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

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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

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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.

Vaccination Controversy Spills Over to Video Sharing Site YouTube

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There is a growing debate over the necessity of the number of vaccines administered today. The controversy often surrounds a number of issues, such as pharmaceutical company lobbying to require administration of vaccinations that critics say have not undergone adequate testing.

For example, many states have pending bills that would require young girls to be vaccinated against HPV with Merck’s Gardasil. Currently only Virginia has passed a bill, as controversy has stalled bills in other states. The Virginia bill requires girls entering the sixth grade to be vaccinated, though it allows parents to opt their daughters out.

In February, 2007, Merck & Co. discontinued its lobbying of state
legislatures in an attempt to make it mandatory for girls to be inoculated with
Gardasil.

Others argue that over-vaccination will have long term detrimental effects on human immune systems. In the Journal Immunology Today researchers wrote:

Modern vaccinations, fear of germs and obsession with hygiene are depriving the immune system of the information input upon which it is dependent. This fails to maintain the correct cytokine balance and fine-tune T-cell regulation, and may lead to increased incidences of allergies and autoimmune diseases. If humans continue to deprive their immune systems of the input to which evolution has adapted it, it may be necessary to devise ways of replacing it artificially.

In a study published today in the Journal of the American Medical Association, University of Toronto researchers have uncovered widespread misinformation in related videos on YouTube.

The researchers, Dr. Kumanan Wilson and Dr. Jennifer Keelan, analyzed 153 videos about vaccination and immunization on YouTube, a popular online video-sharing site. Researchers found that more than half of the videos portrayed childhood, HPV, flu and other vaccinations negatively or ambiguously.

Of those videos, researchers report that about 45 per cent contained messages that contradict the 2006 Canadian Immunization Guide, which provides national guidelines for immunization practices. The Canadian recommendations are similar to guidelines from the American Centers for Disease Control and Prevention.

"YouTube is increasingly a resource people consult for health information, including vaccination," says first author Keelan, an assistant professor in U of T’s Department of Public Health Sciences. "Our study shows that a significant amount of immunization content on YouTube contradicts the best scientific evidence at large. From a public health perspective, this is very concerning."

The research team also found that videos skeptical of vaccinations—many of them highly provocative and powerful—received more views and better ratings by YouTube users than those videos that portray immunizations in a positive light.

"Health care professionals need to be aware that individuals critical of immunization are using YouTube to communicate their viewpoints and that patients may be obtaining information from these videos," says Wilson, senior author and an associate professor with U of T’s Department of Medicine. "YouTube users also need to be aware of this, so they can filter information from the site accordingly."

"The findings also indicate that public health officials should consider how to effectively communicate their viewpoints through Internet video portals," Wilson says.


Sources:

  • Journal of the American Medical Association, December 5, 2007
  • Universtiy of Toronto
  • Immunol Today, 1998 Mar;19(3):113-6.

Speedy Hospitalization After Heart Attack Onset Greatly Improves Care

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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

Most Heart Attack Patients Stop Taking Lifesaving Medications Within Three Years

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Surprisingly, many heart attack victims stop taking their lifesaving medication within three years of the attack. This was the finding of a Mayo Clinic study presented November 5 at the American Heart Association’s Scientific Sessions 2007.

By following patients at 6, 12 and 36 months after an attack, it was found that smokers were more likely to discontinue taking their prescribed medications within three years. Longer term, patients who were enrolled in cardiac rehabilitation programs tended to continue their medications longer than those who were not enrolled.

The researchers recommended a two-program plan for improving the public’s heart health: first, direct education at heart attack patient who are smokers, encouraging them to adopt physicians’ aftercare advice about continuing medications education; and second, encourage all heart patients to participate in a cardiac rehabilitation program, possibly increasing their likelihood of continuing prescribed treatments.

"The study clearly documented that treatments exist that improve outcomes following heart attacks, but patients need to comply with the treatment regimens for the goal of improved patient health to be realized," says Nilay Shah, Ph.D., the study’s lead researcher.

Patients discontinue taking medications too soon for a variety of reasons, including cost, says Veronique Roger, M.D., M.P.H., co-author of the study. More research is crucial to understand and resolve the barriers patients face as they recover from heart attacks she says.

The Mayo researchers evaluated 292 patients enrolled at the Olmsted County, Minnesota registry of heart attack patients, together with their medication histories up to 10 years. These patients had been discharged from the hospital and were taking ACE inhibitors, beta-blockers and statins to help prevent another heart attack.

Results showed that:

  • At six months, smokers were significantly less likely to continue all three heart medications compared to nonsmokers.
  • At six months, 92 percent of the patients taking statins continued treatment, and by three years only 44 percent of the patients continued taking statins.
  • Similarly, the rate of beta-blocker continuation dropped from 89 percent at six months to 47 percent at three years.
  • The rate of ACE inhibitor continuation dropped from 77 percent at six months to 37 percent at three years

Other members of the Mayo research team are: Henry Ting, M.D., Victor Montori, M.D., and Amy Wagie. Their work was supported by the Mayo Foundation for Medical Education and Research.

Teaching Kids Hand Washing Habits to Avoid Flu

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A new study, presented at the American Public Health Association’s Annual Meeting & Exposition in Washington, D.C. shows that with a little effort, kids can be taught to make hand-washing a lifetime habit.
A sample of 492 children in grades 1 through 6 was coached by a teacher, with role-playing and education on hand hygiene and a visual demonstration of its effectiveness. The coaching resulted in a lasting increase in the frequency of hand hygiene among elementary school-aged children.
The researchers suggest that with parent volunteers and the limited funds available, the school nurse could train the volunteers to teach a hand hygiene method, using germ-simulating lotion. The teachers could then prompt students to wash their hands before lunch, setting the example by washing their own hands.
"With flu season right around the corner, now is a great time to be having a conversation about what schools can do to encourage kids to develop the habit of washing their hands," said Michelle Snow, RN, MSPH, SHR, lead researcher on the study. "Our research shows that for a very low cost and just a little bit of effort, we can have an impact on a behavior that is important for our children’s health, not just now, but throughoutmtheir lives."
Source: American Public Health Association (APHA)

Ringing in the Ears? Researchers Now Think They Know Why

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Cells in the developing ear can make their own noise, long before the ear can detect sounds around them. This may explain why people sometimes hear sounds that appear to come from nowhere. Reported in the current issue of Nature, the study results also helps explain how the developing auditory system generates brain activity in the absence of sound.

Non-nerve cells in the ears of young rats were studied, and to the researchers’ surprise these support cells showed strong, spontaneous electrical activity, similar to nerve cells.

"It’s long been thought that nerve cells that connect auditory organs to the brain need to experience sound or other nerve activity to find their way to the part of the brain responsible for processing sound," says the study’s lead author, Dwight Bergles, Ph.D., an associate professor of neuroscience at Hopkins. "So when we saw that these supporting cells could generate their own electrical activity, we suspected they might somehow be involved in triggering the activity required for proper nerve wiring."

Suspecting that a chemical might be involved in the cells’ ability to generate electrical pulses, Bergles’ team applied a number of drugs to the cochlea—the small, hollow and liquid-filled inner ear chamber that converts sound waves to electrical signals—hoping to block the mystery trigger.

The breakthough came when it was discovered that ATP (adenosine triphosphate) also caused the supporting cells to change their shape. The team videotaped the developing cochlea to monitor where and where ATP was released. It was found to be released near hair cells, which transfer sound information to auditory nerves. ATP then signals the hair cells to release another chemical, glutamate, which then activate the nerve cells that project into the brain.

"It’s as if ATP substitutes for sound when the ear is still immature and physically incapable of detecting sound," says Bergles, adding that "the cells we have been studying seem to be warming up the machinery that will later be used to transmit sound signals to the brain."

The research was funded by the National Institutes of Health. Authors on the paper are Nicholas Tritsch, Eunyoung Yi, Elizabeth Glowatzki, and Bergles, all of Hopkins, and Jonathan Gale of University College, London.

Source: Johns Hopkins Medicine

CT Heart Scan Reliable for Detecting Blocked Arteries

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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

Healthy Lifestyle More Important than Supplements for Boosting Immune System

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A healthy lifestyle—not vitamin and herbal supplemnts—is the most important factor in boosting your immune system, according to a recent report by Harvard Medical School.

While manufacturers of supplements make the claim that suplements "support immunity," there is currently little scientific evidence to support that claim, since scientists have not yet determined what level of immune system cells best helps the body resists disease.

According to the report, The Truth About Your Immune System: What You Need to Know, lifestyle factors that promote overall health are:

  • avoiding smoking
  • eating plenty of fruits, vegetables, and whole grains, and a diet low in saturated fat
  • exercising on a regular basis
  • maintaining a healthy body weight
  • controlling your blood pressure
  • drinking alcohol in moderation, if at all
  • getting enough sleep
  • Avoid infection, for example by frequent hand-washing and safe food preparation habits.

The 43-page report was edited by Dr. Michael N. Starnbach, Ph.D., professor of microbiology and molecular genetics at Harvard Medical School.

Source: Harvard Health Publications

Surprising Statin Finding: Slowing the Decline in Lung Functioning

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In a recent paper published by the American Thoracic Society (October 2007), the use of statins appears to slow down the rate in which lung function declines in the senior population. More surprisingly, the decline decrease also is evident in smokers.

The researchers postulate that statins’ known anti-inflammatory properties (along with antioxidant properties) cause this effect.

Dr. Joel Schwartz, the lead researcher on the study, and a professor of environmental epidemiology at Harvard School of Public health, points out that his study shows the importance of "a possibility of reducing the rate of decline."

The primary indication for prescription of statins such as Lipitor and Zocor is for the treatment of high cholesterol.

Source: American Thoracic Society