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Dubai (20 April 2012): High normal blood pressure becomes less of a risk factor for incident cardiovascular disease (CVD) and coronary heart disease (CHD) with age, according to a new study presented today at the World Congress of Cardiology.

The study, carried out over 9.3 years, evaluated the risk of different blood pressure categories among 6,273 participants aged 30 years old and above. The results showed that the risk of developing incident CVD and CHD was significantly higher in people with high normal blood pressure during middle-age (between 30 and 60 years of age) than for people with the same high normal blood pressure aged 60 years and older. Incident CVD and CHD risk was, however, similarly high in people with diagnosed high blood pressure across all age-groups.

“These results reinforce the fact that high blood pressure is a serious risk for CVD in all age groups,” said Dr. F. Hadaegh, Prevention of Metabolic Disorders Research Center, Tehran, Iran. “However, the results also suggest that when looking to manage high normal blood pressure resources should be focused on those individuals that are in middle age.”

High blood pressure is defined as a repeatedly elevated systolic pressure of 140 mmHg or higher OR a diastolic pressure of 90 mmHg or higher. This study was carried out over 9.3 years and the study protocol established before new guidelines around high normal blood pressure were adapted. In 2003, the Joint National Committee 7(JNC7) from the United States introduced the concept of prehypertension into guidelines categorizing the individuals with systolic blood pressure between 120-139 mmHg or diastolic blood pressure between 80-89 as prehypertension groups.

Hypertension and CVD

Hypertension (high blood pressure) is one of the major preventable risk factors for premature death from CVD worldwide. High blood pressure contributes to around half of all CVD and the risk of developing CVD doubles for every 10-point increase in diastolic blood pressure.

High blood pressure that is left untreated can greatly increase a person’s risk of developing CVD. Treating raised blood pressure has been associated with a 35 per cent reduction in the risk of stroke and at least a 16 per cent reduction in the risk of myocardial infarction

CINCINNATI—Researchers at UC have confirmed that fat surrounding the outside of arteries in humans—particularly the left coronary artery—may influence the onset of coronary artery disease, or atherosclerosis, which is the leading cause of death in the U.S.

These findings, being presented at the American Heart Association’s Arteriosclerosis, Thrombosis and Vascular Biology (ATVB) 2012 Scientific Sessions in Chicago April 20, 2012, may help in identifying the molecular culprit, with the goal of creating targeted therapies for atherosclerosis before the disease forms.

Coronary artery disease is a narrowing of the small blood vessels that supply blood and oxygen to the heart.

Tapan Chatterjee, PhD, and researchers in the division of cardiovascular diseases at UC found through global gene expression analysis (measurement of the activity of thousands of genes at once) that this outer fat tissue—known as perivascular fat tissue—is different from subcutaneous (beneath the skin) fat tissues in other parts of the body.

Research has previously shown that perivascular fat tissue in humans with coronary artery diseases is highly inflamed, leading to the belief that dysfunctional perivascular fat is the real culprit in the formation of coronary artery diseases.

Chatterjee’s team was able to replicate this inflammation in animal models.

“The proximity of the perivascular fat to the artery easily influences the function of the coronary blood vessel wall,” Chatterjee says. “The perivascular fat is very sensitive to high-fat diet induced inflammatory changes in mice. We found that by transplanting perivascular fat from high-fat diet fed obese mice to the carotid artery of lean mice, the tissue was detrimental to the blood vessel wall and promptly caused disease to form there.

“Our next steps will be to identify various secreted factors, or signals, from perivascular fat tissue of obese mice that could negatively influence the functions of the blood vessel wall,” he continues. “We believe this cross-talk between perivascular fat and the coronary artery is very important in triggering coronary artery diseases. We hope this knowledge helps in targeting the molecules before the onset of coronary artery diseases and treating patients before they ever experience the disease.”

This study was funded by the National Heart Lung and Blood Institute.

Source: Eurekalert: 4/21/2012

CHICAGO— Cell therapy may present an option for patients with ischemic heart disease to use their own bone marrow cells to repair the damaged areas of their hearts, and may pave the way for future treatment options, according to the FOCUS trial, which will be presented as a late-breaking clinical trial March 24 at the 61st annual American College of Cardiology (ACC) scientific session.

This is the largest study to date to look at stem cell therapy, using a patient’s own stem cells, to repair damaged areas of the heart in patients with chronic ischemic heart disease and left ventricular dysfunction. Researchers found that left ventricular ejection fraction (the percentage of blood leaving the heart’s main pumping chamber) increased by a small but significant amount (2.7 percent) in patients who received stem cell therapy. The study also revealed that the improvement in ejection fraction correlated with the number of progenitor cells (CD34+ and CD133+) in the bone marrow; and this information will help in evaluating and designing future therapies and trials.

“FOCUS is an incredibly important trial, as it has informed the cell therapy community how to better treat this high-risk patient population, and allows us to enter into an exciting, next generation of stem cell therapy armed with more data,” said study investigator Timothy D. Henry, MD, an interventional cardiologist at the Minneapolis Heart Institute® (MHI) at Abbott Northwestern Hospital in Minneapolis and director of research with the Minneapolis Heart Institute Foundation.

This multicenter study was conducted by the Cardiovascular Cell Therapy Research Network (CCTRN), which is supported through a research grant from the National Institutes of Health’s National, Heart, Lung and Blood Institute (NHLBI), with the goal to evaluate novel stem cell-based treatment strategies for individuals with cardiovascular disease.

FOCUS will be presented at ACC.12 by its lead investigator Emerson C. Perin, MD, PhD, director of clinical research for cardiovascular medicine at the Texas Heart Institute, one of the five sites in the CCTRN. The Minneapolis Heart Institute is another site of the five in the network, and a large number of CCTRN patients were enrolled in Minnesota.

For this study, which took place between April 2009 and April 2011, the five sites randomly selected 92 patients to receive stem cell treatment or placebo. The symptomatic patients, with an average age 63, all had chronic ischemic heart disease and an ejection fraction of less than 45 percent (baseline 34 percent) along with heart failure and/or angina and were no longer candidates for revascularization. “These patients had no other options, as medical management failed to improve their symptoms,” explained the study’s co-investigator Jay Traverse, MD, an interventionalist cardiologist at the Minneapolis Heart Institute at Abbott Northwestern Hospital and physician researcher with the Minneapolis Heart Institute Foundation.

Bone marrow was aspirated from the patients and processed to obtain just the mononuclear fraction of the marrow. In patients randomly selected to receive stem cell therapy, physicians inserted a catheter into the heart’s left ventricle to inject 100 million stem cells in more than 15 sites that showed damage on the electromechanical mapping image of the heart.

“Studies such as these are able to be completed much faster because of the team approach of the network” said Sonia I. Skarlatos, PhD, NHBLI’s deputy director of the division of cardiovascular sciences and program director of CCTRN.

The FOCUS trial was designed to determine whether left ventricular end systolic volume and myocardial oxygen consumption improved in patients who received stem cell treatment. Researchers also wanted to see if nuclear scans of the heart showed a reversible change in perfusion defects in patients who had received the treatment.

While the study did not achieve its primary endpoint, the researchers found that those patients with more progenitor cell types had much better improvement with ejection fraction, explained Henry, and demonstrated a linear relationship between the number of CD34+ cells and the improvement in ejection fraction.

“As a result, these findings are revealing the importance of certain cell types that are delivered and that modifying the cells may create more robust cells capable of achieving better results in future studies,” concluded Traverse.

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The study will be simultaneously published in the Journal of the American Medical Association.

MINNEAPOLIS –– February 20, 2012 –– Advancing the clinical practice of interventional cardiovascular medicine, Medtronic Inc. (NYSE: MDT) today announced U.S. Food and Drug Administration (FDA) approval of the Resolute Integrity™ Drug-Eluting Stent (DES) for the treatment of coronary artery disease (CAD).

The new heart device’s FDA approval stems from the results of a global series of studies involving the Resolute DES, which showed consistently powerful clinical performance across a broad spectrum of patients –– including those with diabetes, a common contributor to coronary artery disease that complicates treatment. The Resolute DES uses the same drug-and-polymer combination as the Resolute Integrity DES.

The Resolute Integrity DES builds on the success of the market-leading Integrity bare metal stent. The Integrity platform’s rapid adoption in the United States is the result of a proprietary engineering advance called continuous sinusoid technology (CST).

CST encompasses one continuous, single strand of wire that is molded into a sinusoidal wave and then wrapped in a helical pattern and laser-fused at certain points, making each stent comparable to a flexible spring.

“The Resolute Integrity DES offers several notable benefits, starting with outstanding deliverability, which means it’s exceptionally easy to navigate the stent on the delivery system through the coronary vasculature to the narrowed arterial segment that requires treatment,” explained Martin B. Leon, M.D., director of the center for interventional vascular therapy at New York-Presbyterian/Columbia University Medical Center, founder and chairman emeritus of the Cardiovascular Research Foundation, and a principal investigator (PI) of the RESOLUTE US clinical study. “Its approval by the FDA is based on the impressive performance of the Resolute DES in a wide variety of patients. With the device’s compelling combination of deliverability, efficacy and safety, not to mention that it is the first DES approved for patients with diabetes, the Resolute Integrity DES promises to gain rapid acceptance in cath labs nationwide.”

Clinical Performance

The global RESOLUTE clinical program consisted of a large randomized controlled trial and a series of confirmatory single-arm studies involving nearly 250 sites in 32 countries. In total, the program enrolled more than 5,100 patients who received a Resolute DES; about a third (1,535) of these patients had diabetes, a proportion that mirrors the U.S. patient mix.

RESOLUTE US enrolled 1,402 patients across 128 U.S.-based clinical trial sites. It was led by Dr. Leon and his co-PIs: Laura Mauri, M.D., chief scientific officer of the Harvard Clinical Research Institute and an interventional cardiologist at Brigham and Women’s Hospital in Boston; andAlan Yeung, M.D., director of interventional cardiology at Stanford University School of Medicine in Palo Alto, Calif.
At one year of follow-up in RESOLUTE US, the results included low rates of target lesion failure (TLF, 4.7%), clinically-driven target lesion revascularization (TLR, 2.8%) and definite/probable stent thrombosis (def/prob ST, 0.1%). These results were achieved despite 34 percent of the patients in the study having diabetes, which typically drives higher event rates.

One year of follow-up in a pre-specified analysis of patients with diabetes who received a Resolute DES as participants in the Resolute clinical program also demonstrated low rates of TLF (6.6%), TLR (3.4%) and def/prob ST (0.3%).

In two separate large randomized controlled trials, the Resolute DES matched the safety and effectiveness of Abbott Laboratories’ Xience V® DES, which represents the market-leading DES platform in the United States.

The Resolute All-Comers study, sponsored by Medtronic, enrolled nearly 2,300 patients at 17 centers and was led by Prof. Patrick Serruys, M.D., Ph.D., director of the Thoraxcenter at Erasmus University in Rotterdam, the Netherlands; Prof. Stephan Windecker, M.D., with University Hospital in Bern, Switzerland; and Prof. Sigmund Silber, M.D., of the Heart Catheterization Centre in Munich, Germany. The one- and two-year results of RESOLUTE All Comers were published in The New England Journal of Medicine and The Lancet, respectively.

While not part of the FDA dataset, the TWENTE study, supported jointly by Medtronic and Abbott Laboratories, enrolled nearly 1,400 patients at a single center and was led by Prof. Clemens von Birgelen, M.D., Ph.D., co-director of the Department of Cardiology at Thoraxcentrum Twente and professor of cardiology at the University of Twente in the Netherlands. Prof. von Birgelen presented the one-year results of TWENTE at the 2011 Transcatheter Cardiovascular Therapeutics (TCT) meeting. The results are also reported in a recent issue of the Journal of the American College of Cardiology.
“The new Resolute Integrity DES comes to U.S. cath labs with compelling clinical evidence and a highly differentiated stent platform,” said Sean Salmon, president of Medtronic’s coronary and renal denervation business. “Our next-generation zotarolimus-eluting coronary stent has gained wide global acceptance for its remarkable ability to successfully meet clinical and anatomic challenges that interventional cardiologists confront in their everyday practice. We are excited to provide this important advanced technology to U.S. patients and practitioners.”

With the approval of the Resolute Integrity DES, U.S. patients with both CAD and diabetes now have access for the first time to a medical device that has been approved by the FDA as a treatment option specifically studied and clinically validated for their particularly complex and potentially life-threatening health conditions. Historically patients with diabetes who undergo PCI have been a difficult-to-treat patient population. They tend to have smaller and often tortuous arteries, longer lesions, diffuse disease and a higher rate of treatment failures including relatively high rates of repeat procedures and stent thrombosis.

U.S. Launch

The U.S. release of the Resolute Integrity DES also marks the first major product launch to leverage Medtronic’s entire U.S. Cardiac and Vascular Group (CVG) sales force, which includes nearly 3,000 field representatives whose collective objective is to serve the needs of hospital systems, integrated delivery networks and individual hospital administrators.

“No other medical device company has a U.S. field footprint as robust as Medtronic,” said Mike Coyle, president of Medtronic’s CVG. “We intend to use the launch of the Resolute Integrity DES to demonstrate the impact that our unrivaled scale can deliver for physicians, hospitals and patients looking for safe, effective and cost-effective solutions for cardiac and vascular diseases.”

In collaboration with leading clinicians, researchers and scientists, Medtronic offers the broadest range of innovative medical technology for the interventional and surgical treatment of cardiovascular disease and cardiac arrhythmias. The company strives to offer products and services that deliver clinical and economic value to healthcare consumers and providers worldwide.

ABOUT MEDTRONIC
Medtronic, Inc. (www.medtronic.com), headquartered in Minneapolis, is the global leader in medical technology –– alleviating pain, restoring health and extending life for millions of people around the world.

source: Medtronic

COLUMBIA, Mo. – Human arteries – some smaller than a strand of hair – stiffen as a person ages. This stiffening is a factor in cardiovascular disease, the leading cause of death in the United States, because it contributes to the circulatory complications in disorders such as high blood pressure and diabetes. University of Missouri researchers have now used advanced 3-D microscopic imaging technology to identify and monitor the proteins involved in this stiffening process. These findings could eventually help researchers and physicians understand and treat complications associated with cardiovascular disease.

“A majority of the scientific knowledge of how blood vessels are put together is based on older methodologies that only measured the amount of protein in the artery wall and not how the proteins were architecturally arranged to support artery functions,” said Gerald Meininger, director of the MU Dalton Cardiovascular Research Center and Margaret Proctor Mulligan Professor of Medical Pharmacology and Physiology. “We used state-of-the-art imaging technology and computer-based models to visualize the minute structural elements within an intact blood vessel and found that one of the proteins, elastin, plays a key role in supporting the ability of the arterial wall to properly function.”

As people age, the level of elastin diminishes and other proteins, such as collagen, contribute to altering the arterial stiffness. The researchers believe that learning how to alter elastin levels may alleviate some of the detrimental results associated with vascular aging, such as high blood pressure.

“When people think of blood vessels, they tend to think of rigid pipes, but blood vessels are very dynamic because they continually expand and contract to adjust blood flow and blood pressure to meet the body’s needs,” said Michael Hill, also of the Dalton Cardiovascular Research Center and Professor of Medical Pharmacology and Physiology. “Elastin production peaks at a very young age and declines throughout life.  Molecular biologists are trying to determine how to turn elastin production back on in the correct places, but it has proven very difficult so far.”

The MU researchers believe the knowledge also may be used in future efforts to develop artificial vascular structures to improve tissue replacement. Blood vessels sometimes fail during the tissue replacement process, and understanding how vessels are built and change could lead to a better success rate.

The study, “Spatial Distribution and Mechanical Function of Elastin in Resistance Arteries,” was published in Arteriosclerosis, Thrombosis, and Vascular Biology, the Journal of the American Heart Association. The study was funded by the National Institutes of Health.

Results Presented at AHA 2011

A blood-based gene expression test was found to be more effective for ruling out obstructive coronary artery disease in stable symptomatic patients than myocardial perfusion imaging (MPI), a common test that uses a radioactive agent to evaluate the blood flow and function of the heart.

Study results were presented today at the American Heart Association Scientific Sessions 2011 conference in Orlando, Fla.

“In this real-world patient population, the gene expression test demonstrates very high sensitivity and negative predictive value, enabling clinicians to rule out patients who do not have obstructive coronary artery disease with high accuracy,” said Dr. Gregory S. Thomas, clinical professor of medicine and director of nuclear cardiology education at the UC Irvine School of Medicine, who presented the findings. “The use of this test, followed by MPI for higher scores, may optimize diagnostic performance and utilization of health care resources.”

Gene expression testing provides valuable tissue and cell-specific information about the molecular mechanisms involved in disease processes, enabling evaluation of an individual patient’s disease state, activity, and/or progression at a given point in time. Unlike genetic tests, which measure genetic variations, mutations, traits and predispositions—factors that are constant over a person’s lifetime—gene expression testing assesses a dynamic process, integrating both genetic predisposition and additional behavioral and environmental influences on current disease state.

The COMPASS study enrolled 537 stable patients with symptoms suggestive of coronary artery disease who had been referred to MPI at 19 U.S. sites. A blood sample was obtained in all patients prior to MPI, and gene expression testing was then performed, with study investigators blinded to gene expression test results. Following MPI, patients were referred either to invasive angiography or to CT angiography (CTA), gold-standard measurements for diagnosis of coronary artery disease. A total of 431 patients were eligible for analysis, having completed gene expression testing, MPI and either invasive angiography or CTA.

In the COMPASS study, the gene expression test was superior to MPI in diagnostic accuracy, sensitivity (89 percent vs. 27 percent, p<0.001) and negative predictive value (96 percent vs. 88 percent, p<0.001) and demonstrated excellent performance for ruling out obstructive coronary artery disease relative to both invasive angiography and CTA.

Better methods for risk stratification of patients with obstructive coronary artery disease are needed. A study published in the March 11, 2010 issue of The New England Journal of Medicine found that in nearly 400,000 patients who underwent elective invasive angiographic procedures, 62 percent were found to have no obstructive coronary artery blockage.

The gene expression test used in the study, called Corus CAD (CardioDx, Palo Alto, Calif.), measures the RNA levels of 23 genes from a whole blood sample. Because these RNA levels are increased or decreased when obstructive coronary artery disease is present, the Corus CAD score indicates the likelihood that an individual patient does not have obstructive coronary artery disease.

“Chest pain symptoms account for two percent of all visits to the doctor’s office each year,” said Dr. Mark Monane, chief medical officer of CardioDx. “Corus CAD has now been validated in more than 1,100 patients in three separate studies. For physicians, methods to improve the diagnosis of symptoms suggestive of coronary artery disease represent a huge unmet need, and the Corus CAD test may help clinicians make better decisions. For patients, the test may lead to better diagnostic accuracy as well as avoidance of unnecessary procedures. For payers, we believe that Corus CAD can address a major expense category.”

Source: Eurekalert

OAK BROOK, Ill. – Researchers have found more evidence supporting the role of fat around the heart in promoting atherosclerosis, according to a study published online in the journal Radiology.

New results from the Multi-Ethnic Study of Atherosclerosis (MESA) show that pericardial fat is more strongly related to coronary artery plaque than either body mass index (BMI) or waist circumference.

When plaque forms in the arteries, it deposits in an irregular manner, causing thickening of the artery wall on one side, but not the other. The ratio of the thick side to the thin side is referred to as plaque eccentricity and is a strong indicator of heart disease.

According to the American Heart Association, heart disease is the leading cause of death in the U.S. In 2010, an estimated 785,000 Americans had a new heart attack, and about 470,000 had a recurrent attack. Every 60 seconds, one person in the U.S. dies from a heart attack.

While previous studies have looked at the relationship of pericardial fat to atherosclerosis in patients with severe coronary disease, this is the first study to determine the association of pericardial fat on coronary artery plaque burden in asymptomatic individuals.

“The individuals in this study had no symptoms and were otherwise healthy,” said senior author David A. Bluemke, M.D., Ph.D., director of Radiology and Imaging Sciences at the National Institutes of Health (NIH) Clinical Care. “They did not have significant coronary artery narrowing. Yet, despite this, they had coronary plaque that could be detected by MRI.”

For the study, 183 individuals without clinical cardiovascular disease were recruited from the Baltimore and Chicago field centers of MESA, a study funded by the NIH. Participants included 89 women and 94 men with a mean age of 61 years.

“The individuals were fairly representative of the U.S. population, although the majority were overweight,” Dr. Bluemke said.

The researchers used magnetic resonance imaging (MRI) to measure coronary artery eccentricity (ratio of maximal to minimal artery wall thickness) as a measure of early-stage atherosclerosis and computed tomography (CT) to determine pericardial fat volume.

“Pericardial fat is located behind the sternum, around the heart, and we cannot see it except with CT or MRI,” Dr. Bluemke said. “In some people, extra fat forms preferentially in this area. We do not know why. However, extra fat around the heart is generally associated with being overweight or obese.”

The results showed that pericardial fat volume correlated significantly with the degree of plaque eccentricity in both men and women. After adjustment for BMI, waist circumference, traditional risk factors, C-reactive protein level and coronary calcium content, the relationship between pericardial fat and plaque eccentricity remained significant in men, but not in women.

“The findings indicate yet another reason that obesity is bad for us,” Dr. Bluemke said. “It is particularly bad when the fat forms around the heart, since the heart fat appears to further promote coronary artery plaque.”

“The Association of Pericardial Fat with Coronary Artery Plaque Index at MR Imaging: The Multi-Ethnic Study of Atherosclerosis (MESA).” Collaborating with Dr. Bluemke on this paper were Cuilian Miao, M.D., Shaoguang Chen, M.S., Jingzhong Ding, M.D., Kiang Liu, Ph.D., Debiao Li, Ph.D., Robson Macedo, M.D., Shenghan Lai, M.D., Jens Vogel-Claussen, M.D., Elizabeth R. Brown, Sc.D., and João A. C. Lima, M.D.

In this week’s PLoS Medicine, Anoop Shah of University College London and colleagues report that, in people with stable coronary disease, there were threshold haemoglobin values below which mortality increased in a graded, continuous fashion. As well as a systematic review and statistical analysis of previous studies, the researchers conducted a retrospective analysis of patients from a prospective observational cohort.

Their findings suggest that there are thresholds of haemoglobin that are associated with increased risk of mortality in patients with angina or myocardial infarction, and, though limited by the observational nature of its results, the study supports the rationale for conducting future randomised controlled trials to assess whether haemoglobin levels are causal and whether clinicians should intervene to increase haemoglobin levels, for example by oral iron supplementation.

The authors say that “Irrespective of a possible causal, reversible relationship between haemoglobin concentration and mortality, further research is warranted to assess what incremental prognostic value haemoglobin might offer in risk stratifying patients with stable coronary disease.”

Funding: This study is based on data from the Full Feature General Practice Research Database obtained under a Medical Research Council license from the UK Medicines and Healthcare Products Regulatory Agency (http://www.mrc.ac.uk/). This study was supported by grants from the UK National Institute for Health Research (RP-PG-0407-10314; http://www.nihr.ac.uk/) and the Wellcome Trust (086091/Z/08/Z; http://www.wellcome.ac.uk/). ADH is supported by a British Heart Foundation Senior Research Fellowship (FS05/125; http://www.bhf.org.uk/). KRA is partly funded by the UK National Institute for Health Research as a Senior Investigator (NF-SI-0508-10061). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The interpretation and conclusions contained in this study are those of the authors alone.

Competing Interests: The authors declare no competing interests.

Citation: Shah AD, Nicholas O, Timmis AD, Feder G, Abrams KR, et al. (2011) Threshold Haemoglobin Levels and the Prognosis of Stable Coronary Disease: Two New Cohorts and a Systematic Review and Meta-Analysis. PLoS Med 8(5): e1000439. doi:10.1371/journal.pmed.1000439

CONTACT:
Anoop Shah
University College London
Clinical Epidemiology Group
Department of Epidemiology and Public Health
1-19 Torrington Place
London WC1E 6BT

The coronary arteries of Princess Ahmose-Meryet-Amon – as visualised by whole body computerised tomography (CT) scanning – will feature in two presentations at the International Conference of Non-Invasive Cardiovascular Imaging (ICNC) this week in Amsterdam (15-18 May). ICNC is now one of the world’s major scientific event in nuclear cardiology and cardiac CT imaging.

The Egyptian princess Ahmose-Meryet-Amon, who lived in Thebes (Luxor) between 1580 and 1550 BC and who is now known to be first person in human history with diagnosed coronary artery disease, lived on a diet rich in vegetables, fruit and a limited amount of meat from domesticated (but not fattened) animals. Wheat and barley were grown along the banks of the Nile, making bread and beer the dietary staples of this period of ancient Egypt. Tobacco and trans-fats were unknown, and lifestyle was likely to have been active.

The coronary arteries of Princess Ahmose-Meryet-Amon – as visualised by whole body computerised tomography (CT) scanning – will feature in two presentations at the International Conference of Non-Invasive Cardiovascular Imaging (ICNC) currently taking place in Amsterdam (15-18 May). ICNC is now one of the world’s major scientific event in nuclear cardiology and cardiac CT imaging.

Both presentations will be based on findings from the Horus study, in which arterial atherosclerosis was investigated in 52 ancient Egyptian mummies. Results have shown that recognisable arteries were present in 44 of the mummies, with an identifiable heart present in 16. Arterial calcification (as a marker of atherosclerosis) was evident at a variety of sites in almost half the mummies scanned, prompting the investigators to note that the condition was common in this group of middle aged or older ancient Egyptians; the 20 mummies with definite atherosclerosis were older (mean 45.years) than those with intact vascular tissue but no atherosclerosis (34.5 years).

Although relatively common at other vascular sites, atherosclerosis in the coronary arteries was evident in only three of the mummies investigated, but was clearly visualised in Princess Ahmose-Meryet-Amon (in whom calcification was present in every vascular bed visualised).

The CT scan image below shows that the princess, who died in her 40s, had atherosclerosis in two of her three main coronary arteries. “Today,” said Dr Gregory S Thomas, director of Nuclear Cardiology Education at the University of California, Irvine, USA, and co-principal investigator of the Horus study, “she would have needed by-pass surgery.”

“Overall, it was striking how much atherosclerosis we found,” said Dr Thomas. “We think of atherosclerosis as a disease of modern lifestyle, but it’s clear that it also existed 3500 years ago. Our findings certainly call into question the perception of atherosclerosis as a modern disease.”

If, however, the princess enjoyed a diet deemed to be healthy and pursued a lifestyle probably active, how could this “disease of modern life” affect her so visibly? Dr Thomas and his co-principal investigator Dr Adel Allam of Al Azhar University, Cairo, suggest three possibilities.

First, that there is still some unknown risk factor for cardiovascular disease, or at least a missing link in our understanding of it. Dr Allam noted a likely effect of genetic inheritance, pointing out that much of the human predisposition to atherosclerosis could be secondary to their genes. He similarly raised the possibility that an inflammatory response to the frequent parasitic infections common to ancient Egyptians might predispose to coronary disease – in much the same way that immunocompromised HIV cases seem also predisposed to early coronary disease. Nor can a dietary effect be excluded, despite what we know of life in ancient Egypt. Princess Ahmose-Meryet-Amon was from a noble family, her father, Seqenenre Tao II, the last pharaoh of the 17th Dynasty.

So it’s likely that her diet was not that of the common Egyptian. As a royal, she would have eaten more luxury foods – more meat, butter and cheese. Moreover, foods were preserved in salt, which may also have had an adverse effect.

Despite the suggestion of a genetic, inflammatory or unknown effect, Drs Thomas and Allam were keen not to discount those risk factors for heart disease which we do know about. Indeed, even in the study’s apparent association of atheroma with increasing age, there was a pattern of prevalence consistent with our own epidemiology today. “Recent studies have shown that by not smoking, having a lower blood pressure and a lower cholesterol level, calcification of our arteries is delayed,” said co-investigator Dr Randall C Thompson of the St Luke’s Mid-America Heart Institute in Kansas City, USA. “On the other hand, from what we can tell from this study, humans are predisposed to atherosclerosis, so it behoves us to take the proper measures necessary to delay it as long as we can.”

Most of the Horus study research was performed at the National Museum of Antiquities in Cairo and would not have been possible without the availability of non-invasive CT scanning, the focus of the ICNC congress in Amsterdam. CT scanning and nuclear medicine imaging are the cornerstones of modern quantifiable cardiac disease detection, with safe and reproducible results.

Hamilton, ON (April 4, 2011) -

A landmark international study coordinated by the Population Health Research Institute of McMaster University and Hamilton Health Sciences has found accessing blocked arteries through the forearm compared to groin led to fewer vascular complications and similar success rates for angioplasty.

The large, multi-centre randomized trial – the first of its kind to compare radial access and femoral access – found that both entry points for angioplasty resulted in similar outcomes, including rates of death, heart attack, stroke or non-bypass-related major bleeding. As well, radial access – or entry through the forearm – led to better outcomes in hospitals that conducted a large number of these procedures and in patients suffering heart attacks in which a coronary artery was completely blocked by a blood clot (a condition known as STEMI, or ST-segment elevation myocardial infarction).

Results of the RIVAL (RadIal Vs. femorAL access for coronary angiography or intervention) trial are being presented by Dr. Sanjit Jolly, an interventional cardiologist and assistant professor of medicine in the Michael G. DeGroote School of Medicine, at the annual American College of Cardiology meeting.

The study is also being published simultaneously in The Lancet.

Estimates suggest that more than 10 million coronary angiograms are performed each year worldwide, three million of them in the United States. Entry through the groin, or femoral arterial access, has been the dominant route for coronary angiography and intervention for more than 20 years. It still accounts for approximately 95 per cent of procedures in the United States and 80 per cent of procedures worldwide.

The radial artery, accessed through the wrist, is a superficial and easily compressible site for arterial puncture, and used to avoid femoral bleeding complications. However, there have been concerns that radial access could be associated with reduced angioplasty success rates.

The RIVAL trial, conducted by researchers from 36 countries, was designed to help determine the optimal access site for invasive coronary procedures, such as angioplasty. The study involved 7,021 patients undergoing coronary angiography, with possible angioplasty, who had unstable angina or a heart attack. Patients were randomized to either radial or femoral access for their coronary angiography/intervention.

“Our data suggest that radial compared to femoral access reduces local vascular access site complications with similar angioplasty success rates,” said Dr. Jolly, the principal investigator of the RIVAL Trial Group. “However, greater expertise and procedural volume with radial access may improve the results of the radial approach.”

The researchers concluded both access sites are safe and effective for conducting invasive coronary procedures in patients with acute coronary syndrome, a spectrum of cardiac conditions ranging from unstable angina to heart attack.

“This is the first multi-centre international trial to address this important question,” said Dr. Shamir Mehta, a RIVAL co-investigator, interventional cardiologist, and associate professor of medicine in the Michael G. DeGroote School of Medicine.

“Given the results of previous small trials, we were surprised to not find a difference between the two strategies for the primary outcome. This means either a radial or femoral approach can be used safely and effectively.”

The RIVAL study was supported by Sanofi-Aventis, Canadian Network and Centre for Trials Internationally (CANNeCTIN)/Canadian Institutes of Health Research (CIHR) and the Population Health Research Institute but was independently conducted by the Population Health Research Institute along with an international steering committee.

Dr. Salim Yusuf, the RIVAL study chair, is supported by the Heart and Stroke Foundation of Ontario as the Marion W. Burke Chair in Cardiovascular Disease.