Brachytherapy Two Years Out
Only 7 of 30 patients who underwent vascular brachytherapy after percutaneous transluminal coronary angioplasty underwent a second procedure—3 at 6 months and 4 between 6 and 24 months—indicating that most blood vessels treated with this procedure remained stable beyond the 6-month period, according to researchers from the Montreal Heart Institute and the Shaare Zedek Medical Center in Jerusalem, Israel, in a report in this week’s issue of Circulation (Circulation. 2002;106:539–543).
The study, led by David Meerkin, MBBS, from the Montreal Heart Institute, used intracoronary 90Sr as a treatment to prevent restenosis in these patients who did not receive a stent. Of the 30 patients who received the radiation, 4 underwent stent deployment to the target lesion within the first week.
The authors noted that the absence of complications such as aneurysm or pseudoaneurysm formation is encouraging because it indicates that the procedure is safe. They noted, however, that, “in a small group of patients, longer-term failures are occurring.” They also noted that this is a pilot study.
In a Hurry to Diagnose Heart Failure
The Breathing Not Properly study (BNP), which evaluated a point-of-care test for B-type natriuretic peptide in emergency room patients with shortness of breath, demonstrated in >1500 patients that the bedside test can quickly confirm a diagnosis of heart failure. The study, which was first presented at the March meetings of the American College of Cardiology in Atlanta, Ga, was published in the July 18, 2002, issue of The New England Journal of Medicine (N Engl J Med. 2002;347:161–167).
In an accompanying perspective (New Engl J Med. 2002;347:158–159), Kenneth L. Baughman, MD, of Johns Hopkins Hospital in Baltimore, Md, wrote: “Levels of this peptide appear to be most helpful in confirming the diagnosis of congestive heart failure in patients in whom the diagnosis is uncertain . . . Measurement of B-type natriuretic peptide appears to be more helpful than standard diagnostic studies, including electrocardiography and chest radiography, and it may be more cost effective than echocardiography.” However, he cautioned that the availability of the bedside test should not mean that physicians defer obtaining appropriate history and physical.
Older Patients Likely to Give Up Statins
Elderly patients are likely to stop taking statin drugs over time, according to researchers in 2 studies in the July 24 and July 31, 2002, issues of the Journal of the American Medical Association (JAMA. 2002;288:455–461 and JAMA. 2002;288:462–467).
In the first study, researchers from The Brigham and Women’s Hospital and Harvard Medical School and School of Public Health in Boston, Mass, retrospectively studied the records of 34 501 patients aged ≥65 years who began statin therapy between 1990 and 1998. With the use of a measurement of proportion of days covered, they found that 79% of days were covered in the first 3 months of treatment among the cohort of patients, dropping quickly to 56% in the second quarter. After 10 years, only 42% of days were covered. They noted that only 1 patient in 4 took their statins as prescribed at least 80% of the days.
The group, led by Joshua S. Benner, PharmD, ScD, noted that the persistence in taking the drug was much less than that recorded in clinical trials. They said that their findings “make it clear that one cannot assume long-term persistence in typical settings will approach the levels observed in prospective trials.”
In the second study, Canadian researchers noted that patients were unlikely to adhere to their prescribed statin regimen, regardless of whether or not they had suffered a recent acute coronary syndrome. The researchers, led by Cynthia A. Jackevicius, BscPhm, MSc, were from the University Health Network–Toronto General Hospital, the University of Toronto, and Sunnybrook and Women’s College Health Sciences Center in Toronto, Canada.
They felt that their results could be generalizable to similar populations because of the large numbers of patients involved— >143 000. “Given the low rates of adherence demonstrated in our study, there is a great need to identify strategies that will lead to improved statin adherence if the benefit of clinical trials are to lead to improved population health,” the authors concluded.
In an accompanying editorial (JAMA. 2002;288:495-496), Dr William B. Applegate, MD, MPH, of Wake Forest University Health Sciences in Winston-Salem, NC, noted that the need to persist in therapy is important in all patient groups and that physicians and health systems need to find ways to emphasize the need to continue taking medications. “Because elderly patients are at least as likely to benefit from statin therapy as younger patients and more likely to discontinue medications, particular attention should be paid to initiating statin therapy in elderly persons who present with coronary syndromes or their equivalent.”
Genes for Failing Hearts?
Gene therapists, with the use of a novel vector (an adeno-associated virus), have treated chronic heart disease in hamsters with a calcium-regulating gene called phospholamban. Key to the success of the treatment was the fact that the gene and its vector were injected right into the coronary artery.
The result was expression of the gene only in the heart for many months, said Keith Chien, MD, PhD, Director of the Institute of Molecular Medicine at the University of California at San Diego and senior author of the paper that appeared in the online edition of Nature Medicine on July 21, and which will appear in the printed edition in August (http://www.nature.com/cgi-taf/DynaPage.taf?file=/nm/journal/vaop/ncurrent/full/nm739.html).
“The treatment prevented deterioration of the heart’s function for between 28 and 30 weeks in the hamsters who have a form of chronic heart disease,” said Dr Chien in a released statement.