Keeping you up to date on recent headlines in cardiovascular healthcare:
Study shows Lap-Band lowers co-morbidity risk in teens ... According to a new study of obese teens, laparoscopic gastric banding surgery – the "Lap-Band" procedure – not only helps them achieve significant weight loss but can also improve and even reverse metabolic syndrome, reducing their risk for cardiovascular disease and diabetes. The study was led by Ilene Fennoy, MD, Jeffrey Zitsman, MD, and colleagues at NewYork-Presbyterian Morgan Stanley Children's Hospital and Columbia University Medical Center (New York) and presented at the annual Endocrine Society (Chevy Chase, Maryland) meeting in Washington. Fennoy and her colleagues followed 24 morbidly obese adolescents between the ages of 14 and 17 who underwent the Lap-Band procedure. The study participants either had a BMI of greater than 40 or greater than 35 if already suffering from diabetes or obesity-related illnesses. Six months after surgery, they noted a significant drop in participants' BMI, waist circumference, and blood levels of C-reactive protein. These indicators continued to improve among the 12 patients being followed up at the one-year point, the authors noted.
Policies may impede EMS efforts to resuscitate ... Local laws, insurance reimbursement and public misperceptions impede emergency medical services (EMS) workers from using best resuscitation practices, according to a study reported in Circulation: Cardiovascular Quality and Outcomes. The researchers said less than half of local EMS systems follow national guidelines on transporting cardiac arrest patients and terminating unsuccessful out-of-hospital resuscitation efforts. Researchers identified three key areas where policies or perceptions may impede local efforts to follow the guidelines for terminating unsuccessful resuscitation efforts: private insurers and Medicare who provide higher reimbursement to EMS for patient transport, regardless of whether the cardiac arrest victim is successfully resuscitated in the field or not; state legislation that requires transport to hospitals and restricts the ability of responders to follow do-not-resuscitate (DNR) orders; and community members who overestimate the chance for survival and believe a hospital can provide better care than responders on site.
Endovascular treatments more common than bypass ... According to a new study published in the July issue of the Journal of Vascular Surgery, endovascular interventions are now performed much more commonly than bypass surgery in the treatment of lower extremity peripheral arterial disease (PAD). Researchers from Dartmouth-Hitchock Medical Center (Lebanon, New Hampshire) published the study about the trends in lower extremity endovascular interventions (angioplasty and atherectomy), lower extremity bypass surgery and major above and below the knee amputations in Medicare beneficiaries (Part B claims). The study was done between 1996 and 2006. According to the authors, it is unclear from past research if these newer endovascular treatments are as effective as conventional surgical bypass in preventing amputation. The authors said that larger and broader clinical trials should occur to compare bypass and endovascular interventions in patients with claudication and critical limb ischemia. These trials would further evaluate what medical steps can be taken and resources should be used to obtain the best functional outcomes in patients with PAD, and to prevent death and disability from lower extremity amputation, they noted.
Stem cell treatment seeks to reverse heart attack damage ... Doctors at the Cedars-Sinai Heart Institute (Los Angeles, California) recently completed the first procedure in which a patient's own heart tissue was used to grow specialized heart stem cells that were then injected back into the patient's heart in an effort to repair and re-grow healthy muscle in a heart that had been injured by a heart attack. The minimally-invasive procedure was completed on the first patient on June 26. The procedure is part of a Phase I investigative study approved by FDA and supported by the Specialized Centers for Cell-based Therapies at the National Heart, Lung, and Blood Institute and the Donald W. Reynolds Foundation. The 24 patients participating in the study have hearts that were damaged and scarred by heart attacks. The patients will be monitored for six months. Complete results are scheduled to be available in late-2010.
UCSF study explores bone marrow extract for heart attack ... A University of California, San Francisco (UCSF) study for the treatment of heart failure after heart attack found that the extract derived from bone marrow cells is as effective as therapy using bone marrow stem cells for improving cardiac function, decreasing the formation of scar tissue and improving cardiac pumping capacity after heart attack. The findings were published online and in the July issue of the Journal of Molecular Therapy. The studies were done in mice using a novel stem cell delivery method developed by UCSF researchers to show that the extract from bone marrow cells is as beneficial to cardiac function as are intact, whole cells. Both the cell and cell extract therapies resulted in the presence of more blood vessels and less cardiac cell death, or apoptosis, than no therapy. The study also showed that heart function benefitted despite the finding that few of the injected cells remained in the heart at one month after therapy.
Pig heart valves fail sooner than expected, study finds ... A report from cardiac surgeons at Washington University School of Medicine (St. Louis) says pig heart valves used to replace defective aortic valves in human patients failed much earlier and more often than expected. According to the researchers, this is the first report to demonstrate this potential problem. Between 2001 and 2005, four out of 106 patients with the pig valves implanted in the aortic position developed severe impairment after less than four years, and the patients required surgery to replace the valves. The findings are published in the June issue of the Journal of Thoracic and Cardiovascular Surgery. Lead author Jennifer Lawton, MD, a Washington University cardiothoracic surgeon at Barnes-Jewish Hospital, notes that the valves are expected to last 10 to 15 years in patients over 70 years of age. All four patients who needed a "redo" operation were over 70 years of age.
CRP not linked to heart disease afterall ... A British study published last week finds that a protein known as a key indicator of inflammation in the body and thought to cause heart disease is not linked to development of the fatal ailment. C-reactive protein (CRP), a target for studies of treatment for coronary heart disease, is not in fact directly involved in causing it, as once thought, said the research published in the Journal of the American Medical Association. However, the study did discover new genetic variations associated with coronary heart disease. If confirmed in other studies, these might offer clues to identify new targets to treat the disease, one of the researchers noted. Research teams examined a total of 28,112 people with the disease and 100,823 people without the disease. They reached their conclusion by comparing the genetic variations that play a role in the level of CRP with the prevalence of coronary heart disease in those that they studied.
Women who sleep less more likely to have heart problems ... Lack of sleep apparently hits women harder than men. A study revealed that women who do not sleep well are at higher risk of suffering heart disease and heart related problems than men. Eight hours is the recommended length of time people should spend asleep, and women who get less than that have a higher chance of coronary problems than men with the same sleeping patterns, according to research by the University of Warwick and University College London (UCL). The study found levels of inflammatory markers – indicators of coronary heart disease – vary significantly with sleep duration in women, but not men. Published in the American journal Sleep, researchers found levels of Interleukin-6 (IL-6) were much lower in women who reported sleeping eight hours compared to those who slept for seven hours. Another marker, high-sensitivity C-reactive protein, which predicts future cardiovascular morbidity, were significantly higher in women who reported sleeping for five hours or less, the authors noted. The report was based on findings from the first large-scale study to investigate the associations between measures of inflammation and sleep duration in both men and women, which involved more than 4,600 white participants, of which 73% were men.
— Compiled by Amanda Pedersen, MDD