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Entries in Coronary Arteries (4)

Sunday
Mar252012

Study: Pregnancy Increases Heart Attack Risk

Brand X Pictures/Thinkstock(CHICAGO) -- Heart attacks are often linked to high blood pressure, diabetes and smoking. But a new study suggests pregnancy can also increase the risk.

“There are significant hormonal changes that occur during pregnancy that affect the coronary arteries,” said study author Dr. Uri Elkayam, professor of medicine, cardiology, and obstetrics and gynecology at the University of Southern California.

Those pregnancy-related hormonal changes, Elkayam said, leave women “susceptible to clots.”

Elkayam and colleagues reviewed 150 cases of heart attack during pregnancy between 2005 and 2011. They presented their findings today at the 61st conference of the American College of Cardiology in Chicago.

Heart attacks are usually triggered by atherosclerosis — a build-up of plaque that narrows the arteries and makes it harder for blood to flow.  But only a third of heart attacks that occur during pregnancy are caused by atherosclerosis, Elkayam said. Rather the vast majority are caused by a tear of one of the three layers that make up a blood vessel known as a dissection.

Seventy percent of spontaneous coronary dissections occur in women and 30 percent of those occur during pregnancy or immediately after, according to Dr. Sharon Hayes, a cardiologist at the Mayo clinic in Rochester, Minn. who was not involved in the study. “We have known for decades that young women with heart attacks have higher mortality than men at the same age and also have very different cardiovascular disease risk factors,” she said.

Heart attacks are usually treated with clot-busting drugs and balloons or stents that open up the narrowed artery. But for pregnant women with dissections, typical treatments can make the situation significantly worse.

Elkayam found that “performing a coronary angiogram, in which you inflate a balloon and place a stent, in 5 percent of the patients made things worse… In patients who are stable, we advise to evaluate the patient non-invasively, and only the high risk patient should undergo a cardiac catherization,” he said.

A heart attack occurring in a young, previously healthy young woman is very unusual, with a reported incidence of 1/16,000. Elkayam emphasized that “women should not be afraid to become pregnant because the incidence of a heart attack is very small.”

Copyright 2012 ABC News Radio

Tuesday
Feb282012

For Coronary Artery Disease, Meds as Effective as Stents

iStockphoto/Thinkstock(NEW YORK) -- Inserting stents to open a blocked artery is a common way to treat coronary artery disease. But increasing evidence suggests the procedure is not as beneficial as patients and some doctors might believe.

An analysis published Monday in the Archives of Internal Medicine found that using stents to repair arteries narrowed by plaque was no better than using standard medications to treat patients with stable coronary artery disease.

Patients with the condition usually have angina, or chest pain, at certain times of physical activity or emotional stress. The pain is the result of blocked arteries, which can prevent adequate blood and oxygen from getting to the heart muscle, causing pain.

To relieve the condition, doctors will open the blockages with stents, metal mesh tubes that can be plain or coated with medication to keep the artery open.

Some recent analyses have pointed to the benefit of stents in treating coronary artery disease, but the authors of the current analysis point out that that data came from the 1980s and 1990s, when patients were often treated with balloon angioplasty rather than stents, and when modern drug treatments, such as statins, beta blockers and ACE inhibitors were not yet available.

"Medical management of coronary artery disease with aggressive statin therapy and other medications is much better now than it was in the past," said Dr. Jon Resar, director of interventional cardiology at Johns Hopkins Hospital in Baltimore.

But the popularity of stents persists, despite mounting evidence that less invasive, cheaper drug treatments are just as effective.

The current report analyzed eight clinical trials and a total of 7,229 patients, half of whom received stents and half of whom received medical therapy alone. The treatment outcomes were virtually the same for both groups: 8.9 percent of patients with stents died, compared with 9.1 percent of patients on medication only; 8.9 percent of the stent patients had nonfatal heart attacks, compared with 8.1 percent of the medicated patients.

Nearly 31 percent of patients who took medication eventually got a stent, and more than 21 percent of patients with one stent had to get another stent.

The results of the analysis don't come as a surprise to many cardiologists, who say the knowledge that stents aren't effective in preventing death or heart attacks is widespread. Many treatment guidelines already recommend giving medications to patients with coronary artery disease before turning to stents.

What is surprising, experts say, is that so many physicians continue to recommend and implant stents to treat stable coronary artery disease without first trying to treat patients with medication.

Dr. David Fischman, co-director of the cardiac catheterization lab at Thomas Jefferson University in Philadelphia, said there was never any evidence that they reduce the risk of death or prevent heart attacks in patients with stable disease.

Some say the way the U.S. health care payment system encourages hospitals and doctors to perform revenue-generating procedures rather than prescribing medications. Procedures to insert stents can cost as much as $50,000. The authors of the current analysis estimate that avoiding stents by treating patients with medication only could save the health care system $9,450 per patient.

Resar said some cardiologists turned to stents in response to patients who want more aggressive solutions to their blocked arteries.

"Many patients just want a blockage fixed with a stent," Resar said. "Patients need to understand that simply putting in a stent in a blockage doesn't address the underlying problem. Lifestyle changes and aggressive medical management are far more important than just putting in a stent."

The analysis did note that stents were associated with a reduction in angina. Of patients who received stents, 29 percent still had persistent angina, versus 33 percent of patients treated with medical therapy alone.

Dr. Kirk Garratt, an interventional cardiologist at Lenox Hill Hospital in New York City, said those findings support the value of stents in improving the quality of life of patients who suffer from the disabling chest pain of angina.

"This means stents can help get more patients back to an active lifestyle, back to work and closer to a normal life," he said. "The anti-angioplasty league says this means stents have no value, but I find support for the way we care for our patients."

Copyright 2012 ABC News Radio

Tuesday
Nov152011

Top-Selling Statins Equally Effective, Study Finds

iStockphoto/Thinkstock(CLEVELAND) -- Two top-selling statins, Lipitor and Crestor, are equally effective in treating coronary artery disease, a new study has found.

Both drugs lower levels of LDL cholesterol -- the bad cholesterol that can cause a build-up of blood-blocking plaque inside the arteries.  Although Crestor caused a bigger drop in LDL cholesterol, the drugs tied when it came to reducing plaque.

"The good thing is that these are both effective drugs," said Stephen Nicholls, clinical director of the Cleveland Clinic Center for Cardiovascular Diagnostics and Prevention and lead author of the study published Tuesday in the New England Journal of Medicine.

Nicholls and his team studied more than 1,000 patients taking a daily dose of Lipitor (80 milligrams) or Crestor (40 milligrams).  They used intravascular ultrasound to measure plaque inside patients' coronary arteries -- the vessels that supply oxygen-rich blood to the heart.  And after two years, two-thirds of patients taking either drug had significantly less plaque.

"The takeaway message is that intensive treatment with cholesterol-lowering drugs is very successful at reducing coronary artery disease," said Dr. Aaron Kesselheim, assistant professor of medicine at Harvard Medical School, who was not involved in the study.  "And there doesn't appear to be a substantial difference between the two drugs."

Because they are patented name brand drugs, Lipitor and Crestor can cost patients $160 per month.  But the patent on Lipitor expires on Nov. 30, opening the door for cheaper generic versions.

Using data from 2005 to 2008, the U.S. Centers for Disease Control and Prevention estimated that 25 percent of adults over age 45 used statins -- up from 2 percent in the mid-1990s.  And between 1999 and 2007, deaths associated with heart disease declined by 28 percent.

Now, even more people will have access to high-potency statins, as generic versions of Lipitor could cost 80 percent less.  The cost of name brand Lipitor could also fall with the new competition.

The patent on Crestor doesn't expire until 2016. But because its plaque-battling effects are on par with Lipitor's, some patients could safely make the switch.

Copyright 2011 ABC News Radio

Monday
Sep262011

Standard Heart Attack Testing Doesn't Always Work for Women

iStockphoto(NEW YORK) -- When Bronx resident Carolyn Brown, 64, went to the hospital complaining of shortness of breath, a heart attack was the last thing on her mind.

"I thought I had a cold," she told ABC News. "I always look for the signs of heart attack, chest pain, pain in your shoulder...but I didn't have that," she says.

Even the doctors were unsure of whether Brown had suffered a heart attack. Blood tests suggested she may have had one, but an angiogram -- the imaging test that has been the gold standard for detecting heart attacks -- showed that her coronary arteries were clear. Her doctors sent her home without any of the medication -- such as statins to lower cholesterol and aspirin to thin the blood -- usually given to patients who have had a confirmed heart attack.

When Brown returned to the ER with much more severe symptoms in April 2010, the angiogram yet again revealed clear arteries, but this time doctors used a different kind of test -- an intravascular ultrasound, or IVUS -- that was more suited to detecting arterial plaque in women. Thanks to the IVUS, doctors found a dangerous block in Brown's neck, and she has since received the heart medication she needed all along.

Brown's case is not that unusual. Anywhere from 40,000 to 100,000 women every year with arteries that show up clear on an angiogram suffer from a heart attack. Thirty-eight percent of the time, like Brown, they have the kind of plaque that doesn't show up on an angiogram, according to new research from the Cardiac and Vascular Institute at New York University Langone Medical Center. In these women, a rupture or ulcer in the plaque of their coronary arteries is behind their heart attack, but this rupture would not show up in standard angiogram.

"When a woman comes in with heart attack symptoms, but the angiogram is clear, doctors will sometimes turn around and tell them they didn't have a heart attack at all," says Dr. Harmony Reynolds, the lead author of the study and an associate director of the Cardiovascular Clinical Research Center. "This is a big deal, because these patients are not getting the medication they need."

In the past, cardiologists have suspected that women with heart attack symptoms but clear angiogram results had the kind of plaque rupture identified in this study, but this research is the first to suggest that using additional ultrasound imaging testing could help determine that these women are in fact suffering from a heart attack, Reynolds says.

For years it seemed that heart disease was more of a health problem for men, but now doctors know that once women go through menopause, they are even more likely than men to have a heart attack. The way their heart disease and heart attack symptoms show up can be very different than in men, however, and this can make it difficult to detect these heart attacks using the standard tests.

What cardiologists and women should take from this research is that "even if the 'regular' test shows no blockages, you are not totally out of the woods," says Dr. Christopher Cannon, a cardiologist at Brigham and Women's Hospital. Instead, doctors should treat these women's risk factors to lower their risk of a repeat cardiac event, he says.

"Women in Brown's situation should also make sure to ask their doctors if they should be put on medication to lower their cardiovascular risk," Reynolds says.

Copyright 2011 ABC News Radio