Martin Leon, MD, a leading U.S. cardiologist, says the Federal Aviation Administration (FAA) should require emergency medical equipment on all commercial airline flights to help heart attack victims. Leon, who is president and CEO of the Cardiovascular Research Foundation (New York), said the agency also should make CPR training mandatory for all flight attendants.

While on a flight to California early last month to attend the American College of Cardiology annual scientific sessions, Leon found that no medical equipment was available to help a passenger who became seriously ill and may have been having a heart attack. "The good news for the stricken passenger was that there were a dozen cardiologists on the flight who could have helped him," Leon said. "The bad news was that there was no equipment available for us to work with." The plane had to make an emergency landing and the passenger was taken off.

Leon said he was "shocked to learn that the FAA does not require even rudimentary medical equipment, nor does it mandate CPR training," he said. "I had just assumed, until this experience, that these relatively inexpensive precautionary measures were in place." While some airlines have already voluntarily equipped their planes with a small battery-powered monitor/defibrillator, which costs about $3,000, Leon said that every commercial flight should carry such a device, as well as drugs to alleviate pain. And he added that CPR training should be a routine part of flight-attendant schooling.

Prodded by Congress, the FAA has been studying the issue of emergency medical equipment since 1998. For Leon, the decision should be an easy one: "The time to act is now and the decision should be to mandate the presence of emergency medical equipment on all commercial flights."

Test predicts heart disease in Type 1 diabetics

Researchers at the University of Pittsburgh (Pittsburgh, Pennsylvania) say a series of questions and measurements to determine insulin sensitivity could help save the lives of many people with Type 1 diabetes by identifying those who are at an increased risk of heart disease.

The test, known as the Insulin Resistance Syndrome (IRS) score, is a clinical means of measuring insulin resistance, a condition that researchers believe may be common, but often overlooked, in patients with Type 1 diabetes. In the past, insulin resistance has been associated only with Type 2 diabetes.

The new test is described by researchers from the university's graduate school of public health and school of medicine in a paper published in the April issue of Diabetes, a journal of the American Diabetes Association (Alexandria, Virginia).

Insulin resistance is associated with an increased risk of coronary artery disease, a leading cause of mortality in people with Type 1 diabetes. With the new IRS score, physicians can identify insulin resistant patients and begin heart-saving treatment interventions including exercise, weight loss and medication. Trevor Orchard, MD, professor of epidemiology in the public health school and senior author of the article, said, "Insulin resistance has long been recognized in Type 1 diabetes, but few studies have examined the association between clinical IRS risk factors and insulin resistance in this population."

The IRS score is based on clinical risk factors in adults with type 1 diabetes, including hypertension, high waist-to-hip ratio, family history of type 2 diabetes, and glycemic control. By applying a personalized rating of 1 (lowest) to 3 (highest) for each risk factor, then dividing by the total number of risk factors for which data are available, a physician can calculate an IRS score for the patient.

ACC issues warning on alpha blockers

The American College of Cardiology (ACC; Bethesda, Maryland) last month urged that physicians stop using Cardura, a widely prescribed alpha-adrenergic blocker, for the treatment of hypertension. The recommendation follows announcement of the results of a large high blood pressure study at the ACC's annual scientific sessions.

The study sponsor, the National Heart, Lung, and Blood Institute (NHLBI), halted the study in February due to data showing that the alpha blocker, doxazosin, is less effective than more traditional diuretics in reducing some forms of cardiovascular disease, such as congestive heart failure. The Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) study showed that users of doxazosin had 25% more cardiovascular events and were twice as likely to be hospitalized for heart failure than users of the diuretic chlorthalidone.

According to the NHLBI, of the 24 million Americans who take medication to treat their hypertension, about 1 million use an alpha blocker. "The ACC encourages physicians who treat hypertensive patients to review the new data with their colleagues to ensure the rapid dissemination of this important information," said Robert Cody, MD, chairman of the ACC's Hypertensive Diseases Committee.