Sex Heart Transplants are better
for "good" cholesterol fail tests.
angioplasties unneeded, study finds.
Scans may speed chest pain diagnosis
Disease More Common in WV and KY
Transplant Patients Celebrate Life
shouldn't nix heart transplant
ponder fixing heart
Oil Reduces Risk of Heart Disease
Correction Shows Early Vioxx Risks
Heart Disease,Stroke Plague Third World
Risk Cited in Replacing Heart Device
||Heart Disease Information
|Heart disease is the leading cause of death for
both women and men in the United States.*|
|In 2002, 696,947 people died of heart disease (51%
of them women), accounting for 29% of all U.S. deaths. The
age–adjusted death rate was 241 per 100,000 population.†|
|Heart disease is the leading cause of death for
American Indians and Alaska Natives, blacks, Hispanics, and whites.
Although cancer is the leading cause of death for Asians and Pacific
Islanders (accounting for 26.1% of all deaths), heart disease is a
close second (26.0%).†|
|Heart disease death rates per 100,000 population
for the five largest U.S. racial/ethnic groups are as follows:
Hispanics, 72; Asians and Pacific Islanders, 78; American Indians,
80; blacks, 206; and whites, 259.†|
|In 2005, heart disease is projected to cost $393
billion, including health care services, medications, and lost
|Studies among people with heart disease have shown
that lowering high blood cholesterol and high blood pressure can
reduce the risk of dying of heart disease, having a nonfatal heart
attack, and needing heart bypass surgery or angioplasty.|
|Studies among people without heart disease have
shown that lowering high blood cholesterol and high blood pressure
can reduce the risk of developing heart disease.|
11/13/2008 Turns out men and women really are
different at heart: New research finds that heart transplant patients
have better odds of survival and a lower risk of rejection if they get
organs from donors of the same sex.
Size may be part of the explanation. Men's hearts
are bigger than women's and have greater pumping capacity, and men
who get men's hearts fare better. But doctors think differences in
hormones or immune systems between the sexes may also play a role.
The study was paid for by the federal government
and led by Dr. Eric Weiss, a cardiac surgery researcher at Johns
Hopkins University in Baltimore. He presented his findings Wednesday
at an American Heart Association conference.
Unfortunately for many patients, the findings
won't make much of a difference. About 2,700 Americans are waiting
for a heart, and only 2,200 heart transplants are done each year _
some of them second operations for people whose first transplant
failed, according to UNOS, the United Network for Organ Sharing,
which manages the nation's transplant system.
The average wait for a heart is 108 days for women
and 119 for men. Three-fourths of heart transplants are done in men,
so by necessity, many must receive organs from the opposite sex.
Smaller earlier studies have found hints that
gender differences may play a role in other types of transplants,
such as lungs or kidneys, but this is the largest by far to find an
Weiss used UNOS records on 18,240 heart
transplants between 1998 and 2007. Among the recipients 77 percent
of the men and 51 percent of the women were of the same gender as
The best results were seen in male-to-male
transplants. The worst were in men who received hearts from women.
When the donor was bigger than the recipient, the
sex difference did not affect survival. But when the donor was
smaller, people did not fare as well.
"The organ may not have the strength to
supply blood to the body," Weiss explained.
But the donor's gender made a difference even
after size was taken into account, he found.
Matching donor and recipient by gender led to:
_ a 13 percent lower risk of organ rejection in
the first year;
_ a 14 percent lower risk of rejection throughout
the study, which had an average follow-up of more than three years;
_ a 24 percent drop in the risk of dying in the
first 30 days after transplant;
_ and a 20 percent lower risk of dying after one
Why the difference? Doctors are not certain. But
Dr. Maryl Johnson of the University of Wisconsin-Madison said women
who have been pregnant generally have slightly worse outcomes from
transplants because their immune systems have been "revved
up" from carrying foreign genes from their partners through the
As for the findings, "it's a huge data set _
I don't think we can disregard it," but the issue needs more
study, said Johnson, who heads a UNOS panel that sets policies for
In the meantime, few doctors would advise someone
who needs a new heart to pass up one from a donor of the opposite
"Organs are in such scarce supply that it's
hard to make a blanket statement," Weiss said. "You're
still much better off getting a heart transplant" than waiting
and risking your own heart will give out before another becomes
On the Net:
Heart meeting: http://www.americanheart.org
03/26/2007 The hot new strategy of trying to
prevent heart disease by raising good cholesterol had more setbacks
Monday as new studies showed that experimental drugs didn't work and
also had safety problems.
The news follows Pfizer Inc.'s abandonment in
December of an $800 million investment in torcetrapib, the leading
contender in this class of drugs, because it raised the risk of
heart attacks and deaths.
Heart specialists have been anxious to know
whether the problems extend to all such drugs and doom this
"A lot of people think it's the next big
thing, and we'll need to understand what went wrong with torcetrapib
to move forward," said Dr. Steven Nissen, a Cleveland Clinic
heart specialist who is president of the American College of
The new studies, reported at the group's
conference, gave a mixed answer. The Pfizer drug seems uniquely
risky, but other drugs have problems, too.
And even though they and the Pfizer drug raised
HDL good cholesterol as intended, that made no difference in the
odds of heart attacks or deaths, or key measures of cholesterol
buildup in arteries.
Doctors long have focused on lowering LDL, or bad
cholesterol, to cut heart attack risk. Statins, sold as Lipitor and
Zocor and also in generic form, lower LDL, which ferries fats from
food into the bloodstream.
But many statin users suffer heart attacks anyway,
so doctors have been trying to boost HDL, or good cholesterol _
which transports fat from the blood to the liver to be disposed of _
to further lower risk.
An extended-release niacin drug called Niaspan,
sold by Kos Pharmaceuticals Inc., does this. But it can cause a
prickly hot sensation called flushing that some people find
intolerable. Pfizer, Merck & Co. and Swiss drug maker Roche
Holding AG are testing drugs that boost HDL in a novel way.
Pfizer shares rose 7 cents to $25.73 in afternoon
trading on the New York Stock Exchange while Merck stock sank 42
cents or nearly 1 percent to $44.03 on the NYSE. Meanwhile, Roche's
U.S. traded shares were flat at $90.05 on the Pink Sheets.
On Monday, scientists reported the results of
several studies on torcetrapib. In one, the drug boosted HDL by 61
percent, but trends in death, hospitalization and heart attacks
"are all going in the wrong direction," Nissen said.
An experimental diabetes drug by Eli Lilly and Co.
that is 10,000 times more potent than fibrates, a current
cholesterol treatment, also proved disappointing. The new drug
raised HDL but also raised the risk of kidney, heart and other
serious problems, Nissen reported.
Finally, infusions of a reconstituted form of HDL
developed by CSL Ltd., an Australian company, made no big difference
in the burden of artery buildups in a study led by Dr. Jean-Claude
Tardif of the Montreal Heart Institute.
In several of these studies there were hints of
some improvements in less important measures of artery buildup,
which provides "a glimmer of hope for future development of
this class of drugs," Dr. Alan Tall of Columbia University
writes in an editorial in the New England Journal of Medicine.
That journal and the Journal of the American
Medical Association published several of the new studies.
"The bar has been raised a lot for this
entire class, but I do not think we can abandon this entire
approach," Nissen said.
If Baycol had been the first statin tested and
research had stopped after safety problems emerged, there wouldn't
even be this class of drugs, he noted. Baycol, sold by Bayer AG, was
withdrawn from the market in 2001 after reports of a severe and
sometimes fatal muscle disorder.
03/26/2007 More than half a million people a year
with chest pain are getting an unnecessary or premature procedure to
unclog their arteries because drugs are just as effective, suggests a
landmark study that challenges one of the most common practices in
The stunning results found that angioplasty did
not save lives or prevent heart attacks in non-emergency heart
An even bigger surprise: Angioplasty gave only
slight and temporary relief from chest pain, the main reason it is
"By five years, there was really no
significant difference" in symptoms, said Dr. William Boden of
Buffalo General Hospital in New York. "Few would have expected
He led the study and gave results Monday at a
meeting of the American College of Cardiology. They also were
published online by the New England Journal of Medicine and will be
in the April 12 issue.
Angioplasty remains the top treatment for people
having a heart attack or hospitalized with worsening symptoms. But
most angioplasties are done on a non-emergency basis, to relieve
chest pain caused by clogged arteries crimping the heart's blood
Those patients now should try drugs first, experts
say. If that does not help, they can consider angioplasty or bypass
surgery, which unlike angioplasty, does save lives, prevent heart
attacks and give lasting chest pain relief.
In the study, only one-third of the people treated
with drugs ultimately needed angioplasty or a bypass.
"You are not putting yourself at risk of
death or heart attack if you defer," and considering the safety
worries about heart stents used to keep arteries open after
angioplasty, it may be wise to wait, said Dr. Steven Nissen, a
Cleveland Clinic heart specialist and president of the College of
Why did angioplasty not help more?
It fixes only one blockage at a time whereas drugs
affect all the arteries, experts said. Also, the clogs treated with
angioplasty are not the really dangerous kind.
"Even though it goes against intuition, the
blockages that are severe that cause chest pain are less likely to
be the source of a heart attack than segments in the artery that are
not severely blocked," said Dr. David Maron, a Vanderbilt
University cardiologist who helped lead the new study.
Drugs are better today than they used to be, and
do a surprisingly good job, said Dr. Elizabeth Nabel, director of
the National Heart, Lung and Blood Institute.
"It may not be as bad as we thought" to
leave the artery alone, she said.
About 1.2 million angioplasties are done in the
United States each year. Through a blood vessel in the groin,
doctors snake a tube to a blocked heart artery. A tiny balloon is
inflated to flatten the clog and a mesh scaffold stent is usually
The procedure already has lost some popularity
because of emerging evidence that popular drug-coated stents can
raise the risk of blood clots months later. The new study shifts the
argument from which type of stent to use to whether to do the
procedure at all.
It involved 2,287 patients throughout the U.S. and
Canada who had substantial blockages, typically in two arteries, but
were medically stable. They had an average of 10 chest pain episodes
a week _ moderately severe. About 40 percent had a prior heart
"We deliberately chose to enroll a sicker,
more symptomatic group" to give angioplasty a good chance to
prove itself, Boden said.
All were treated with medicines that improve chest
pain and heart and artery health such as aspirin,
cholesterol-lowering statins, nitrates, ACE inhibitors,
beta-blockers and calcium channel blockers. All also were counseled
on healthy lifestyles _ diet, exercise and smoking cessation.
Half of the participants also were assigned to get
After an average of 4 1/2 years, the groups had
similar rates of death and heart attack: 211 in the angioplasty
group and 202 in the medication group _ about 19 percent of each.
Heart-related hospitalization rates were similar,
Neither treatment proved better for any subgroups
like smokers, diabetics, or older or sicker people.
At the start of the study, 80 percent had chest
pain. Three years into it, 72 percent of the angioplasty group was
free of this symptom as was 67 percent of the drug group.
That means you would have to give angioplasties to
20 people for every one whose chest pain was better after three
years _ an unacceptably high ratio, Nissen said.
After five years, 74 percent of the angioplasty
group and 72 percent of the medication group were free of chest pain
- "no significant difference," Boden said.
The study was funded by the U.S. Department of
Veterans Affairs, the Medical Research Council of Canada and a host
of drug companies. Stent makers refused to help pay for the
research, said scientists who led the study.
The study renewed a heated animosity between
doctors who perform angioplasty and other heart specialists.
In fact, one who does the procedures and who spoke
at a meeting in New Orleans sponsored by stent maker Boston
Scientific Corp. was responsible for the early release of the
study's results, which were not due out until Tuesday.
The study "was rigged to fail, and it
did," the Wall Street Journal quoted Dr. Martin B. Leon of
Columbia University telling several hundred of his colleagues Sunday
"A lot of people have been taking shots at
us, and we need to go on the offense for awhile," the Journal
reported Leon said.
He claimed to have inside knowledge of the results
because he reviewed the study for the New England Journal. The
journal would not comment, saying the identity of its reviewers is
The cardiology college issued a statement saying
it was "extremely disappointed" results were released
prematurely, "betraying the confidentiality of the scholarly
process and the professional integrity of the scientific
The college "will be considering strong
sanctions against the individual or individuals involved," the
Boston Scientific shares fell $1.05, or 6.6
percent, to close at $14.22 on the New York Stock Exchange at double
their average volume.
Dr. Spencer King of Piedmont Hospital in Atlanta,
a leading cardiologist who does many angioplasties, said he was
disappointed in the study results.
"How many patients have interventions in
which the only expectation is to reduce the use of nitroglycerin or
to walk a bit faster? Most patients anticipate a better prognosis
and might opt for an extended course of medical therapy if they
believe they are not putting their life at excess risk," he
wrote in a recent editorial in an American Heart Association
In an interview at the cardiology meeting, King
said he recently had surgery for back pain and did not expect
permanent relief but added, "If it only held up for five years,
I wouldn't be happy about it."
The new study "should lead to changes in the
treatment of patients with stable coronary artery disease, with
expected substantial health care savings," Dr. Judith Hochman
of New York University wrote in an editorial in the journal.
An angioplasty costs roughly $40,000. The drugs
used in the study are almost all available in generic form.
Maron, the Vanderbilt doctor who helped lead the
study, said people should give the drugs a chance.
"Often I think that patients are under the
impression that unless they have that procedure done, they're not
getting the best of care and are at increased risk of having a heart
attack and die," he said.
Dr. Raymond Gibbons, a Mayo Clinic cardiologist
and American Heart Association president, agreed: "This trial
shows convincingly that that assumption is incorrect."
02/26/2007 Garlic doesn't do much for the breath
and it stinks for lowering cholesterol. That's the conclusion of the
most rigorous, head-to-head study of raw garlic and popular garlic
supplements, despite promoters' claims to the contrary.
Whether it was eaten raw in heart-healthy
sandwiches, or in pills made of powdered or aged garlic, the
strong-smelling herb had no effect on cholesterol in people whose
levels were already elevated, the government-funded study found.
"If garlic was going to have a chance to
work, it would have worked in this study," said researcher
Christopher Gardner. But it didn't.
Garlic is a longtime folk remedy for a variety of
ills, including heart disease, cancer, infections and even mosquito
bites. Scientific research on its purported benefits has had
conflicting results. Some previous studies suggested garlic might
help lower risks for digestive and prostate cancers, or might reduce
blood pressure and cholesterol levels; others found no benefit.
Health benefits have been thought to come from a
sulfur-containing substance called allicin that is released when raw
garlic is chopped or crushed. In lab tests, it can be applied
directly to cells and has been shown to prevent cholesterol
But any direct benefits to the body from allicin
may be diluted when garlic is eaten, said Gardner, an assistant
professor of medicine at Stanford University.
Still, Gardner, a garlic lover, was optimistic
when he and colleagues began their study. He called the results
disappointing but said it's still possible garlic might improve
cholesterol when eaten in bigger doses or by people with more severe
cholesterol problems. Also, garlic could have characteristics other
than influencing cholesterol that might benefit the heart, he said.
The study appears in Monday's Archives of Internal
An Archives editorial agreed and said "the
jury is still out" on whether garlic might prevent
The study involved 192 adults aged about 50 on
average with moderately elevated levels of LDL cholesterol, the bad
kind that contributes to heart disease. The average LDL level was
140 milligrams per deciliter of blood, or in the borderline-high
range. Below 100 is considered ideal.
Participants were randomly assigned to eat the
equivalent of an average clove of garlic in either raw form or
garlic pills, or dummy pills, six days weekly for six months.
Raw garlic was mixed into salsa, fat-free
mayonnaise or other condiments spread on portobello mushroom
sandwiches, chicken quesadillas and other specialty sandwiches.
Participants in the garlic pill and dummy pill groups also got
sandwiches, but without garlic.
Bad breath and body odor were reported by more
than half the raw garlic eaters, and a handful of people in the
supplement groups reported flatulence, but there were no major side
effects. There also was virtually no effect on cholesterol levels in
any of the groups.
Blood samples were taken monthly to detect any
changes in cholesterol readings but found none that were
statistically significant. Diet and exercise levels also were
monitored to detect any changes that could affect cholesterol
Robert Borris, a scientist with the Council for
Responsible Nutrition, a trade group for nutritional supplement
makers, said the study doesn't answer whether garlic might help
regulate cholesterol levels in healthy people.
The results also don't refute scientific evidence
suggesting that garlic can reduce the tendency of blood platelets to
build up and form clots that could block arteries, Borris said.
"I certainly would not give up on
garlic," he said.
02/27/2007 Millions of people with chest pain
enter emergency room limbo, spending up to 24 hours waiting for tests
to tell if a heart attack really is brewing or if it's something less
dire. A computerized heart scan may start easing the wait, giving
doctors a faster picture of clogged arteries to help determine who can
go home _ within just four hours _ and who needs more care. If these
souped-up CT scans pan out _ and major studies of several thousand
chest-pain sufferers are to begin soon _ they may do more than send
the worried well home faster.
"To be able to show the patient what's going
on in their arteries is very powerful," says Dr. James
Goldstein of William Beaumont Hospital in Royal Oak, Mich.
He's finding that the 3-D pictures of gunk-filled
arteries can motivate patients to change their heart-risky behaviors
better than lecturing them about high blood pressure or cholesterol.
On the other side, when arteries look clean,
"you can say the chance that this patient would have any
cardiac event in the next five years will be very, very low,"
adds Dr. Udo Hoffmann of Massachusetts General Hospital. "If
they come back a week later with chest pain, you know it's not the
Sudden chest pain sends about 6 million people to
U.S. emergency rooms every year. It's the most common symptom of a
heart attack, but a maddening symptom, too _ because half the time
it signals something other than heart disease, and telling the
difference can be tough.
The dilemma starts with describing the pain. The
classic "elephant on my chest" sensation isn't what
everyone experiences. Some feel not pain but a tightening of the
chest. Others feel pain in the arm, neck or jaw. Some people say it
felt like they had a toothache before their heart attack; others
"Trying to sort out whether there's a
life-threatening heart problem based on symptoms alone is
difficult," explains Goldstein. "Sometimes it seems
obvious, and you're wrong. Sometimes the symptoms are unimpressive,
and you're wrong. The implications of missing the diagnosis are
An electrocardiogram, or EKG, sometimes catches a
heart attack in progress, or an artery so unstable that one's
But at least half the time, early tests are
inconclusive and patients are admitted to the hospital for repeat
EKGs, blood tests and other checks that can last 24 hours _ and
eventually rule out a heart attack two-thirds of the time. Patient
anxiety aside, the tab for all that testing surpasses $10 billion
Worse are those whose heart attacks are missed,
between 2 percent and 8 percent of patients who are sent home too
Cardiac catheterization _ threading a probe up
into the heart to view the inside of arteries _ or stressing the
heart with exercise can provide a faster answer, but both are risky
so doctors until now have stuck with the wait-and-see approach.
Enter CT angiography. Doctors inject patients with
a dye to illuminate artery walls. Then newer machines called
64-slice CT scanners use computerized X-rays to measure both
rock-like calcium and soft fatty blockages inside arteries. Within
30 minutes, the 3-D images can show if arteries are narrowed, and
Beaumont researchers studied 197 chest pain
sufferers considered at low risk of a heart attack, giving half the
souped-up CT scan. The noninvasive test either ruled in or ruled out
heart disease in 75 percent, helping to decide who really needed to
be hospitalized 11 hours faster than with routine testing,
researchers report in this week's Journal of the American College of
Don't reserve the souped-up CTs for low-risk
patients, says Mass General's Hoffmann. He tested the scans in 103
patients, 14 of whom had either a full heart attack or a dangerous
condition called unstable angina. The CT scans correctly spotted
blocked arteries in those patients, and correctly cleared others who
had no or minimal clogs, he reported last fall in the journal
So who should get the scans? Hoffmann and the
Beaumont group both are preparing larger studies to try to settle
that, and to tell if CT angiography improves patients' outcomes or
just speeds the diagnosis.
Finding clean arteries or very blocked ones makes
for an easy diagnosis. But if the clog is medium-sized, is it
causing the chest pain and does it need immediate treatment? A CT
alone won't be enough to tell, notes Hoffmann.
Nor is even this noninvasive test risk-free. CT
scans do involve radiation, and the injectible dye isn't for people
with kidney disease.
While some hospitals already are using the CTs to
diagnose chest pain, "most physicians at this time are not
familiar with a cardiac CT and what it means," Hoffmann
For now, just insisting on a thorough check may be
the best consumer advice. A disturbing new study of more than 7,000
emergency room visits found blacks and women were less likely to get
even that first-step EKG than other chest-pain sufferers. The study
couldn't explain the disparity, but lead researcher Liliana Pezzin
of the Medical College of Wisconsin suspects harried workers in
overcrowded ERs were too quick to assume another cause.
"Be your own advocate," Pezzin says.
"Say, 'I need to be tested.'"
02/15/2007 West Virginia and Kentucky _ states
known for high levels of obesity, diabetes and smoking _ have the
highest proportion of people with heart disease in the nation, U.S.
health officials said Thursday.
The findings, from the first study ever to look at
heart disease prevalence state by state, showed that states in the
Southeast and Southwest were heart disease leaders. Colorado and the
District of Columbia had the lowest percentages.
The results line up well with previous,
state-specific reports about heart disease death rates, obesity and
other risk factors, said Wayne Rosamond, an epidemiology professor
at the University of North Carolina who chairs a statistics
committee for the American Heart Association.
He called the report by the U.S. Centers for
Disease Control and Prevention "very important. It confirms
what we know about regional differences in the burden of
For the nation as a whole, roughly 4 percent of
those surveyed had had a heart attack. A slightly higher percentage
reported angina or coronary heart disease, and 6.5 reported any of
But in West Virginia, more than 10 percent had at
least one of the conditions. The prevalence in Kentucky was nearly 9
percent, and Mississippi was No. 3, with 8 percent.
CDC researchers drew their data from a 2005
telephone survey of 356,112 U.S. adults in all 50 states, the
District of Columbia, Puerto Rico and the U.S. Virgin Islands.
Participants were asked if a doctor or health care
professional had told them they had experienced a heart attack,
angina, or coronary heart disease. The researchers then
statistically adjusted the results to correct demographic
differences in state samples to better mirror the U.S. census.
The prevalence in both Colorado and the District
of Columbia was a little under 5 percent, tying them for the
nation's lowest rate. Hawaii was close behind.
The regional differences are believed to stem from
rates of obesity, high blood pressure, high cholesterol, diabetes,
smoking and other known risk factors for heart disease, said the
study's lead author, Jonathan Neyer, a CDC epidemiologist.
That means the explanation would come from
differences in cultural norms, poverty rates and other social
factors, and not environmental causes, he said. "There's not
something in the water," Neyer said.
_ Among those who didn't finish high school, 1 in
10 had at least one of the conditions. Among college graduates, only
1 in 20 did.
_ More than 8 percent of men had one of the
conditions, but only 5 percent of women did.
_ Nearly 1 in 5 people 65 and older had at least
one of the conditions. The percentages were much smaller among
younger age groups.
_ The results were the same for blacks and whites,
with just over 6 percent having one of the conditions. Fewer than 5
percent of Asian-Americans had any of the health problems, making
them the healthiest ethnic group. American Indians and Alaska
Natives had the highest prevalence, at about 11 percent.
02/14/2007 Eddie Knipp's two heart transplants
have given him the wisdom to savor the small wonders of life and the
strength to endure one of its largest losses _ the death of a child.
On Tuesday, Knipp and nine other heart transplant recipients
celebrated more than 20 years of survival after surgery at the place
that made it possible: the Texas Heart Institute at St. Luke's
"It has given me a new perspective on life, a
new dimension," said Knipp, 61, an El Paso resident who had
transplants in 1987 and 1999.
In 1995, Knipp's 17-year-old son was killed in a
car accident. His organs were donated and went to at least 70 other
people, Knipp said. Despite the tragedy, Knipp says he is grateful
for his second _ and third _ chance at life.
"Every day I wake up and I thank God for
every breath I take," Knipp said. "It's the little things
in life that we really take for granted that I now realize are so
wonderful, so big."
Besides celebrating the longevity of some of its
patients, the renowned cardiac center marked the 25th anniversary of
a program dedicated to repairing failing hearts.
The first successful heart transplant in the
United States was performed at the hospital in 1968 by founder Dr.
Denton Cooley, who is now surgeon-in-chief. Since then, more than
1,000 transplants have been performed there, according to hospital
By the end of the year, the Texas Heart Institute
could have 23 patients who have reached the 20-year survival
milestone. The average heart transplant patient survives eight to 10
years. According to the American Heart Association, the five-year
survival rate is 71 percent for men and 67 percent for women.
The risks were even greater when the field of
transplant surgery was still evolving two decades ago.
"The real brave ones were the patients,"
said Dr. Branislav Radovancevic, director of the Center of Cardiac
Support and associate director of Cardiovascular Surgery and
Charles Washington of Oak Ridge, Tenn., was one of
In 1982, he suffered a massive heart attack,
leaving his heart functioning at less than 30 percent of capacity.
"I was literally gasping for air,"
Washington said. After seven bypasses, Washington's health continued
to deteriorate and his prognosis was bleak. Then, on March 27, 1983,
Washington received a new heart, and a new appreciation for life.
Now 70, the longest-surviving Texas Heart
Institute transplant recipient at nearly 24 years had the chance to
watch his children and grandchildren become adults.
"It makes you really enjoy all of life, not
just a special occasion," said Washington, who is four years
shy of the longest-surviving heart transplant recipient in the U.S.,
according to the United Network for Organ Sharing in Richmond, Va.
Shortly after the surgery, Washington was
attending the annual Oak Ridge dogwood blossom celebration and was
taken aback by the sight of the trees in full bloom.
"I looked up, grabbed a leaf and tears came
to my eye," Washington said. "I thought about the beauty
and tragedy of nature. It reminded me that there was tragedy about
the beauty of life. The trees blooms, they die, they come back the
next year in full bloom."
2006-11-06 Diabetics who don't have other
health problems survive heart transplants about as well as
nondiabetics, according to a new study, which suggests diabetes
shouldn't disqualify patients from a transplant waiting list.
"It actually reinforces the approach that
we've taken for 20 years, that diabetes without major complications
... does not exclude transplantation," said Dr. W. Steves Ring,
chairman of cardiovascular and thoracic surgery at the University of
Texas Southwestern in Dallas. Ring, who heads up heart transplant
programs at three Dallas area hospitals, was not involved in the
While national rules do not prevent diabetics from
getting heart transplants, each transplant center has its own rules.
A spokeswoman with the United Network for Organ
Sharing, which helps coordinate organ distribution, said the network
doesn't know what criteria individual transplant centers use. She
said 135 U.S. hospitals offer heart transplants.
Dr. John Buse, president-elect of the American
Diabetes Association, said he believes that rules automatically
denying heart transplants to diabetics was something that may have
been more common in the past.
For the study, published online Monday in the
American Heart Association journal Circulation, researchers analyzed
UNOS records for survival rates of more than 20,000 people who had
heart transplants between 1995 and 2005. That included 3,687 people
who were diabetic.
The researchers found that nondiabetics had a
median survival rate of 10.1 years, while diabetics had a survival
rate of 9.3 years, a difference the study authors said was not
About 21 million Americans suffer from diabetes,
mostly Type 2, which is linked to obesity. The disease, which
significantly increases the risk for heart disease and stroke, is
often associated with other cardiovascular risk factors, including
high blood pressure, cholesterol problems and insulin resistance.
And more people are developing heart failure, said
one of the study authors, Dr. Mark Russo, a researcher at Columbia
University. A transplant is often the only solution for heart
failure, when the weakened heart gradually loses its pumping power.
Russo said the study confirms doctors' intuition.
While showing that many diabetics do well with a heart transplant,
the research also showed that median survival for those with one
complicating condition of diabetes fell to under 7 years and for
those with two complications, transplant survival was under 4 years.
"Prior to this it was unclear whether
diabetes mattered and what it meant if they had complications
related to their diabetes," Russo said.
2006-10-30 One in five adults has a little
hole in the heart. Most will never know it. But the defect may play a
role in certain strokes and severe migraines, leading thousands to get
devices implanted to seal it shut.
The problem: Doctors haven't yet proved when the
hole is harmful, and whether fixing the heart in turn helps the
It's a controversy dividing cardiologists, even as
use of the umbrella-shaped implants steadily rises. Now the Food and
Drug Administration has taken an unusual step to push manufacturers
to settle the issue, stopping promotion of the expensive implants.
"What's really incumbent upon us now is
proving these relationships and proving that closing the hole is
beneficial," says Dr. Robert Sommer of Columbia University
Medical Center, who implants the devices and is helping to study
Everyone is born with a tiny flap-like opening
between the heart's two upper chambers. Usually, it grows shut
during infancy. But in at least 20 percent of the population, the
opening doesn't heal over, a defect called "patent foramen
ovale" or PFO.
When blood returns to the heart, it's supposed to
go to the lungs to pick up more oxygen and be filtered clean. A PFO
can allow some blood to seep back into circulation without that
filtering step. The theory: That could allow small blood clots or
other substances into the bloodstream, traveling straight to the
What's the evidence? It's mostly circumstantial.
Among people who have strokes at a young age _ 55 or under _ with no
apparent risk factors, up to 60 percent also have a hole in the
heart. By some estimates, that could equal 30,000 to 60,000 strokes
In the late 1990s, cardiologists started
aggressively sealing PFOs in stroke survivors, in hopes of lowering
their risk for further strokes. They threaded tiny implants into the
heart through a hole in the groin, pulling them against the PFO's
flap to seal it shut.
Then some implant recipients started reporting an
odd side effect: Their migraine headaches went away. Subsequent
research suggested at least 40 percent of people who suffer a severe
type of migraine _ the kind that comes with an "aura" or
visual disturbance _ have fairly large PFOs.
None of that research proves a PFO actually causes
the ailments, cautioned Dr. Joseph Carrozza of Boston's Beth Israel
Deaconness Hospital, in a debate about whether to close the holes at
an international cardiology meeting last week.
"Association is not causation," Carrozza
said, noting that the vast majority of people with PFOs will never
report symptoms, and that PFO closure occasionally causes such
serious side effects as blood clots and irregular heartbeats.
"I would argue passionately ... we need the
Studies comparing the $23,000 implants to
stroke-fighting drugs are going on now. Yet PFO closure already is
widespread in Europe. And until this week, the FDA had allowed two
manufacturers to market implants here for repeat-stroke sufferers,
under a special rule that lets promising devices for rare conditions
sell before there's final proof that they work.
But with PFO closure no longer rare, the FDA has
withdrawn that special approval, urging makers NMT Medical and AGA
Medical to finish their studies and tightening, slightly, how stroke
patients get the devices in the meantime. Both makers have pledged
to push forward, although Sommer notes that repeat-stroke sufferers
often want their PFOs closed despite the controversy, and thus won't
enter a study.
Proponents say migraines may settle the questions
faster _ because the only way a migraine sufferer can receive a PFO-closing
implant today is through a clinical trial. Three major U.S. studies
have begun recruiting hundreds of patients whose aura-inducing
migraines overwhelm medications. Those patients would test competing
Among them is the first dissolvable implant, NMT's
BioStar, made of collagen that's designed to hold the PFO closed
until the heart's own cells seal it over, and then to degrade.
"It's designed to repair this defect in a very natural
way," said Dr. Michael Mullen of London's Royal Brompton
Hospital, who reported promising results from BioStar's first human
safety test in the journal Circulation last week.
Next up: trying to weld PFOs shut with heat,
beaming radiofrequency energy into the heart, instead of using an
implant. Studies have begun in Europe.EDITOR'S NOTE _ Lauran
Neergaard covers health and medical issues for The Associated Press
On the Net:
Info on PFO-and-stroke studies: http://www.closurei.com
Migraine study info: http://www.pfo-migraine.com;
2006-10-07 Canola oil may now be sold to
consumers as a product that can reduce the risk of coronary heart
The disease is the leading cause of death in the
United States, killing half a million people every year.
Canola oil and certain foods made with canola oil
are allowed to start making the claim, the Food and Drug
Administration said Friday.
Labels can say that limited evidence suggests
eating 19 grams _ about 1 1/2 tablespoons _ of canola oil daily may
reduce the risk of coronary heart disease due to its unsaturated fat
content, the FDA said. Canola oil should replace a similar amount of
saturated fat and not increase the total number of calories a person
eats each day, FDA said.
The U.S. Canola Association, which petitioned FDA
for permission to make the claim, said studies show that unsaturated
fat from canola oil lowers cholesterol, including LDL or
"bad" cholesterol, as part of a diet low in saturated fat.
On the Net:
Food and Drug Administration: http://www.fda.gov/
U.S. Canola Association: http://www.uscanola.com
2006-06-26 A correction published Monday by a medical
journal to a key study on withdrawn painkiller Vioxx reveals the risk
of heart problems was elevated throughout the time people took the
drug and did not develop only after 18 months of use as the drug's
maker, Merck & Co., has contended.
The correction in the New England Journal of Medicine supports many
doctors' contention that risks showed up with as little as four months
Heart attacks and strokes occurred more frequently after people had
been on the drug for at least 18 months, but the actual harm might
have occurred much earlier, said Dr. Jeffrey Drazen, editor-in-chief
of the journal, who worked with the authors to correct their original
findings of the APPROVe trial, published in March 2005.
"It's a subtle but very critical point," Drazen said,
comparing the situation to health problems being detected months after
exposure to excessive radiation.
Cleveland Clinic cardiologist Dr. Steven Nissen, who has challenged
the study's conclusions in the past and did so again in a separate
letter also published by the medical journal on Monday, agreed.
"A key legal defense in the liability cases has been the
suggestion that there was no risk until patients had taken the drug
for 18 months," he said. Now, with the correction, "the
authors have removed any claim that there was a delay in risk."
The main authors, Dr. Robert Bresalier of the University of Texas'
M.D. Anderson Cancer Center and Dr. John A. Baron of Dartmouth Medical
School, could not be reached for comment but acknowledge in a letter
released by the journal that their statistical analysis had been
Merck, which paid for the study and helped conduct it, acknowledged
the flawed analysis last month but claimed it did not change the
On Monday, the company posted on its Web site what it called
"an open letter to the scientific community," saying it
stands behind the original results of the study.
"This correction did not change the data in the APPROVe study
or its results," said a statement from Peter S. Kim, president of
Merck Research Laboratories. "It is important to understand that
the correction centered on the description of a single statistical
"The scientific debate surrounding the APPROVe study in no way
changes our commitment to defending the VIOXX litigation on a
case-by-case basis," says a statement from Kenneth C. Frazier,
senior vice president and general counsel of the company.
Merck faces more than 13,000 lawsuits over Vioxx, a blockbuster
arthritis drug until it was pulled from the market in September 2004.
An ongoing trial in Atlantic City, N.J., is the seventh case to
reach trial. Merck has won half of the previous six.
Legal experts think there could be a spurt of additional suits
filed against Merck soon, as a two-year statute of limitations
affecting patients in most states ends at the end of September.
Shares of Whitehouse Station, N.J.-based Merck rose 8 cents to
close at $35.02 on the New York Stock Exchange.
Associated Press Business Writer Linda A. Johnson in Trenton, N.J.,
contributed to this report.
__On the Net:
Surgery' Is Newest Frontier
2006-04-01 Dr. Samuel Lichtenstein cut a 2-inch hole between
an elderly man's ribs. Peering inside, he poked a pencil-sized wire up
into the chest, piercing the bottom of the man's heart.
minutes, Bud Boyer would have a new heart valve _ without having his
chest cracked open.
it closed-heart surgery.
consider it some kind of magic," said Boyer, who left the
Vancouver, British Columbia, hospital a day later and was almost fully
recovered in just two weeks.
Michigan, Dr. William O'Neill slipped an artificial valve through an
even tinier opening. He pushed the valve up a patient's leg artery until
it lodged in just the right spot in the still-beating heart.
dramatic experiments, in a few hospitals in the U.S., Canada and Europe,
are designed to find easier ways to replace diseased heart valves that
threaten the lives of tens of thousands of people every year. The
experiments are starting with the aortic valve that is the heart's key
doorway to the body.
need for a less invasive alternative is great and growing. Already,
about 50,000 people in the U.S. have open-heart surgery every year to
replace the aortic valve. Surgeons saw the breastbone in half, stop the
heart, cut out the old valve and sew in a new one. Even the best
patients spend a week in the hospital and require two months or three
months to recuperate.
more are turned away, deemed too ill to survive that operation and out
of options. Demand is poised to skyrocket as the baby boomers gray; the
aortic valve is particularly vulnerable to rusting shut with age.
new experiments are a radical departure from that proven, if arduous,
artificial valves do not even look like valves, squished inside metal
cages until they are wedged into place. Barely 150 of any type have been
implanted worldwide, most in the last year. It is unclear if they will
work as well as traditional valve replacements, which last decades.
now, the only patients who qualify for these valves are too sick to be
good candidates for regular valve replacement.
deaths during the earliest attempts at implanting the devices forced
doctors to come up with safer techniques. Clinical trials apparently are
back on track, and even the most skeptical cardiologists and heart
surgeons are watching how these pioneers fare.
hope is that one day, replacing a heart valve could become almost an
lots of technical challenges that need to be overcome," said Dr.
Robert Bonow, a valve specialist at Northwestern University, who is
monitoring the research for the American Heart Association. "Most
of us do think this is the future," he said.
first successful patient in March celebrated the one-year anniversary of
his through-the-leg implant.
call it a new birthday," chuckled Fred Grande, 78, a Richmond,
Mich., car collector who took one of his beloved models for a fast spin
less than a week after the procedure.
the home run we want to hit with all the patients," said O'Neill,
cardiology chief at William Beaumont Hospital in Royal Oak, Mich.
gratifying" to watch people once deemed beyond help bounce back,
added Dr. Jeffrey Moses of New York-Presbyterian Hospital/Columbia
University, who with O'Neill is leading the U.S. study. One of Moses'
first patients is playing golf at age 92.
heart has four valves, one-way swinging doors that open and close with
each heartbeat to ensure blood flows in the right direction. More than 5
million Americans have moderate to severe valve disease, where at least
one valve does not work properly, usually the aortic or mitral valves.
Worldwide, roughly 225,000 valves are surgically replaced every year.
that list is the aortic valve. It can become so narrowed and stiff that
patients' hearts wear out trying harder and harder to push oxygen-rich
blood out to the rest of the body.
deposits accumulate on its tender leaflets. Touch one chipped out of a
patient and it feels almost like a rock.
minimally invasive valve replacement, doctors do not remove that
diseased valve. Instead, they prop it open and wedge an artificial one
into that rigid doorway.
ironic. You use the disease process to actually help hold your valve in
place," said Lichtenstein, of St. Paul's Hospital in Vancouver, who
helped create the between-the-ribs method.
Calif.-based Edwards LifeSciences, the biggest maker of artificial heart
valves, and Paris-based CoreValve are testing versions of a collapsible
valve made of animal tissue that is folded inside a stent, a mesh-like
scaffolding similar to those used to help unclog heart arteries.
difference is how doctors get the new valve to the right spot, pop open
its metal casing and make it stick.
U.S. studies thread the Edwards valve through a leg artery up to the
heart, known as "percutaneous valve replacement."
with open-heart surgery, doctors do not stop the patient's heart. So the
trickiest part is keeping regular blood flow from washing away the new
valve before it is implanted.
the device is almost in place, doctors speed the heartbeat until normal
pumping pauses for mere seconds _ and quickly push the new valve inside
the old one. Inflating a balloon widens the metal stent to the size of a
quarter, lodging it into place and unfolding the new valve inside, which
immediately funnels the resuming blood flow.
far, 19 Americans have been implanted this way, plus more than 80 other
people worldwide, most of them in France by the procedure's inventor,
Dr. Alain Cribier, and in Vancouver by Lichtenstein's colleague, Dr.
14 people in Canada, Germany and Austria have received the Edwards valve
through the ribs. That is a more direct route to the heart for patients
whose leg arteries are too clogged to try the other experiment. Doctors
make a tiny hole in the bottom of the heart muscle so the new valve can
enter. Then they use the same balloon technique to wedge it inside the
have begun with the Food and Drug Administration about opening a similar
U.S. study later this year.
slightly different valve is being tested in Europe and Canada. It, too,
is threaded up the leg artery. But it is made of pig tissue instead of
horse tissue and has a self-expanding stent that requires no balloon.
Doctors remove a sheath covering it and the stent's metal alloy, warmed
by the body, widens until it lodges tight against the old, rocky valve.
than 45 have been implanted; CoreValve hopes to begin a U.S. study next
year. Lead researcher Dr. Eberhard Grube of The Heart Center in Siegburg,
Germany, expects within months to begin testing a newer version small
enough to thread through an artery at the collarbone, another more
direct route to the heart.
experiments come with some significant risks.
temporarily halted the U.S. study last year after four of the first
seven U.S. patients died. Initially, doctors threaded the valve up a leg
vein, not an artery, a route that required tortuous turns inside the
heart and sometimes damaged a second valve, O'Neill said.
people have been implanted since the study restarted in December using
the artery route considered easier and safer. All but one have survived
and are faring well, researchers say.
and Moses _ plus doctors at a third hospital, the Cleveland Clinic _
have government permission to implant eight additional patients in the
U.S. pilot study, which will be expanded if it goes well.
first four patients died as doctors struggled to develop and learn the
through-the-artery technique, Grube said.
doctors, pushing the large valve through tiny, twisting arteries _
against regular blood flow and guided by X-rays _ is laborious.
Occasionally, they are not able to wedge it into position.
they are squeezing a round valve into an irregular-shaped opening, there
is a risk that the new valve will leak blood backward into the heart,
once researchers master how to get the valve into place safely, the
question becomes how much recipients benefit. Do these very ill patients
live longer than expected? If not, does quality of life improve enough
to warrant the procedure anyway?
of French inventor Cribier's original patients have lived 2 1/2 years so
far, with a "return to normal life and no sign of heart
failure," he said. Eleven others have lived a year and counting.
reports five patients faring well a year later.
from those who did not survive the implantation, others have died from
their advanced illnesses even though their new valve was working.
is the cases of astounding successes _ Grande and Boyer, for example _
that have other heart specialists taking note, Northwestern's Bonow
have to know what they're getting into," he said. Many of the
seriously ill are willing to chance the experimental procedure because
"they're so debilitated and ... there have been some good examples
of patients who have gotten better."
bigger challenge, Bonow added, is whether to expand the studies to
include less sick patients who could survive open-heart valve
replacement but want to avoid its rigors. Already, there are such
patients clamoring to be included.
is a difficult decision because even 80- and 90-year-olds successfully
can have regular valve replacement. When performed by the most skilled
surgeons, risk of death from the operation is about 2 percent _ but in
less experienced hands, it can reach 15 percent, Bonow said.
as using a balloon to unclog heart arteries is sometimes done on
patients who would fare better with bypass surgery, researchers
eventually will have to ask if patients would accept a less-than-perfect
aortic valve if they got to skip surgery's pain and risks, said Dr.
Michael Mack of Medical City Hospital in Dallas.
is a trade-off, and how you make that trade-off is a totally gray
area," he said.
Vancouver's Boyer, who had two previous open-heart surgeries for clogged
arteries, said avoiding that kind of pain is not a trivial issue for
doing something to the field of medicine that's going to make life a
hell of a lot easier to people who've got that problem," said a
grateful Boyer, describing how he could finally breathe easy after the
through-the-ribs valve implant. "I think I'll have a bunch of other
parts go bad before I have a problem with this."
2006-04-05 Each year cardiovascular disease kills 13
million people in developing countries, almost triple the number who
die from AIDS, tuberculosis and malaria combined, researchers said
Cardiovascular disease _ including heart disease, heart failure and
stroke _ is the world's biggest killer, and it often strikes people in
their prime working years of 35 to 64, experts said during a four-day
In China, deaths from cardiovascular disease have skyrocketed
alongside the country's rapid economic development, making it the No.
1 killer _ fueled by smoking, high blood pressure, diabetes and
obesity, said Dr. Runlin Gao, a cardiologist at Fu Wai Hospital.
"The total disease burden of cardiovascular disease in China
is higher than in the United States and most other Western
countries," he said. "Cardiovascular disease has been the
leading cause of deaths in China since the 1990s."
In many developing countries, growing prosperity has led to vast
changes in diet and lifestyle. Easy access to cheap, fatty foods along
with migration from rural farming areas into cities has altered the
way many people live.
The conference launched the Disease Control Priorities Project,
which includes three books compiled by nearly 500 international
experts focusing on cost-effective strategies for improving global
Senior editor Dean Jamison, a health economics professor at the
University of California, San Francisco, said taxing tobacco and
reducing trans fat in foods, as the Dutch have done, are effective
government interventions to help lower cardiovascular disease risk
"You don't have to change people's hearts and minds, you
change behavior through changing prices people face or changing
specific aspects of their environment like putting in speed bumps or
simply taking things off the shelves. They don't have any
choice," he said.
But he said persuading people to make lifestyle changes can be much
more difficult _ especially with fast, processed foods available
"It's right there at your fingertips, anytime you want
it," Jamison said. "We have our genes being given this
feast. How do you stop that?"
Creating areas in cities where people can exercise or adding
bicycle lanes are simple ways to promote healthier living along with
ensuring that children are served healthy meals in schools, he said.
Using drugs to lower cholesterol and high blood pressure are
cost-effective ways to help lower the risk of cardiovascular disease,
while aspirin and beta-blockers can help prevent costly heart bypass
surgeries, the researchers reported.
While the number of male smokers has dropped in China from 61
percent to 54 percent over the past two decades, Gao said
cigarette-smoking continues to rank as the country's highest
contributor to cardiovascular disease.
Taxing cigarettes 70 percent globally could save 46 million to 114
million smoking-related deaths over the next 50 years, the researchers
Last update: 2006-04-05
Cited in Replacing Heart Device
2006-04-25 A new study suggests that for some patients with
implanted heart defibrillators that have been recalled by the
manufacturer, replacing the device might be riskier than leaving it in.
Canadian researchers found a much higher than expected rate of
surgical complications in people who had their potentially faulty
a result, some patients "might want to hang out and wait and see
what happens," said study co-author Dr. Andrew Krahn of the London
Health Sciences Center in Ontario.
percent of the 533 patients who decided to have their recalled
defibrillators replaced over a 12-month period suffered major
complications, including two deaths, the study found.
contrast, the risk of failure among recently recalled defibrillators has
been estimated by the manufacturers at just 0.009 percent to 2.6
percent. And not every failure is deadly.
study, published in Wednesday's Journal of the American Medical
Association, provides the first estimate of the risk of major
complications from replacement surgery. That is important information
for patients and doctors faced with the decision of whether to leave a
possibly defective device in the body or replace it.
defibrillators can be as small as a half dollar and are placed
surgically under the skin of the upper chest. Vice President Dick Cheney
is among the thousands of Americans who have one.
the device senses a dangerous and potentially deadly irregular
heartbeat, it sends electrical impulses to jolt the heart back to
normal. It can correct a heart that beats too fast, as in ventricular
tachycardia, or quivers chaotically, a condition known as ventricular
total of 270,000 defibrillators have been recalled since January 2005,
though it is unclear how many were inside patients and how many were on
the shelf, according to the Food and Drug Administration. About 80,000
patients received the implantable devices in 2004.
said the rate of complications from surgical removal will surprise
doctors, because replacing a defibrillator is considered a minor
typically performed with a local anesthetic and sedation. It takes an
hour or less," he said. "Most patients return home the same
researchers studied 2,915 patients who were tracked by 17 Canadian
hospitals in 2004-05. All the patients had devices that were recalled by
manufacturers, Canada's national health system or the FDA.
18 percent decided to undergo replacement surgery. Infection, bruising
or bleeding required a follow-up operation in 31 of those patients. Two
risk is much higher than we initially thought," Krahn said.
researchers did not follow the people who decided against replacement to
see whether anything actually went wrong with their defibrillators.
findings are applicable to the U.S. because American medical practices
are similar to those in Canada, Krahn said.
probably should leave more of these alone if they appear to be
functioning normally," said Dr. Anne Curtis, president of the Heart
Rhythm Society, a nonprofit group of heart specialists, and chief of
cardiology at the University of South Florida. Curtis was not involved
in the study.
Heart Rhythm Society plans to release draft recommendations Wednesday on
pacemakers and implantable defibrillators. The draft will include
guidelines to help doctors respond to recalls, Curtis said.
defibrillators, which cost between $30,000 and $40,000, contain
batteries, insulated wires, memory chips, magnetic switches and other
parts that can go awry. But some flaws are worse than others.
some people might die because the device doesn't deliver the necessary
shock, other devices might have a flaw that merely causes the battery to
run down early, something that can be caught during routine monitoring.
some people who have defibrillators don't need them as much as other
patients do. Some patients are implanted with the devices as a
preventive measure and have never actually suffered from fibrillation.
and patients often decide to leave a potentially faulty device in place
after weighing the details of the recall and the patient's health. Krahn
said some patients may decide they cannot risk a device failure, and may
go ahead with replacement surgery.
Dan Schultz, director of the FDA's Center for Devices and Radiological
Health, praised the study.
will allow the agency, as well as manufacturers and professional
societies, to develop guidelines based on actual evidence, and to
provide better advice to patients and doctors in the future,"
a recall, manufacturers provide free replacements. But insurance
companies must pay for the surgery, which can cost thousands of dollars.
reported that he has financial ties to two device makers, Medtronic and
Guidant. But he said that the study was conducted without funding or
influence from industry, and that his consulting work does not involve