Fish and Long-Chain Omega-3 Fatty Acids Could Be Lifesavers for Diabetic Women
Fish and long-chain omega-3 fatty acids appeared to be associated with a statistically significant lower total mortality as well as a lower death rate from coronary heart disease among women with diabetes, according to a study from the Harvard School of Public Health, Harvard Medical School, the Brigham and Women’s Hospital, and Massachusetts General Hospital in the April 15, 2003, issue of Circulation (Circulation. 2003;107:1852–1857).
The authors, led by Frank B. Hu, MD, of the Harvard School of Public Health, monitored 5103 female nurses with type 2 diabetes but without cardiovascular disease or cancer between 1980 and 1996. All were part of the Nurses’ Health Study. During that period, 362 of the women died of documented coronary heart disease, and 468 died of a variety of diseases. Compared with the risk of coronary heart disease among women who consumed fish less than once a month, the relative risk of those who ate fish 1 to 3 times a month was 0.70; for those who ate fish once a week, 0.60; 2 to 4 times a week, 0.64; and 5 or more times a week, 0.36. Those who ate high volumes of fish also had a lower total mortality, according to the authors.
In an editorial in the same issue (Circulation. 2003;107:1834–1836), Scott Grundy, MD, of The University of Texas Southwestern Medical School at Dallas, noted: “Use of N-3 fatty acids in preventive cardiology is at a crossroads. Expert opinion in the dietary field now favors moderate increases in intakes of plant-derived alpha linolenic acid based on epidemiological evidence of benefit for CVD [cardiovascular disease] risk reduction. The costs of such a clinical trial to confirm this reasonable recommendation would be prohibitive. The same is true for ‘increased fish intake,’ which is likewise based on epidemiological evidence. At the least, both of these recommendations are consistent with general dietary guidelines about ‘healthy eating patterns.’ AHA’s recent guidelines for using fish-oil supplements for patients with coronary heart disease are more problematic. Available evidence is suggestive of benefit in the immediate post-MI [myocardial infarction] period, but a solid recommendation cannot be made without more definitive controlled clinical trials.”
Boston Cardiologist Named New Editor of Circulation
Joseph Loscalzo, MD, PhD, has been named the next editor of Circulation: Journal of the American Heart Association. Dr Loscalzo assumes the post in July 2004 at the end of the term of the current editor, James T. Willerson, MD.
Dr Loscalzo is director of the Whitaker Cardiovascular Institute, as well as professor and chairman of the Department of Medicine at Boston University School of Medicine. He also serves as physician-in-chief of the Department of Medicine and president of Evans Medical Foundation for Boston Medical Center.
“Dr. Loscalzo has the scientific breadth, vision, leadership, and energy to maintain and enhance the reputation of Circulation as the premier journal in cardiovascular medicine. He has the uniform and enthusiastic support of the Scientific Publishing Committee,” says Richard A. Walsh, MD, chairman of the American Heart Association’s Scientific Publishing Committee and chairman of the Department of Medicine at Case Western Reserve University in Cleveland. “I’m confident that he will build upon the outstanding contributions that Jim Willerson has made during his term as editor of our flagship journal.”
Dr Loscalzo said: “Circulation always has been the premier cardiovascular journal. It has risen to great heights under Dr Willerson, and I hope to maintain the quality of the journal and improve its broad access to all members of the clinical cardiovascular community as well as its special position with academic cardiologists.”
Dr Loscalzo earned his medical and postdoctorate degrees from the University of Pennsylvania. An active volunteer for the American Heart Association for 15 years, Loscalzo has served on the editorial boards of several of the association’s journals: Hypertension; Circulation Research; Circulation; and Atherosclerosis, Thrombosis and Vascular Biology.
He is currently chair of the American Board of Internal Medicine’s Cardiovascular Board and chair of the Board of Scientific Counselors of the National Heart, Lung, and Blood Institute of the National Institutes of Health. He has published 20 books and more than 400 research articles related to vascular biology, nitric oxide, and atherothrombosis. Dr Loscalzo also holds several US patents for his work in the field of nitric oxide.
Dr Willerson, president of the University of Texas Health Science Center at Houston, has been Circulation editor since 1993. He is credited with increasing the relevance and scientific prestige of the journal.
“Dr Willerson has helped physicians and scientists stay abreast of the latest information by transforming Circulation from a monthly journal to a weekly one. And, most recently, he was at the helm of the journal’s move to online ‘rapid access’ publication,” says association president Robert Bonow, MD. “This represents a major advance.”
Rapid access publication accelerates the publishing process by posting papers online about 3 weeks ahead of the printed issue. In addition, Dr Willerson added “Patient Pages” and “Clinician Updates,” which provide summaries on important cardiovascular topics to the lay community and to the practitioner.
“We look forward to the further advances that will accompany Dr Loscalzo’s tenure,” Dr Bonow said.
Influenza Immunizations—Not Just for Flu
A growing body of evidence shows that influenza immunizations not only protect people from annual outbreaks of flu, they also reduce the risk of heart disease.
The most recent report appears in the April 3, 2003, issue of The New England Journal of Medicine (N Engl J Med. 2003;348:1322–1332), with lead author Kristin L. Nichol, MD, MPH, MBA, and researchers from Veterans Affairs Medical Center and the University of Minnesota, Minneapolis; HealthPartners Research Foundation, Minneapolis; Kaiser Permanente Northwest, Portland, Ore; Oxford Health Plan, New York; and the Centers for Disease Control and Prevention, Atlanta, Ga.
The researchers assessed the influence of flu vaccine on the risk of hospitalization for heart disease and stroke, pneumonia and influenza, and death from all causes. The cohorts came from individuals who lived in the community and were members of 3 large managed-care organizations. They were all at least 65 years old. Researchers followed them for the 1998 to 1999 (140 055 subjects) and 1999 to 2000 (146 328 subjects) influenza seasons. Immunization rates in the first season were 55.5%, and 59.7% in the second. Those who received vaccines were, on the whole, sicker with higher rates of commorbidities, use of outpatient care, and prior hospitalization for pneumonia. Those who did not receive vaccines were more likely to have a prior diagnosis of dementia or stroke.
Vaccination against influenza was associated with a 19% reduction in the risk of hospitalization for cardiac disease during both seasons. The risk reduction for stroke was 16% in the first season and 23% in the second. Pneumonia and influenza hospitalizations were reduced 32% during the first season and 29% during the second.
Mortality risk was reduced 48% during the first season and 50% during the second. The researchers noted that the research supported efforts to increase rates of vaccination among the elderly.
In an earlier publication in the journal Circulation (Circulation. 2003;107:762–768), researchers from The University of Texas Medical School at Houston found that in patients with chronic coronary heart disease, vaccination against influenza was “negatively associated” with development of near heart attack during the same flu season.
The researchers, who included Morteza Naghavi, MD; Zeba Barlas, MD; Said Siadaty, MD; Sameh Naguib, MD; Mohammad Madjid, MD; and Ward Casscells, MD, performed a case-control study at Memorial Hermann Hospital in Houston, Tex, on 218 coronary heart disease patients during the 1997 to 1998 flu season. Patients who had new heart attacks were in the case group, and those who did not have a heart attack were considered controls.
The researchers concluded, “It may be worth exploring whether influenza-trigger MI contributes to the well-documented increase in MIs during the winter months and to the higher rates of MI among the economically and educationally disadvantaged. It will be also interesting to determine whether pneumonococcal vaccination, which is even more underutilized than influenza against vaccine, protects against MI. In conclusion, this case-control study suggests that vaccination against influenza may reduce the risk of MI.”
In a second, earlier study published in Circulation (Circulation. 2002;105:2143–2147), researchers from the Fundación Favaloro, Capital Federal in Buenos Aires, Argentina, also concluded that influenza vaccination may reduce the risk of death ischemic events in patients suffering from infarction as well those who are recovering from percutaneous interventions during flu season.
In the FLUVACS (FLU Vaccination in Acute Coronary Syndromes) study, the researchers included 200 patients with myocardial infarctions who were admitted to the hospital in the first 72 hours after start of symptoms and 101 percutaneous intervention patients without serious prior disease or intervention into a prospective, multicenter log during the winter. Those who had had a myocardial infraction were allocated either to a group that received a unique intramuscular vaccination or to a control group. PCI patients were also randomized to vaccine or control groups.
At 6 months, the researchers determined how many in each group had reached one of the combined end points of death, reinfarction, or rehospitalization. Only 2% of those vaccinated died compared with 8% of the controls. Of those vaccinated, 11% reached one of the combined end points compared with 23% of controls.
Researchers led by Enrique Gurfinkel, MD, PhD, concluded that influenza vaccination may reduce the risk of death and ischemic events in this patient population.
From the 52nd Scientific Sessions of the American College of Cardiology (Chicago, Ill; March 30–April 2, 2003)
The Folate Surprise
CHICAGO—When Helmut Lange, MD, and his collaborators from the Heart Center in Bremen, Germany, and the Kliniken de Weezenlanden in Zwolle, the Netherlands, began their study of the effect of folate on patients who had had a coronary stent, they expected the results to mimic those in a prior study (New Engl J Med. 2003;345:1593–1600), which had found that the B-vitamin had a positive effect.
Instead, said Dr Lange, FACIT (Folate After Coronary Intervention Trial) found that treatment with a combination of folate, vitamin B6, and vitamin B12 after the stent procedure resulted in a narrowing of the stented arteries. In fact, he said, the lumen in patients who took the vitamin combination was 1.5 mm on average compared to 1.74 mm for patients who did not take the vitamins.
The restenosis rate in those who took folate was 35%, compared with 27% in the control group—a statistic that was not significant, said Dr Lange. Sixteen percent of those in the folate group required revascularization of the target lesion compared with 11% of those in the control group.
The rationale for giving such patients folate was to reduce their homocysteine levels. That worked, Dr Lange said, during a late-breaking presentation at the 52nd Scientific Sessions of the American College of Cardiology here March 30 to April 2, 2003.
The folate reduced the homocysteine levels in treated patients by 30%, whereas individuals in the control group maintained high levels of homocysteine. “Almost all subgroups had a negative effect with higher risk ratios of restenosis with the exception of females and diabetics, who had less restenosis under treatment,” he said.
“The vitamin combination had untoward effects in patients after coronary stent implantation by increasing neointimal proliferation and the risk of target vessel revascularization,” he said.
“Folate should be avoided following stent implantation,” said Dr Lange. “Vitamins are not always good. This is the first study to show that they can be harmful.”
Lipoprotein-Associated Phospholipase A2 Independently Predicts Coronary Heart Disease
CHICAGO—A new marker called lipoprotein-associated phospholipase A2 (Lp-PLA2) appears to independently identify people at high risk of heart disease who are not identified by traditional risk factors such as low-density lipoprotein (LDL), said Christie Ballantyne, MD, professor of medicine at Baylor College of Medicine.
“Measurement of high-sensitivity C-reactive protein has been recommended to identify high-risk patients with low LDL who might benefit from statin therapy,” said Dr Ballantyne.
In this study, Dr Ballantyne and his colleagues conducted a prospective, case-cohort study of 12 819 apparently healthy middle-aged American men and women in the ARIC (Atherosclerosis Risk in Communities) study—the so-called Baby-Boomers Study. They examined the relationship of Lp-PLA2, C-reactive protein, traditional risk factors, and the occurrence of coronary heart disease in the cohort over a period of 6 years.
Dr Ballantyne found that mean levels of both proteins—Lp-PLA2 and C-reactive protein—were higher in the 609 patients who had coronary heart disease events. In patients with low LDL, both C-reactive protein and Lp-PLA2 were independently associated with coronary heart disease events, he said.
“Both Lp-PLA2 and high-sensitivity C-reactive protein are individually and independently predictive of coronary heart disease,” said Dr Ballantyne. “Those with the highest levels of Lp-PLA2 and C-reactive protein have the highest risk of incident coronary heart disease.”