News Release

Monday news tips, Nov. 15, 2010

American Heart Association meeting report

Peer-Reviewed Publication

American Heart Association

9:30 a.m. Abstract 17248/P2020 – People taking anti-clotting medication often unaware of dangers of taking herbal supplements

People who use herbal and dietary supplements along with warfarin, an anti-clotting medication, are often not aware that they might be compromising the drug's safety and efficacy, according to new research.

Researchers surveyed 100 warfarin-treated patients for 1) the frequency of herbal and dietary supplement use among patients treated with warfarin (also known as Coumadin); 2) if a communication gap about the simultaneous use of warfarin and herbal and dietary supplements existed between physicians and patients; and 3) barriers to communication.

They found that:

  • More than two-thirds use herbal and dietary supplements, yet only one-third reported their provider asked them about herbal and dietary supplement use.
  • Forty-seven percent of the patients didn't view herbal supplements as drugs and thus combined them with high-risk medications, unknowingly exposing themselves to dangerous herb-drug interactions.
  • Most patients (63 percent) revealed that they did not consult with their physician or pharmacist before using a supplement; rather, they learned about it from other sources, such as the Internet or friends.
  • Patients (92 percent) said they would readily disclose information about supplement use if asked.

The findings show that documentation of supplement use in the medical chart is poor and a dangerous communication gap exists — compromising patient safety and placing them at risk for bleeding or stroke complications. Efforts to bridge this communication gap should focus on consumer education, policy changes (cautionary statements on herbal and dietary supplements that they may interact with certain medications) and improved patient-clinician communication.

Jennifer Strohecker, Pharm.D., B.C.P.S., clinical pharmacist, Intermountain Medical Center, Salt Lake City, Utah; (801) 918-0532; jenstrohs@hotmail.com.


11:15 a.m. Abstract 17353 – Nontraditional cardiovascular risk factors common in overweight black youth

Doctors should screen for non-traditional cardiovascular risk factors when assessing heart disease risk in overweight black adolescents, according to new research.

Childhood obesity is linked to the development of cardiovascular disease and death in adulthood. However, black youth are not routinely assessed for cardiovascular risk factors.

To predict the number of cardiac risk factors in overweight and obese black teens, researchers examined the interaction of the severity of obesity, insulin resistance, family history of heart attack, diet and physical activity in 122 black teens (average age 15).

They found that, on average, overweight and obese black teenagers had four risk factors for cardiovascular disease, and 36 percent had five or more risk factors.

Commonly assessed risk factors seen in about half of the youth included:

  • 55 percent with high blood pressure;
  • 47.5 percent with low "good" high density lipoprotein (HDL) cholesterol; and
  • More than 50 percent with risk factors for inflammation and clots (not routinely checked in teenagers).

Age, pubertal status, family history of heart attack, severity of obesity and insulin resistance predicted the number of risk factors present in overweight and obese black teenagers. Diet and physical activity did not predict cardiovascular risk factors. This may be due to the children's low level of physical activity and high fat intake, researchers said.

Based on these findings, children who are younger, earlier in puberty, more seriously obese, with greater insulin resistance and a positive family history of heart attack would have more cardiovascular risk factors.

Doctors should assess youth for insulin resistance, family history of early heart attack and use blood pressure percentile charts to determine hypertension. Incorporating screenings for inflammation and thrombosis will aid in risk stratification and earlier intervention, researchers said.

Patricia A. Cowan, Ph.D., associate professor, College of Nursing, University of Tennessee Health Science Center, Memphis, Tenn.; (901) 448-3318; PCowan@uthsc.edu.


11:15 a.m. Abstract 19322 – Heart disease risk similar between poor, wealthy in universal healthcare system

In an Australian universal healthcare system, the difference in the risk of heart disease between people living in poor areas and those in affluent areas is minimal, according to new research.

Heart disease is more likely to affect people living in poor areas. So researchers examined whether this is true in developed countries where the healthcare system is available to everyone, including the poor and unemployed.

The researchers compiled their data by first asking 1,258 general practitioners in Australia to recruit patients for a risk factor assessment. They then determined the nearly 9,917 patients' cardiovascular disease risk and socioeconomic status based on the doctors' zip codes.

They found that:

  • Men in poor areas only had a slightly higher risk of heart disease compared to men in affluent areas. There was no difference in risk for women.
  • Risk of heart disease in men and women increased by 7 percent as their region became more disadvantaged, which was partly attributable to higher rates of smoking in disadvantaged areas.
  • Thirteen percent of people smoked in poor areas compared to 6 percent in affluent areas.
  • Fifty percent of people living in poor areas were prescribed cholesterol-lowering medications and had lower cholesterol (total cholesterol of 186 mg/dl vs 195 mg/dl) compared to 39 percent in the wealthy areas.

Andrea Driscoll, R.N., M.Ed., Ph.D., senior research fellow, Monash University, Melbourne, Australia; (011) 61 3 9903 0588; andrea.driscoll@monash.edu.


11:30 a.m. Abstract 12337 – Optimizing AED placement may save lives

Researchers have developed mathematical modeling techniques to optimize the geographical placement of automated external defibrillators (AEDs) in the Toronto and Peel regions of Ontario, Canada.

They found that the current distribution of registered AEDs in the study region was not optimal. Of 1,414 out-of-hospital cardiac arrests, 2,041 pre-existing registered AEDs provided coverage (within 100 meters) for only 226, or 16 percent of arrests. The average distance to the closet AED was 487 meters, resulting in an average bystander travel time of about 5 minutes.

Using their optimization model, the researchers determined that the top five locations for additional AED placement would cover another 51 out-of-hospital cardiac arrests. Adding AEDs to these five locations would reduce the average distance from a cardiac arrest to the closest AED by about 50 meters, or 10 percent. A minimum of 884 additional AEDs would be required to cover all historical public location out-of-hospital cardiac arrests, with sequential priority placement of AEDs resulting in one-to-one coverage after about 200 new AEDs. Sequential priority placement refers to placing AEDs in locations with the densest clusters of cardiac arrest first; so one properly placed AED could have serviced several cardiac arrests.

The researchers said mathematical modeling has the potential to improve AED distribution, use and, ultimately, survival after public location out-of-hospital cardiac arrest.

Timothy C. Y. Chan, B.Sc., Ph.D. assistant professor, University of Toronto, Toronto, Canada; (416) 946-5721; tcychan@mie.utoronto.ca.


11:30 a.m. Abstract 19470 – Genetically targeted enzyme replacement therapy dramatically improves heart failure patients' lives

In a new phase II study, a genetically targeted enzyme replacement therapy safely restored levels of a key enzyme that regulates calcium cycling and contractility.

The enzyme declines after late-stage heart failure, resulting in reduced pumping ability of the heart.

Researchers examined the effect of AAV1 SERCA2a (brand name MYDICAR®) in patients with advanced heart failure. They analyzed data from the CUPID trial, comparing AAV1 SERCA2a to placebo in 39 patients with severe but stable forms of heart failure, including significantly impaired pumping function of their hearts, with less than half normal exercise capacity.

The researchers evaluated AAV1 SERCA2a's 1) safety; 2) episodes of worsening heart failure leading to hospitalization; 3) frequency of and time to cardiac transplantation or a mechanical heart pump implantation; 4) changes in patients' abilities to exercise; 5) function tests of the heart – a blood test biomarker of heart failure severity; 6) patients' symptoms of heart failure; and 7) quality of life.

At six and 12 months, the frequency of death, worsening heart failure, heart failure-related hospitalizations, heart transplant and need for a mechanical heart pump for patients on high-dose AAV1 SERCA2a was dramatically lower compared to patients who received placebo.

Furthermore, at six months, changes in patients' ability to exercise occurred and symptoms of heart failure and quality of life improved.

Researchers said their results suggest AAV1 SERCA2a was safe with better outcomes across several parameters sustained for one year. The therapy is ready to be tested in a larger number of patients, they said.

Donna Mancini, M.D., professor of medicine and Choudhrie professor of cardiology, Columbia University, New York; (212) 305-4629; dmm31@columbia.edu.


2 p.m. Abstract 12250 – Young adults with healthy lifestyle lower risk for cardiovascular disease in middle age

Maintaining a healthy lifestyle from young adulthood to middle age plays a significant role in achieving a low cardiovascular disease (CVD) risk profile in middle age, according to new research.

Researchers studied the long-term follow-up of the Coronary Artery Risk Development in Young Adults (CARDIA) study, examining whether adopting a healthy lifestyle from young adulthood to middle age can lead to a low CVD risk profile in middle age. CARDIA included 2,498 black and white participants 18 to 30 years old in 1985 at baseline.

Healthy lifestyle factors included:

  • Not being overweight or obese;
  • Having no or only moderate alcohol intake;
  • Eating higher intakes of potassium, calcium and fiber and lower intake of saturated fat relative to peers;
  • Being more physically active relative to peers; and
  • Never smoking cigarettes.

After 20 years, more than 60 percent of people with all five healthy lifestyle factors from young adulthood to middle age had a low CVD risk profile as compared to less than 6 percent of people with none of the healthy lifestyle factors. The proportion of people with a low risk CVD profile increases as the number of healthy lifestyle factors increases.

A low CVD risk profile is defined by low blood cholesterol and blood pressure, never smoking, no diabetes and no history of heart attack. Studies have reported that middle-aged adults with a low CVD risk profile have a longer life expectancy, dramatically lower CVD rates, better quality of life, and lower Medicare charges in their older ages. However, while the majority of young adults have a low CVD risk profile, only about 7 percent of American middle-aged men and women satisfy the low CVD risk profile.

To maximize the benefit of a low CVD risk profile in and beyond middle age, more emphasis should be devoted to encouraging healthy lifestyles among young adults, researchers said.

Kiang Liu, Ph.D., professor and associate chair for research, Northwestern University, Chicago, Ill.; (312) 908-8307; Kiangliu@northwestern.edu.

Editor's Notes:

  • The American Heart Association's Start! initiative encourages all Americans to participate in regular physical activity. Start! created personalized walking plans for people at any fitness level. Visit startwalkingnow.org to download the Start! Walking Plans and locate Start! Walking Paths near you.
  • Take action and find fun ways to get physically active with steps that encourage incremental, achievable change for a healthy lifestyle. For more information, visit http://activeplaynow.com/.


2 p.m. Abstract 18067 -– Some young advanced heart failure patients recover heart function after LVAD support

In a retrospective review of data from recent clinical trials, almost 2 percent of patients on a new generation of continuous flow left ventricular assist devices (LVADs) recovered ventricular function, no longer needing heart transplantation or permanent device support.

The mechanical devices support patients with advanced stage heart failure until heart transplantation, or they provide permanent mechanical circulatory support in patients ineligible for transplantation.

In the group of 20 patients who recovered, researchers reviewed data for certain characteristics that make advanced heart failure patients on support more likely to recover.

The researchers found that the patients who recovered were more likely to have nonischemic cardiomyopathy, which means their heart muscle damage was not related to coronary artery disease. Seventy-five percent of the 20 patients also were younger than 45 years and 65 percent had been diagnosed with heart failure for less than one year.

Based on their findings, researchers said clinicians should look for the possibility of heart function recovery in patients on left ventricular assist devices who are younger, recently diagnosed and have nonischemic cardiomyopathy.

Daniel J. Goldstein, M.D., cardiothoracic surgeon, Montefiore-Einstein Medical Center, Bronx, N.Y.; (718) 920-2144; dgoldste@montefiore.org.


3 p.m. Abstract 12205/P4053 – CPR-AED programs in schools save children's, adults' lives

Programs that help schools implement cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) use are successful and lead to higher survival rates for sudden cardiac arrests on school grounds, according to new research.

With 20 percent of the U.S. population (adults and children) spending time in school each week, schools are a strategic location for sudden cardiac death prevention programs, researchers said.

Researchers studied the lifesaving impact of two school-based CPR-AED programs, Project ADAM, in Pennsylvania and Wisconsin, and Project SAVE in Georgia.

The researchers reported on 850 schools in Wisconsin using Project ADAM. Across Wisconsin, in schools where an AED was deployed during a sudden cardiac arrest, the rate of survival to hospital discharge was 36 percent. In Pennsylvania eleven "saves" — six adults and five children or adolescents — have occurred at schools since Project ADAM started there.

In Georgia, Project SAVE has provided CPR-AED program information to all 180 school districts in the state. Sixty-five percent of all schools have AEDs and 728 schools have a HeartSafe program. From October 2004 to May 2010, 49 (26 students, 23 adults) sudden cardiac arrest events were reported. Due to improved school AED and emergency response plans, 22 (10 students, 12 adults) of the incidents resulted in survival to hospital discharge (45 percent).

The programs' goals are: education and awareness of signs, symptoms and treatment of sudden cardiac death; implementation of CPR-AED programs in schools and advocacy for students to learn CPR/AED use prior to graduation. The programs include monitoring sudden cardiac death events at participating schools. A comprehensive program includes a coordinator, emergency medical services, first responder team development/training, purchase/maintenance of AED(s) and an emergency response plan.

Stuart Berger, M.D., professor of pediatrics, Medical College of Wisconsin, Milwaukee, Wis.; (414) 266-2477; sberger@mcw.edu.

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Author disclosures are on the abstracts.

Statements and conclusions of study authors that are presented at American Heart Association scientific meetings are solely those of the study authors and do not necessarily reflect association policy or position. The association makes no representation or warranty as to their accuracy or reliability. The association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific association programs and events. The association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and device corporations are available at www.heart.org/corporatefunding.

NR10-1144 (SS10/Monday News Tips)

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