Lifestyle Counseling Reduces Heart Risk

(HealthDay News) -- An intensive, across-Europe effort to offer lifestyle advice to people at high risk of heart disease effectively helped them reduce such risk factors as high blood pressure, cholesterol and smoking.

"The results we see are very encouraging compared to what we see in usual care," said Dr. David Wood, a cardiology professor at Imperial College in London and the lead author of a report on the trial in the June 13 issue of The Lancet.

But, he added, "there is certainly room for improvement, particularly in relation to helping patients quit smoking."

The program, mainly run by nurses, was developed by the European Society of Cardiology and tested on more than 5,000 people in six pairs of hospitals and six pairs of general practice in eight countries.

"It was for two groups of patients," Wood said. "One was those who already had developed coronary heart disease, another those who were asymptomatic but at high risk because of a combination of risk factors that gives a high chance of developing heart disease over 10 years."

The trial, called the Euroaction study, compared the results of added counseling on lifestyle issues such as diet, physical activity and smoking to the usual care. It included more than 3,000 people with coronary heart disease and 2,300 at high risk. Half got the counseling from a team headed by nurses, assisted by dietitians and physiotherapists, with doctors in the background. The counseling was given to families as well as individuals.

"It was the nurses who coordinated the day-to-day program, with a comprehensive assessment of lifestyle and risk factors such as blood pressure and glucose," Wood said.

In diet, 55 percent of those getting the counseling reduced their intake of saturated fat, compared to 40 percent for those note getting the advice. Increased consumption of fruits and vegetables was seen in 72 percent of the counseled group, and 17 percent of them also increased their consumption of heart-friendly oily fish, compared to 35 percent and 8 percent in the other group.

Similar results were seen for blood pressure, cholesterol and physical activity, but it proved difficult to have people seen in general practice quit smoking, Wood said.

"But the fact that we ran it in eight countries and both in general hospitals and general practice means that we have demonstrated that this nurse-administered program is practical," he said. "We are looking at cost-effectiveness at this moment, and the early data suggest that it is cost-effective in preventing heart attack and stroke."

"What really was new here was that they actually made an effort to give the advice we know should be given but often isn't," said Dr. Dariush Mozaffarian, an assistant professor of medicine at Harvard Medical School and the Harvard School of Public Health, who wrote an accompanying comment in the journal.

While there have been many trials aimed at improving drug treatment in cardiology, "there are few trials in getting doctors and patients to concentrate on lifestyle," Mozaffarian said. "This shows that a relatively modest intervention can bring dramatic improvements in lifestyle."

However, he added, it's not clear whether such a program could be started in many U.S. hospitals and medical practices. "In principle, every physician should be doing it," he said. "But the system would have to change."

For such a program to work, Mozaffarian said, "policy makers, insurance companies and indicators of quality would have to focus on lifestyle and stimulate hospitals to put preventive measures into place."

More information
Recommendations on a healthy diet and lifestyle are given by the American Heart Association.

Suffering of Heart Failure Similar to Cancer

(HealthDay News) -- Heart failure is as crushing a blow to someone's psychological well-being as cancer, a new study finds.

Indeed, people in the study with the most severe degrees of heart failure, the inability to supply the body with oxygen-carrying blood, had measures of severity of symptoms, depression and loss of spiritual well-being that are seen in people with advanced cancer, Dr. David Bekelman, an assistant professor of medicine at the University of Colorado at Denver Health Sciences Center, reported Friday at an American Heart Association meeting in Baltimore.

Palliative care, aimed at improving quality of life as the end of a life approaches, is often offered to people with advanced cancer, Bekelman said. "We should consider offering it to people with heart failure," he noted.

The study compared 60 people with heart failure severe enough to cause symptoms but not hospitalization with 30 people with advanced cancer of the lung or pancreas.

"We looked at physical symptoms, things like fatigue, weakness and pain," Bekelman said. "A second measure was of depression, and a third was of spiritual well-being."

Heart failure and cancer patients reported similar numbers of physical symptoms. The scores for depression on a standard test were slightly higher in heart failure than in cancer -- 3.9 versus 3.2.

"The measure of spiritual well-being we used looked at two domains, a sense of meaning and peace and a sense of faith," Bekelman said. The people with heart failure scored lower than those with cancer.

When the people with the most severe forms of heart failure were singled out, their scores on all three measures were worse than for people with advanced cancer.

Survival in heart failure severe enough to send someone to the hospital is comparable to that in advanced cancer, with death coming an average of 1.6 years after hospitalization.

"We're very good at treating the physical part of heart failure," Bekelman said. "But people suffer in other ways that also should warrant attention. It's important that we offer it to them."

The burden of heart failure is well known to physicians, but "nonprofessionals dont realize it," said Dr. Gerald L. DeVaughn, a clinical associate professor of medicine at Drexel University in Philadelphia.

"People given the option of heart failure or cancer might think that heart failure is the choice," he said. "But heart failure is quite lethal. Many cancers have a better prognosis."

Caretakers for people with heart failure should take its effects into account, DeVaughn said.

Symptoms such as dry mouth, constipation and shortness of breath can be improved with medical management, he said, while depression can be treated with medication and counseling.

"If they mention that spirituality is important in their lives, we should endeavor to have them see someone in that area, such as a chaplain," Bekelman said.

Approaches used to improve spiritual well-being in cancer, such as psychotherapy, should also be considered in heart failure, he said.

"People with cancer get all kinds of supportive services, but people with heart failure don't," Bekelman said.

More information
Symptoms and treatment of heart failure are described by the American Heart Association.

Embryonic Stem Cells Turned Into Three Types of Heart Cells

(HealthDay News) -- A multinational team of researchers has succeeded in turning human embryonic stem cells into three types of human heart muscle cells.

When transplanted, the cells also improved heart function in mice.

The findings have a number of implications, the most immediate of which would be to use the cells to test drugs.

"We have now a supply of human heart cells for biotech and drug companies to start testing the beneficial effects of drugs or the toxic effects of drugs," said Gordon Keller, senior author of a paper published in this week's issue of Nature. "There are really no roadblocks in beginning to set up such tests."

Researchers may also be able to use the cells to make artificial heart tissue, which could then be transplanted into an actual human heart.

"It's not clear how effective injecting cells directly into the heart ever will be," said Keller, who is director of the McEwen Centre for Regenerative Medicine at University Health Network in Toronto. "A huge advantage we have is that these unique progenitor cells can make three of the major types of cells in the heart, so we hope we can simply seed these progenitor cells onto scaffolding and make what might be an artificial piece of heart tissue and possibly transplanting such small pieces of tissue, and engrafting them into the heart, would be more effective than transplanting the cells themselves."

Keller's lab had previously succeeded in coaxing cardiac cells out of mouse embryonic cells.

For this study, the team used similar principles, applying specific growth factors at different stages of development, but in human embryonic stem cells.

"They're showing that different 'recipes' can induce different types of cardiac cells," said Paul Sanberg, director of the Center for Aging and Brain Repair at the University of South Florida College of Medicine in Tampa.

In this way, the researchers were able to isolate heart progenitor cells then coax them into three different types of heart cells, called cardiomyocytes, which make up functioning heart muscle.

"Now we have our hands on a cell that doesn't have the same developmental potential as embryonic stem cells but can still make three of the major types of heart cells," Keller explained. "When we have these cells in isolation, we have a better handle on directing their pathway to cells that beat, or other [cardiac] cells. That's much more difficult when we haven't isolated the cells."

Also, when these cells were transplanted, they didn't form tumors, which often happens when a group of cells is more mixed. "In essence, we have isolated the most immature human heart cells, and we think we can control these cells much better than we would if we were starting with embryonic stem cells," Keller said.

The findings will help researchers better understand how the heart develops in humans, but therapeutic applications are still a ways off.

"It's important that we understand the basic biology," Sanberg said. "But it's still going to be a while till we see this in the clinic."

More information
The National Institutes of Health has more on stem cells.

Atherosclerosis May Also Harm Vital Organs

(HealthDay News) -- New research indicates that the fatty plaques that harden arteries may also harm vital organs.

"Atherosclerosis is usually associated with plaque formation in arteries," said study author Rita K. Upmacis, an associate research professor in pathology and laboratory medicine at Weill Medical College of Cornell University in New York City. "But using a mouse model of atherosclerosis, we have demonstrated that the effects of this disease are more widespread, affecting . . . the heart, liver and lungs."

The finding, scheduled to be presented this week at the American Chemical Society annual meeting, in New Orleans, centers around the availability of nitric oxide (NO), an important gas within the body that relaxes blood vessel walls and helps prevent atherosclerosis. Certain substances in plaque remove NO and create a toxic substance known as peroxynitrite, which hampers the function of enzymes necessary to the health of blood vessel walls.

In the latest study, researchers found that in mice that were fed a high-fat diet and who developed atherosclerosis, peroxynitrite, nitrotyrosine and other substances that interfered with NO were common not only in the blood vessels, but also in the hearts, lungs and liver.

"During many disease states, reactive oxygen species such as superoxide are formed," explained Upmacis. "The problem here is that nitric oxide, which is beneficial to the body, reacts with superoxide, and forms something called peroxynitrite, which is a powerful oxidant that can cause all sorts of damage and wreak havoc. These reactions are predicted to lead to the vascular dysfunction encountered in atherosclerosis."

It is possible drugs could be developed to increase NO production and prevent organ damage from atherosclerosis. However, there could be unwanted side effects, such as an increased risk of infection, so it would be difficult to create a drug targeted specifically to atherosclerosis, Upmacis said.

Since nitrotyrosine levels can be detected in the blood, it may also be possible to one day develop a test that could both detect and track the development of atherosclerosis, the researchers added.

What about using statins to prevent organ damage?

Dr. John C. LaRosa, president of the State University of New York Downstate Medical Center, New York City, said it's a possibility.

"Statins improve flow rates in the kidney and may delay or prevent deterioration of kidney function in older adults," he said. "Statins also improve retinal [eye] blood flow in diabetics and may deter diabetic eye disease. These effects are currently under investigation, however, and are not current indications for statin use."

Dr. Alan Kadish, associate director of the Northwestern Cardiovascular Institute in Chicago, said when it comes to atherosclerosis, prevention is the best cure.

"At the present time, the best thing patients can do is understand that atherosclerosis can have bad effects, even some that are still being identified, and adhere to exercise, diet and lifestyle modifications that will decrease their risk of developing atherosclerosis," he said.

More information
For more on atherosclerosis, go to American Heart Association.

Managing Stress Can Lower Heart Death Risk

(HealthDay News) -- Emphasizing an old adage, new medical research confirms that keeping stress levels under control can significantly reduce the risk of a heart attack or death in patients with coronary artery disease.

Although a correlation between stress and various heart ailments has been established in the past, this is the first observational study to examine the effect of anxiety or depression treatment on a heart patient's risk factors, according to lead study investigator Yinong Young-Xu of the Lown Cardiovascular Research Foundation in Brookline, Mass.

The research, which was to scheduled to be presented Tuesday at the American College of Cardiology's annual meeting in Chicago, examined 516 patients with coronary artery disease. Those who reduced or kept their anxiety level steady were as much as 60 percent less likely to have a heart attack or die compared to those who had an increase in anxiety level, the study concluded.

This ratio remained steady after adjusting for other potential cardiovascular risk factors including age, sex, education, marital status, smoking, hypertension, diabetes mellitus, previous heart attack, body mass index, total cholesterol, blood pressure, heart rate, ejection fraction and exercise treadmill test duration, the report said.

Patients were divided into three groups according to their baseline level of anxiety -- high, intermediate and low. Heart conditions in the study included irregular heartbeat (arrhythmia), atherosclerosis ("hardening of the arteries"), and atherothrombosis (blood accumulation leading to clotting).

Researchers asked patients about their feelings and moods, sleep patterns, irregularity in bowel or stomach functions and other stress markers. In addition to anxiety, the questionnaire also measured depression, hostility and physical complaints.

"These findings should reinforce to cardiologists a need to attend to the whole patient by paying attention to psychological problems in addition to cardiovascular disease," Young-Xu said in a prepared statement.

He added that the lifetime prevalence of anxiety disorder is around 30 percent among people with heart disease.

"If we can lower heart patients anxiety level, we may be able to reduce their risk of heart attack and prolong their life," he added.

More information
To keep your heart and your lifestyle healthy, visit the U.S. government for heart health advice.

Diabetics Face Doubled Risk of Heart Attack

(HealthDay News) -- Diabetics are more than twice as likely to suffer a heart attack, stroke and death from cardiovascular disease, putting them at the same risk level as non-diabetics who had previously suffered a heart attack, Danish researchers report.

The findings, appearing in April 1 issue of Circulation, led one study author to suggest all diabetics talk to their doctors about possibly starting treatments to control cholesterol levels and blood-pressure levels.

"We've talked about 'the lower, the better' for cholesterol and blood pressure to reduce the risk of heart attack," lead author Dr. Tina Ken Schramm, a research fellow at the Gentofte Hospital in Hellerup, Denmark, said in a prepared statement. "Now I think we should be saying the sooner, the better for primary prevention of cardiovascular diseases in diabetics."

The study analyzes patient and national registries for people aged 30 and older living in Denmark in 1997. Researchers found 71,801 people with diabetes and 79,575 who had a previous heart attack, then identified deaths and causes of death over five years.

"The increased risk was observed in people at all ages with either type 1 or type 2 diabetes who were receiving insulin or other drugs to reduce levels of sugar in the blood," Schramm said. "When people with diabetes do have heart attacks, they are twice as likely to die as non-diabetics."

The relative risk, or hazard ratio, of dying from cardiovascular disease was found to be 2.45 times greater for female diabetics compared with 2.62 times greater for women with a prior heart attack. The relative risk of dying from cardiovascular causes was 2.42 times higher in male diabetics; for men who had a prior heart attack the hazard ratio was 2.44.

When looking at heart attack, stroke or death from cardiovascular disease combined, men with diabetes faced a 2.32 higher risk while the risk rate was 2.48 for men who had at least one heart attack. For female diabetics, the combined relative risk was 2.48 while those with a history of myocardial infarction had a hazard ratio of 2.71.

The study did not look at patients on diet-only treatment for diabetes. The researchers also couldn't differentiate between type 1 and type 2 diabetes patients or adjust for common risk factors, including high blood pressure, high cholesterol, obesity, smoking, physical activity and blood glucose levels.

Type 2 diabetes, the most common form of diabetes, develops when the body doesn't make enough insulin and fails to efficiently use what insulin it does produce. In type 1 diabetes, the pancreas makes little or no insulin, requiring the patient to need daily doses of insulin.

More information
The American Diabetes Association has more about diabetes prevention.

Heart Risk Can Be Predicted Without Lab Tests

(HealthDay News) -- When it comes to predicting a person's cardiovascular disease risk, cheap, simple and noninvasive methods can be as effective as lab tests, a new study finds.

The U.S. researchers noted these non-lab methods could be especially useful where lab testing is inconvenient or unavailable, such as in developing countries.

Worldwide, about 80 percent of cardiovascular deaths occur in developing nations, Dr. Thomas Gaziano, of the division of cardiovascular medicine at Brigham & Women's Hospital in Boston, said in a prepared statement.

The team analyzed data on 6,186 people who were aged 25 to 74 when they were first examined between 1971-75 for the NHANES I study. At the time, these participants did not report any history of cardiovascular disease -- such as heart attack, heart failure, stroke or angina -- or cancer.

Over a 21-year period, people in this group had 1,529 first-time cardiovascular events, including 578 deaths due to cardiovascular disease.

The researchers compared the lab-based method and the non-lab method in calculating a number called the c-statistic to assess cardiovascular risk prediction. The lab method included age, systolic blood pressure, smoking status, total cholesterol, diabetes status, and current treatment for high blood pressure. The non-lab method substituted body mass index (BMI, a ratio of weight to height) for cholesterol.

The lab and non-lab method gave similar c-statistics, but the non-lab method can provide risk factor information non-invasively and much faster -- just five to 10 minutes, the study authors said. They added that a cholesterol test is too costly for many people in developing countries.

The study was published in the March 15 issue of The Lancet.

"Although this method requires further validation and calibration, use of a simple non-laboratory approach, as suggested by WHO [World Health Organization], could have profound effects on the affordability and availability of an adequate screening program in developing countries," the study authors wrote. "Initial screening without blood testing could lead to the quick initiation of treatment without the added cost or inconvenience of laboratory testing, and would also keep any potential loss to follow-up due to the extra step in testing to a minimum."

However, an accompanying editorial in the journal suggested this approach may not be appropriate for people in developing countries.

"Although tools that use non-laboratory-based variables can help to improve affordability of screening programs for non-communicable diseases, they should not compromise the safety of patients. For equitable care of cardiovascular disease and other major non-communicable diseases, universal access to a set of essential interventions, including laboratory assays, may be required, even in settings with limited resources," wrote Dr. Shanthi Mendis, of the WHO in Geneva, and Dr. V. Mohan, of the Madras Diabetes Research Foundation in India.

More information
The U.S. Centers for Disease Control and Prevention has more about heart disease risk factors.

Docs urged to ask young heart patients about cocaine

Story Highlights

Cocaine use can result in symptoms that look like a heart attack

• Cocaine-related chest pain is a heart attack in only 1 percent to 6 percent of patients


• 2 common heart attack treatments can be dangerous to those using cocaine


• Admitting illegal substance use confidential; info won't be reported to authorities

DALLAS , Texas (AP) -- Younger ER patients with heart attack symptoms should be asked whether they've recently used cocaine, which can cause similar chest pain, the American Heart Association warns doctors.

For these patients, honesty can be a matter of life or death: Some heart attack treatments can be deadly to someone using cocaine.

New guidelines published online Monday in the American Heart Association journal Circulation say that emergency room doctors need to be aware that symptoms of a heart attack in younger patients with no heart disease risk factors may be caused by cocaine use.

The drug can cause chest pain, shortness of breath, anxiety, palpitations, dizziness, nausea and heavy sweating -- all symptoms of a heart attack.

"Not knowing what you are dealing with and giving the wrong therapies could mean death rather than benefit," said Dr. James Reiffel, professor of clinical medicine at Columbia University Medical Center/New York Presbyterian Hospital.

The number of cocaine-related users visiting ERs rose 47 percent from 1995 to 2002, increasing from 135,711 to 199,198, according to the government's Substance Abuse and Mental Health Services Administration. (That's a tiny percentage of the more than 100 million patient visits to emergency rooms each year.)

Depression After a Heart Attack Dangerous for Years

(HealthDay News) -- The increased risk of death associated with depression after a heart attack persists for at least five years, a study finds.

"We've known for a number of years that depression increases the risk of mortality as well as morbidity [illness] after a heart attack for at least three to six months," said study author Robert M. Carney, a professor of psychiatry at Washington University School of Medicine in St. Louis. "We assumed that we would find a decline in risk, but that was not what we found. The risk remained worse after five years."

Carney and his colleagues followed more than 750 people after their heart attacks, according to their report in the current online issue of the Journal of Affective Disorders. Using diagnostic interviews rather than the self-reporting common in most such studies, the researchers determined that 163 had major depression, and 195 had minor depression. Over the five-year study, the death rate was 87 percent higher for those with major depression and 76 percent higher for those with any form of depression.

In real numbers, 62 people diagnosed with depression died during the study, while 44 non-depressed heart attack patients died.

Why depression should increase the risk of dying is a mystery, Carney said. "We think that because depression is a chronic and recurrent problem, the factors causing that risk recur over time," he said. "But we don't know the mechanism."

The researchers have started a trial to determine whether the omega-3 fatty acids that are found in fish oil can reduce that risk. Heart patients are being given an antidepressant drug and a special formulation of omega-3 fatty acids, comparing them with a similar group that gets only an antidepressant.

"A number of studies over the years have found an inverse relationship between the amount of fish people eat and depression," Carney said. "The advantage of giving them in heart disease is that they have an effect on the cardiovascular system as well."

The major finding of the study and the use of omega-3 fatty acids are already in the mainstream of research on depression and heart disease, said Dr. Alexander H. Glassman, a professor of psychiatry at Columbia University Medical Center in New York City.

"There is a torrent of information that depression in relation to vascular disease worsens the outcome," Glassman said. "If you look at post-stroke patients, you find the same data. If you look at heart failure, depression has a similar effect on mortality."

The value of the study is that it had the longest follow-up of any trial using diagnostic interviews, which are regarded as more accurate than self-reporting, Glassman said. "It makes the evidence firmer and extends the evidence," he explained.

The use of omega-3 fatty acids is "a hot issue," being tried in cardiac and non-cardiac cases, Glassman said. "It is a logical thing to do," he added.

The study and the omega-3 trial will still leave some major issues about depression and heart disease open, Glassman said.

"The two key questions that remain are: Does treating depression make the outcome better? And what is it about depression that is causing the problem in the first place?" he said.

More information
Advice on depression after a heart attack is offered by the American Academy of Family Physicians.

Health Tip: Anxiety Attacks

(HealthDay News) -- Anxiety attacks attacks cause sudden, severe and sometimes paralyzing fear, often for no apparent reason.
The American Academy of Family Physicians lists these common symptoms of an anxiety attack:

• Feeling shortness of breath or a choking feeling.
• 
  Tightness or pain in the chest, and rapid or pounding heart.
• 
  Rapid pulse.
• 
  Dizziness, nausea, sweating and lightheadedness.
• Shaking or trembling.
• Hot flashes, chills or feelings of tingling or numbness in the hands and feet.
• Feelings of a dream-like state, losing control or going crazy.