Despite the high rates of cardiovascular disease, heart attack and stroke in the United States, Americans aren't very knowledgeable about these problems, according to the results of a new poll commissioned jointly by the American Heart Association (AHA; Dallas, Texas) and the Discovery Health Channel (Bethesda, Maryland). Of those surveyed, nearly two-thirds (63%) said they would not recognize the warning signs of stroke and nearly half (47%) said they did not know the early signs of heart attack. Perhaps even more surprising was the number of people who did not know what action to take – calling 911 – if a heart attack strikes (43%), and are not trained in CPR (also 43%).

Not surprisingly, there was even less knowledge about more detailed information about heart attack: 69% did not know that the risk of heart attack rises sharply if menopause is caused by surgery to remove the uterus and ovaries. And only 65% of those surveyed who have been diagnosed with heart and/or stroke-related conditions said they follow the advice of their doctors and other health professionals "a great deal." The nationally representative telephone survey on heart disease, heart attacks and strokes polled 750 Americans 18 years of age and older.

"Although many Americans are taking steps to improve their health, protect and strengthen their heart and reduce their chances of stroke, they can still do a lot more," said Lynn Smaha, MD, PhD, president of the American Heart Association. "In addition, there is a lack of awareness about heart disease and stroke that needs to be directly addressed through public education." One conclusion from the survey is that there is a broad need for new programs to fill this knowledge gap, and the AHA soon will be providing Discovery Health Channel with what it termed "editorial input" to promote the association's programs. The AHA reported spending $327 million on research support, public and professional education, and community programs during fiscal 1998-99.

In another recent survey, the National Stroke Association (New York) found that fewer than 40% of those individuals in the U.S. who have been diagnosed as having had a transient ischemic attack (TIA), or mini-stroke, understood what a TIA is. The primary purpose of the survey, however, was to quantify the incidents of TIA, and it reported the condition "much more common than previously thought." It reported that 2.5% of adults over the age of 18 – or a total of more than 5 million – have experienced TIA and that up to 1.2 million over age 45 may not know they have had such an attack.

Hostile men, snoring women at risk

In the search for what causes heart disease, two new reports indicate that hostile men and females who snore may be at greater risk for cardiovascular disease than others. In a recent issue of Psychosomatic Medicine, a research team at Brown University School of Medicine (Providence, Rhode Island) reported on its study of more than 1,000 men – almost all Caucasian and over age 43 – drawn from another study on aging and tested via the Cook-Hedley Hostility Scale. Those with higher hostility scores were more likely to be overweight, have abdominal and upper body obesity, and have insulin resistance (also a precursor to diabetes), all risk factors for heart disease.

Lead researcher Raymond Niaura, MD, warned against attaching a direct link between a particular hostility score and increased risk, but emphasized that the various factors probably interact to create the greater risk. Additionally, men with less education were more likely to be more hostile. The finding suggests that hostility "may be part of the cognitive/ emotional/ behavioral response to the chronic stress of low socioeconomic status," Niaura said, and he suggested the need for more research on those socioeconomic factors.

In another study, women with a snoring problem are also at greater risk for cardiovascular illness, at least twice that compared to those who don't snore.

Reported in the February issue of the Journal of the American College of Cardiology, the study was led by Frank Hu, MD, of the Harvard School of Public Health (Boston, Massachusetts), following 72,000 nurses over eight years. The researchers noted that the study was different than previous work which has focused primarily on men.

Those who snored regularly were less healthy than non-snorers, and they also were more likely to have other risk factors such as diabetes, high blood pressure and high cholesterol, and were more likely to smoke and drink. Even after adjustment for poorer general health, the risk of cardiovascular disease remained 20% higher for occasional snorers and 33% higher for regular snorers than for non-snorers, and the researchers suggest that physicians should be more aggressive in determining if women snore and then treating them for cardiovascular problems.

Frequent flossing protects the heart

One of the most important devices for maintaining cardiovascular health, according to the American Dental Hygienists Association (ADHA; Chicago, Illinois), may be one of the simplest – dental floss. Last month, ADHA president and registered dental hygienist Lisa Potter pointed to a large number of research studies that suggest "a connection between periodontal and cardiovascular disease," and one way to prevent periodontal disease is to floss. She notes that because manipulating floss is difficult for many people, they don't do it. And so she suggests using alternate interdental cleaners currently on the market: thin plastic or wooden dental picks or mechanical floss threaders – until they find something that is comfortable and easy for them to use.

What the ADHA did not note in its statement about flossing is that failure to floss regularly and then going infrequently to the dentist to have your teeth cleaned can be particularly dangerous to your health. Besides removing plaque, flossing helps to oxgenate the teeth and gums, while low levels of oxygen in these areas of the mouth serve to support the breeding of anaerobic bacteria. If these bacteria build up and then are released into the system during professional cleaning, they can "run amok," the phrase used by Dr. Tim Rose, president of the American Academy of Periodontology. This can have two effects: These bacteria have been associated with the production of enzymes that may clog the arteries over the long term. But the short-term possibility is even more serious. Releasing large amounts of bacteria into the system can shock the heart, an effect associated with a high rate of heart attacks following professional cleaning.

Marrow donor program expands options

The National Marrow Donor Program (NMDP; Minneapolis, Minnesota) registry has initiated its first cord blood stem cell transplant program to expand its transplant options for patients with leukemia and other blood diseases. Cord blood is rich in blood stem cells that, when used in a transplant, can mature into healthy marrow and offer a cure to patients with leukemia or other life-threatening blood diseases.

Launched in 1986, NMDP provides unrelated marrow for transplant patients, and the organization's registry is the only database in the world with information on both volunteer unrelated donors and stored umbilical cord blood units. That registry, according to NMDP's chief medical officer, Dennis Confer, MD, "provides a single point of access for all sources of blood stem cells used in transplant patients."

The NMDP registry lists the names of more than 4 million volunteers who are willing to donate marrow or blood stem cells, allowing a patient to turn to a single source for multiple transplant options.

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