Keeping you up to date on recent headlines in cardiovascular healthcare:

ACOG refines fetal heart rate monitoring guidelines ...The American College of Obstetricians and Gynecologists (ACOG; Washington) has issued guidelines refining the definitions, classifications, and interpretations of fetal heart rate (FHR) in order to reduce the inconsistent use of common terminology and the potential variability in FHR interpretations. The new guidelines support the recommendations of a workshop on electronic fetal monitoring (EFM) of the Eunice Kennedy Shriver National Institute of Child and Health Development, held in April 2008. ACOG said that a "notable update" is the three-tier classification system for FHR tracings: Category 1 FHR tracings considered normal (no specific action required); Category 2 indeterminate (evaluation, surveillance and possibly other tests needed); Category 3 abnormal (prompt evaluation needed). The guidelines state that women in labor with high-risk conditions or suspected fetal growth restriction should be monitored continuously during labor. (Practice Bulletin #106, "Intrapartum Fetal Heart Rate Monitoring: Nomenclature, Interpretation, and General Management Principles," appears in the July issue of Obstetrics & Gynecology.

Nearly half of UK heart attack patients treated by angioplasty ... Results from the Myocardial Ischaemia National Audit Project (MINAP) show that nearly half of heart attack patients in the UK received primary angioplasty rather than thrombolytic drugs. MINAP is commissioned and funded by the Healthcare Quality Improvement Partnership (HQIP) and run by the National Institute for Clinical Outcomes Research at the Heart Hospital, University College London. It collects data from eligible hospitals and ambulance services in England and Wales. The number of hospitals performing primary angioplasty increased from 54 to 66 over the past year, but 14 of these performed fewer than 10 cases. The audit found that from about three hours after symptom onset, primary angioplasty is significantly more effective than thrombolytic treatment for heart attack patients. At present more than six out of 10 heart attack patients receive one or other form of treatment within three hours of symptom onset. (

CT angiography identifies risk of acute coronary syndrome ... A study by Japanese researchers indicates that computed-tomography (CT) angiography is able to identify vulnerable plaques most likely to result in a subsequent acute coronary syndrome. Sadako Motoyama, MD, of Fujita Health University School of Medicine (Toyoake, Japan), and colleagues, write that study data "suggest that once a patient is identified to be at risk of having an adverse event on the basis of traditional clinical, biochemical, and biomarker risk profiles, imaging may help identify those at greater risk of acute coronary events." Among 1,059 patients who underwent CT angiography, 45 had coronary plaques that had undergone positive remodeling and were classified as low attenuation. After more than two years of follow-up, 10 patients (22.2%) with both characteristics of vulnerable plaque developed acute coronary syndrome. The study appears in the June 30 issue of the Journal of the American College of Cardiology.

Study projects heart attack deaths in Australia ...A study by Australian consultancy Access Economics (Sydney) estimates that nearly 10,000 people in Australia will die of a heart attack in 2009, with 2,423 of these expected to occur within 28 days of hospitalization. It projects around 79,990 hospitalizations associated with acute coronary syndrome (ACS) in 2009, with 59% of these the result of myocardial infarction (MI), the rest associated with chest pain (unstable angina). Deaths following hospitalization are expected to account for about 24% of all deaths associated with heart attacks. Most MI deaths will occur before a person can be admitted to hospital. Access Economics was commissioned by Eli Lilly & Co. (Indianapolis) to estimate the economic costs of heart attack and ACS in Australia for 2009. (

Sleep disorders may increase men's risk for arrhythmia ... Arrhythmia risk for older men rises with severity of sleep apnea and other sleep-related breathing disorders, a large cross-sectional study reveals that men with the worst respiratory disturbances at night were likely to have nocturnal atrial fibrillation twice as much as those in the lowest quartile for sleep-disordered breathing. Reena Mehra, MD, of Case Western Reserve University (Cleveland) and colleagues, said the highest quartile for apneas and hypopneas was also at 43% greater risk of complex ventricular ectopy. The report appears in the June 22 issue of Archives of Internal Medicine. (Abstract:

Migraine with aura linked to heart disease in women ... Women who have migraines with aura (a visual or sensory disturbance) appear to be at greater risk for stroke or heart attack than those without this condition, and this association varies by migraine frequency, according to research in the June 24, online issue of Neurology. Among 27,798 female health professionals, those with migraine with aura whose migraines occur at least once a week are more than four times as likely to have a stroke as women without migraines. Those with migraine with aura less than once a month were more than twice as likely to have a heart attack and nearly twice as likely to have had heart procedures such as coronary artery bypass or angioplasty. Study author Tobias Kurth, MD, ScD, of Brigham and Women's Hospital (Boston), Harvard Medical School (Boston) and INSERM (Paris), recommended more research to study these differences "and whether preventing migraines could reduce the risk of stroke and heart problems."

Cytos reports findings from Phase IIa study of hypertension vaccine ... Cytos Biotechnology (Schlieren, Germany) said that in a Phase IIa study (study 02) of its vaccine candidate CYT006-AngQb for the treatment of hypertension blood pressure reductions were much lower than in study 01. Cytos said that a hypothesis explaining these findings is that the accelerated treatment regimen in study 02 leads to the induction of antibody responses with higher titers but lower affinities, creating a lower capacity for sequestering angiotensin II in the blood and leading to smaller BP reduction. Cytos said it will test this hypothesis in study 03, ongoing, to be un-blinded in Q309. Study 03 uses the same treatment regimen as study 02, but at higher doses. (

Tel Aviv U. study finds high carb/heart attack link ... A study by researchers at the Sackler School of Medicine (Tel Aviv) and the Heart Institute of Sheba Medical Center (Tel Hashomer, Israel) and the Endocrinology Institute (Prague, Cech Republic) shows that high carbohydrate foods increase the risk for heart problems. It found that foods with a high glycemic index distend brachial arteries for several hours and that over time a sudden expansion of the artery wall can reduce its elasticity, causing heart disease or sudden death. Comparing volunteers consuming four different diets cornflake mush mixed with milk, a pure sugar mixture, bran flakes, and a placebo – brachial reactive testing over four weeks showed all groups, except the placebo group, had reduced function. "Enormous peaks indicating arterial stress" were found in the high glycemic index groups: the cornflakes and sugar group. (

Initiative vs. venous thromboembolism in UK hospital patients ... UK officials recently held a meeting focused on the prevention, diagnosis and treatment of venous thromboembolism (VTE). The Department of Health said it is committed to reducing the number of people who develop blood clots by encouraging staff to follow national policy which states that all adult patients in England receive a VTE risk assessment on admission to hospital. Best practice regional VTE prevention initiatives were showcased and Strategic Health Authorities were encouraged to develop their own initiatives. An online site will be launched to educate clinicians concerning the assessment of a patient's risk of VTE and the appropriate preventive measures. (

— Compiled by Don Long, MDD National Editor