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Preliminary data from new Harvard report presented at the World Congress of Cardiology organized by the World Heart Federation

Voluntary industry reductions in salt content and taxation on products containing salt in 19 developing countries could reduce the number of deaths each year from cardiovascular disease (CVD) by 2-3 per cent in these countries. The preliminary data presented today at the World Congress of Cardiology are the first findings from a new report from Harvard that will be published later this year.

The study set out to assess the cost-effectiveness of two interventions – voluntary salt reduction by industry, and taxation on salt – in 19 developing countries, that represent more than half of the world’s population. The required salt reduction levels were modeled on the UK Food Standards Agency experience which set a series of targets for individual food products that have led to a net intake reduction, so far, of 9.5 per cent overall in the country. While a taxation increase of 40 per cent on industry prices (similar to tobacco), determined by previous work to lead to a 6 per cent reduction in consumption, was also evaluated.

The analysis found that both strategies would be save money by reducing the number of people needing treatment for hypertension and CVD events such as myocardial infarction (heart attacks) and stroke. Moreover, the study found that these two strategies could reduce the incidence of myocardial infarctions (heart attacks) by up to about 1.7 per cent and 1.47 per cent in China and India respectively. Reductions would also been seen in the incidence of stroke of 4.7 per cent in China and 4 per cent in India.

“These results show that strategies to reduce sodium consumption, even by modest amounts, could lead to significant reductions in CVD mortality in developing countries and potentially save overall healthcare costs associated with these diseases,” said Dr. Thomas Gaziano, assistant professor, Harvard School of Medicine. “In developing countries, where the burden of CVD is highest, these simple steps could deliver a significant long-term impact and must be something that governments trying to manage rising healthcare costs should consider.”

CVD is the world’s biggest killer, claiming 17.3 million lives each year. More than 80 per cent of CVD deaths occur in low- and middle-income countries. Projections suggest that CVD will remain the single leading cause of death, and by 2030 will be responsible for 23.6 million deaths each year.

Voluntary industry reductions in salt content and taxation on products containing salt in 19 developing countries could reduce the number of deaths each year from cardiovascular disease (CVD) by 2-3 per cent in these countries. The preliminary data presented today at the World Congress of Cardiology are the first findings from a new report from Harvard that will be published later this year.

The study set out to assess the cost-effectiveness of two interventions – voluntary salt reduction by industry, and taxation on salt – in 19 developing countries, that represent more than half of the world’s population. The required salt reduction levels were modeled on the UK Food Standards Agency experience which set a series of targets for individual food products that have led to a net intake reduction, so far, of 9.5 per cent overall in the country. While a taxation increase of 40 per cent on industry prices (similar to tobacco), determined by previous work to lead to a 6 per cent reduction in consumption, was also evaluated.

The analysis found that both strategies would be save money by reducing the number of people needing treatment for hypertension and CVD events such as myocardial infarction (heart attacks) and stroke. Moreover, the study found that these two strategies could reduce the incidence of myocardial infarctions (heart attacks) by up to about 1.7 per cent and 1.47 per cent in China and India respectively. Reductions would also been seen in the incidence of stroke of 4.7 per cent in China and 4 per cent in India.

“These results show that strategies to reduce sodium consumption, even by modest amounts, could lead to significant reductions in CVD mortality in developing countries and potentially save overall healthcare costs associated with these diseases,” said Dr. Thomas Gaziano, assistant professor, Harvard School of Medicine. “In developing countries, where the burden of CVD is highest, these simple steps could deliver a significant long-term impact and must be something that governments trying to manage rising healthcare costs should consider.”

CVD is the world’s biggest killer, claiming 17.3 million lives each year. More than 80 per cent of CVD deaths occur in low- and middle-income countries. Projections suggest that CVD will remain the single leading cause of death, and by 2030 will be responsible for 23.6 million deaths each year.

Source: Eurekalert 4/21/2012

The Health Professionals Follow-up Study (HPFS) is a prospective cohort study of 51,529 US male health professionals.

During the follow up of these men between 1986 to 2006, published in the European Heart Journal, 1,818 men were confirmed with incident non-fatal myocardial infarction (MI) – a non fatal heart attack. Among heart attack survivors, 468 deaths were documented during up to 20 years of follow up. Repeated reports were obtained on alcohol consumption every four years. Average alcohol consumption was calculated prior to and then following the MI.

The overall results show that, in comparison with no alcohol consumption, the pre-MI and the post-MI intakes of light (0.1-9.9 g/day of alcohol, or up to one small typical drink) and moderate (10.0-29.9 g/d, or up to about 2 ½ to 3 drinks) amounts of alcohol were both associated with lower risk of all-cause mortality and cardiovascular morality among these men.

The significant reductions in all-cause mortality risk (22% lower for 0.1-9.9 g/day and 34% lower for 10.0 – 29.9 g/day, in comparison with non-drinkers) were no longer present for those who drank more than 30 g/day; for this highest consumer group, the adjusted hazard ratio was 0.87 with 95% CI of 0.61-1.25.

There are a number of other informative and interesting results described from this study. First, there was little change in reported alcohol intake prior to and following the MI: drinkers tended to remain drinkers of similar amounts. Few non-drinkers began to drink after their heart attack; among heavier drinkers, there was a tendency to reduce drinking (but very few stopped drinking completely). Further there were no significant differences in outcome according to type of beverage consumed although, interestingly, lower hazard ratios were seen for consumers of beer and liquor than of wine. While the authors state that the effects of alcohol were stronger for the association with non-anterior MI’s, the relative risk (versus non-drinkers) for all-cause mortality were little different: among the moderately drinking men the relative risks were 0.58 for anterior MI and 0.51 for other types of MI.

Even though exposures (such as alcohol) for cardiovascular events (such as MI) may be different after a person has an event than it was before the event, in this study the reductions in risk were almost the same. For example, both for alcohol intake reported prior to a MI, and that after a non-fatal MI, the risk of mortality was about 30% lower for moderate drinkers than it was for abstainers. This suggests that, in terms of reducing cardiovascular disease, alcohol may have relatively short-term effects, suggesting that frequent but moderate consumption (of under 30g a day for men) may result in the best health outcomes.

Reference: Pai JK, Mukamal KJ, Rimm EB. Long-term alcohol consumption in relation to all-cause and cardiovascular mortality among survivors of myocardial infarction: the Health Professionals Follow-up Study. European Heart Journal 2012; doi:10.1093/eurheartj/ehs047

Newswise — ORLANDO, Fla. (April 11, 2012) — Stem cells from the pelvic bone may help hearts beat stronger. Doctors and other clinicians at the Orlando Health Heart Institute are researching the use of stem cells from pelvic bone marrow to restore tissue and improve heart function after muscle damage from heart attacks.

“The thought is the body may use itself to heal itself,” said Vijaykumar S. Kasi, MD, PhD, an interventional cardiologist, director, Cardiovascular Research, and principal investigator for the clinical trial at ORMC. “Because stem cells are immature cells they have the potential to develop into new blood vessels and preserve cardiac muscle cells. By infusing certain stem cells into the area of the heart muscle that has been damaged from a heart attack, tissue can be preserved and heart function restored.”

The PreSERVE-AMI Study, sponsored by Amorcyte, LLC, a NeoStem, Inc. company (NYSE Amex: NBS), is for patients who have received a stent to open the blocked artery after a specific heart attack history (in part a ST-Segment Elevation Myocardial Infarction, or STEMI, a critical type of heart attack caused by a prolonged period of blocked blood supply, affecting a large area of the heart muscle and causing changes in the blood levels of key chemical markers). The study evaluates the effectiveness and safety of infusing stem cells collected from a patient’s bone marrow into the artery in the heart that may have caused the heart attack. About 160 patients will participate in this national study at approximately 34 sites.

The infusion procedure begins with a catheter inserted through an incision in the groin. An X-ray camera is used to guide doctors in positioning the catheter in the heart artery where the stent was placed. A balloon is inflated within the stent and the infusion takes place in the area impacted by the heart attack. Because the study is randomized, double blinded and placebo controlled, patients are infused with either AMR-001, a cell therapy product comprised of stem cells taken from one’s own bone marrow, or a placebo (inactive substance).

Prior to the infusion, patients are screened using various assessments including an electrocardiogram, a cardiac MRI (magnetic resonance image) and a cardiac nuclear test. After the necessary screenings, patients have a mini-bone marrow procedure where the stem cells are “harvested” (removed) from the bone marrow in their pelvic bone, using a special needle. The stem cells are processed at Progenitor Cell Therapy, another NeoStem, Inc. company, in preparation for infusion. Patients who are randomized to placebo will have their bone marrow frozen and stored and available to them for clinical use, should they require bone marrow for any reason.

“We are excited to participate in innovative clinical trials as part of our continued efforts to play a vital role in future solutions to improve patient outcomes,” said Dr. Kasi. “Heart disease remains the No.1 killer of men and women in our country.”
Effective treatment options are part of the medical journey to more heart healthy communities locally and globally.

“Severe heart failure, often the end result of large or multiple heart attacks, is a major health care challenge, impacting more than five million people in the United States and costing more than $35 billion annually,” said Dr. Kasi. “Stem cell therapy is part of the movement from treatment to cure and has the potential to overcome limitations and expenses of heart transplants and offers hope for patients who are desperately praying for another chance at life.”

For more information on the trial please visit www.neostem.com.

Newswise — April 11 2012 – Although observational studies have suggested that losartan, a drug used primarily for the treatment of hypertension, may be associated with an increased risk of death among patients with heart failure compared with other medications in the same class of drugs (angiotensin II receptor blockers [ARBs]), an analysis that included nearly 6,500 patients found that overall, use of losartan was not associated with increased all-cause death or cardiovascular death compared with use of the ARB candesartan, according to a study in the April 11 issue of JAMA.

Henrik Svanstrom, M.Sc., of Statens Serum Institut, Copenhagen, Denmark, and colleagues conducted a study to assess whether use of losartan is associated with increased all-cause mortality in heart failure patients compared with candesartan. The study, which included data from a nationwide Danish registry, linked individual-level information on hospital contacts, filled prescriptions, and potential confounders (factors that can influence outcomes). Patients ages 45 years and older with first-time hospitalization for heart failure in 1998-2008 were identified from the registry. New users of losartan and candesartan were selected for inclusion in the study cohort. The final study group included 6,479 patients; 2,082 users of candesartan and 4,397 users of losartan.

During follow-up, there were 2,378 deaths in the study population. Among these, 330 occurred during ongoing candesartan use and 1,212 during ongoing losartan use. The researchers found no significantly increased risk of death associated with use of losartan as compared to candesartan. Also, use of losartan was not significantly associated with an increased risk of cardiovascular mortality compared with candesartan use.

The authors did find that use of low-dose losartan (12.5 mg) was associated with a more than 2-fold increased risk of mortality as compared with high doses of candesartan (16-32 mg). Treatment with 50 mg of losartan (medium dose) was also associated with a higher mortality risk. However, there was no increased risk associated with use of 100 mg of losartan (high-dose).

The authors write that compared with previous observational studies, “our data provide a more detailed insight into the complexity of the association between losartan use and mortality risk in heart failure.”

“This large, nationwide cohort study of patients with heart failure found no significantly increased risk of all-cause mortality associated with use of losartan as compared with candesartan. Whereas lower doses of losartan were associated with increased mortality risk as compared with higher doses of candesartan, there was a decreasing risk of mortality with increasing losartan dose; and no significantly increased mortality risk was observed when comparing the highest dose of losartan against the highest doses of candesartan. These findings do not support the hypothesis of differential effects of specific ARBs in patients with heart failure,” the researchers conclude.

Newswise  April 11 2012— Can a simple diagnostic test used to measure a heart’s electrical activity help predict heart attacks? And can that knowledge help doctors reroute their patients away from coronary heart disease?

These are the questions researchers at UCSF asked in a comprehensive eight-year study focused on senior citizens in the United States. Researchers found a higher risk of heart attack when abnormalities showed up on electrocardiogram (EKG) results of healthy elderly people.

“We did not include them if they reported a previous heart attack,” said lead author Reto Auer, MD, a research fellow at UCSF’s Department of Epidemiology and Biostatistics. “So we looked at people who lived independently – not in assisted living facilities – with no history of heart attacks or coronary heart disease.”

The findings, scheduled to be published tomorrow in theJournal of the American Medical Association (JAMA), help answer the question of whether or not EKGs can be used to detect heart disease earlier in patients who don’t have chest pain or other symptoms.

“This research is taking the information from an EKG and adding it to other traditional risk factors to better predict who is going to have a heart attack,” said second author Douglas Bauer, MD, director of the UCSF Division of General Internal Medicine Research Program.

FOCUS ON HEALTHY SENIOR CITIZENS

Researchers studied 2,192 healthy adults aged 70 and older for eight years in Memphis, Tenn., and Pittsburgh. Those with EKG abnormalities had more heart attacks. The results were consistent even when researchers took into account known risk factors for heart attacks, such as smoking, high cholesterol, high blood pressure and diabetes.

At baseline, 276 (13%) participants had minor and 506 (23%) major EKG abnormalities. During follow-up, 351 participants (16%) had coronary heart disease (CHD) events (96 heart-related deaths, 101 heart attacks, 154 hospitalizations for chest pain or a procedure to restore blood flow to the heart). Both baseline minor and major EKG abnormalities were associated with an increased risk of heart disease after adjusting for traditional risk factors.

Each abnormality was categorized in terms of the level of experienced risk. High risk markers included left bundle branch block, a cardiac condition in which the left ventricle contracts later than the right ventricle, as well as major ST-T wave changes in an EKG, among others. Low risk markers included subtle ST-T wave changes and T-wave abnormalities.

“There was a trend towards increased coronary heart disease (CHD) risk from no abnormality to minor, and from minor up to major abnormality,” Auer said. “But both minor and major EKG changes were significantly associated with an increased risk of CHD.”

GENDER AND RACIAL VARIATIONS?

Researchers were also interested in whether or not gender or self-reported racial differences played a role in determining a healthy person’s likelihood of a future heart attack among the 2,192 participants who identified themselves as either Caucasian or African American. Researchers found no correlation between elevated risk factors and gender or race.

“It was a good surprise,” Auer said. “It shows that it’s really the EKG changes that predict risk.”

Researchers say it is premature to advocate for the widespread use of their findings in a clinical setting, but that their initial evidence suggests there may be a role for EKG in adding to traditional risk factors, to better predict who is at risk for a heart attack.

“Anytime someone goes into the emergency room, especially elderly people, they typically get an EKG,” Auer said. “So in the patient’s electronic record system, you could include these EKG abnormalities as part of the patient’s overall risk – but we’re not there yet.”

For now, though, researchers recommend patients become familiar with well-established risk factors that health care providers use to counsel individuals for their risk of future heart attacks and other heart problems.

CONTROVERSY SURROUNDING EKGS

Organizations such as the American Academy of Family Physicians recommends against ordering annual EKGs or any other cardiac screening for low-risk patients without symptoms. They say “there is little evidence that detection of coronary artery stenosis in asymptomatic patients at low risk for coronary heart disease improves health outcomes.”

The American Heart Association (AHA), however, recommends that EKG is reasonable for assessing the risk of coronary heart disease events of adults with hypertension or diabetes even though the U.S. Preventive Services Task Force (USPSTF) found that there is insufficient evidence to recommend for or against routine screening in adults at increased risk of heart disease. For adults at low risk, the AHA recommends that it may be considered while the USPSTF recommends against screening. However, prediction of heart attack by major cardiovascular risk factors is not as reliable in elderly adults as in younger individuals.

“Our view is that novel screening interventions should be tested on clinical outcomes,” Auer said. “Just because you know you might be at increased risk does not mean that you will be better off if your treatment is modified as a consequence of the test.”

This finding, still, could help an estimated 785,000 Americans who will have a first heart attack this year, and 470,000 who will have a recurrent attack. Heart disease remains the number one killer in the United States, accounting for one out of every three deaths, according to the American Heart Association.

Auer is the lead author of the paper; Bauer is the second author; co-authors are Pedro Marques-Vidal, MD, PhD, and Jacques Cornuz, MD, MPH, of the University of Lausanne, Switzerland; Javed Butler, MD, MPH, of Emory University School of Medicine; Lauren J. Min, PhD; Suzanne Satterfield, MD, of the University of Tennessee Health Science Center; Anne B. Newman, MD, MPH, of the University of Pittsburgh’s Department of Epidemiology; Eric Vittinghoff, PhD, of the UCSF Department of Epidemiology and Biostatistics; and Nicolas Rodondi, MD, MAS of the University of Lausanne, Switzerland.

Newswise — ROCHESTER, Minn. — Patients who went to the emergency room with chest pain but were at low risk for a heart attack were less likely to seek more tests after their conditions were explained to them using an educational tool known as a decision aid, a Mayo Clinic study found. The findings are published in Circulation: Cardiovascular Quality and Outcomes, an American Heart Association journal.

Chest pain is the No. 2 reason people seek emergency care at U.S. hospitals. It accounts for about $8 billion in health care costs annually, researchers estimate.

“To avoid missing a diagnosis of heart attack — which could have substantial medical and legal implications — emergency physicians often admit patients to observation units for stress testing, even though patients are at a very low risk for heart attack,” says lead author Erik Hess, M.D., a Mayo Clinic emergency room physician. “This results in false-positive test results, unnecessary additional procedures, exposure to radiation and increased cost.”

Researchers randomly assigned 204 chest pain patients at low risk of heart attacks additional counseling through a decision aid — a tool that summarizes the evidence and helps educate and engage patients in making decisions about their care — or the typical care. The decision aid included initial results of the patient’s chest pain diagnosis, the patient’s personal risk for heart attack within the next 45 days and a menu of evaluation options ranging from urgent cardiac stress testing to making an appointment with a primary care doctor within 72 hours.

Both patient groups were followed for 30 days, and no acute heart problems occurred in either group after leaving the hospital.

“In this study, we found that low-risk chest pain patients who participated in shared decision making often chose less extensive testing once it was clear that they weren’t having a heart attack,” says co-author Victor Montori, M.D., director of Mayo Clinic’s Center for the Science of Health Care Delivery.

Researchers surveyed both groups of patients immediately after the ER visit to test their knowledge and analyze their involvement in decision making. Findings include:
• Decision-aid patients decided to be admitted to the observation unit for stress testing 58 percent of the time, compared to 77 percent for patients in the traditional care group.
• Patients in the decision-aid group were significantly more knowledgeable about their heart attack risk and options than those in the traditional care group.
• The degree of involvement in care decisions in patients who received the decision aid was four times greater than those who didn’t receive the decision aid.
• Patients in the decision-aid group said the information was clear and helpful, and 3 of 4 surveyed said they would recommend it to others.

“Using a decision aid to discuss evaluation options appears to improve patients’ understanding of their condition and to reinforce the decisions they’ve made,” Dr. Hess says. “In addition, patients who used the decision aid chose less expensive evaluation options and reported greater satisfaction with the decision-making process.”

Other study co-authors are Meghan Knoedler; Nilay Shah, Ph.D.; Jeffrey Kline, M.D.; Maggie Breslin.; Megan E. Branda.; Laurie Pencille; Brent Asplin, M.D.; David Nestler, M.D.; Annie Sadosty, M.D.; Ian Stiell, M.D. and Henry Ting, M.D.

Developed in Canada and conducted by researchers from the University of Ottawa Heart Institute, in partnership with Spartan Bioscience, the world’s first bedside genetic test has received acknowledgment by The Lancet, the world’s leading general medical journal.

The article Point-of-care genetic testing for personalisation of antiplatelet treatment (RAPID GENE): a prospective, randomised, proof-of-concept trial, reports on the use of a simple cheek swab test, the Spartan RX CYP2C19, performed by nurses at the patient’s bedside. This revolutionary technology allows doctors to rapidly identify patients with a genetic variant known as CYP2C19*2. Cardiac stent patients with this variant are at risk of reacting poorly to standard anti-platelet therapy with Plavix® (clopidogrel).

The study demonstrated that tailored drug treatment therapy made possible by the genetic testing successfully protected all of the patients with the at-risk genetic variant from subsequent adverse events, while 30 per cent of patients treated with standard therapy did not receive adequate protection.

“For the first time in medicine, nurses were able to perform DNA testing at the patient’s bedside. This is a significant step towards the vision of personalized medicine,” said Dr. Derek So, Interventional Cardiologist at the University of Ottawa Heart Institute (UOHI), and principal investigator of the RAPID GENE study.

Study Details

The RAPID GENE study enrolled 200 patients who were being treated with cardiac stenting for an acute coronary syndrome or stable angina. Patients were randomized to a treatment strategy of rapid point-of-care genotyping and Effient® (prasugrel) for CYP2C19*2 carriers, or to standard therapy with Plavix® (clopidogrel). The Spartan RX CYP2C19 bedside DNA test was performed by nurses who received a 30-minute training session, but had no prior laboratory training. The test had a sensitivity of 100% and a specificity of 99.4% compared with DNA sequencing. For CYP2C19*2 carriers, treatment with prasugrel completely eliminated High on-treatment Platelet Reactivity (HPR). HPR is a marker for patients at risk of complications after stenting. In contrast, 30.4% of carriers receiving clopidogrel had HPR at 1 week.

New study shows fortified “doogh” improves inflammatory markers in patients with type 2 diabetes

Newswise — Chevy Chase, MD— Daily intake of vitamin D-fortified doogh (Persian yogurt drink) improved inflammatory markers in type 2 diabetics and extra calcium conferred additional anti-inflammatory benefits, according to a recent study accepted for publication in The Endocrine Society’sJournal of Clinical Endocrinology and Metabolism (JCEM).

Inflammation is known to have a central role in the development of type 2 diabetes and its further complications like coronary heart disease and stroke. Vitamin D carries benefits for skeletal health but evidence of an anti-inflammatory effect from clinical studies in humans remains scarce.

“Our previous research showed that improvement of vitamin D status by regular daily intake of a fortified yogurt drink resulted in lowered blood glucose levels in diabetic patients,” said Tirang Neyestani, PhD, of Shahid Beheshti University of Medical Sciences in Tehran, Iran and lead author of the study. “The current study found that consuming a vitamin D-fortified yogurt drink also decreased serum substances like highly sensitive C-reactive protein (hsCRP) which are known to have an inflammatory role.”

In this study, researchers conducted a double-blind, randomized, controlled trial over 12 weeks in 90 patients with type 2 diabetes. Study participants were randomly allocated to one of three groups to receive two 250mL bottles a day of either plain doogh, vitamin D-fortified doogh or calcium plus vitamin D-fortified doogh. Vitamin D levels, insulin resistance, and inflammatory markers such as hsCRP, fibrinogen and adiponectin were measured in blood samples taken from study participants.

“Our study showed for the first time that adiponectin, a substance secreted by fat tissue that has an anti-inflammatory effect, increased when calcium and vitamin D-fortified doogh was consumed,” said Neyestani. “Our findings may offer interesting therapeutic options for diabetic patients.”

Other researchers working on the study include: Bahareh Nikooyeh, Hamid Alavi-Majd, Nastaran, Shariatzadeh, Ali Kalayi, Nima Tayebinejad, Soudabeh Heravifard, Shabnam Salekzamani and Malihe Zahedirad, all with Shahid Beheshti University of Medical Sciences.

The article, “Improvement of vitamin D status via daily intake of fortified yogurt drink either with or without extra calcium ameliorates systemic inflammatory biomarkers, including adipokines, in the subjects with type 2 diabetes,” appears in the June 2012 issue of JCEM.

CHICAGO (March 25, 2012) —Heart attacks during pregnancy tend to be more severe, lead to more complications, and also occur for different reasons than commonly seen in the non-pregnant general population, suggesting that, in some cases, the standard approach to managing this condition may not always be best, according to research presented today at the American College of Cardiology’s 61st Annual Scientific Session. The Scientific Session, the premier cardiovascular medical meeting, brings cardiovascular professionals together to further advances in the field.

The changes brought about by pregnancy, including the dramatic shift in hormones and increased volume of blood being pumped through the body, can increase a woman’s risk of heart attack during pregnancy and in the 12 weeks after delivery. There is limited clinical information about how to optimally treat—and perhaps, more importantly, how not to treat—heart attacks during pregnancy and post partum. This study, which is an extension of two previous surveys by the same research group, analyzed 150 new cases of heart attacks associated with pregnancy occurring since 2005 to better understand how heart attacks occur and are being treated in pregnant women.

The analysis found that most pregnant women did not present with traditional cardiovascular risk factors, such as high blood pressure, diabetes or high cholesterol levels, yet they tended to have more serious heart attacks. In fact, the death rate in these women was 7 percent, which is two to three times higher than what is expected in non-pregnant patients of the same age. In addition, heart attacks in most of these women were caused by different mechanisms than those occurring in the non-pregnant general population.

“Despite advances in the management of myocardial infarction, we found that the rate of severe complications including heart failure, cardiogenic shock, and maternal or fetal mortality continues to be high among pregnant women compared to others,” said Uri Elkayam, MD, professor of medicine at the University of Southern California in Los Angeles and the study’s lead investigator. “Therefore, every effort should be made for early diagnosis and appropriate treatment of pregnancy-associated acute myocardial infarction. We believe this study provides important information that can help guide clinicians, and hopefully improve the care of these patients.”

While atherosclerosis—or a narrowing of the arteries due to fatty build-up—is the most common cause of heart attacks in the general population, this was only the cause in one-third of pregnant women. More common among pregnant women was coronary dissection, a separation of the layers of the artery wall that blocks normal blood flow. This is very rare in non-pregnant patients and is thought to occur during and immediately after pregnancy because of the weakening of the wall of the coronary arteries. Researchers also found that coronary dissection may actually be worsened by blind use of guideline-recommended standard therapies such as thrombolytic therapy.

“We have very clear guidelines for treating myocardial infarction in the general population. These guidelines, however, may not always apply to women with pregnancy-associated heart attacks, and may actually cause more harm than good,” said Dr. Elkayam. “It is, therefore, important to identify the cause of heart attack in pregnant women before deciding what therapies to use.”

In particular, he said coronary angiography to identify the mechanism of heart attack and guide therapy is recommended in high-risk patients when urgent treatment is needed. At the same time, however, in several patients coronary dissection was reportedly caused by coronary angiography or angioplasty and led to either death, a need for extensive stenting or coronary bypass surgery. For this reason, Dr. Elkayam advises that stable and low-risk women with pregnancy-associated heart attack be treated conservatively.

Although the likelihood of having a heart attack during pregnancy is very low—estimated to occur in 1 in 16,000 deliveries—this risk is still three to four times higher in pregnant women than in non-pregnant women of the same age, according to Dr. Elkayam. As more women postpone having a first baby, the incidence of this condition is expected to grow.

This analysis included 150 cases published in the literature or consulted by the research team since 2005 and builds upon previous analysis of another 228 cases prior to 2005.  More positively, maternal mortality has been decreasing steadily since the first survey, dropping from 16 percent prior to 2005 to 7 percent after 2005.

“This study is another step in better understanding the cause of pregnancy-associated heart attacks and their potential management,” said Dr. Elkayam. He is hopeful that a national registry will be created to better track heart attacks in pregnant women and establish optimal protocols that lead to better outcomes.

New research finds ongoing treatment with ticagrelor safe and effective in patients with acute coronary syndrome.

Ticagrelor, a potent anti-platelet medication, was approved by the Food and Drug Administration in the summer of 2011 and is known to significantly reduce the risk of stroke, heart attack, vascular death and death overall in patients with acute coronary syndromes (ACS), which are characterized by symptoms related to obstruction in coronary arteries, which supply blood to the heart.  Now, new research from Brigham and Women’s Hospital (BWH) shows that the use of ticagrelor not only reduces the time to a first cardiovascular event (the metric used in most trials) but also significantly reduces the time to a second cardiovascular event or death, and reduces total events including cardiovascular death, heart attack, stroke, ischemic events and urgent revascularization.  These findings will be presented at the American College of Cardiology Scientific Sessions on March 25, 2012.

“These data help show both clinicians and patients that if a patient is on ticagrelor and experiences a cardiac event, continued use of this anti-platelet is both safe and effective, and may prevent even more cardiac events than we previously thought” said Payal Kohli, MD a cardiology fellow and BWH researcher in the TIMI Study Group, who is the lead author on this study.

Researchers analyzed data from the PLATO study, where 18,624 patients with ACS were randomly allocated to receive aspirin plus either ticagrelor or clopidogrel. In this cohort of patients, 318 experienced multiple cardiac events during the follow up period. In addition to observing a reduction in the average number of events per patient, and a reduction in total vents, researchers also note that there was no difference in bleeding in patients taking ticagrelor compared to those taking clopidogrel, although the number of bleeding events may have been too small to detect a difference.

“Interestingly, we also found that that those patients who had more cardiac events tended to be older, have a lower body weight and have a higher number of cardiovascular risk factors.  There were also a higher proportion of females in this group.” Kohli said.