(Circulation. 2001;104:e9057.)
© 2001 American Heart Association, Inc.
Cardiovascular News
Circulation News Contributor
Bone Marrow Implant May Improve Blood Flow in Limbs
Eleven patients with peripheral artery disease who received implants of their own bone marrow cells into their legs had ankle brachial pressure indices that improved from 0.26 to 0.41 four weeks after the procedure, said Hiroaki Matsubara, MD, PhD, of Kansai Medical University in Osaka, Japan, at the 2001 Scientific Sessions of the American Heart Association in Anaheim, Calif, on November 13, 2001.
In 10 patients, pain-free treadmill time increased from 2.5 minutes before the procedure to 5.3 minutes afterward. In addition, ulcers related to ischemia cleared up in the same patients, said Dr Matsubara. No improvement was reported in the opposite limbs, which received a placebo injection.
Dr Matsubara said the 500 mL of marrow cells was taken from the patients’ ilial crests while they were under general anesthesia. In the laboratory, the cells were sorted to concentrate the volume to 30 mL. Dr Matsubara implanted the cells at 40 different sites on the muscles in the ischemic lower limb.
Being Too Thin Could Increase Risk for Heart Disease
Thin may be in, but being too thin could increase the risk posed by a heart attack, according to a French study presented at the American Heart Association’s Scientific Sessions in Anaheim, Calif, on November 13, 2001. Using a French national registry, the researchers analyzed data on >2000 patients who had a heart attack in November of 1995 to see how thin patients fared after 1 year compared with individuals of moderate weight.
"Patients who had the worst prognosis were the patients who were the leanest," said Nicolas Danchin, MD, a Professor of Medicine with Hopital Europeen George Pompidou in Paris, France. Thin patients with a body mass index <22 were less likely to have elevated cholesterol levels or diabetes but were more likely to have peripheral vascular disease and congestive heart failure. After 1 year, the thin patients had an increased risk of death from heart attack, independent of other risk factors, compared with patients with a BMI >22.
The results contrasted with reports on the growing problem of obesity in the United States. The Coronary Artery Disease Risk Development in Young Adults (CARDIA) study, which tracked participants between the ages of 18 and 30 over 15 years, found an alarming increase in weight among study subjects that could not be attributed to normal weight gain from aging.
"People are getting heavier and heavier, unfortunately," said Cara Elizabeth Lewis, an Associate Professor of Medicine at University at Alabama at Birmingham. "The increase doesn’t seem to be slowing down."
Cigarette Smoking Damages Right Coronary Artery
Smokers are more likely to develop blockages in the left anterior descending (LAD) and right coronary artery of the heart than are nonsmokers, according to Julie Hoff, MD, Assistant Professor at the School of Public Health and the University of Illinois at Chicago, who presented her study at the 2001 Scientific Sessions of the American Heart Association in Anaheim, Calif, on November 13, 2001. Dr Hoff said her results contrast with current thinking that smoking contributes to atherosclerosis through changes in serum lipids and vascular tone.
In her study, Dr Hoff used electron-beam computed tomography (EBCT) to determine the pattern of damage in the hearts of smokers. None of the 22 204 individuals in the 4-year study reported symptoms of heart disease.
The study found that in single-vessel disease, smokers tended to develop coronary calcium lesions in the right coronary or the LAD artery. In double-vessel disease, smokers tended to have lesions in both the LAD and the right coronary artery disease or both the LAD and the left circumflex. "As in symptomatic individuals with coronary artery disease, smoking is an independent predictor for the development of subclinical coronary disease and follows a characteristic pattern of development," said Dr Hoff.
Women Behind Men in Treatment, Awareness of Heart Disease
Women continue lag behind men in treatment and awareness of heart disease, according to research presented at the American Heart Association’s 2001 Scientific Sessions on November 11 and 12, 2001, in Anaheim, Calif.
Paul N. Hopkins, MD, MSPH, from the University of Utah at Salt Lake, said that a 1998 survey of men and women with familial hypercholesterolemia (FH) found that women with the hereditary disorder had significantly higher levels of cholesterol and low-density lipoprotein (LDL) than men who also had FH. Dr Hopkins and his colleagues found that women were, on the average, prescribed lower doses of statins and were less likely to be treated with 2 or more cholesterol-lowering drugs than were their male counterparts. Dr Hopkins found that lipid levels were less aggressively treated in women than in men, with only 52% of women reaching LDL goals of <160 mg/dL compared with >70% of men.
Doctors at Yale University School of Medicine found that there were no sex differences among referrals to cardiac catheterization when there are strong indications for the procedure. A study by Saif S. Rathore, MPH, and Harlan Krumholz, MD, used data from the federal Cooperative Cardiovascular Project to determine why differences in the referrals for such procedures might occur. They analyzed data on 143 444 heart attack patients aged 65 years and older. They were divided into 3 groups: Group 1 included those for whom catheterization was clearly indicated; Group 2, those for whom weighing the risks and benefits of the procedure resulted in an unclear decision; and Group 3, those for whom the procedure was not indicated. In the patient charts reviewed, 46% of patients fell into Class 1 and 47% were in class 2. Only 6% were in Class 3. Of those in Class 1, 45% of men and 44% of women underwent cardiac catheterization, the researchers said. Sex differences were seen only in women who were in the ambiguous Class 2. The researchers concluded that the differences between men and women were statistically significant only in the groups in which the indication for catheterization was equivocal.
A study by Viola Vaccarino, MD, PhD, at Emory University School of Medicine in Atlanta, Ga, and colleagues at her institute as well as at Yale University School of Medicine found that women were on average 6 years older than men when they underwent bypass surgery and more often had a history of diabetes and hypertension. In addition, the women in the study of 1170 patients aged 30 years or over reported more frequent and severe chest pain and difficulty in breathing than a similar group of men. However, they did not report longer duration of symptoms before bypass and did not have more severe coronary artery disease than men.
Although heart disease is the number-one killer of American women, less than 10% of US women polled in a 2000 follow-up to a 1997 American Heart Association survey view it as a major health threat.
"There has been a significant improvement in awareness among white women, but there has not been a change among black women or Hispanic women," said Lori Mosca, MD, PhD, Associate Professor of Medicine at New York Presbyterian Hospital. "We still have a lot of work to do among our minority populations."
The number of women who talk to their doctors about heart disease is still low, 38% in 2000 compared with 30% in 1997. On the basis of the study results, the American Heart Association has begun a new minority health initiative as part of its Women’s Campaign to educate women on their risk for heart attack and stroke.
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