Researchers confirm link between flu and heart attack

This study confirms the importance of flu vaccination for people at risk of heart disease. 

Chances of a heart attack are increased six-fold during the first seven days after detection of laboratory-confirmed influenza infection, according to a new study by researchers at the Institute for Clinical Evaluative Sciences (ICES) and Public Health Ontario (PHO).

26 jan 2018--"Our findings are important because an association between influenza and acute myocardial infarction reinforces the importance of vaccination," says Dr. Jeff Kwong, a scientist at ICES and PHO and lead author of the study.
In the study published today in the New England Journal of Medicine, the researchers found a significant association between acute respiratory infections, particularly influenza, and acute myocardial infarction.
The risk may be higher for older adults, patients with influenza B infections, and patients experiencing their first heart attack. The researchers also found elevated risk - albeit not as high as for influenza - with infection from other respiratory viruses.
"Our findings, combined with previous evidence that influenza vaccination reduces cardiovascular events and mortality, support international guidelines that advocate for influenza immunizationin those at high risk of a heart attack," says Kwong.
The researchers looked at nearly 20,000 Ontario adult cases of laboratory-confirmed influenza infection from 2009 to 2014 and identified 332 patients who were hospitalized for a heart attackwithin one year of a laboratory-confirmed influenza diagnosis.
"People at risk of heart disease should take precautions to prevent respiratory infections, and especially influenza, through measures including vaccinations and handwashing," says Kwong.
The researchers add that patients should not delay medical evaluation for heart symptoms particularly within the first week of an acute respiratory infection.
The article "Acute myocardial infarction after laboratory-confirmed influenza infection" is published in the January 25th issue of the New England Journal of Medicine.


Provided by Public Health Ontario

Eating more fruit and vegetables can substantially increase happiness levels

University of Warwick research indicates that eating more fruit and vegetables can substantially increase people's later happiness levels.

14 july 2016--To be published shortly in the prestigious American Journal of Public Health, the study is one of the first major scientific attempts to explore psychological well-being beyond the traditional finding that fruit and vegetables can reduce risk of cancer and heart attacks.
Happiness benefits were detected for each extra daily portion of fruit and vegetables up to 8 portions per day.
The researchers concluded that people who changed from almost no fruit and veg to eight portions of fruit and veg a day would experience an increase in life satisfaction equivalent to moving from unemployment to employment. The well-being improvements occurred within 24 months.

Cancer

The study followed more than 12,000 randomly selected people. These subjects kept food diaries and had their psychological well-being measured. The authors found large positive psychological benefits within two years of an improved diet.
Professor Andrew Oswald said: "Eating fruit and vegetables apparently boosts our happiness far more quickly than it improves human health. People's motivation to eat healthy food is weakened by the fact that physical-health benefits, such as protecting against cancer, accrue decades later. However, well-being improvements from increased consumption of fruit and vegetables are closer to immediate."
The work is a collaboration between the University of Warwick, England and the University of Queensland, Australia. The researchers found that happiness increased incrementally for each extra daily portion of fruit and vegetables up to eight portions per day. The study involved an examination of longitudinal food diaries of 12,385 randomly sampled Australian adults over 2007, 2009, and 2013 in the Household, Income, and Labour Dynamics in Australia Survey. The authors adjusted the effects on incident changes in happiness and life satisfaction for people's changing incomes and personal circumstances.

Western diet

The study has policy implications, particularly in the developed world where the typical citizen eats an unhealthy diet. The findings could be used by health professionals to persuade people to consume more fruits and vegetables.
Dr Redzo Mujcic, research fellow at the University of Queensland, said: "Perhaps our results will be more effective than traditional messages in convincing people to have a healthy diet. There is a psychological payoff now from fruit and vegetables—not just a lower health risk decades later."
The authors found that alterations in fruit and vegetable intake were predictive of later alterations in happiness and satisfaction with life. They took into account many other influences, including changes in people's incomes and life circumstances. One part of the study examined information from the Australian Go for 2&5 Campaign. The campaign was run in some Australian states which have promoted the consumption of two portions of fruit and five portions of vegetables each day.

Antioxidants

The academics think it may be possible eventually to link this study to current research into antioxidants which suggests a connection between optimism and carotenoid in the blood. However they argue that further research is needed in this area.

More information: "Evolution of well-being and happiness after increases in the consumption of fruit and vegetables." American Journal of Public Health. ajph.aphapublications.org/doi/abs/10.2105/


Provided by University of Warwick

Heart attack patients could be treated more quickly

Clinical judgement, combined with an electrocardiogram (ECG) and blood test on arrival, is effective in reducing unnecessary hospital admissions for chest pain, a new study shows.

28 july 2014--The findings of a research group in Manchester, published in the Emergency Medicine Journal, could potentially make a huge difference to a large number of patients.

Chest pain is the most common reason for emergency hospital admission. In Manchester, the incidence of premature death due to heart disease and stroke is amongst the highest in England.

Previous research has shown that typical symptoms in patients presenting to emergency departments have not been useful in differentiating between heart conditions requiring immediate hospital admission (acute coronary syndromes; ACS), and non-cardiac conditions. This is because the symptoms of patients with heart disease can be similar to those experienced by patients with non-cardiac conditions, such as indigestion. However, the role of overall clinical judgement has not been extensively studied.

The latest research, led by Dr Richard Body, Consultant in Emergency Medicine at Manchester Royal Infirmary, assessed the diagnostic accuracy of emergency doctors' clinical judgement for acute coronary syndromes – both alone and in combination with the tests available on arrival – ECG and a blood test which detects a protein called troponin.

The study was undertaken at Stockport NHS Foundation Trust, where doctors in the emergency department recorded their overall clinical judgement for ACS using a five-point Likert scale (from 'definitely ACS' to 'definitely not' ACS). This data was then compared with patients' outcomes, including heart attack or the occurrence of major adverse cardiac events within 30 days.

The results showed that for patients who are suspected to have an ACS, clinical judgement cannot be relied upon by itself to rule out or rule in that diagnosis. However, when combined with an ECG and troponin test clinical judgement appeared to be an effective tool and the results suggest that at least 25 per cent of patient admissions could have avoided. The study also suggested that this was the case regardless of whether the clinician was a consultant or junior doctor.

Dr Rick Body, who is also National Institute for Health Research Postdoctoral Research Fellow and Honorary Lecturer in Cardiovascular Medicine at The University of Manchester, said: "I think the beauty of this technique is its simplicity. For years we've been working hard to improve our technology and our tests for heart attacks. This research suggests that, if the initial tests are normal and the doctor thinks that the diagnosis of a heart attack is unlikely, it may be perfectly safe to reassure patients that they do not have a heart attack without relying on further tests and observation in hospital.

"It is still early days but the study, which was funded through an NIHR Clinical Lecturer grant and a College of Emergency Medicine Research Grant, could potentially make a huge difference to large numbers of patients.

"In order to ensure the safety of patients, further research is still vital to ensure that our findings can be repeated with different groups of doctors and patients. We will also need to know if doctors would be confident enough in their judgement to use the technique in practice."

Provided by University of Manchester

Blood pressure cuff may save lives in patients with acute heart attack

A simple blood pressure cuff can reduce the damage to the cardiac muscle caused by a heart attack Credit: Aarhus University Hospital, Communication Unit

25sept 2013--In patients with an acute heart attack, remote ischemic conditioning – intermittent inflation of a blood pressure cuff to cut off blood flow to the arm during transportation to hospital for acute balloon dilatation – reduces subsequent cardiac symptoms and mortality after acute heart attack. The results are presented by researchers from Aarhus University Hospital and Aarhus University in European Heart Journal online 12 September 2013.

Activating the body's defense mechanism

Lack of oxygen for short periods of time in a distant organ by intermittently stopping blood flow to a limb, can protect another organ (i.e., the heart), during a prolonged period of lack of oxygen as it is the case during a heart attack. Professor Hans Erik Bøtker and his research team have previously demonstrated that remote ischemic conditioning reduces cardiac tissue damage on average 30% in patients undergoing acute balloon treatment for a heart attack. In patients treated with conditioning, a blood pressure cuff was placed around the upper arm and inflated to 200 mmHg for 5 minutes to cut off blood flow, and then released. The arm then rested for 5 minutes, and then the blood pressure cuff was re-applied. This procedure was repeated 4 times.

The rate of complications is halved

The researchers have now followed 251 patients assigned to receive conditioning or no conditioning in addition to usual care during transportation to the heart centre for up to 4 years. During the follow-up period the initial salvage of heart tissue by conditioning was translated into a clinical benefit for the patients. The occurrence of new heart symptoms was reduced by 51% in the conditioning group compared to the control group. The total number of deaths was low and death caused by heart disease was reduced by 61%.

The underlying mechanisms are thought to involve activation of endogenous protective systems that induces resistance towards tissue damage in the heart during a heart attack and in particular when re-opening the occluded heart vessel by balloon dilatation. Ph.D student Astrid Drivsholm Sloth, who conducted the present study, characterizes the treatment as promising and predicts that it will have widespread potential in the treatment of heart attacks. However, larger studies are required confirm the clinical implications of this smaller pilot trial such that it can be clarified whether the new intervention can reduce mortality and the development of heart failure after a heart attack.

Provided by Aarhus University

Many women having a heart attack don't have chest pain

23 feb 2012--Two out of five women having a heart attack do not experience chest pain, according to a new study.

Instead, they may have harder-to-recognize symptoms, such as pain in the jaw, neck, shoulders or back; stomach discomfort; or sudden trouble breathing, researchers said.

That may be one reason why women also have a higher risk of dying from a heart attack when they're in the hospital compared to men, the study found.

"The hallmark symptoms of a heart attack are chest pain and discomfort. But, women are more likely to have a different attack presentation," said study lead author Dr. John Canto, director of cardiovascular prevention, research and education at the Watson Clinic and director of the Chest Pain Center at Lakeland Regional Medical Center in Fla.

Men and women who have risk factors for heart disease, such as obesity, diabetes, high blood pressure, high cholesterol or a family history of heart disease, should be particularly concerned if they experience these symptoms.

"The reality is that most people who have chest pain and discomfort aren't having a heart attack. But, you can't wait to find out. Time is heart muscle. If you delay seeking treatment, you may be outside the window where you can get the most effective treatment," he said.

The study is in the Feb. 22/29 issue of the Journal of the American Medical Association.

Researchers analyzed data on more than 1.1 million patients seen at U.S. hospitals for heart attacks from 1994 to 2006. About 42 percent were women, who were also on average older than men when they had their heart attack.

Among both men and women, just over 35 percent -- or about one in three -- did not have chest pain.

However, women were more likely to experience an attack without chest pain compared to men, at 42 percent and 31 percent, respectively.

In-hospital deaths from heart attack were also more common among women: 14.6 percent of women died while still in the hospital, compared to just over 10 percent of men.

Dr. Suzanne Steinbaum, director of women and heart disease at Lenox Hill Hospital in New York City and a spokeswoman for the American Heart Association, said other heart attack symptoms women may experience include sweating, nausea and flu-like symptoms.

Though it can be hard to connect those symptoms to a heart attack, if "all of a sudden your daily activities become daunting, and you feel like you just can't function, you have to get checked out. If it's not your heart, so what? It's better to be safe than sorry," she said.

She also advised women to be assertive about their worries with doctors. Say, "I think I'm having a heart attack," she recommended.

Men may need to heed this advice as well, because they too may not have classic chest pain symptoms, she added.

The study found that for men and women -- but particularly for young women -- heart attacks without chest pain were associated with a greater risk of death. One of the main reasons, said Canto, is that people may delay going to the ER, and once they do call for help or go to the hospital, they may downplay their symptoms, leading to less urgent action from health care providers.

In the case of women, said Canto, the higher mortality rates may also be linked to biological differences in heart disease between men and women. When the researchers compared women without chest pain and men without chest pain, they still found a higher risk of death for women.

BLOOD PRESSURE TABLETS SHOULD BE GIVEN TO ALL OVER 55

24 MAY 2009--Blood pressure drugs should be given to everyone over 55 to reduce heart attacks and strokes”, the Daily Mail has reported. The newspaper said the medication should be prescribed even if blood pressure is normal, as new research estimates that common drugs reduce risk of heart attack by a quarter and stroke by a third.

This research was a large, thorough analysis combining the results from a number of trials on blood-pressure-lowering treatments, looking at how medication affected risk of future stroke or heart disease events such as heart attacks. The trials featured data on nearly half a million patients, including people both with and without a history of cardiovascular disease, as well as people with a range of blood pressure levels. These trials collectively demonstrated a reduction in risk of coronary heart disease and stroke regardless of a patient’s history of these conditions or high blood pressure. Based on this, the authors suggest that blood pressure medications should be offered to all people above a certain age, regardless of blood pressure or pre-existing disease.

This was a well conducted study, but its results will need to be considered alongside other issues, such as potential harms, before any change to current treatment practice and recommendations is made.

Where did the story come from?

This research was conducted by Professors MR Law, JK Morris and NJ Wald of the Centre for Environmental and Preventive Medicine, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine.

No sources of funding were reported for the study, but two of the authors declared holding patents on the formulation of a combined pill to reduce simultaneously four cardiovascular risk factors, including blood pressure. The study was published in the peer-reviewed British Medical Journal.

What kind of scientific study was this?

This was a systematic review and meta-analysis designed to determine how effective different drugs for lowering blood pressure (BP) are for preventing coronary heart disease (CHD) and stroke, and to decide who should receive these treatments.

The researchers searched the Medline database for randomised controlled trials (RCTs) investigating BP-lowering drugs where CHD events (fatal or non-fatal heart attacks or sudden cardiac death) or strokes had been recorded. They included studies published from 1966 to 2007, and excluded trials where patients had kidney failure or where other drugs, such as cholesterol-reducing statin medication, were given as part of the intervention in addition to BP medications.

All RCTs had to have a treatment duration of greater than six months and at least five CHD events or strokes recorded in the study period. Trials could include participants of any age or disease status, and those with prior BP treatment or use of other medications.

From each study, the researchers recorded the number of participants who had a CHD event, stroke or new diagnosis of heart failure or worsening of existing heart failure. Changes in BP in the treated and control groups were also recorded.

The authors categorised the RCTs based on the type of participants recruited: those with no history of CHD or stroke, a history of CHD (heart attack, coronary artery disease without recent heart attack or heart failure) or a history of stroke. In trials where the participants had no history of CHD or stroke, they usually had high BP and were usually being treated to reach a target BP.

The authors also categorised trials into:

• ‘Blood pressure difference trials’, which aimed to achieve a difference in BP between those randomised to the study drug and those receiving control (placebo or non-treatment) and show the effect this had on the incidence of CHD events and stroke.
• ‘Drug comparison trials’, where two different BP-lowering drugs were compared, and the aim was not to demonstrate a difference in BP between the groups, but to look at other effects of the treatments.

The researchers pooled the results of the trials using meta-analysis. In their analysis they also looked at the effect that taking one or more BP drug had on CHD and stroke risk according to age group and pre-existing BP status. In order to estimate the possible effect of BP medications at different doses, the authors combined their results with the results from a meta-analysis of placebo controlled RCTs looking at the effects of different doses of BP drugs and with data from the largest meta-analysis to date of epidemiological cohort studies observing how blood pressure changes affected risk of CHD events and stroke.

What were the results of the study?

Of the selected RCTs:

• 108 were ‘blood pressure difference trials’ (248,445 subjects),
• 46 were ‘drug comparison trials’ (230,491 subjects), and
• seven fell into both of these categories.

The trials included a total of 464,164 people divided into the three categories. The trials covered a total of 22,115 CHD events and 12,034 strokes. The average age of participants across all trials was 64 years.

Looking at the blood pressure difference trials, beta-blocker drugs were beneficial for reducing BP compared to a control treatment, but also for reducing risk of a further CHD event in those with a prior history of CHD (across all groups they gave an overall 29% reduction in risk compared to 15% in other drugs trialled). However, this benefit was mainly in those who were taking the beta-blocker following a heart attack in the previous few years, for whom their risk reduction of another CHD event was 31%. This risk reduction was only 13% for those who had a history of CHD but had not had a recent heart attack. Beta-blockers gave no significant reduction in CHD risk for those with no history of cardiovascular disease.

In all blood pressure difference trials (excluding trials of beta-blockers in CHD patients), reduction in systolic BP by 10mmHg, or reduction in diastolic BP by 5mmHg, reduced overall risk of CHD events by 22% and risk of stroke by 41%.

All classes of BP-lowering drugs (beta-blockers, angiotensin converting enzyme (ACE)-inhibitors, angiotensin receptor blockers, calcium channel blockers and thiazides) had a similar effect in reducing risk of CHD events and stroke, although calcium channel blockers reduced risk of stroke more than the other drugs.

Across all classes of drugs, risk reduction for CHD events and stroke was found to be similar in those with a history of CHD or stroke and those without prior cardiovascular disease, and also regardless of the BP level prior to treatment. This risk reduction extended to individuals not classified as having high blood pressure. The meta-analysis additionally showed that risk of heart failure was reduced by 19% by calcium channel blockers and 24% by all other drugs.

The researchers combined their results with a previous meta-analysis of cohort studies and with trials determining BP-lowering effect of different doses of the same drug. From this they found that three drugs given in combination at half standard dose reduced the risk of CHD by about 46% and of stroke by about 62% in people aged 60 to 69 (the age group generally covered by trials) who had a pre-treatment diastolic BP of 90mmHg. One drug at standard dose reduced CHD and stroke risk by about half this amount.

What interpretations did the researchers draw from these results?

The authors conclude that all classes of BP-lowering drugs have a similar effect in reducing risk of CHD events and stroke in relation to a given reduction in blood pressure. Calcium channel blockers appear to be slightly more effective than other drugs in preventing stroke, and beta-blockers appear to have added benefit in reducing further CHD events when taken in the immediate post-heart-attack period. The reduction in CHD and stroke appears to be similar regardless of pre-treatment BP and the presence or absence of existing cardiovascular disease.

The authors say that their results highlight the importance of lowering blood pressure in everyone above a certain age, rather than measuring BP and only treating it if it is elevated.

What does the NHS Knowledge Service make of this study?

This was a large and thorough meta-analysis that has examined trials of blood-pressure-lowering treatments and evaluated how they affect future risk of heart disease events (such as heart attack) or stroke. The trials included both people with a history of cardiovascular disease and those without, as well as people with a range of pre-treatment blood pressure levels. Collectively, these trials have demonstrated a reduction in risk of CHD and stroke through use of any medication to lower blood pressure, regardless of prior history or existing blood-pressure levels.

As the authors say, the combined results of the blood pressure difference trials demonstrated that a 10mmHg reduction in systolic pressure or a 5mmHg reduction in diastolic pressure reduced risk of CHD by 22% and stroke by 41%. These findings are consistent with results of a previous large meta-analysis of cohort studies, in which similar blood pressure reductions resulted in CHD risk being reduced by 25% and stroke risk being reduced by 30%.

The results of this review point to there being a benefit of disease prevention through lowering blood pressure, and this benefit did not seem to be affected by blood pressure at the start of the trial. From this, the authors suggest that guidelines may need to be changed so that the reviewed medications are offered to all people above a certain age, regardless of blood pressure or pre-existing disease.

A few points to note include:

• Meta-analysis can involve combining results of trials with different methods, study populations, follow-up and measured outcomes. This can create some inaccuracy in the quantified risk estimates.
• As the authors mention, across all trials, 25% of those allocated to take the study medication discontinued their treatment, which will affect the accuracy of the estimated effect of the drugs.
• Although some trials did include people with normal BP, most participants with no history of cardiovascular disease had elevated BP. Therefore, the study does not include wide representation of healthy people with normal BP and no other risk factors for cardiovascular disease.
• In people without history of cardiovascular disease there was not always an observed benefit in risk reduction.
• All medications carry the risk of adverse effects, and this must be taken into account when considering offering medications to a whole age group, including those who may have other medical conditions or take treatments that would make anti-BP medication unsuitable.
• Blood pressure is not the only risk factor for heart disease or stroke. Genetic factors, gender, smoking, raised cholesterol, obesity and diabetes are all factors that contribute to disease risk, and prevention strategies would ideally take into account all of these factors.

These review findings will undoubtedly prove invaluable, and are likely to lead to further study and consideration of the current treatment and practice for these common, serious conditions.

Links to the headlines

Blood pressure drugs 'should be given to everyone over 55 to reduce heart attacks and strokes'. Daily Mail, May 20 2009

Blood pressure drugs reduce heart attack and stroke risk regardless of raised blood pressure. The Daily Telegraph, May 20 2009

Blood pressure pill action urged. BBC online, May 20 2009

Links to the science

Law MR, Morris JK and Wald NJ: Use of blood pressure lowering drugs in the prevention of cardiovascular disease: meta-analysis of 147 randomised trials in the context of expectations from prospective epidemiological studies. BMJ 2009; 338:b1665

Editorial citing study
McManus RJ and Mant J: Management of blood pressure in primary care. BMJ 2009;338:b940

Bleeding hearts revealed with new scan

20 jan 2009--Images that for the first time show bleeding inside the heart after people have suffered a heart attack have been captured by scientists, in a new study published today in the journal Radiology.

The research shows that the amount of bleeding can indicate how damaged a person's heart is after a heart attack. The researchers, from the MRC Clinical Sciences Centre at Imperial College London, hope that this kind of imaging will be used alongside other tests to create a fuller picture of a patient's condition and their chances of recovery.

The research was funded by the Medical Research Council, the British Heart Foundation and the Department of Health, UK.

People suffer heart attacks when an artery that feeds blood to the heart becomes blocked, stopping the heart's blood supply and depriving the heart muscle of oxygen. Currently, most people treated for a heart attack are fitted with a metal tube called a stent to keep the blocked artery clear.

Recent research has shown that some people experience bleeding inside the heart muscle once blood starts to pump into it again. However, the significance of this bleeding is currently not understood.

For the new small study, the researchers captured images of bleeding inside the heart in 15 patients from Imperial College Healthcare NHS Trust who had recently suffered a heart attack, using Magnetic Resonance Imaging (MRI). Analysis of the MRI scans revealed that the amount of bleeding correlated with how much damage the heart muscle had sustained.

Patients who had suffered a large heart attack, where a lot of the heart muscle was damaged, had a lot of bleeding into the heart muscle compared with those whose heart attack was relatively small.

The researchers were able to detect the area of bleeding because of the magnetic effects of iron, which is present in the blood.

Dr Declan O'Regan, the first and corresponding author of the study from the MRC Clinical Sciences Centre at Imperial College London, said: "Our study gives us a new insight into the damage that heart attacks can cause. Using this new scanning technique shows us that patients who develop bleeding inside their damaged heart muscle have a much poorer chance of recovery. We hope that this will help us to identify which patients are at most risk of complications following their heart attack"

Dr Stuart Cook, the study's senior author from the MRC Clinical Sciences Centre at Imperial College London, added: "We still have a lot of unanswered questions about whether the bleeding itself may cause further damage to the heart muscle and this is an area that needs further research. The more we understand about what happens during and after a heart attack, the greater the chances are of scientists finding new ways to combat the damage that heart attacks cause."

Severe Heart Attacks Deadlier for Women

By RONI CARYN RABIN

10 dec 2008--Women who suffer a type of severe heart attack were less likely than men to survive the first 24 hours in a hospital, a new study has found.

Female heart attack patients overall were less likely to receive timely treatment with aspirin or certain heart drugs, therapy to restore blood flow, or angioplasty to open blocked arteries, the authors also reported.

The study appears in today’s issue of the medical journal Circulation, which is published by the American Heart Association.

Researchers at the University of California, Los Angeles and elsewhere reviewed data on treatments and outcomes from more than 78,000 patients admitted to 420 hospitals between 2001 and 2006. The data were gathered by hospitals using an online tool to track patient care.

While the researchers found no gender gap in deaths for all heart attacks after accounting for differences in risk factors and age, they did find that women who suffered a type called a ST-elevation myocardial infarction, or STEMI, had a 12 percent higher risk of dying in the hospital than men. ST-elevation refers to an abnormal heart rhythm visible by electrocardiogram.

“For these types of heart attacks, which are usually caused by complete occlusion of the arteries and where immediate treatment to try and get the artery opened is so important, we still found important differences in early treatment and in outcomes,” said Dr. Gregg C. Fonarow, a professor of cardiovascular medicine at the University of California, Los Angeles and an author of the study.

Previous studies have shown that women are less likely to survive heart attacks than men, but experts disagree over the causes.

While some have suggested that women aren’t diagnosed as promptly or treated as aggressively as men, others note that women tend to develop heart disease at a more advanced age. As a result, female patients are more likely to suffer such complicating ailments as diabetes or lung disease.

Women may also be more likely to experience confusing heart attack symptoms, such as unexplained fatigue, rather than the classic symptom of crushing chest pain, making it more difficult to diagnose.

In the new study, the researchers found that women were 14 percent less likely than men to be treated with aspirin and 10 percent less likely to be treated with beta-blockers, which modify heart rhythm, soon after arriving at a hospital.

Women were 22 percent less likely to receive reperfusion therapy, which restores blood flow to the heart, within 30 minutes of arrival as treatment guidelines recommend. Women also were 13 percent less likely to receive angioplasty within 90 minutes of arrival, the study found.

Still, the data represent an improvement in timely treatment for women since the 1990s, Dr. Fonarow pointed out. “Overall the gaps in care between men and women have narrowed," he said.

Care for all heart attack patients seems to be improving, as well. “Earlier studies found less than one in 10 patients were receiving balloon angioplasty within 90 minutes and drug infusion within 30 minutes," Dr. Fonarow said. "Here we’re seeing two-thirds are getting it.”

Dr. Nieca Goldberg, a spokeswoman for the American Heart Association, said the results were “bittersweet.”

The higher death rate among women with STEMIs was troubling, she said, because they can be diagnosed easily with an electrocardiogram.

“Part of the reason women fare so badly immediately after a heart attack may be because they delay treatment and have more heart damage,” Dr. Goldberg said.

Doctors must treat women more aggressively for risk factors like high blood pressure and high cholesterol, she said. “We have to encourage women to be aware of symptoms and go to the hospital. Don’t think about it -- call 911.”

High Blood Pressure Can Mask Dangerous Chest Pain

MONTREAL, July 11 -- Patients with high blood pressure may be at risk for silent ischemia because they have a decreased perception of the pain that would otherwise signal heart disease, researchers here said.
In a prospective study of 907 men and women suspected of having myocardial ischemia, those with high blood pressure tended to have significantly lower pain scores during exercise (P=0.003) than those with normal pressure, according to Bianca D'Antono, Ph.D., of the Montreal Heart Institute, and colleagues.
The relationship was present whether or not imaging showed an actual deficit in perfusion, the researchers reported in the July issue of Psychophysiology.
Previous studies - using experimental models of pain - have suggested that people with high blood pressure feel less discomfort, but this is one of the first to look at pain in a more natural setting, the researchers said.
From 2000 through 2003, men and women referred to the Montreal Heart Institute for diagnosis of possible myocardial ischemia were asked to take part in the study, which measured their pain both at rest and during exercise stress testing.
Patients' cardiac perfusion was measured using single positron emission tomography (SPECT) at baseline, at rest, and after a stress test. The participants also filled out the short form of the McGill Pain Questionnaire on the rest day and after exercise.
The exercise test itself was conducted on a treadmill using the Bruce protocol and was stopped when a patient reported considerable pain, was out of breath, showed anomalies on an electrocardiogram, or reached 90% of the maximal heart rate expected for the patient's age.
The cohort was divided in two on the basis of median post-exercise systolic blood pressure, with the cut-off for high blood pressure being 170 millimeters of mercury.
In a general linear model of total score on the pain questionnaire, ischemia, post-exercise systolic blood pressure, and exercise duration were significant predictors of pain.
Specifically:
Patients who had ischemia, as determined by SPECT, felt significantly more pain during exercise, at P=0.025.
Patients who exercised longer had significantly less pain, at P<0.001.
Patients with high post-exercise systolic blood pressure had significantly less pain, at P=0.003, regardless of whether they had a perfusion deficit or EEG anomalies.
The patients also evaluated their pain as being more or less widespread. Analysis of those evaluations showed that exercise duration was significantly associated (at P<0.001) with the perception of widespread pain, but blood pressure was not, the researchers said.
They noted that the inverse relationship between blood pressure and pain remained significant after adjustment for a range of possible confounding variables.
The researchers also evaluated exertional chest pain during daily living, using the Canadian Cardiovascular Society grading scale. Again, higher blood pressure was significantly associated at P=0.001 with lower angina, they found.
The latter findings are important, the researchers concluded, because "the clinical problems associated with silent ischemia, such as failure to take medication or seek medical care, are related to the experience of angina in the daily life rather than in the hospital."
The study was supported by the Canadian Institutes for Health Research and the Heart and Stroke Foundation of Quebec. The authors did not report any potential conflicts. Primary source: PsychophysiologySource reference: Ditto B et al. "Chest pain is inversely associated with blood pressure during exercise among individuals being assessed for coronary heart disease." Psychophysiology, 44 (2007), 183-188.

Obese survive heart attacks better

By MARIA CHENG, AP Medical WriterMon Jul 9, 5:33 PM ET
While being fat increases your chances of a heart attack, some studies suggest a puzzling paradox: Obese people seem to have a better chance of surviving one. Scientists are stumped over why that seems to be the case and pose several theories.
There may be physiological differences in the hearts of obese and normal-weight people. Or perhaps it depends on where the fat is on their bodies.
However, experts warn, the results should not be used as an excuse for the overweight to indulge.
"We really don't want people to think that they should put on a bit of weight to have a better chance with their bypass surgery," said Dr. Gerald Fletcher, a cardiologist at the Mayo Clinic in Florida and a spokesman for the American Heart Association.
"These results do not mean it's OK to be fat. Being fat is still dangerous to your health for lots of other reasons," Fletcher said.
A 2005 study published in the American Journal of Medicine by scientists at Duke University examined nearly 16,000 people in 37 countries. The authors found that one year after a heart attack, the death rate for normal-weight patients was 4.3 percent. For obese patients, it was just 2.2 percent.
Several other studies have confirmed those findings, including a paper last month in the European Heart Journal. German and Swiss doctors tracked more than 1,600 patients for three years after their heart attacks, and concluded that only 3.6 percent of fat patients had died, against nearly 10 percent of normal-weight patients.
"We don't have a good explanation for the biological phenomenon that's causing this," said Dr. Eric Eisenstein, leader of the Duke study. "We need to understand scientifically what's happening in these folks before we can develop new therapies."
There is a higher prevalence of smoking among thin patients, one possible explanation. But even after statistically adjusting for that, fat patients still had a distinct advantage, researchers found.
Some experts suggest it depends on where the fat is located, noting that fat around the abdomen is the biggest risk. Other doctors think there may be physiological differences in the heart.
"It could be that the hearts of obese people are 'pre-conditioned' because they're under more stress in the first place," said Dr. Andrew Newby, a professor of vascular biology at Bristol Heart Institute and spokesman for the European Society of Cardiology. Newby said that fat people who had heart attacks might be better able to withstand the initial shock to the system.
Dr. Rob Califf of Duke University said the survival rate difference between fat and thin "is not a big enough factor" to make changes in patient care. Other signs such as the magnitude of the heart attack and whether patients have kidney problems are more important in predicting survival, he said.
But experts say it is important to better understand the fat-thin paradox so doctors can provide better treatment.
Some suggested that fat people who have heart attacks can markedly improve their survival odds if they make some major lifestyle changes, an option that normal-weight patients may not have.
"Even moderate weight loss can have a big impact," said Dr. Heinz Buettner of the Heart Centre in Bad Krozingen in Germany. "Obese patients have a better chance to correct their situation compared to thin patients who may just have bad genes."
Because obesity can lead to other dangers — including high blood pressure, diabetes, and cancer — the apparent survival advantage fat people have after a heart attack might be erased by something worse down the line.
"Obese patients may get lucky after one heart attack, but they are still high-risk patients," said Fletcher. "If they stay fat after their surgery, they could end up back in the hospital soon and more bad things could happen."

Flu triggers heart attacks, study shows

Wed Apr 18, 2007 2:07PM EDT
WASHINGTON (Reuters) - Influenza can trigger deadly heart attacks, researchers said on Wednesday in a study that supports what experts have long believed -- flu can kill people even if they do not die directly from the flu.
Their report shows that the seasonal virus can worsen heart disease and that deaths from heart attacks and heart disease are far more common during flu season.
This can add up to 90,000 extra deaths a year in the United States alone, said Dr. Mohammad Madjid of the University of Texas-Houston, who led the study.
Writing in the European Heart Journal, the researchers said their findings add to a growing list of reasons why people should get annual flu shots. They also said people with heart disease should stick to their medications religiously.
"Our research has shown that influenza epidemics are associated with a rise in coronary deaths," Madjid said in a statement. "This calls for more intensive efforts to increase the vaccination rate in people at risk of coronary heart disease.
"This may be especially important in an influenza pandemic when we would expect to see high mortality among the elderly and those suffering from heart problems or who have multiple coronary risk factors," he said.