Tuesday news tips, Nov. 16, 2010

(Press-News.org) 9 a.m. Abstract 18350 – Explanted re-sterilized ICDs are safe, practical for patient use. Implantable cardioverter defibrillators (ICDs) removed for upgrades or infection may be reused safely in other patients. Researchers sent explanted ICDs with 70 percent or more battery life to India, where the devices were carefully cleaned and re-sterilized. They were re-implanted in indigent patients who were at risk of life-threatening arrhythmias but couldn't afford the devices. Thirty-one patients received explanted, re-sterilized ICDs for standard ICD indications. During an average follow-up of two years and two months, there were no infections and 42 percent of the patients got appropriate life-prolonging shocks from their ICDs. Five of 31 (16 percent) patients got a second re-sterilized ICD after almost three years because of battery depletion. If additional studies prove this to be a safe strategy, there could be important socioeconomic implications, researchers said. Behzad Pavri, M.D., associate professor of medicine, Thomas Jefferson University, Philadelphia, Pa.; (215) 955-8882; behzad.pavri@jefferson.edu.

9:15 a.m. Abstract 16034 – Shorter sleep duration, neck artery thickening linked in men. Shorter sleep duration was associated with increased carotid artery wall thickening (intima-media thickness, IMT) among men, but not women. In a major national study of 617 black and white middle-aged people (37-52 years; 58 percent female) researchers calculated IMT from the average of 20 measurements of the average common carotid, bulb and internal carotid IMT, assessed using high-resolution B-mode ultrasound. They used wrist monitors to measure sleep duration. The average IMT was 0.68 mm for women and 0.74 mm for men. Men slept less than women (5.7 hours vs. 6.3 hours). After adjusting for other factors, the researchers found that one hour of longer sleep duration was associated with 0.021 mm lesser IMT among men, and 0.002 mm lesser IMT among women. IMT is a marker for cardiovascular disease. These findings provide novel evidence of potential underlying biological mechanisms, and suggest that sleep duration may be an important risk factor associated with carotid IMT in men. Megan R. Sands, M.P.H., Brown University, Providence, R.I.; (401) 863-7416; megan_sands@brown.edu.

11:15 a.m. Abstract 12102 – Rapid body cooling improves outcome after CPR. In laboratory animals, California researchers achieved markedly better heart function after cardiopulmonary resuscitation by using an experimental drug to rapidly cool body temperature to target levels. Researchers applied a cannabinoid receptor agonist to create pharmacologic therapeutic hypothermia in 10 rats. Thirty minutes after resuscitation, animals were randomized to receive either a cannabinoid receptor agonist or vehicle placebo as a control for six hours. Infusing the drug progressively lowered blood temperature from 37 degrees to 34 degrees Centigrade four hours after resuscitation. The researchers observed significantly improved post-resuscitation heart function and lower neurological deficit scores in the treated animals, and the treatment was associated with longer durations of survival. "This method that quickly achieves body cool-down after CPR may be an improvement over current techniques that are either less effective or cumbersome for early application," researchers said. "Therapeutic hypothermia following CPR could be induced pharmacologically with a cannabinoid receptor agonist, improving post-resuscitation heart and cerebral functions and duration of survival compared with the control group." Shijie Sun, M.D., Institute of Critical Care Medicine, Rancho Mirage, Calif.; (760) 778-4911; shijiesun@aol.com.

2:30 p.m. Abstract 19027 -– Intravenous iron treatment quickly boosts quality of life for some heart failure patients. Iron-deficient, chronic heart failure patients may experience rapid and meaningful improvements in their quality of life from intravenous treatment with the iron compound, ferric carboxymaltose, researchers said. Researchers analyzed 449 iron-deficient chronic heart failure patients randomly assigned to receive intravenous ferric carboxymaltose or placebo for 24 weeks. They measured chronic heart failure symptoms, quality of life and exercise capacity at the start of the study, and after four, 12 and 24 weeks of the study. They found: Chronic heart failure symptoms, quality of life and exercise capacity improved with the intravenous iron treatment. After just four weeks, patients receiving intravenous ferric carboxymaltose had a significantly improved quality of life compared to those who received placebo. The beneficial effects of intravenous ferric carboxymaltose on quality of life were also seen at the later time points (12 and 24 weeks). Improvements were not influenced by patients' anemia status.

Josep Comin-Colet, M.D., Hospital del Mar Heart Failure Program, Barcelona, Spain; (011) 34 932483118; jcomin@hospitaldelmar.org.

2 p.m. Abstract 17341 – Intravenous iron compound improves kidney function in some chronic heart failure patients. Kidney function significantly improved in iron-deficient patients with chronic heart failure who received intravenous ferric carboxymaltose in a study. Researchers randomly assigned 459 patients to receive the compound or a placebo for 24 weeks. Piotr Ponikowski, M.D., Ph.D., Medical University, Wroclaw, Poland; (011) 48-71-7660237 or (011) 48-602664975 (cell); piotrponikowski@4wsk.pl.

2:15 p.m. Abstract 12827 — Mouse model of LEOPARD syndrome reveals potential therapy to reverse heart enlargement. In an analysis of mice with LEOPARD syndrome, researchers have identified abnormally regulated signaling pathways and a potential therapy for the heart defects associated with LEOPARD syndrome, a rare inherited disease affecting multiple biological systems in children. LEOPARD syndrome causes enlargement and thickening of the heart without a known cause (hypertrophic cardiomyopathy) in nearly 90 percent of patients. An enlarged heart has reduced pumping ability, which can result in irregular heartbeats and sometimes lead to heart failure. Using genetically-engineered mice, researchers analyzed mutations in the gene PTPN11, one of the two most commonly associated with LS. The gene encodes for the protein Shp2, which is important for cell-to-cell communications, or signaling, during cell growth and function. Mice born with reduced Shp2 phosphatase activity (indicating a defect in the Shp2 gene) mimicked the problems found in LEOPARD syndrome patients, including growth retardation, abnormally formed skull and facial structure, and abnormal chest walls. The mice also displayed the heart defects in LEOPARD syndrome, a progressive hypertrophic cardiomyopathy in the left ventricle that peaked at 12-16 weeks. By 52 weeks the researchers noted the mice had developed dilated cardiomyopathy, an indication of end-stage heart failure, and were unable to pump normal amounts of blood out of the left ventricle. Upon investigating the mechanism behind this abnormal cell signaling, researchers found alterations in pathways previously shown to help muscle adapt to changes in workload. Significantly, they found a reduced activity in the Erk/MAPK signaling pathway, but an increased activity in several other important signaling pathways, including Akt/mTOR. Remarkably, treating the mice with rapamycin, an immunosuppressant drug that targets and inhibits mTOR, reversed the cardiomyopathy. The researchers say this indicates the potential for using rapamycin to treat cardiac defects in LEOPARD syndrome patients. Kimberly Keith, B.S., Beth Israel Deaconess Medical Center, Boston, Mass.; (508) 216-3588; kmkeith@bidmc.harvard.edu and Maria Kontaridis, Ph.D., Beth Israel Deaconess Medical Center, Boston, Mass.; (617) 953-8846; mkontari@bidmc.harvard.edu.

2:45 p.m. Abstract 17003 – Rise in BMI increases risk for ischemic heart disease. As body mass index (BMI) increases, so does the risk for ischemic heart disease, according to a study. Researchers examined about 81,000 people from the Danish population, the Copenhagen General Population Study, the Copenhagen City Heart Study and the Copenhagen Ischemic Heart Disease Study. For the three studies combined, every 4kg/m2 (approx. 8.8 lbs./m2) increase in BMI resulted in a 52 percent increased risk of ischemic heart disease. Ischemic heart disease is characterized by narrowed heart arteries (reduced blood flow to the heart) that could lead to heart attack. Researchers first assessed increases in BMI to test whether overweight and obesity directly impact ischemic heart disease risk. They then analyzed specific genetic variants, which played a role in leading to both increased BMI and increased ischemic heart disease. All participants were genotyped for three genetic variants identified in previous studies to lead to lifelong increased BMI. Researchers said their results show an independent cause and effect between BMI and ischemic heart disease and have important public policy implications for public health. Børge Nordestgaard, M.D., D.M.Sc., University of Copenhagen, Herlev, Denmark; (011) 45 4488 3297; brno@heh.regionh.dk.

3 p.m. Abstract 16921/P2037 – Barbers and beauticians: cutting hair, cutting blood pressure. Blood pressure screening and follow-up and health education at minority, low-income barbershops and hair salons led to reductions in blood pressure among patrons. Black-owned and run barbershops and hair salons have been used in health promotion programs because of their role as trusted neighborhood institutions. In 18 months, 807 (53 percent women) clients were screened. Almost half (49 percent) were 18 to 45 years old. Ninety-five participants had a total of 179 follow-up blood pressure measures. Of those with follow-up measures, 38 percent had hypertension at the start of the study. Of these, 50 percent were no longer hypertensive at their last follow-up visit. Researchers recruited barbers and hair stylists from 16 shops in low-income urban areas of Washington, D.C. Shop operators measured blood pressure with an automated cuff and provided treatment referrals to local providers using a written algorithm. The shops provided patrons with access to written materials and videos about diet, exercise and medications. Other shop activities included cooking demonstrations, walking groups, local newsletters and lectures. Angela Silverman, M.S.N., C.A.N.P., MedStar Health Research Institute, Hyattsville, Md.; (301) 560-7305; angela.silverman@medstar.net.

3 p.m. Abstract 10314/P2058 – Rising incidence of valvular heart disease has public health implications. The incidence of hospitalization and treatment of patients with diseases of the heart valves in New York State has progressively and constantly risen since the early 1980s, and researchers say they expect relatively these constant growth curves to continue as the population ages. Using New York's Statewide Planning and Research Cooperative System (SPARCS), researchers identified 1,882,504 hospitalized patients who had diseases of at least one heart valve (mitral, aortic, tricuspid or pulmonic) between 1983 and 2007. They found: During the study, total hospitalizations in New York decreased from 3,032,235 cases (1983) to 2,628,545 cases (2007). Simultaneously, hospitalizations among patients with valvular diseases increased markedly at an average rate of increase of 9.1 percent per year. The trend was similar for valve replacement or repair, which collectively grew 7.8 percent per year. Both hospitalization and procedure rates increased with age at admission. As a result of the increase in cases over the study period, inpatient deaths subsequently increased 6.7 percent per year. These deaths were associated with advancing age, non-elective admission, male gender and presence of associated heart failure.

Researchers said their findings suggest that nationwide intensive planning is needed to deal with the public health implications of these increases to meet the growing needs of these patients. Phyllis Supino, Ed.D., State University of New York (SUNY) Downstate Medical Center, Brooklyn, N.Y.; (718) 613-8355; Phyllis.supino@downstate.edu.

3 p.m. Abstract 18734/P1018 -– New pocket-sized ultrasound device provides safe, accurate images. A new pocket-mobile ultrasound device allows clinicians to evaluate heart function, wall motion, heart cavity size, and valve anatomy quickly and safely in most patients. Researchers evaluated the new technology by comparing the visibility and accuracy of heart images seen with this hand-held echocardiographic device to those obtained with the more-cumbersome, expensive, standard transthoracic echocardiographic machines. Researchers, studying 97 patients (average age 68) referred for standard ultrasound examination of the heart, found: More than half (59 percent) of the exams performed with the small ultrasound were obtained within five minutes. The images adequately interpreted heart pumping function 95.4 percent of the time; heart cavity size 94.6 percent; mitral valve appearance 89.9 percent; aortic valve appearance 82.7 percent; local movement of heart walls 83.3 percent; and great vein collapse (inferior vena cava) 75 percent.

Experienced cardiologists and cardiology trainees with only rudimentary echocardiography experience interpreted the images. Although more studies are needed, researchers said their data suggests that this device will be "viable, efficient and a potentially cost-effective point-of-care screening tool that can be used in virtually any medical setting." Max J. Liebo, M.D., Scripps Clinic, La Jolla, Calif.; (858)-554-5588; liebo.max@scrippshealth.org.

3 p.m. Abstract 17295/P7094 -– Ticagrelor-aspirin combination reduces ICU days; cuts costs. The new antiplatelet medication ticagrelor (brand name Brilinta), when combined with aspirin, resulted in a significantly reduced number of days in the intensive care unit after hospital admission for heart attack when compared with a regimen of clopidogrel (brand name Plavix) and aspirin, according to new research. Antiplatelet agents, such as ticagrelor and clopidogrel, reduce the blood's ability to clot, which can lead to heart attack or stroke. One or a combination of these medicines is used to prevent heart attack and stroke in people who have already had heart attacks. In the study, researchers randomized 18,624 patients with acute coronary syndrome in 43 countries to either ticagrelor and aspirin or clopidogrel and aspirin. Acute coronary syndrome, which includes heart attack, is a set of clinical symptoms resulting from insufficient blood supply to the heart muscle. Ticagrelor resulted in 1,149 fewer bed days, of which 712 were categorized as intensive care days occurring after hospital admission. This study, called Platelet Inhibition and Patient Outcomes (PLATO) also previously showed a reduced risk of heart attack, stroke and death from vascular causes among the patients taking ticagrelor and aspirin. The effect of these shifts on net medical costs forecasting to one year will be reported from the perspective of several of the main participating PLATO countries in this trial. Magnus Janzon, M.D., Ph.D., head of cardiology and consultant to the Heart Centre, Linköping University Hospital, Linköping, Sweden; (011) 46706724800; magnus.janzon@liu.se.

3 p.m. Abstract 20698/P2042 – Most Hispanic women with PAD unaware of disease and its complications. A significant number of Hispanic women are unaware that they have peripheral arterial disease (PAD) and its complications, according to a new study. During a two-year period, researchers visited several Hispanic senior community centers in Dallas County, Texas, where they performed face-to-face interviews, blood tests, and non-invasive vascular tests on Hispanic women who had risk factors for PAD. They found: Ninety-four percent of 181 Hispanic women affected by the disease were not aware of their condition and its potential complications. The average age of aware women was 77 years and 72 for unaware women. Before the vascular tests were performed, among women who knew they had PAD, the estimated risk of heart attacks within the next 10 years was about 27 percent. In contrast, the estimated risk of future heart attacks was only 11 percent among women unaware of PAD. After establishing the diagnosis of PAD, 25 percent of women initially classified as low or intermediate risk for future heart attacks were identified as having greater than 20 percent risk of heart attacks within the next 10 years.

PAD affects blood circulation and results from progressive narrowing of the blood vessels (arteries) in the legs. Untreated, the disease may result in leg ulcers and even in leg amputations. Researchers said early recognition of PAD is key to assessing the risk of stroke, heart attack and death and to start effective risk factor modification. Eric B. Rosero, M.D., UT Southwestern Medical Center, Dallas, Texas; (214) 857-0336; Eric.Rosero@UTSouthwestern.edu and Carlos H. Timaran, M.D.; Carlos.Timaran@UTSouthwestern.edu.

4 p.m. Abstract 19608 – Public reporting of performance on heart failure quality indicators may spur hospitals to provide more evidence-based care. Public reporting of hospital performance on heart failure quality indicators may stimulate hospitals to provide more evidence-based therapies to their patients and lead to fewer readmissions, researchers said. Researchers analyzed data from Enhanced Feedback for Effective Cardiac Treatment (EFFECT), a study in which 86 Ontario hospital corporations were randomized to either early (January 2004) or delayed (September 2005) publication of their performance on a set of six heart failure "process of care" quality indicators. The researchers analyzed whether public reporting stimulated hospitals to improve on indicators, such as angiotensin-converting enzyme (ACE) inhibitor prescribing, and reduced heart failure readmissions. They found:

No significant differences in the overall rates of heart failure readmission in the two arms of the study. However, among patients with the most severe type of heart failure treated at the early report card hospitals, there was a 20 percent lower rate of heart failure readmission at one year for patients initially treated between April 2004 and March 2005. This difference persisted through four years of follow-up.

Doctors in the January 2004 early report card hospitals were more likely than the September 2005 delayed report card hospitals (90 percent versus 87 percent) to treat heart failure patients with ACE inhibitors or angiotensin II receptor blockers (for those who cannot tolerate ACE inhibitors).

"Early feedback hospitals" were also more likely than "delayed feedback hospitals" (44 percent versus 40 percent) to use doses of the medications proven effective in clinical trials. Jack V. Tu, M.D., Ph.D., Institute for Clinical Evaluative Sciences, Sunnybrook Schulich Heart Centre, University of Toronto, Toronto, Canada; (416) 480-4700; tu@ices.on.ca.

4 p.m. Abstract 14666 – Overweight diabetics can improve high-sensitivity C-reactive levels with nutrition and exercise interventions. Lifestyle behaviors aimed at weight loss and better sugar control help improve high-sensitivity C-reactive protein (hs-CRP) in people with type 2 diabetes, according to new research. Increased levels of hs-CRP in the bloodstream have been associated with a high risk of heart disease in people without diabetes. People with type 2 diabetes who are overweight or obese are at increased risk of heart disease and have increased levels of hs-CRP. Researchers measured hs-CRP levels in 1,759 people (average age 58) with diabetes enrolled in the Look AHEAD (Action for Health in Diabetes) at the start of the study and at one year. Look AHEAD is a multicenter clinical trial evaluating the effects of improved lifestyle behavior for weight loss on heart disease in overweight and obese people with diabetes in the United States. Participants were randomized to receive either lifestyle intervention or usual care. The lifestyle intervention group received frequent counseling to increase moderate-intensity exercise to 175 minutes/week and reduce caloric intake; the usual group received three information sessions in the year. Forty percent of participants were on statin therapy at baseline. The researchers found: Lifestyle intervention reduced average hs-CRP by 43.6 percent, compared with a 16.7 percent reduction with usual care. There was a significant reduction in hs-CRP levels with lifestyle intervention both in statin and in non-statin users.



Lifestyle intervention for weight loss decreases hs-CRP levels in obese men and women with type 2 diabetes even if they are already on statin therapy. Researchers suggest that efforts to improve lifestyle behaviors may be of benefit in patients who are taking statins and still have an elevated hs-CRP level. L. Maria Belalcazar, M.D., University of Texas Medical Branch, Galveston, Texas; (409) 772-1922; lmbelalc@utmb.edu. ### Note: Actual presentation time is 4:45 p.m., CT, Tuesday, Nov. 16, 2010.

Author disclosures are available on the abstracts.

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

NR10-1149 (SS10/Tuesday News Tips)

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



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