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

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Doctors Proactive in Pre-diagnosis Treatment of Heart Attacks

Doctors are treating patients with a suspected heart attack as aggressively as they are patients who have been diagnosed with an attack. Researchers from Wake Forest University School of Medicine analyzed patient data from over 450 hospitals in 12 countries. They compared the treatment received by patients with different levels of troponin—a protein and a marker of damage to the heart muscle—in their initial evaluation after arriving at hospital.

Troponin levels become elevated over a six- to eight-hour period after the occurrence of a heart attack, making a definite diagnosis problematic in the first few hours following an attack. The study aimed to determine whether the resulting delay in diagnosis can impact on patient care. Patients were divided into three groups: those who presented with elevated troponin levels and were therefore known to have had a heart attack, those whose troponin levels became elevated within 12 hours, and those who showed no elevation. The results showed that for the first two groups, which can be classified as high-risk, treatment options were very similar. Both groups were initially treated with blood-thinning agents such as aspirin and received similar levels of invasive treatment such as angioplasty and bypass surgery.

The finding is encouraging, as it suggests that doctors are being proactive in their treatment decisions, with patients receiving vital treatment even before the presence of a heart attack is confirmed through laboratory tests.

Aspirin Less Effective Therapy for Women

Women who take aspirin daily to reduce the risk of heart attack or stroke may not be benefiting from the therapy at all. Researchers from the University of Michigan College of Pharmacy have found that women are more resistant to aspirin, regardless of their medical history.

Aspirin is taken regularly by approximately 20 million people and is thought to cut the probability of a non-fatal heart attack or stroke by around one-fifth. It works by suppressing the tendency of platelets in the blood to clump together to form blood clots. Previous studies had indicated aspirin therapy to be less effective for women, but did not indicate why. Furthermore, previous studies on aspirin resistance were carried out in patients with a history of heart attacks. The present study involved 100 patients with stable coronary heart disease, half of whom had experienced a heart attack in the past. Blood samples taken from the patients were exposed to a blood-clotting agent, and platelet activity was analyzed using the VerifyNow Aspirin Assay device. Platelet inhibition of 40% or more is taken as a mark of aspirin resistance.

Results showed that women were more resistant to aspirin than men, which researchers believe could be due to women having a more active platelet system. Further research on aspirin resistance in women is vital in order to find a heart disease therapy that meets the potentially differing needs of both men and women.

Outcome for Drug-eluting Stents Similar to Bypass Surgery

The risk of major complications after drug-eluting stent therapy for coronary artery disease is similar to that following bypass surgery, researchers have found. Previous studies had shown bypass surgery to be more successful at improving a patient’s blood flow in the long term compared with traditional stents, which—although considered safer—re-narrow in one out of three patients.

Drug-eluting stents, however, have been designed to prevent the re-narrowing of arteries, and may prove a viable alternative to bypass surgery. In order to test this, researchers from St Luke’s Episcopal Hospital and Texas Institute, Houston, compared the outcomes of 800 patients who underwent surgery and 800 patients who received drug-eluting stents. Patients were monitored for 30 days after surgery and followed up after three years. The study showed the rate of early complications to be roughly the same between the two patient groups, with 5% of drug-eluting stent patients and 3.8% of bypass patients experiencing complications. There was no significant difference in death rates after three years (9% of drug-eluting stent patients and 6.6% of bypass patients). Researchers explain that since the safety and efficacy of drug-eluting stents have been established, they are increasingly fitted in high-risk patients, accounting for the slight differences in the complication and death rates. The study predicts a future in which the choice between drug-eluting stents and bypass surgery will be determined not by differences in efficacy but by risk factors specific to each patient.

Report Warns of Emerging Global High Blood Pressure Crisis

Increasing prevalence of uncontrolled high blood pressure may lead to a global epidemic of cardiovascular disease, causing a massive burden on health systems and economies in both developed and developing countries. The warning is contained in a report presented to the European Parliament and endorsed or supported by 12 leading medical groups.

Although recognizing the significant reductions in cardiovascular disease that have been achieved over the last 40 years, High Blood Pressure and Health Policy: Where We Are and Where We Need to Go Next reminds governments and health policy makers not to become complacent about the risks posed by high blood pressure, both to individuals and at a socioeconomic level. While high blood pressure can cause fatal heart attacks, kidney disease, and dementia, it remains a modifiable risk factor. The report therefore urges further improvements to be made in education, management strategies, and medical collaboration. A further warning concerns the encroachment of cardiovascular disease into younger age groups, impacting individuals with high earning power. The economic consequences of this may be devastating, as contributors to public revenues instead become a burden on healthcare systems.

The report also emphasizes a number of specific lifestyle issues that need further attention, including excessive alcohol consumption, smoking, and high-salt high-fat diets. A concerted effort to address these areas could prevent the predicted global increase in high blood pressure, which it is estimated will affect 1.56 billion people by 2025.

Migraines Linked to Increased Heart Attack Risk in Men

Men who experience migraine headaches are more likely to suffer from cardiovascular disease, and in particular are at an increased risk of heart attack, Harvard researchers have found.

Approximately 28 million people in the US experience migraines, which cause dizziness, nausea, and, in severe cases, visual disturbance. In a longitudinal study lasting 24 years (1981–2005) just over 20,000 men were asked to complete annual questionnaires on their health and occurrence of cardiovascular events. Around 7% of the men surveyed were classified as having migraines and 2% had frequent migraines. Analysis revealed that men with migraines suffer from a higher rate of major cardiovascular disease (8.5 out of 10,000 men) in comparison with those who do not have migraines (10.4 out of 10,000 men). Among the various cardiovascular events recorded, the risk of heart attack was found to be a particular risk for men with migraines.

Although there is as yet no clear explanation for the increased cardiovascular risk in men with migraines, researchers suspect that migraines may be a marker of artherosclerosis—the formation of plaque within the arteries. In order to test such hypotheses, future studies may focus on women, who in fact are three times as likely to suffer from migraines in comparison with men (6%).