(Circulation. 2001;103:e9036.)
© 2001 American Heart Association, Inc.
Cardiovascular News
Food and Drug Administration Warns of Dietary Supplements That Cause End-Stage Renal Disease and Cancer
The US Food and Drug Administration (FDA) on April 11, 2001, warned consumers to stop using botanical products containing aristolochic acid. The product may have been called "traditional medicine" or it may be an ingredient in dietary supplements.
The agency took the action because consumption of products containing aristolochic acid has been associated with permanent kidney damage that sometimes causes renal failure, requiring dialysis or transplant. In addition, some patients have developed urinary tract cancers.
In May 2000, the FDA became aware of the association between the use of the dietary supplement and permanent kidney damage in 2 patients in the United Kingdom. Similar cases had been reported in France and Belgium, causing the FDA to impose an import alert on products containing the ingredient. The recent identification of 2 US patients who suffered kidney damage after using botanical products containing aristolochic acid and the identification of products in this country that contain the substance has prompted the FDA to request that US manufacturers recall these products.
The agency is also advising consumers to avoid using products containing aristolochic acid, including those with the words Aristolochia, Bragantia, or Asarum listed as ingredients. The 18 products analyzed by the FDA can be found at www.cfsan.fda.gov/~dms/ds-bot3.html.
Health and Human Services Secretary Thompson Lauds Organ Donations
Making good on his promise to boost organ donation nationwide, Health and Human Services Secretary Thomas Thompson on April 17, 2001, launched a national initiative to increase the numbers of donors nationwide. Included in his program is the "Workplace Partnership for Life," which brings employers, unions, and employee organizations together in a nationwide network to promote such donations.
As part of his campaign, the secretary made public a model organ and tissue donor card. However, he warned that donor cards alone will not ensure that a person’s wishes in the matter will be followed. He ordered an immediate review of the potential of organ and tissue registries, where donors’ wishes could be recorded electronically and made available to families and hospitals.
Caring for the Poor Creating Financial Crisis for Nation’s Academic Hospitals
As the numbers of uninsured Americans grow, America’s 125 teaching hospitals are taking up the burden of caring for them as well as for the poor. According to a report released by the Commonwealth Fund Task Force on Academic Health Centers on April 17, 2001, the trend could result in a "downward spiral in their financial status."
Between 1991 and 1996, the amount of charity care provided in academic health centers grew 8%, from 20% to 28%. However, in the parts of the country where more people were enrolled in managed care organizations, those numbers were even higher: amounts of care grew from 23% in 1991 to 36% in 1996.
The reason, said the study’s authors, is that the growing numbers of uninsured patients (estimated as >44 million in 2001) have burdened hospitals and clinics. Those that could simply decreased the number of low-income patients they were willing to treat. "Teaching hospitals don’t have that option," David Blumenthal, executive director of the task force and director of the Institute for Health Policy at Massachusetts General Hospitals/Partners Health Care in Boston told the Chronicle of Higher Education in an article in the April 17, 2001 issue. Providing care to the poor and uninsured is one of the social missions of academic health centers.
At the same time that teaching hospitals have seen their censuses of the poor and uninsured climb, they have seen decreasing numbers of Medicaid patients, said James Reuter, another of the report’s authors and an associate executive vice president for administration at Georgetown University Medical Centers, to the Chronicle. The funds from Medicaid and from the federal disproportionate share program that supplements payments to hospitals that care for large numbers of the poor are crucial to the continued function of such hospitals.
The report recommends the following:
- Reducing the numbers
of uninsured patients by increasing the proportion of the population
eligible for publicly financed programs such as
Medicaid.
- Increasing the amount of Medicare and Medicaid funds available for teaching hospitals that care for a large number of poor and uninsured patients.
- Insuring that medical students and residents learn how to care for the poor and uninsured.
- Increasing the amount of Medicare and Medicaid funds available for teaching hospitals that care for a large number of poor and uninsured patients.
The report is available at http://www.cmwf.org, and copies can be obtained by calling (888) 777-2744 and ordering publication No. 443.
Older, Moderate Drinkers at Lower Risk of Heart Failure
Moderate alcohol consumption seems to be associated with a decreasing risk of heart failure among older persons, according to a study by researchers at Emory University School of Medicine in Atlanta. The report was published in the Journal of the American Medical Association (2001;285:1971–1977). "The community-based nature of our study population suggests that the results of this study may have wide applicability," said the authors. "Heavy consumption of alcohol can lead to negative cardiovascular outcomes such as higher blood pressure, cardiomyopathy, and sudden cardiac death. Thus, individuals should continue to be cautioned against drinking excessive amounts of alcohol."
The study, which was conducted by Jerome L. Abramson, PhD, Setareh A. Williams, PhD, Harlan M. Krumhotz, MD, MPH, and Viola Vaccarino, MD, PhD, evaluated a sample of 2235 elderly patients living in New Haven, Connecticut who did not have heart failure when they were enrolled in the study. Those who reported drinking >70 ounces of alcohol in the month before enrollment were excluded from the study.
The major end point of the study was time to first fatal or nonfatal heart failure event measured against the amount of alcohol consumed in the month before enrollment. Crude rates of heart failure per 1000 years of follow-up were 16.1 for people who consumed no alcohol, 12.2 for those who consumed 1 to 20 oz of alcohol, and 9.2 for those who drank 21 to 70 oz of alcohol in the month before enrollment.
When the rates were adjusted for age, sex, race, education, angina, previous heart attack, diabetes, heart attack during the study period, high blood pressure, pulse pressure, body mass index, and current smoking, the relative risks of heart failure were 1 for those who drank no alcohol, 0.79 for those who drank 1 to 20 oz of alcohol, and 0.53 for those who drank 21 to 70 oz. All the findings were statistically significant.
"We expected that moderate drinking would be linked to a lower incidence of heart failure because moderate drinking is associated with a lower risk of heart attack, which would, in turn, lower heart failure risk, " Dr Abramson said. "What was surprising was that moderate drinking was linked to less heart failure independently of heart attack risk. That suggests alcohol is lowering the risk of heart failure through another pathway than the one that lowers risk of heart attack."
During follow-up, a total of 281 study participants experienced a first heart failure event and 28 of these patients died. The people who reported the highest levels of alcohol consumption (in the moderate range of 21 to 70 ounces per month) had the lowest rates of heart failure: a 47% decrease in risk when compared with nondrinkers. Those consuming no alcohol had the highest incidence of heart failure. The study found similar reductions in heart failure risk whether study participants drank beer, wine, or liquor. "That suggests it is pure alcohol, and not the kind of beverage, that is lowering the heart failure risk," Dr Abramson said.
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