Heart Disease Appears Early in Obese Children

A new study published in the Winter 2007 issue of the Journal of Cardiometabolic Syndrome finds that early signs of heart disease  appear in obese children or in children at risk for obesity.

"Based on this study, these subtle markers can help us predict who could be at risk for heart disease and heart attacks," said Angela Sharkey, M.D., associate professor of pediatrics at Washington University School of Medicine and a pediatric cardiologist at St. Louis Children’s Hospital.

Nationally, 19% of children in the 6 to 11 age group and 17% of children aged 12 to 19 are overweight, which amounts to an epidemic says the Centers for Disease Control (CDC). Being overweight during childhood means a higher risk of adult obesity, with the possibility of diabetes, elevated blood pressure and heart disease.

Dr. Sharkey and Dr. Steven M. Lorch of the University of Texas Health Science Center at Houston reviewed data from 168 children aged 10 to 18 who suffer from heart murmur, chest pain, acid reflux or hiogh blood cholesterol. CDC guidelines for BMIA indicated that 33 patients were obese, 20 had a BMIA putting them at risk for obesity, and 115 were considered normal.

The obese children’s hearts were evaluated by Drs. Sharkey and Lorch using a new tissue Doppler imaging technique called vector velocity imaging. This tracks the movement of the heart’s muscular wall: changes in the rate of motion of heart muscle were averaged within each group and compared to the normal rate of motion.

"In the patients who are obese, the rate of motion of heart muscle changed," Sharkey said. "As a child’s BMIA increases, we see alterations in both the relaxation and contraction phase of the heartbeat. Many of these changes that have been seen in adults were assumed to be from long-standing obesity, but it may be that these changes start much earlier in life than we thought."

The results of the study, said Dr. Sharkey, help physicians in counseling patients and parents about the risks of obesity and the importance of achieving a normal weight.

"Even in teenagers, obesity leads to decreased myocardial performance and abnormal diastolic function," she said.

Source: Washington University in St. Louis

Increased Risk for Heart Disease in Women May Be Linked to Calcium in Coronary Arteries

Some 5% of women rated as low-risk for heart disease show indications of advanced coronary artery calcium, and may be at risk for cardiovascular problems, according to a report in Archives of Internal Medicine.

The standard method for assessing a person’s risk of developing coronary heart disease in the next 10 years is the Framingham risk score, which measures age, cholesterol and blood pressure levels, smoking habits and diabetes. Americans are considered low-risk if their risk is estimated at less than 10% in 10 years, and high risk if the risk is 20% or more in 10 years.

Approximately 95% of American women aged less than 70 are considered low-risk. “Nevertheless”, write the authors, “most women will ultimately die of heart disease, suggesting that the Framingham risk score alone does not adequately identify women in ways that would be useful for targeted preventive interventions”.

Susna G. Lakoski, M.D., M.S., of the Wake Forest School of Medicine, Winston-Salem, N.C., and colleagues measured 3,601 women aged 45 to 84, in 2000. Computed tomographic (CT) chest scans determined scores for coronary artery calcium. High scores pointed to considerable amounts of calcium deposits. Participants were interviewed by telephone every 9 to 12 months about any subsequent cardiovascular diagnoses and hospital admissions.

2,684 (90%) of women were assessed as low-risk by the Framingham score. 32% had detectable calcium in their coronary arteries, while during an average of 3.75 years, 24 of the low-risk women had heart attacks or heart pain, and 34% had a cardiovascular disease event such as heart attacks, stroke or death.

“Compared with women with no detectable coronary artery calcium, low-risk women with a coronary artery calcium score greater than zero were at increased risk for coronary heart disease and cardiovascular disease events,” the authors write. In addition, almost 5 percent of the low-risk women had advanced coronary artery calcium, defined as a score of 300 or greater. These women had a 6.7 percent risk of a heart event and 8.6 percent risk of a cardiovascular event over the 3.75-year follow-up.

The authors believe that these data provide new information on cardiovascular disease risk and the evaluation and treatment of it in middle-aged and older women. They also maintain that women with coronary artery calcium are at potentially higher risk that A Framingham risk score would suggest. Further studies with longer follow-up periods will be required to determine whether women should be screened for coronary artery calcium, or treated more aggressively for heart disease risk factors.

Source: Arch Intern Med. 2007;167(22):2399-2401

Physical Health After Age 49 Correlated to Stroke Risk

People after the age of 40 who can climb stairs, kneel, bend and lift may lower their risk of stroke by 50%.

Between 1993 and 1997 researchers checked a sample of 13,615 men and women in the UK aged between 40 and 79. Participants had not had a stroke, heart attack or cancer. They reported on their physical ability 18 months later, itemizing their ability to climb stairs, carry groceries, kneel, bend and lift. The number of strokes suffered by the group through 2005 was also noted.

Participants who scored in the top 25% on the physical function test had a 50% lower rate of stroke than participants with the lowest scores. For every 10-point increase, the mens’ risk of stroke was reduced by 19% and the women by 29%.

“People who reported better physical health had significantly lower risk of stroke”, said study author Phyo Kyaw Myint, MRCP, of the University of Cambridge. “This is independent of the known risk factors for stroke in the general population”. Myint said that people with poor physical health could represent a high risk for stroke, while pointing to other health issues such as chronic inflammation, leading to vascular disease. Increased physical activity, and eating more fruit and vegetables might also help reduce risk of stroke, he said.

Speedy Hospitalization After Heart Attack Onset Greatly Improves Care

A Mayo Clinic Research study finds that getting a heart attack patient to hospital within one to two hours of heart attack onset can assure that chances of receiving proper treatment are 70 percent better than a patient who waits 11 to 12 hours. The results of the study were presented at the American Heart Association’s Scientific Sessions 2007, In Orlando, Florida.

"This research should emphasize to patients that getting help immediately, by calling 911, gives them the best chance of receiving treatments we know can help save their lives or lessen the damage to their hearts" says Henry Ting, M.D., lead Mayo Clinic cardiovascular researcher on the national study. "If patients wait at home for hors with symptoms and come in later, unfortunately they aren’t getting the proper treatment."

The most serious type of heart attack is known as a STEMI, for which the best treatment is reperfusion therapy. The study documents how long it took for 440,398 heart attack patients to arrive at the hospital after heart attack onset, and correlate arrival time with the rates of reperfusion therapy they received upon arriving at the hospital.

  • Of patients who arrived at the hospital within one to two hours of heart attack onset, 77% received reperfusion therapy
  • Of those patients arriving at the hospital within two to three hours of attack onset, 73% received reperfusion therapy
  • Of those patients who reached the hospital within 11 to 12 hours of attack onset, only 46% received reperfusion therapy

"Although current guidelines recommend that STEMI patients who reach the hospital within 12 hours after their symptoms started should receive reperfusion therapy, we found that this is not happening," Dr. Ting says. "These delays represent a novel and modifiable risk factor and warrant further investigation. These results show that gaps remain in quality of care in patients with STEMI — first, we need to encourage patients with potential heart attacks to come to the hospital as early as possible; second, hospitals need to implement systems that treat all eligible patients rapidly regardless of the delay in presentation."

Source: Mayo Clinic

CT Heart Scan Reliable for Detecting Blocked Arteries

An international team of cardiac specialists, led by Johns Hopkins researchers, found that sophisticated computed tomography (CT) heart scans are almost as reliable as more invasive procedures.

The 64-slice CT scans, initially tested at Hopkins, will help cardiologists select patients who can avoid more invasive procedures. But the newer scans will not replace the cardiac catheterization, or coronary angiography, although perhaps 25% of the 1.3 million cardiac catheterizations performed annually in the U.S may be unnecessary.

In addition, the latest study showed that early detection with 64-CT would be a good forecaster of patients needing angioplasty or coronary bypass surgery.

Researchers chose 291 men and women over 40 years of age who already planned to have cardiac catheterization to check for blocked arteries. They were then checked to see who developed coronary artery disease, and who required subsequent bypass surgery. On average 91% of patients with blockages were detected by 64-CT scan, which also identified 83% without blockages. This accuracy, said researchers, enabled them to identify patients needing angioplasty or bypass surgery. More than 250,000 Americans undergo coronary bypass surgery annually.

"This study is the first step to realizing the full potential of CT imaging in predicting coronary artery disease, and these scans complement the arsenal of diagnostic tests available to physicians to prevent heart attacks," says cardiologist Julie Miller, M.D., who led the study at Hopkins.

"Use of 64-CT scans will dramatically improve our ability to detect and treat people with suspected coronary disease and chest pain much earlier in their disease," says cardiologist João Lima, M.D., senior investigator to the team whose findings will be presented at the American Heart Association’s (AHA) annual Scientific Sessions in Orlando, Florida. "Cardiac catheterization is still the gold standard for evaluating clogged arteries, but our results show that this test could easily be the best backup or alternative."

Source: Johns Hopkins Medicine

Angry Men at Higher Risk for Heart Disease, Diabetes

It’s not healthy to be hostile, according to a recent study from Duke University.

Steven Boyle, Ph.D., a researcher at Duke University Medical Center, says men who regularly exhibit strong feelings of anger or depression may face increased risk of coronary heart disease.

The study was conducted on 313 men who were given a standard psychological test that measures hostility, anger and depression.

Men whose psychological screening showed the highest level of hostility, depressive symptoms and anger had a 7.1 percent increase in levels of an immunity protein known as C3, while men with lower levels of hostility, depression and anger showed no during the decade-long study.

According to the study’s co-author, Edward Suarez, Ph.D., the lifestyle of individuals with a hostile attitude, "often leads to greater stress and possibly changes in the way the body functions that could lead to disease.”

The study appears in the August issue of the journal Brain, Behavior, and Immunity.

Source: Health Behavior News Service

Heart Bypass Survival Ratings Report – “Best” Hospitals Get Worst Ratings

California health authorities will release the results of a study showing the rate of death of bypass surgery patients in California hospitals, including the names of some of the surgeons with the poorest patient survival records.

Doctors and hospitals have argued that the study does not adequately consider the difficulty of each individual case, and may lead to surgeons turning away patients who have lesschance of survival.

According to the San Francisco Chronicle "the state-mandated survey gave the worst ratings to some hospitals that have been regarded as among the best in the business" including UCSF Medical Center and Santa Rosa Memorial Hospital.
Supporters of the study say that outcome reports are important when consumes make healthcare decisions.

Source: San Francisco Chronicle (7/13/2007)