USPSTF: Individualize counseling for primary prevention of cardiovascular disease

The U.S. Preventive Services Task Force (USPSTF) recommends that physicians individualize the decision to refer adults without known cardiovascular disease (CVD) risk factors to behavioral counseling interventions for healthy diet and physical activity. This recommendation forms the basis of a draft recommendation statement published by the USPSTF on Jan. 18.

29 jan 2022--Carrie D. Patnode, Ph.D., M.P.H., from the Kaiser Permanente Evidence-based Practice Center in Portland, Oregon, and colleagues conducted a systematic review to support the USPSTF in updating recommendations on behavioral counseling to promote a healthy diet and physical activity for adults without known CVD risk factors. Data were included from 113 randomized clinical trials, with 129,993 participants. The researchers found that only three trials reported long-term outcomes related to mortality or cardiovascular events, with no clear benefit seen for dietary or physical activity interventions. Few trials demonstrated statistically significant or clinically significant quality-of-life changes after interventions. Small, statistically significant reductions in continuous measures of blood pressure, low-density lipoprotein cholesterol, and adiposity-related outcomes were seen at six months to 1.5 years in association with diet and physical activity behavioral interventions. Consistent evidence was seen for improvements in dietary intake and physical activity levels among participants in behavioral interventions.

Based on these findings, the USPSTF recommends that clinicians should individualize the decision to offer or refer adults without known CVD risk factors to behavioral counseling interventions that promote healthy diet and physical activity (C recommendation).

The draft recommendation statement and evidence review have been made available for public comment. Comments can be submitted from Jan. 18 to Feb. 14, 2022.

---

More information: Draft Evidence Review

Draft Recommendation Statement

COPD is independent risk factor for cardiovascular death, but not risk of stroke

Chronic obstructive pulmonary disease, or COPD, is associated with increased risk of dying from a cardiovascular disease such as heart failure or a heart attack, as well as diseases not associated with the heart. However, COPD is not by itself associated with increased likelihood of having a stroke or a systemic embolism, according to a new research study.

22 may 2015--Researchers from Duke University and the Mayo Clinic reached this conclusion after analyzing data from a large randomized trial of patients with atrial fibrillation, a condition that produces an irregular heartbeat. The trial, ARISTOTLE (Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation), compared the effectiveness of two anticoagulants—apixaban and warfarin—on reducing the risk of stroke or systemic embolism in these patients. A systemic embolism occurs when a clot formed in the heart travels to another part of the body and blocks blood flow; typically, this blockage occurs in the brain, causing a stroke, but systemic emboli can also travel to other organs or a person's extremities.

The researchers examined the data from the 18,206 patients, all with atrial fibrillation, enrolled in ARISTOTLE to explore the connection between COPD and stroke in this patient population. The researchers will present their data during ATS 2015 in Denver, May 15 to 20.

"Other studies have shown that COPD is an independent risk factor for cardiovascular disease, but what hadn't been studied was whether COPD was an independent risk factor for stroke, specifically among patients with atrial fibrillation," said Michael Durheim, MD, a pulmonary and critical care fellow at Duke. Atrial fibrillation is itself a known risk factor for stroke and systemic embolism because clots more easily form when blood is pumped irregularly by the heart.

In their analysis, Dr. Durheim and his colleagues found that COPD was present in 1,950 (10.8%) of the 18,134 patients for whom pulmonary disease history was available. Patients with COPD were older, more often men and more likely to be current or former smokers. They were also more likely to suffer from other diseases that would put them at higher risk for stroke, including coronary artery disease, a prior heart attack and heart failure.

After adjusting for these and other patient characteristics, COPD was not associated with increased risk of stroke or systemic embolism (adjusted HR 0.86 [95% CI 0.61, 1.21], p = 0.382). However, COPD was associated with increased mortality from all causes by 54 percent (adjusted HR 1.54 [95% CI 1.31, 1.82], p < 0.001), including both cardiovascular and non-cardiovascular death.

Dr. Durheim says that because COPD independently raises mortality in patients with atrial fibrillation, further studies are warranted to "elucidate the mechanisms" by which COPD contributes to increased mortality. The results of those studies, he adds, might change clinical practice.

Meanwhile, he notes one practical outcome of his study: the effect of apixaban compared with warfarin on stroke or systemic embolism did not differ between subjects with and without COPD (HR 0.92 vs 0.78, interaction p = 0.617). "The presence of COPD doesn't need to affect provider's choice of an anticoagulant," he says.

More information: Abstract 65465: Chronic Obstructive Pulmonary Disease is Associated with Increased Risk of Mortality Among Patients with Atrial Fibrillation: Insights from the ARISTOTLE Trial

Provided by American Thoracic Society

New model for predicting cardiovascular disease risk worldwide

Researchers have developed the first global model for predicting cardiovascular disease (CVD) risk. The model—developed by Harvard T.H. Chan School of Public Health, Imperial College London, and colleagues—will be of particular help to public health professionals, clinicians, and patients in developing countries for prevention of CVD.

31 mar 2015--A paper on the new CVD risk prediction method, and its application in several example countries, appears online March 26, 2015 in The Lancet Diabetes & Endocrinology.

"This new tool allows healthcare professionals around the world to make optimal clinical decisions about treatment of their patients and for health policy makers to efficiently allocate resources to CVD prevention," said Goodarz Danaei, assistant professor of global health at Harvard Chan School.

To develop the model, which will be available later this year at http://www.globorisk.org, the researchers analyzed data from more than 50,000 participants in eight existing long-term studies, which included risk factors such as blood pressure, cholesterol, diabetes, and smoking, as well as gender and age.

The researchers generated risk charts that estimated risk of fatal CVD over a span of 10 years for 11 countries in different regions of the world. The risk of fatal CVD was lowest in South Korea, Spain, Japan, and Denmark, and highest in the Czech Republic, China, Iran, and Mexico. In the former group of countries, only 5%-10% of men and women had more than a 10% risk of fatal CVD. But in China, 33% of men and 28% of women had a 10-year fatal CVD risk of 10% or higher. In Mexico the prevalence of high-risk CVD was 16% for men and 11% for women.

The researchers found that more people were at high risk of CVD in many developing countries compared with developed ones. Within developed countries, they found that the U.S. had a larger share of its population at high risk of CVD than England, Japan, South Korea, Denmark, or Spain.

The results emphasize the need to use the current momentum for universal health coverage to ensure that people at high risk of CVD in low- and middle-income countries receive the same basic treatments available to those in the high-income world, according to the authors. The U.S. results also demonstrate the urgent need for equitable access to primary health care as a tool for CVD prevention.

More information: "Globorisk - A novel risk score for predicting cardiovascular disease risk in national populations: a pooled analysis of prospective cohorts and health examination surveys," Kaveh Hajifathalian, Peter Ueda, Yuan Lu, Mark Woodward, Alireza Ahmadvand, Carlos A. Aguilar-Salinas, Fereidoun Azizi, Renata Cifkova, Mariachiara Di Cesare, Louise Eriksen, Farshad Farzadfar, Nayu Ikeda, Davood Khalili, Young-Ho Khang, Vera Lanska, Luz León-Muñoz, Dianna Magliano, Kelias P. Msyamboza, Kyungwon Oh, Fernando Rodríguez-Artalejo, Rosalba Rojaz-Martinez, Jonathan E. Shaw, Gretchen A. Stevens, Janne Tolstrup, Bin Zhou, Joshua A Salomon, Majid Ezzati, and Goodarz Danaei, Lancet Diabetes & Endocrinology, online March 26, 2015, DOI: 10.1016/S2213-8587(15)00081-9

Provided by Harvard School of Public Health

Loss of sensation in the feet of diabetes patients linked to cardiovascular disease, say researchers

Experts have discovered that loss of sensation in the feet, a result of diabetes, may be a predictor of cardiovascular events such as heart attack and strokes.

09 aug 2014--Diabetes, which affects 3.7million people in the UK, can cause damage to a person's blood vessels and nerves, especially if their blood sugar is poorly controlled, leading to poor circulation and loss of sensation in the feet, known as peripheral neuropathy.

The damage to vessels and nerves may be associated with the development of foot ulcers and, in extreme cases, can lead to foot or leg amputation.

The new research, carried out using information on over 13,000 patients, with type 2 diabetes in England, shows that lack of sensation in feet, which can be easily identified by a patient's GP, may also indicate future heart and circulation problems.

The new study suggests that testing for peripheral neuropathy, which is offered on an annual basis to all patients with diabetes, may provide a simple clinical way to identify those higher-risk individuals with diabetes who may need more intensive monitoring or treatment.

Jack Brownrigg, a PhD student at St George's, University of London, who conducted the research at St George's Vascular Institute, said: "While the risk of cardiovascular disease is known to be higher in patients with diabetes, predicting which patients may be at greatest risk is often difficult.

"We looked at data on individuals with no history of cardiovascular disease and found that those with peripheral neuropathy were more likely to develop cardiovascular disease."

Robert Hinchliffe, Senior Lecturer and Consultant in Vascular Surgery at St George's who co-led the study with Professor Kausik Ray, said: "While loss of sensation in the feet is known to be a key risk factor for foot ulcers, it may also provide additional useful information to guide patient management. This is the first study to show that it can also indicate an increased risk of cardiovascular problems like heart attacks or strokes.

"The good news is that peripheral neuropathy can be easily identified by simple tests carried out in GP surgeries. The results of the study warrant further investigation as to whether even greater control of risk factors including blood pressure and blood sugar can prevent or delay the onset of cardiovascular disease.

"There is likely an unmet potential to reduce cardiovascular disease in this group of patients through greater monitoring and simple treatments".

The paper, "Peripheral Neuropathy and the Risk of Cardiovascular Events in Type 2 Diabetes Mellitus", is published in the leading UK cardiovascular journal Heart.

More information: "Peripheral neuropathy and the risk of cardiovascular events in type 2 diabetes mellitus." Jack R W Brownrigg, Simon de Lusignan, Andrew McGovern, Cian Hughes, Matthew M Thompson, Kausik K Ray, Robert J Hinchliffe.Heart heartjnl-2014-305657Published Online First: 5 August 2014 DOI: 10.1136/heartjnl-2014-305657

Provided by St. George's University of London

'Tomato pill' improves function of blood vessels in patients with cardiovascular diseases

Micrograph of a heart with fibrosis (yellow) and amyloidosis (brown). Movat's stain. Credit: Nephron/Wikipedia

A daily supplement of an extract found in tomatoes may improve the function of blood vessels in patients with cardiovascular disease, according to new research from the University of Cambridge.

10 jun 2014--The incidence of cardiovascular disease varies worldwide, but is notably reduced in southern Europe, where a 'Mediterranean diet' consisting of a larger consumption of fruit, vegetables and olive oil predominates. Recent dietary studies suggest that this diet reduces the incidence of events related to the disease, including heart attack and stroke, in patients at high cardiovascular risk, or those who have previously had the disease.

One component of the Mediterranean diet thought to play a role in reducing this risk is lycopene, a powerful antioxidant which is ten times more potent than vitamin E. Lycopene is found in tomatoes and other fruits, and its potency appears to be enhanced when it is consumed pureed, in ketchup or in the presence of olive oil. Whilst there is strong epidemiological evidence to support the role of lycopene in reducing cardiovascular risk, the mechanism by which it does so is unclear.

In a study published in the journal PLOS One, researchers at the University of Cambridge and the Cambridge University Hospitals National Health Service Foundation Trust demonstrate one mechanism by which they believe lycopene reduces the risk.

Dr Joseph Cheriyan, consultant clinical pharmacologist & physician at Addenbrooke's Hospital and Associate Lecturer at the University of Cambridge, says: "There's a wealth of research that suggests that the Mediterranean diet – which includes lycopene found in tomatoes and other fruit as a component – is good for our cardiovascular health. But so far, it's been a mystery what the underlying mechanisms could be."

The researchers carried out a randomised, double blind, placebo controlled, interventional trial investigating the effects of lycopene a gold standard method of measuring the function of blood vessels called forearm blood flow, which is predictive of future cardiovascular risk. Thirty-six cardiovascular disease patients and thirty-six healthy volunteers were given either Ateronon (an off-the-shelf supplement containing 7mg of lycopene) or a placebo treatment. As a double blind trial, neither the study participants nor the researchers dispensing the pills were aware which treatment was being provided.

The patients with cardiovascular disease were all on statins (cholesterol-lowering drugs). However, despite this, they still had a relatively impaired function of the endothelium – the inner lining of blood vessels – compared to healthy volunteers. This function is determined by the response of blood vessels in the forearm to a naturally occurring molecule called acetylcholine. Endothelial function predicts future events, so having a healthy endothelium is an important factor in preventing the evolution of heart disease.

The researchers found that 7mg of oral lycopene supplementation improved and normalised endothelial function in the patients, but not in healthy volunteers. Lycopene improved the widening of the blood vessels by over a half (53%) compared to baseline in those taking the pill after correction for those who took the placebo; constriction of the blood vessels is one of the key factors that can lead to heart attack and stroke. However, the supplement had no effect on blood pressure, arterial stiffness or levels of lipids.

"We've shown quite clearly that lycopene improves the function of blood vessels in cardiovascular disease patients," adds Dr Cheriyan. "It reinforces the need for a healthy diet in people at risk from heart disease and stroke. A daily 'tomato pill' is not a substitute for other treatments, but may provide added benefits when taken alongside other medication. However, we cannot answer if this may reduce heart disease – this would need much larger trials to investigate outcomes more carefully."

Professor Jeremy Pearson, Associate Medical Director at the British Heart Foundation, says: "Impaired endothelial function is a known predictor of increased risk of future heart disease. Further work is needed to understand whether the beneficial effects seen in this small study translate into clinical benefit for at-risk patients."

More information: Gajendragadkar, PR et al. Effects of Oral Lycopene Supplementation on Vascular Function in Patients with Cardiovascular Disease and Healthy Volunteers: A Randomised Controlled Trial. PLoS One; 9 June 2014.

Provided by University of Cambridge

*

A good night's sleep increases the cardiovascular benefits of a healthy lifestyle

A good night's sleep can increase the benefit of exercise, healthy diet, moderate alcohol consumption and non-smoking in their protection against cardiovascular disease (CVD), according to results of a large population follow-up study.(1) Results showed that the combination of the four traditional healthy lifestyle habits was associated with a 57% lower risk of cardiovascular disease (fatal and non-fatal) and a 67% lower risk of fatal events. But, when "sufficient sleep" (defined as seven or more hours a night) was added to the other four lifestyle factors, the overall protective benefit was even further increased - and resulted in a 65% lower risk of composite CVD and a 83% lower risk of fatal events.

03 july 2013--"If all participants adhered to all five healthy lifestyle factors, 36% of composite CVD and 57% of fatal CVD could theoretically be prevented or postponed," the authors report. "The public health impact of sufficient sleep duration, in addition to the traditional healthy lifestyle factors, could be substantial."

The study is published today in the European Journal of Preventive Cardiology, and is the first to investigate whether the addition of sleep duration to the four traditional healthy lifestyle factors contributes to an association with CVD.

The Monitoring Project on Risk Factors for Chronic Diseases (MORGEN) is a prospective cohort study in the Netherlands from which 6672 men and 7967 women aged 20 years and free of CVD at baseline were followed up for a mean time of 12 years. Details of physical activity, diet, alcohol consumption, smoking and sleep duration were recorded between 1993 and 1997, and the subjects followed-up through a cross-link to national hospital and mortality registers.

As expected, results showed that adherence to each of the four traditional lifestyle factors alone reduced the risk of CVD. Those at baseline who recorded sufficient physical activity, a healthy diet and moderate alcohol consumption reduced their risk of composite CVD from 12% for a healthy diet to 43% for not smoking; and risk reduction in fatal CVD ranged from 26% for being physically active to 43% for not smoking.

However, sufficient sleep duration alone also reduced the risk of composite CVD by about 22% (HR 0.78) and of fatal CVD by about 43% (HR 0.57) when compared with those having insufficient sleep. Thus, non-smoking and sufficient sleep duration were both strongly and similarly inversely associated with fatal CVD.

These benefits were even greater when all five lifestyle factors were observed, resulting in a in a 65% lower risk of composite CVD and an 83% lower risk of fatal CVD.

As background to the study, the investigators note that poor sleep duration has been proposed as an independent risk factor for CVD in two other (non-European) studies, but without adding the effect of sleep to other healthy lifestyle benefits. This study - in a large population - now suggests that sufficient sleep and adherence to all four traditional healthy lifestyle factors are associated with a lower CVD risk. When sufficient sleep duration is added to the traditional lifestyle factors, the risk of CVD is even further reduced.

As an explanation for the results, the investigators note that short sleep duration has been associated with a higher incidence of overweight, obesity and hypertension and with higher levels of blood pressure, total cholesterol, haemoglobin A, and triglycerides, effects which are "consistent with the hypothesis that short sleep duration is directly associated with CVD risk".

The study's principal investigator, Dr Monique Verschuren from the National Institute for Public Health and the Environment in the Netherlands, said that the importance of sufficient sleep "should now be mentioned as an additional way to reduce the risk of cardiovascular disease". "It is always important to confirm results," she added, "but the evidence is certainly growing that sleep should be added to our list of CVD risk factors."

Dr Verschuren noted that seven hours is the average sleeping time that "is likely to be sufficient for most people". An earlier study from her group in the Netherlands, which included information on sleep quality, found that those who slept less than seven hours and got up each morning not fully rested had a 63% higher risk of CVD than those sleeping sufficiently - although those who woke rested, even from less than seven hours' sleep, did not have the increased risk.(2)

More information: 1. Hoevenaar-Blom M, Spijkerman AMW, Kromhout D, Verschuren WMM. Sufficient sleep duration contributes to lower cardiovascular disease risk in addition to four traditional lifestyle factors: the MORGEN study. Eur J Prevent Cardiol 2013; DOI: 10.1177/2047487313493057

2. Hoevenaar-Blom MP, Spijkerman AM, Kromhout D, et al. Sleep duration and sleep quality in relation to 12-year cardiovascular disease incidence: the MORGEN study. Sleep 2011; 34: 1487-92.

Provided by European Society of Cardiology

Mortality from CVD in Brazil has increased 3.5 times more than in other developing countries

Despite Brazil's successful prevention campaigns which have contributed to a reduction in risk factors such as smoking, cardiovascular disease (CVD) remains the first cause of death in the country, at 32%. Tobacco consumption and decrease of salt in local diets are some of the risk factors that will be discussed at the 67th Annual Congress of the Brazilian Society of Cardiology (1) which takes place in Recife, Brazil from 14 to 17 September 2012. This meeting is the largest cardiology conference in Latin America. The Brazilian Society of Cardiology is an affiliated society of the European Society of Cardiology since 2009 and has around 13,000 members.

15 sept 2012--Brazil's fast development has brought many positive changes to people's lives, but the move from a rural to an urban society has introduced changes in eating and exercise patterns resulting in growing obesity, diabetes and dyslipidaemia in the 185 million population.Cardiovascular mortality in Brazil has increased 3.5 times more than in other developing countries (2) making prevention of CVD an urgent issue. The recently updated European Guidelines on CVD Prevention (3), will be part of the one-day educational session (4) presented in Recife by senior faculty of the ESC together with representatives of the host society. These Guidelines have been reformatted to help disseminate the information from to where it is needed: health professionals working in the field, politicians and the general public.

"Most of CVD related deaths could be prevented through the widespread adoption of simple interventions such as smoking cessation, improved diets and increased exercise. Evidence that CVD is caused by modifiable risk factors, comes from clinical trials and observational community studies," says Professor Panos Vardas, President of the ESC who is leading the European delegation to Brazil. "We will be promoting these and other ESC Guidelines in Brazil. Our agenda (4) also includes highlights from ESC Congress 2012 with the latest information in diagnosing and treating cardiovascular disease as well as "Meet the expert" sessions where ESC faculty will explain recent Clinical Trials that will impact practice."

In recent years, the Brazilian Society of Cardiology has also sought greater international collaboration. Jadelson Pinheiro de Andrade, President of the Brazilian Society of Cardiology said "We think this will be our most international congress ever. We are happy to welcome the ESC sessions once again. Exchanges with our European colleagues are stimulating and we are hoping to collaborate on projects concerning registries and surveys in the future."

The ESC's GSA Committee was established to meet demand for ESC science and knowledge outside of Europe, to build closer ties with international cardiology organisations, and to extend the ESC mission beyond its traditional borders.

"International collaboration is a key objective of the ESC. There are worrying and significant disparities in the way CVD is diagnosed and treated, both in developed and developing countries. We will only be able to fulfill our mission of reducing the burden of CVD by joining forces across frontiers, exchanging experiences and promoting education and research in the cardiovascular field.," concluded Prof Vardas.

More information:

References

(1) congresso.cardiol.… gramacao.asp

(2) eurheartj.oxfordjo… 13/1541.full and www.who.int/chp/ch… a/brazil.pdf

(3) www.escardio.org/g… x?hit=TLinks

(4) www.escardio.org/c… welcome.aspx

Omega-3 fatty acid supplementation not associated with lower risk of major CVD events

In a study that included nearly 70,000 patients, supplementation with omega-3 polyunsaturated fatty acids was not associated with a lower risk of all-cause death, cardiac death, sudden death, heart attack, or stroke, according to an analysis of previous studies published in the September 12 issue of JAMA.

12 sept 2012--"Treatment with marine-derived omega-3 polyunsaturated fatty acids (PUFAs) for the prevention of major cardiovascular adverse outcomes has been supported by a number of randomized clinical trials (RCTs) and refuted by others. Although their mechanism of action is not clear, their postulated effect on cardiovascular outcomes may be due to their ability to lower triglyceride levels, prevent serious arrhythmias, or even decrease platelet aggregation and lower blood pressure. Current guidelines issued by major societies recommend their use, either as supplements or through dietary counseling, for patients after myocardial infarction [MI; heart attack], whereas the U.S. Food and Drug Administration has approved their administration only as triglyceride-lowering agents in patients with overt hypertriglyceridemia, and some (but not all) European national regulatory agencies have approved the omega-3 administration for cardiovascular risk modification. The controversy stemming from the varying labeling indications causes confusion in everyday clinical practice about whether to use these agents for cardiovascular protection," according to background information in the article.

Evangelos C. Rizos, M.D., Ph.D., of the University Hospital of Ioannina, Ioannina, Greece, and colleagues performed a large-scale synthesis of the available randomized evidence by conducting a systematic review and meta-analysis to determine the association between omega-3 PUFAs and major cardiovascular outcomes.

Of the 3,635 citations retrieved, 20 studies with 68,680 randomized patients were included, reporting 7,044 deaths, 3,993 cardiac deaths, 1,150 sudden deaths, 1,837 heart attacks, and 1,490 strokes. Analysis indicated no statistically significant association with all-cause mortality,cardiac death, sudden death, heart attack, and stroke when all supplement studies were considered.

"In conclusion, omega-3 PUFAs are not statistically significantly associated with major cardiovascular outcomes across various patient populations. Our findings do not justify the use of omega-3 as a structured intervention in everyday clinical practice or guidelines supporting dietary omega-3 PUFA administration. Randomized evidence will continue to accumulate in the field, yet an individual patient data meta-analysis would be more appropriate to refine possible associations related to, among others, dose, adherence, baseline intake, and cardiovascular disease risk group," the authors conclude.

More information: JAMA. 2012;308[10]:1024-1033.

Provided by JAMA and Archives Journals

Is it the alcohol or polyphenols in red wine that decreases cardiovascular disease?

Observational epidemiologic studies relating wine and alcohol to health all suffer from the fact that they, of necessity, compare people who prefer certain beverages, but not the beverages themselves. While there have been many intervention trials in animals, randomized trials in humans are less common. Randomized crossover trials, in which each subject receives all interventions in sequence, can be especially important as they tend to avoid baseline differences among subjects and can detect effects of different interventions with smaller numbers of subjects.

23 jan 2012--This study by Chiva-Blanch G et al, just published in the American Journal of Clinical Nutrition, included 67 male volunteers in Spain who were considered to be at "high-risk" of cardiovascular disease on the basis of increased BMI, smoking, diabetes, hypertension, or other risk factors. About one half of the individuals were taking ACE inhibitors, statins, aspirin, and/or oral hypoglycemic drugs, so the results of this study may be especially relevant for patients in the real world.

The subjects agreed to not consume any alcohol for a baseline period, then for three one-month periods consumed 30 g/day of alcohol as red wine or as gin, or an equivalent amount of phenolics from dealcoholized red wine. The polyphenol contents of the RW and the DRW interventions were the same. A very high degree of compliance of the subjects with the assigned interventions is evidenced by results of counting numbers of empty bottles of the intervention beverage returned, dietary records, urinary metabolites, etc. Further, there is good evidence that there were no important changes between periods in diet or exercise habits. The effects of each intervention on a large number of adhesion molecules and chemokines that affect inflammation and relate to the development of vascular disease were evaluated.

The key results of the study were that both ethanol and nonalcoholic compounds in red wine have potentially protective effects that may reduce the risk of vascular disease. Specifically, the authors conclude that "the phenolic content of red wine may modulate leukocyte adhesion molecules, whereas both ethanol and polyphenols of red wine may modulate soluble inflammatory mediators in patients at high risk of cardiovascular disease."

Specific comments on the study: Most reviewers considered this to be a well-done, comprehensive study. As one reviewer commented: "This is an excellent paper. The results strongly indicate an effect of wine polyphenols on inflammation (in broad and modern terms) and this is just what we expect from the biochemistry and nutritional effects of fruits and vegetables. The effect of ethanol, on the other hand, likely fits a hormetic mechanism, where low doses regularly supplied are protective while high doses in a single shot are worsening the progression of disease." Another reviewer added: "We need more information on separating the effects of beer, wine, and various types of spirits. Some spirits like brandy and whisky can have useful antioxidant effects, so distinguishing effects among different types of beverages may be informative."

Another Forum reviewer commented: "This is a very interesting paper that goes a way towards answering the question whether it is the alcohol or polyphenols in red wine that confer the health benefits. The trial was well conducted and controlled, with very detailed analyses. It would have been interesting to analyse any changes in conventional risk factors after the interventions. It would also have been interesting in the study to determine the effects on vascular function by, for example, brachial artery activity (flow mediated dilatation)."

Given that the effects of both alcohol and polyphenols on physiologic factors (e.g., platelet function, fibrinolysis) are transient, generally lasting for no more than 24 hours, it was appropriate that the subjects in this study were instructed to consume the intervention substance (RW, gin, DRW) on a daily basis. When drinking is moderate, there is no evidence that having "alcohol-free days" is beneficial to health. Indeed, most epidemiologic studies show better health effects from daily consumption rather than from drinking on a few days per week.

Concerns about the present study: One Forum reviewer stated: "This appears to be a carefully designed and well executed study, but I have four concerns: (1) The study has been undertaken in high-risk individuals, more than half of whom are hypertensive, a quarter dyslipidaemic, and a quarter diabetic. It is not described what happened to the conventional risk factors during the interventions. (For example, any improvement in inflammatory markers may have come at the cost of higher blood pressure with the alcohol interventions.) (2) Was there any weight change that could have confounded any of the outcomes? (3) Both polyphenol and alcohol biomarkers were measured – did the change in these biomarkers correlate with the changes in any of the inflammatory markers; i.e., any suggestion of a dose response relationship? (4) Even though at least 30 outcome variables were assessed, the authors do not describe any correction for multiple comparisons."

Another Forum reviewer: "This is a well conducted study, and adds to our understanding of the potential cardiovascular benefits of alcohol and the non-alcoholic compounds of alcoholic beverages. However, in this study more than one-half of the high-risk subjects consumed drugs with known anti-inflammatory effects, which could be a confounding factor. The anti-inflammatory effects of these pharmaceuticals may be responsible for the beneficial results, and may not be related to the RW, DRW and gin interventions." However, others think that this concern is unlikely to be important since this was a crossover study, and there were no changes in lifestyle or medication use between the intervention periods.

The key results of the study were that both ethanol and nonalcoholic compounds in red wine have potentially protective effects that may reduce the risk of vascular disease. Specifically, the authors conclude that "the phenolic content of red wine may modulate leukocyte adhesion molecules, whereas both ethanol and polyphenols of red wine may modulate soluble inflammatory mediators in patients at high risk of cardiovascular disease." Thus, this study provides important new mechanistic evidence that the reduced risk of cardiovascular disease among red wine drinkers observed in most epidemiologic studies may result from a combination of both the alcohol and the polyphenols in the wine.

More information: Chiva-Blanch G, Urpi-Sarda M, Llorach R, Rotches-Ribalta M, Guillèn M, Casas R, Arranz S, Valderas-Martinez P, Portoles O, Corella D, Tinahones F, Lamuela-Raventos RM, Andres-Lacueva C, Estruch R. Differential effects of polyphenols and alcohol of red wine on the expression of adhesion molecules and inflammatory cytokines related to atherosclerosis: a randomized clinical trial. Am J Clin Nutr 2012. doi: 10.3945/ajcn.111.022889

Provided by Boston University Medical Center

Study shows polypill to be safe and accepted by physicians and patients in developing countries

For a patient at high risk of cardiovascular disease (CVD), keeping up with what pills to take at different times of the day can be tedious. Window sills lined with prescription bottles – a pill for cholesterol, another for blood pressure, and an aspirin to keep blood thin and flowing – the list can get quite long and, as a result, many people, especially the elderly, often forget doses or take the wrong pill at the wrong time.

22 mar 2011--But what if there was a single pill that had all the benefits of multiple medications in one dose? Would people take it? Would doctors prescribe it? And would it be effective?

A new study done by researchers at Wake Forest Baptist Medical Center provides evidence that, in fact, such a pill may be a viable option for developing countries, where CVD is strongly emerging and the demand for cost-effective, low maintenance treatment is high.

"The idea behind the polypill is that it offers a simpler way to give medications to people so that they will have better adherence to their pills," said Elsayed Z. Soliman, M.D., M.Sc., M.S., director of the Epidemiological Cardiology Research Center (EPICARE) at Wake Forest Baptist and lead author on the study. "It's not always easy for people to consistently take multiple pills, even if they are needed to treat a serious condition, like CVD. This is especially true in developing countries, where cost of CVD medications is another major challenge. This one pill has the potential to improve adherence while being less costly to the population in developing countries."

To adopt the polypill approach in developing countries, a large scale clinical trial is needed, Soliman added. However, before conducting such a trial, research was needed to see if it was even possible to conduct a clinical trial in a developing country.

Going into this study, there were many perceived barriers to doing research in a developing country, Soliman said. Among them, would the country have investigators capable and willing to participate in a study and the necessary follow-up? Would patients sign up to participate? And if the pill was proven to work, would doctors even feel comfortable prescribing it?

So Soliman and colleagues brought the study to Sri Lanka, where they enrolled 216 participants without diagnosed CVD, in the hope of answering some of these questions. Half of the participants received "standard' treatment for CVD risk prevention, and the other half received the polypill. Patients were recruited as planned. Two hundred three patients (94.0%) completed the treatment program and returned for their follow-up visits. No safety concerns were reported.

These findings suggest a high rate of patient acceptability, a finding that is bolstered by the fact that the majority of patients who completed the trial – 90 percent – indicated that they would take the polypill "for life" if proven to be effective in reducing CVD risk. Approximately 86 percent of the physicians surveyed agreed with and supported use of the polypill for primary prevention and 93 percent for secondary prevention of CVD. In terms of reduction in CVD risk, both the polypill and "standard treatment" resulted in marked reductions in systolic blood pressure, total cholesterol and 10-year estimated risk of CVD.

"Our trial has fulfilled its purposes," Soliman said. "We wanted to check the feasibility of doing a large-scale clinical trial with a polypill in a developing country and to examine the acceptability of the polypill by patients and physicians, and we now know that it's feasible and acceptable."

He added that the "standard" treatment in this trial was administered by highly specialized physicians in tertiary-care centers, making it a tough competitor, yet the simple polypill held its own.

Although feasibility has been demonstrated, Soliman explained that there are other important questions about the polypill that still need answers, such as: Which patient population should a polypill target: those who have not yet been diagnosed with CVD (primary prevention) or those who have a CVD diagnosis in their medical history (secondary prevention)? Also, what components should make up the pill and in what doses will they be most effective?

"There are many questions, but a single trial will never answer all of them," Soliman said. "At least now we know that it is possible to begin looking for the answers."

More information: The study was published in Trials.

Provided by Wake Forest University Baptist Medical Center

Following 7 steps can cut a person's death risk by more than half, experts say

For those interested in reducing their risk of death from cardiovascular disease, heart experts have some good news: regular exercise, a healthy diet and five other simple measures can cut one's near-term risk of death by more than half.

19 nov 2010--And here's the bad news: In a nationwide study of more than 17,820 adults, only two people met all of the criteria for top-notch cardiovascular health.

The message of the study, presented Monday at the American Heart Association's Scientific Sessions conference in Chicago, is clear, said Dr. Mark Urman, medical director of Cedars-Sinai Heart Institute's Preventive and Consultative Heart Center.

"Boy, most Americans aren't very healthy," said Urman, who wasn't involved in the research. However, he added, "on a more positive note, the study confirms that individuals can take control of their health. Incremental changes can make a huge difference."

The changes, dubbed Life's Simple 7, were laid out in January as part of an AHA campaign to guide Americans toward "ideal cardiovascular health." They are:

-At least 150 minutes of moderate exercise, or 75 minutes of intense exercise, per week.

-Having a body mass index of less than 25.

-Being a non-smoker for at least one year.

-Meeting four out of five of the AHA's key components for a healthy diet.

-Keeping total cholesterol below 200 milligrams per deciliter of blood.

-Maintaining blood pressure below 120/80 millimeters of mercury.

-Having a fasting blood sugar level below 100 mg/dL of blood.

"These are the sorts of things your grandmother told you," said Dr. Mary Cushman, the cardiovascular disease researcher at the University of Vermont who conducted the study.

Cushman used a database of people between the ages of 45 and 84 who were already enrolled in a nationwide study on the prevalence of stroke. All of the participants had been evaluated for the factors that make up Life's Simple 7.

In addition to the two individuals who met all seven criteria, another 213 people were compliant with six.

Death rates for those who met at least five of the criteria were 55 percent lower over the five-year study period than for those who met none, Cushman reported.

The analysis showed how much each health factor mattered - for every additional one met, a person reduced his or her chance of dying in the next four years by 15 percent.

"That tells how powerful these things relate to heart-disease risk," Cushman said. "Being as good as you can be on all of these factors is what your goal should be."

On the whole, Americans are most compliant when it comes to maintaining a healthy blood pressure and abstaining from smoking. More than 80 percent of those in the survey were nonsmokers, and almost 67 percent were in the ideal range for blood pressure, Cushman said.

On the flip side, eating a healthy diet was the criterion with the fewest adherents - only 0.43 percent managed to do so, the study found.

The ideal diet requires meeting four of five of these key components based on a 2,000-calories-per-day meal plan: four-and-a-half cups of fruits and vegetables per day, two or more 3.5 ounce servings of fish (preferably oily fish) per day, fewer than 450 calories a week of sugar-sweetened beverages, three or more one-ounce servings per day of whole grains and less than 1,500 mg of sodium per day.

Cushman could not identify the two people who scored perfect on the assessment. "It would be interesting to go back and talk to them," to see just how they live so healthfully, she said.

But the large portion of Americans who are far from the ideal range suggests that societal, not just individual, changes are needed, she said. Public projects like more parks, sidewalks and farmers' markets; soda taxes; smoking restrictions and physical activity requirements in preschools and schools could move large numbers of people toward better health.

Elderly Slow Walkers at More Risk of Cardiovascular Death

Study finds association applies regardless of sex, body mass index or age

15 nov 2009-- Elders who walk slowly are more likely to die of cardiovascular disease than their faster walking counterparts, regardless of age, sex, body mass index or the amount of physical activity they engage in, according to a study published Nov. 10 in BMJ.

Julien Dumurgier, M.D., of INSERM in Paris, and colleagues conducted a study of 3,208 community-dwelling men and women aged 65 years and above who were followed up for an average of 5.1 years.

During follow-up, 209 participants died, 99 due to cancer and 59 from cardiovascular disease, while 51 died from other causes, the researchers found. There was a higher risk of mortality among the lowest third based on walking speed versus the upper two-thirds (hazard ratio, 1.44), and the risk of cardiovascular death among slow walkers increased about three-fold compared to the risk for faster walkers, while there was no increased risk of cancer mortality noted.

"This increased risk of cardiovascular death was seen in both sexes, younger as well as in older participants, those with or without a high risk vascular profile, and those with low or usual physical activity," the authors write. "These findings show that assessment of motor performances in older people with simple measures such as walking speed can be performed easily and that the role of fitness in preserving life and function in older age is important."

Abstract
Full Text
Editorial

High Inflammation, Low Heart Disease in Amazonian Tribe

New research finds inflammation, infection not always predictive of cardiovascular disease

18 aug 2009-- As shown by an Amazonian population with high rates of inflammation and infection but low adiposity and robust fitness, inflammation is not always a risk factor for arterial degeneration and cardiovascular disease, according to research published Aug. 11 in PLoS One.

Michael Gurven, Ph.D., of the University of California in Santa Barbara, and colleagues conducted a study of 258 Tsimane adults, an Amazonian forager-horticulturalist population. Several predictors of heart disease were measured, including hypertension, obesity, diet, and smoking habits.

Using markers including C-reactive protein and white blood cells, the researchers found high levels of inflammation and infection among the Tsimane. However, rates of obesity, smoking, and blood lipids (total cholesterol and low density lipoprotein) were lower among the Tsimane population compared with the U.S. population. The investigators found peripheral artery disease was absent among all the Tsimane adults included in the study. In addition, the overall rate of hypertension among the adult population was 3.5 percent, and although this increased with age it peaked at 23.5 percent, a rate much lower than that in the United States and other developed countries.

"Our study provides evidence that chronic low-grade inflammation in the absence of several other risk factors is not a determinant of cardiovascular disease in a subsistence population. Inflammation and infection may not accelerate arterial degeneration in the context of restricted caloric intake, parasitism, and daily physical activity that maintains low body mass index," the authors conclude.

Abstract
Full Text (subscription or payment may be required)

Who should take aspirin

as CVD primary preventive?

What factors should be considered for women in decision making about aspirin

JoAnn E. Manson, MD, DrPH

Which women should take aspirin for the primary prevention of cardiovascular disease? What factors should be considered in decision making about aspirin?

13 mar 2009--Only recently have clinicians had rigorous evidence to guide decision making about the use of aspirin in the primary prevention of cardiovascular disease (CVD) in women. Although it is well established that aspirin is effective in the secondary prevention of CVD and in the treatment of acute myocardial infarction (MI) among both women and men,¹ there had been sparse data about the benefits and risks of aspirin in primary prevention among women until results from a large-scale trial, the Women's Health Study (WHS), were reported in 2005.² Previously, guidelines had been largely extrapolated from results of clinical trials in men, which had suggested that aspirin reduces the incidence of first MI by 30% to 35% while having little effect on stroke.^3,4

Primary prevention results in women, including results stratified by age. The WHS, the only large primary prevention trial of aspirin in women, suggested a different pattern of cardiovascular outcomes with aspirin in women compared to men. The WHS evaluated the benefits and risks of low-dose aspirin (100 mg on alternate days) in the primary prevention of major cardiovascular events (MI, stroke, and cardiovascular death) among 39,876 initially healthy women age 45 and over, followed for 10 years.² Overall, the trial showed a statistically nonsignificant 9% reduction in the primary outcome of major cardiovascular events. In contrast to the significant reduction in MI and neutral effect on stroke observed in the Physicians' Health Study³ and other primary prevention trials in men,⁴ the WHS demonstrated that aspirin significantly lowered the risk of total stroke by 17% (95% confidence interval, 1% to 31%) and the risk of ischemic stroke by 24% (7% to 37%) in women, but did not lower the risk of MI or cardiovascular death. As expected, aspirin increased bleeding risks. Gastrointestinal hemorrhages requiring transfusion were 40% more common with aspirin, and there was also a nonsignificant 24% increase in hemorrhagic stroke risk.

However, age appeared to be a key determinant of a woman's cardiovascular response to aspirin and her benefit/risk ratio with treatment.² Among WHS participants over age 65, aspirin was associated with clear evidence of benefit: a statistically significant 26% (8%-41%) reduction in risk of major cardiovascular events, with a significant benefit on both ischemic stroke (relative risk [RR], 0.70) and MI (RR, 0.66). In contrast, for younger participants, aspirin appeared to provide little or no cardiovascular protection (RR of major CVD events, 1.01 in women ages 45-54; 0.98 in women ages 55-64) and MI risk was not reduced in either group (RR, 1.23 and 1.17, respectively). Testing for statistical interaction by age group revealed P values for interaction of 0.05 for major CVD events and 0.03 for MI. In a benefit/risk assessment by age group, the 4,097 women who were over age 65 at enrollment experienced 44 fewer major CVD events with aspirin than with placebo (P = 0.008) but had 16 more gastrointestinal hemorrhages requiring transfusion (P = 0.05). In contrast, women under age 65 had no reduction in major CVD events, while experiencing a similar increase in gastrointestinal bleeding (leading to a net adverse effect and an unfavorable benefit/risk ratio). A woman's age appeared to be a stronger predictor of her benefit/risk ratio with aspirin than her Framingham risk score, but few women in the cohort had high 10-year coronary risks.

Omega-6 PUFAs and risk of cardiovascular disease

AHA stands by advice to include omega-6 PUFAs in heart-healthy diet

31 jan 2009--A new Science Advisory report from the American Heart Association recommends that omega-6 polyunsaturated fatty acids (PUFAs), as found in vegetable oils, nuts and seeds, are beneficial when part of a heart-healthy eating plan. Consumers should aim for at least 5-10% of energy (calories) from omega-6 PUFAs, and will derive most benefit when omega-6 PUFAs replace saturated or trans fats in the diet. Precise recommended daily servings will depend on physical activity level, age and gender, but range between 12 and 22 grams per day.

The AHA report also addresses the recent controversy that omega-6 fatty acids, via linoleic acid, which accounts for 85-90% of dietary omega-6, may actually increase inflammation and thereby increase rather than reduce cardiovascular risk. Any link between omega-6 and inflammation, says the AHA, comes from the fact that arachidonic acid, which can be formed from linoleic acid, is involved in the early stages of inflammation, but anti-inflammatory molecules are also formed; these suppress the production of adhesion molecules, chemokines and interleukins, all of which are key mediators of the atherosclerotic process. Thus, concludes the report, it is incorrect to view the omega-6 fatty acids as pro-inflammatory.

The report also reviewed epidemiological data and found that, in randomised controlled trials, those assigned to the higher omega-6 diets had less heart disease. 
A meta-analysis of several trials indicated that replacing saturated fats with PUFA lowered risk for heart disease events by 24%. Reducing omega-6 intakes, said the report, would be more likely to increase than to decrease the risk of CHD.

Professor Heinz Drexel from the VIVIT Research Institute at Feldkirch, Austria, speaking on behalf of the European Society of Cardiology, adds that the report not only recommends the consumption of at least 5-10% of energy from omega-6 PUFAs but indicates that intakes higher than 10% of energy appear safe and may even be even beneficial. This latter statement, says Professor Drexel, "is somewhat discordant with earlier recommendations made by other authorities".

Commenting on the report, Professor Drexel adds: "This advisory is a resurrection of older recommendations on omega-6 PUFAs, in particular on linoleic acid. It is based on new ecological, case-control, prospective cohort and randomised controlled studies. Concerns raised in the past decade that omega-6 PUFAs may be pro-inflammatory are dispelled with evidence that omega-6 PUFAs have anti-inflammatory properties at the level of vascular endothelial cells. On balance, the advantages outweigh the disadvantages.

"However, the effects of Omega-6 PUFAs appear weak and require long-term interventions. Many studies in the past were not long enough for a nutritional intervention. Moreover, in the intervention studies other nutrients were changed along with the enrichment of omega-6 PUFAs."

###

REFERENCES:

1. Harris WS, Mozaffarian D, Rimm E, et al. Omega-6 fatty acids and risk for cardiovascular disease. Circulation 2009; DOI: 10.1161/CIRCULATIONAHA.108.191627.

Impaired kidney function raises risk of heart problems in the elderly

21 jan 2009--A study published next week in the open access journal PLoS Medicine suggests that elderly people with damaged kidneys are at greater risk of cardiovascular disease, such as heart failure and stroke, and other causes of mortality. The findings indicate that greater efforts should be made to encourage elderly people who have impaired kidney function alongside other risk factors—such as high blood cholesterol and high blood pressure, which are often a result of smoking and diet—to make lifestyle changes to avoid developing cardiovascular problems.
Most countries face increasing rates of cardiovascular disease and it is the single leading cause of death in the United States and many European countries. It has already been established that young and middle-aged people with a reduced estimated glomerular filtration rate (eGFR)—the measurement of the movement of waste and excess fluid through the kidneys—are more likely to develop cardiovascular disease than those with healthy kidneys. To establish how at risk elderly people with impaired kidney function were, Ian Ford of the University of Glasgow and colleagues analysed existing data from a three year clinical trial conducted among men and women aged between 70 and 82 in Scotland, Ireland and the Netherlands.
The trial—known as the Prospective Study of Pravastatin in the Elderly at Risk, or PROSPER trial—had been designed to test the effect of the statin pravastatin on the development of cardiovascular disease. Dividing the trial participants into four groups based on their eGFR at the start of the study, Ian Ford and colleagues established that the patients with a low eGFR—those with the most impaired kidney function—were twice as likely to die from any cause as those with healthier kidneys. They also established that the patients with the most damaged kidneys were three times more likely to have non-fatal heart failure or disease and were more likely to die as a result of heart disease or failure.
The data also showed that treatment with the drug pravastatin reduced the number of fatal and non-fatal heart problems more effectively amongst the group of patients with the most damaged kidneys—although the researchers warn that this finding is statistically borderline and say the most that can be concluded is that there is no reason to exclude elderly people with damaged kidneys from treatment with statins, the drugs that reduce blood cholesterol levels in those at risk of cardiovascular disease.
###
Citation: Ford I, Bezlyak V, Stott DJ, Sattar N, Packard CJ, et al. (2009) Reduced glomerular filtration rate and its association with clinical outcome in older patients at risk of vascular events: Secondary analysis. PLoS Med 6(1): e1000016.

Elevated Sodium-to-Potassium Excretion Ratio Linked to Greater Risk for CVD

18 jan 2009--Patients with elevated sodium-to-potassium excretion ratios may face increased risk for cardiovascular events, reports Archives of Internal Medicine.

In two prospective studies, some 2300 adults aged 30 to 54 and with prehypertension provided four 24-hour urine samples over 18 to 36 months, and then were followed for 10 to 15 years.

During follow-up, 8% of the participants experienced major cardiovascular events, including MI, coronary revascularization, and cardiovascular death. After adjustment for multiple confounders, the risk for cardiovascular events increased as the sodium-to-potassium excretion ratio increased. Neither sodium nor potassium excretion alone was significantly associated with cardiovascular risk.

The authors conclude that these results, taken together with previous research, suggest that "lowering dietary sodium intake, while increasing potassium consumption, at the population level might reduce the incidence of CVD."

LINK(S):

Archives of Internal Medicine article (Free)

Vitamin D Deficiency Linked to Cardiovascular Disease

Has also been linked to insulin resistance

15 dec 2008-- Vitamin D deficiency is associated with a higher frequency of cardiovascular disease, according to a study in the Dec. 1 issue of the American Journal of Cardiology. A related review in the Dec. 9 issue of the Journal of the American College of Cardiology discusses the links between vitamin D deficiency, cardiovascular disease and insulin resistance.

In the study published in the American Journal of Cardiology, Dae Hyun Kim, M.D., and colleagues from Jefferson Medical College in Philadelphia, analyzed data on serum 25-hydroxyvitamin D and cardiovascular disease in 8,351 U.S. adults. They found that the overall prevalence of hypovitaminosis D (less than 30 ng/mL) was 74 percent. There was a higher frequency of cardiovascular disease, including coronary heart disease, heart failure, stroke, and peripheral arterial disease, with decreasing vitamin D levels.

In the study published in the Journal of the American College of Cardiology, John H. Lee, M.D., from the Mid America Heart Institute and University of Missouri in Kansas City, and colleagues reviewed the data on vitamin D deficiency and supplementation. They note that low serum vitamin D has been adversely linked to cardiovascular health, possibly because vitamin D deficiency activates the renin-angiotensin-aldosterone system. Vitamin D deficiency also activates parathyroid hormone, which increases insulin resistance and has been linked to diabetes, hypertension, inflammation and higher cardiovascular risk.

"Vitamin D supplementation is simple, safe and inexpensive," Lee and colleagues write. "Monitoring serum 25-hydroxyvitamin D levels and correction of vitamin D deficiency is indicated for optimization of musculoskeletal and general health."

One of the authors of the second study is a consultant for the National Dairy Council and the UV Foundation, and another is an unpaid scientific consultant to CardioTabs.

Heart disease patients may not benefit from depression screening

Penn medicine researcher questions physician guidelines

PHILADELPHIA, 14 nov 2008 – Results of a new study call into question recent clinical guidelines issued by leading cardiovascular groups, including the American Heart Association, which recommend patients with cardiovascular disease be screened for signs of depression and treated accordingly. The study, published in the November 12 edition of the Journal of the American Medical Association and conducted by an international team of researchers including James Coyne, Ph.D., Professor of Psychology in Psychiatry at the University of Pennsylvania School of Medicine, determined that there is no clear evidence that depression screening plays a conclusive role in improving cardiovascular patients' health.

Nearly one in five patients with cardiovascular disease suffer from major depressive disorder, but because some heart disease symptoms can be confused with signs of depression, standard screening tools for depression may not be appropriate for this patient population.

"If a patient has a positive score on a depression screening test, most cardiologists do not have the time or training to conduct a follow-up interview, rule out false-positive results and establish an appropriate depression treatment plan." said Dr. Coyne. "Given the scientific evidence concerning the necessary steps to diagnose and treat depression effectively, cardiologists should be discouraged from dispensing antidepressants casually, without proper diagnosis and follow up planning."

Even if treatment improves depression, investigators found no evidence that improvement in depression results in delaying a new heart attack or improving survival, but noted that the relevant data were quite limited.

"For a patient to benefit from depression treatment, they need to receive comprehensive education, an appropriate treatment (i.e. medication, psychotherapy) and a follow-up care to monitor progress," Coyne said. "That is hard to accomplish in a busy cardiology practice and may not benefit the cardiac health of the patient."

###

In addition to Dr. Coyne, other researchers who contributed to this study were Brett Thombs, Ph.D. of McGill University and the affiliated Jewish General Hospital, Roy Ziegelstein, M.D., Johns Hopkins University School of Medicine, Peter de Jonge, Ph.D., at the University Medical Center Groningen, Netherlands; Mary Whooley, M.D., at the University of California, San Francisco; Nancy Frasure-Smith, Ph.D., also at McGill; Alex Mitchell, M.Sc., M.R.C. Psych, at the Leicester Royal Infirmary, United Kingdom; Marij Zuidersma, M.Sc., also at Groningen; Cheri Smith, M.L.S., and Karl Soderlund, B.S., at Johns Hopkins, Chete Eze-Nliam, M.D., M.P.H., at Interfaith Medical Center in Brooklyn, N.Y.; and Bruno Lima, at Federal University of Ceara School of Medicine, in Fontalez-ce, Brazil.

Researchers discover new risk factor for cardiovascular disease, and a way to control it

MUHC serves as Canadian centre for international study that could revolutionize treatment options

Montreal, 11 nov 2008- A team of international researchers – including scientists from the McGill University Health Centre (MUHC) and McGill University – have discovered that having high levels of particular protein puts patients at increased risk of developing cardiovascular disease. The results of the study were so conclusive that the clinical trial had to be stopped before its scheduled completion date.

Researchers associated with the international JUPITER Project have demonstrated that high levels of high-sensitivity C-reactive protein (hs-CRP) leads to increased risk of cardiovascular disease. This risk decreases by up to 44% if the patients are treated with statin medications.

Dr. Jacques Genest, of the Research Institute of the MUHC and McGill's Faculty of Medicine led the Canadian component of the JUPITER clinical study, which was initiated by Dr. Paul Ridker of the Harvard University Faculty of Medicine.

"The risk of cardiovascular disease due to increased hs-CRP levels has been greatly underestimated until now," according to Dr Genest. "Our results show that this is an extremely important indicator that doctors will have to consider in the future."

"We hope that this study will prompt a review of current clinical practices, especially in terms of screening and prevention in adults," he added. "However, we still need to do more research to establish specific standards."

The JUPITER study included 17,802 patients from 27 different countries. All had normal levels of cholesterol (LDL-c) and high levels of hs-CRP, and according to current standards, were not considered "at risk" for cardiovascular events, and were therefore not receiving any treatment. During the study, participants received a daily dose of the statin drug rosuvastin, and its consequences were striking: a 44% decrease in the risk of cardiovascular disease and a 21% decrease in mortality.

"These results definitely surpassed our predictions," said Dr. Genest. "We had to stop the study before its scheduled completion, as the benefit of the treatment for the selected patients was so great that we needed to present our findings to the medical community as soon as possible."

Since statins have a cholesterol-lowering effect, they are currently used to prevent cardiovascular disease in patients who are at-risk due to high LDL-c levels. But cardiovascular disease is also caused by vascular inflammation, which is marked by levels of hs-CRP. This study shows that statins indeed act on both cholesterol and inflammation, an effect that has long been suspected but not proven.

###

This clinical study was investigators-initiated and funded by Astra Zeneca.

Dr. Jacques Genest is Director of Cardiology at the MUHC and Director of the Cardiovascular Genetics Laboratory at the Research Institute of the MUHC. He also holds the Novartis Chair in Medicine at the Faculty of Medicine of McGill University.

About the Research Institute of the MUHC

The Research Institute of the McGill University Health Centre (RI MUHC) is a world-renowned biomedical and health-care hospital research centre. Located in Montreal, Quebec, the institute is the research arm of the MUHC, the university health center affiliated with the Faculty of Medicine at McGill University. The institute supports over 600 researchers, nearly 1200 graduate and post-doctoral students and operates more than 300 laboratories devoted to a broad spectrum of fundamental and clinical research. The Research Institute operates at the forefront of knowledge, innovation and technology and is inextricably linked to the clinical programs of the MUHC, ensuring that patients benefit directly from the latest research-based knowledge.