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.

A Month of Exercise Helps Ease Heart Failure

(HealthDay News) -- Just four weeks of moderate exercise is enough to boost the cardiac performance and breathing capacity of patients with heart failure, a new study finds.

This slightly more strenuous exercise program -- in standard use in Europe for people with heart failure -- works at least as well as the less intense American regimen, the researchers noted. They presented the findings Tuesday at the Experimental Biology conference in San Diego.

In heart failure, the heart progressively loses the ability to pump blood. In the United States, doctors typically recommend three-times-a-week exercise sessions for eight to 12 weeks to help ease the condition, noted study author Stephen F. Crouse, a professor of kinesiology and internal medicine at Texas A&M University, in College Station.

His team looked at data from an Austrian rehabilitation center where 366 heart failure patients (average age 63) exercised 14 to 22 minutes on stationery bicycles six times a week. Participants also did a brisk 45-minute walk each day.

Four weeks of that regimen were enough to produce a significant increase in the participants' breathing capacity, Crouse said.

"This is something that we can recommend continuing for the rest of their lives," he added.

The benefits of exercise for people with heart failure are well-established, Crouse acknowledged. "There are some data from U.S. studies showing that the European regimen has at least equal benefits," he said.

The study used such standard measures of heart function as VO2max, which measures oxygen consumed; resting heart rate; and blood pressure. But of greater interest was the measurement of blood levels of the protein NT-proBNP, which is secreted when heart muscle cells are stressed, Crouse said.

"We have this biomarker in the blood that can be followed very well and that correlates with [cardiac] performance," he said.

Levels of NT-proBNP went down as standard measures of heart performance went up, Crouse said. Blood levels of the protein dropped by 33 percent in the study group after four weeks of the exercise regimen.

Measuring NT-proBNP "is something we would suggest could become a routine clinical test, of treatment and performance," Crouse said. A blood test for the protein is not expensive and is a better alternative for more costly tests such as echocardiography, he said.

The longer-term effects of a continued exercise program for heart failure will be assessed by the Texas A&M team, Crouse said. "We need data to follow them out," he said.

The results were not surprising and will not affect advice on exercise now given to people with heart failure, said Dr. William E. Kraus, research director at the Duke University Center for Living. His center is currently leading a major trial of long-term exercise training for people with heart failure, with results expected later this year.

Use of NT-proBNP as a measure of performance is "a new wrinkle, but not so much of one that it makes me want to change practice," Kraus added.

More information

Guidelines for exercise in heart failure are provided by the Cleveland Clinic.