Article

The European Cardiovascular Arena - In Brief A Round-up of Trends, Statistics and Clinical Research

Abstract

Citation:European Cardiovascular Disease 2007;3(2):12–3

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New Technique to Aid Early Diagnosis of Pulmonary Hypertension in Scleroderma Patients

Researchers have developed an innovative system to help doctors make earlier diagnosis of pulmonary hypertension in patients suffering from scleroderma. This rare disease, affecting around 1,200 people per million, is a systemic autoimmune disorder acting on multiple organs and is most commonly characterised by colour variation to the skin of the hands, neck and face, as well as damage to the oesophagus, kidneys and lungs. Pulmonary hypertension is the main cause of death, however, and attempts to identify it have centred on cardiac catheterisation through the jugular vein directly into the right side of the heart.

Now, an exercise-based technique, developed by Dr Lourdes Lopez Perez and directed by lecturers Norberto Ortego Centeno and Jose Luis Callejas Rubio from the University of Granada, allows specialists to measure the systolic pressure of the pulmonary artery in scleroderma sufferers during exercise. Patients were observed via ultrasound and echocardiogram techniques while exercising on a ‘bicycle ergometer’. Sufferers exhibited increased pulmonary artery systolic pressure, breathing difficulty or dyspnoea both during and after exercise. The research, published in the European Journal of Echocardiography, may offer a simple, non-invasive technique to aid diagnosis of the disorder before it becomes irreversible and without requiring complex interventional procedures.

Swedish Snuff Increases Risk of Fatal Heart Attacks

A smokeless tobacco snuff called ‘snus’ – which is growing in popularity in Sweden, where it accounts for half of tobacco consumption – can cause a 30% increase in risk of fatal heart attacks, according to a doctoral thesis by Maria-Pia Hergens, PhD, at the Karolinska Institutet. Snuff consumption in Sweden has increased substantially in recent years, with 20% of men between the ages of 18 and 79 years consuming it daily; however, the evidence on health effects has so far been limited. Hergens’ thesis has revealed that, although consumers are spared many of the toxic chemicals that are formed on smoking, they still face increased risk of fatal myocardial infarction, high blood pressure and fatal strokes.

The thesis was based on two published epidemiological reports. The first had studied Swedish men between the ages of 45 and 70 years living in the counties of Stockholm or Västernorrland between 1992 and 1994. The tobacco habits of the men diagnosed with first-episode myocardial infarction were compared with an equivalent group of men from the same regions without heart problems. The second study used data on tobacco habits taken from workers in the building industry between 1978 and 1993. Information recorded at these checks included tobacco habits and blood pressure.

Coronary Death Rates in Young Adults Now Increasing

Despite decades of progress in combatting coronary heart disease (CHD) in the US and elsewhere, a new report has found that improvements in the 35–54-year-old age bracket is slowing to a halt, with figures now worsening among women. The research, conducted by Professor Earl S Ford (US Public Health Service) and Professor Simon Capewell (University of Liverpool), showed some signs of overall progress in tackling the disease. The overall CHD mortality rate has fallen by 52% in men and by 49% in women, and declined on average by 2.9% per year during the 1980s to 4.4% per year from 2000 to 2002 in men, and by 2.6% to 4.4% in women. However, when analysed by age the data revealed that among men aged 35 to 54 years the average annual rate of death from coronary disease fell by 6.2% in the 1980s, but slowed to 2.3% in the 1990s and just 0.5% between 2000 and 2002. Progress has also slowed in young women, from a 5.4% improvement in the 1980s to 1.2% in the 1990s, and between 1997 and 2002 data showed a 1.3% increase in CHD. Bad diet, increasing obesity and sedentary lifestyles are all potential causes.

Drug-eluting Stents Superior to Bare-metal Stents

Drug-eluting stents (DES) are more effective than bare-metal stents (BMS) when used in routine clinical practice, according to a new study. Lead researcher Dr J Dawn Abbott and her team at Rhode Island Hospital compared outcomes for 1,460 patients who received at least one DES (2004) with 1,760 patients who received at least one BMS just before the approval of DES (2001–2002).

Observing lesion characteristics and procedural outcomes after one year, the researchers discovered that the cumulative death rate in patients receiving DES was 7.6% compared with 8.7% in those treated with BMS. The durability of angioplasty was also improved in DES, as was reduction in target vessel revascularisation (5 and 8.7%, respectively).

“These findings confirm the safety and effectiveness of DES up to one year, but we are continuing to follow these patients to assess possible later complications related to the stent implantation,” said senior author Dr David O Williams, a cardiologist at Rhode Island Hospital.

‘Runner’s High’ Endorphins Play Key Role in Cardiovascular Benefits of Exercise

Natural serum opioids released during physical exertion may be directly responsible for – rather than a side effect of – the essential cardiovascular benefits of exercise.

Researchers at the University of Iowa (UI) found that rats did not achieve the full cardioprotective benefits of exercise – including enhanced myocardial ischaemin tolerance – when the receptors that bind certain opioids were actively inhibited. According to the paper, published in the American Journal of Physiology’s Heart and Circulatory Physiology, an injection of 10mg/kg of opioid receptor antagonist naltrexone “completely blocked the cardioprotective effect of exercise”. This discovery means that other benefits of exercise, including decreased risk of atherosclerosis and stroke, may also be mediated by opioid receptor-dependent mechanisms.

“This is the first evidence linking the natural opioids produced during exercise to the cardioprotective effects of exercise,” said Professor Eric Dickson, lead investigator, UI Associate Professor and Head of Emergency Medicine at the Roy J and Lucille A Carver College of Medicine. “It serves as a reminder of how important it is to get out and exercise every day.”

Get Up, Stand Up

Researchers at the University of Missouri- Columbia claim that standing up whenever possible can have tangible benefits on cardiovascular health, especially for those who spend much time sitting at computers or who do not have time to exercise daily. In a series of studies to be presented at the Second International Congress on Physical Activity and Public Health, the research team will present their findings into the effects of sitting in office chairs, using computers, reading, talking on the phone and watching television, all of which were found to have negative effects on fat and cholesterol metabolism.

“The enzymes responsible for ‘fat burning’ are shut off within hours of not standing. Standing and moving lightly will re-engage the enzymes,” said co-author Professor Marc Hamilton, who added that standing up can double the body’s metabolic rate. The change is also easy to assimilate into daily life: “Many activities, such as talking on the phone or watching a child’s ballgame, can be done just as enjoyably upright,” he concluded.

The researchers claim that scientists and the public have underestimated such mundane changes because they are intermittent and do not take as much effort as a heavy workout, but the benefits.

Report Warns of Emerging Global High Blood Pressure Crisis

The increasing prevalence of uncontrolled high blood pressure may lead to a global epidemic of cardiovascular disease, causing a massive burden on health systems and economies in both developed and developing countries. The warning is contained in a report presented to the European Parliament and endorsed or supported by 12 leading medical groups.

Although recognising the significant reductions in cardiovascular disease that have been achieved over the last 40 years, ‘High Blood Pressure and Health Policy: Where We Are and Where We Need to Go Next’ reminds governments and health-policy-makers not to become complacent about the risks posed by high blood pressure both to individuals and at a socioeconomic level.

While high blood pressure can cause fatal heart attacks, kidney disease and dementia, it remains a modifiable risk factor. The report therefore urges further improvements to be made in education, management strategies and medical collaboration. A further warning concerns the encroachment of cardiovascular disease into younger age groups, having an impact on individuals with high earning power. The economic consequences of this may be devastating, as contributors to public revenues instead become a burden on healthcare systems.

The report also emphasises a number of specific lifestyle issues that need further attention, including excessive alcohol consumption, smoking and high-salt, high-fat diets. A concerted effort to address these areas could prevent the predicted global increase in high blood pressure, which is estimated to affect 1.56 billion people by 2025.