking and physical activity into the equation in the prevention of cardiovascular disease.

Of note, these latest guidelineswhich have been formulated following the research and review of a plethora of scientific publicationsinclude significant revision in areas such as fat intake. In 2000, the guidelines recommended that cholesterol-lowering fatty acids should comprise 10% or less of daily calorie intake. The amended recommendations advise that trans-fat should comprise less that 1%, while saturated fat should attribute less that 7% of daily calorie intake.

Despite the changes, the suggested core diet remains much the same; lean meats and fish, vegetables and fruit, and whole-grain are all integral to a healthy lifestyle.

With obesity at an all-time high, the report also specifies guidelines on the consumption of high sugar drinks, as well as stressing the need for education to ensure consumers understand their calorie requirements. In addition, the report also recommends that restaurants, schools, and other food establishments list calorie content in foods, whilst reducing portion size.

New Non-invasive Imaging Technology May Enable More Precise Diagnosis of Coronary Artery Disease

A recent study has demonstrated a new non-invasive cardiac imaging technology for the assessment of coronary heart disease.

Coronary heart disease caused by the narrowing of heart arteries may be combated by a new technique that enables an accurate reading of blood vessel narrowing and the subsequent impact on blood supply to the heart.This may be done in a single imaging session.

Initial results of the study, presented at the Society of Nuclear Medicines Annual Meeting in June, suggest that non-invasive imaging technology could lead to significantly enhanced accuracy in the diagnosis of coronary heart disease. "This could enable treatment tailoring in the individual patient who may be directed to either invasive or conservative medical procedures," said study leader Zohar Keidar, Rambam Healthcare Campus, Haifa, Israel.

A computed tomography (CT) coronary angiography represents a fast developing technique for non-invasive assessment of the narrowing of blood vessels. The technology in question, cardiac single positron emission CT (SPECT)/CT combines two imaging modalities in the one device. This consists of the CT coronary angiography and perfusion imaging.

Results indicate that the combined information from the imaging permits the precise location of abnormal ischemic areas of the cardiac muscle, indicating if one of the arteries is obstructed and needs treatment.

It is hoped that combining the physiological imaging with anatomical imaging will mark a significant advance in the understanding and treatment of cardiovascular disease, which still remains the leading cause of death among citizens of the US.

Older Blood Associated with Worse Outcomes for Repeat Heart Surgery

Older blood transfused in patients undergoing repeat heart surgery is linked to increased risk of death, concludes new research from Duke University Medical Center.

The research monitored patients over the duration of their hospital stays and over periods following hospital discharge, and noted a significant association between older blood and adverse outcomes following repeat heart surgery.

Results of the research, published in the June edition of Anaesthesia & Analgesia Journal, show that the number of transfusions given is a robust predictor of long-term mortality. "The duration of blood storage has independent adverse effects," commented lead investigator Dr E Bennett-Guerrero.

In the study the medical files of 320 patients who had undergone repeat heart surgery during the period 1995-2001 and received donor blood were analyzed. For each patient the researchers correlated the data with the number and age of blood received by the patient, whilst factoring in other significant criteria such as patient age and weight.

The study concluded that there was a direct correlation between the age of blood and the risk of patient death. Scientists have long known that red blood cells undergo changes during their storage, but little was known about whether these changes have clinical implications for patients.

The findings may have serious health implications and will likely ignite further, large-scale, randomized studies to fully uncover the health dangers of using longer-term stored blood.

High Mortality Rates for Patients with Heart Failure and Kidney Disease

Over half of all patients with heart failure also have kidney disease, a combination synonymous with poor patient survival rates.

These findingsderived from a study by researchers at Yale School of Medicineare based on data of over 80,000 heart failure patients, amalgamated from 16 previous studies. This study, published in the Journal of American College of Cardiology in May 2006, compared survival rates in heart failure patients with and without kidney disease.

"The study confirmed that heart failure patients with kidney disease had worse survival rates [than patients without kidney disease]. Moreover, we were surprised to find that an extraordinarily high number of heart failure patients had kidney disease," commented lead researcher Grace Smith, MD.

Over 50% of heart failure patients were found to have at least mild disease, whilst almost one-third had either moderate or severe disease. When patients were tracked for a year, it become apparent that 38% of patients with mild kidney disease died, whilst the mortality rate of patients with either moderate or severe disease was 51%.

The extremely high mortality rates in this patient group is of major concern, more so due to the lack of current treatment options available for patients with heart failure and kidney disease.The results of the study heighten the need to better understand outcomes in this patient group in order to improve treatment strategies.