Swimming advice for patients with CHF
Patients who had a severe acute MI and have compensated severe chronic heart failure should not swim, or exercise in water, as much as those who had mild or no cardiac events, according to research from Switzerland. The researchers claim this is explained by the central hemodynamic responses during immersion and swimming in healthy subjects.
Meyer K. Br J Sports Med 2006 doi:10.1136/bjsm.2006.029165
Identifying high-risk patients
Researchers in Austria have created a score to identify patients at high risk of peri-procedural complications following elective carotid artery stenting (CAS). They looked at 606 patients assigned to CAS and identified diabetes mellitus with inadequate glycaemic control, ulceration of the carotid artery stenosis and a contralateral stenosis as independent risk factors. The presence of two or more of these factors identified patients with a risk of 11 per cent for peri-procedural complications, compared with 2 per cent in patients with up to one risk factor.
Hofmann R, Niessner A, Kypta A et al. Stroke 2006; 37: 2557-61
Gender differences in urolithiasis
Men are known to be at greater risk of urolithiasis and renal diseases than women. Previous studies have linked greater urine concentration with an acceleration of progression of chronic kidney disease; research in France lends weight to this theory. This study of urine volume and osmolality (Uosm) found Uosm to be 21–39 per cent higher in men than in women. The authors noted that men’s larger osmolar load was excreted in a more concentrated urine, with no difference in volume, and this tendency to concentrate urine may participate in men’s greater susceptibility to urolithiasis, hypertension and more rapid progression towards end-stage renal failure.
Perucca J, Bouby N, Valeix P et al. Am J Physiol Regul Integr Comp Physiol 2006; doi:10.1152/ajpregu.00500.2006
Adiponectin and CVD risk
Adiponectin (ADIPOQ) gene variations are associated with a risk of cardiovascular disease in patients with diabetes. However, until now, no prospective data were available on the risk in non-diabetic people with ADIPOQ. Researchers from several US medical centres assessed DNA samples from ‘healthy’ men and identified the presence of five ADIPOQ genetic variants.
They took DNA samples from 600 men who subsequently suffered an atherothrombotic event and from a control of 600 white men, matched for age and smoking, who remained free of reported vascular disease. They found evidence for a protective role of adiponectin gene variation in the risk of ischaemic stroke that was independent of the presence of diabetes.
Hegener HH, Lee IM, Cook NR et al. Clin Chem 2006; 21 Sept (Epub ahead of print)
Reduce salt in food
US food manufacturers may need legislation to compel them to reduce salt in food. In a strong editorial, Professor Lawrence J Appel, professor of medicine, epidemiology and international health, lambasted the Salt Institute for its claims that the American Medical Association (AMA) had ‘misread the science, confusing BP effects with health outcomes’.
The Salt Institute had made its comments in response to the AMA’s call for salt levels to be halved in processed and restaurant food. Professor Appel concluded that any meaningful strategy to reduce salt intake must involve food manufacturers and restaurants – either ‘voluntarily or involuntarily’ – as well as public health approaches.
Appel LJ. BMJ 2006; 333: 561-2
A study from Hong Kong suggests that telephone counselling can help patients to be more compliant with drug-taking and reduce mortality. Some 442 patients receiving five or more drugs for chronic disease, found to be non-compliant at the screening visit, were assigned to a telephone counselling or a control group.
After two years, 17 per cent of the control group had died, compared to 11 per cent of the intervention group. Researchers concluded that telephone counselling was associated with a 41 per cent reduction in the risk of death.
Wu JYF, Leung WYS, Chang S et al. BMJ 2006; 333: 522
Intensive statin therapy
The TIMI Study Group in Boston has found that intensive statin therapy reduces acute cardiac events in patients with acute coronary syndrome with diabetes mellitus, just as it does in those without diabetes mellitus – with 55 v 40 events prevented per 1,000 patients treated.
Although the researchers found that the rate of acute cardiac events and unstable angina was much higher in patients with diabetes mellitus, it was reduced with intensive v standard therapy similarly in patients with diabetes and those without. However, despite intensive therapy, 62 per cent of the diabetes group did not reach the dual goal of LDL <70mg/dL and high-sensitivity C-reactive protein <2mg/L, prompting the researchers to conclude that ‘additional strategies’ were needed for high-risk patients.
Ahmed S, Cannon CP, Murphy SA et al. Eur Heart J 2006; 27(19): 2323-9
Education about defibrillation
Researchers in Germany suggest that defibrillation education programmes for at-risk patients and their relatives should have higher priority. They compiled data showing that most cases of out-of-hospital sudden cardiac death occurred at home, in the presence of relatives and after a longer period of warning symptoms. Of 5,831 out-of-hospital cases handled by Berlin’s emergency services, 72 per cent of arrests occurred at home and 67 per cent in the presence of a witness. Some 66 per cent had known cardiac disease and typical angina was present for an average of 120 minutes in many of the patients.
Muller D, Agrawal R, Arntz HR. Circulation 2006; 114(11): 1146-50
Measures of quality
US researchers have found that variation in indicators used to assess quality of diabetes care across provider groups is associated with differences in patient-centred measures of quality. The researchers used data from 8,733 patients receiving care from 68 providers. Measures included HbA1c (A1C), systolic BP, HDL and LDL, patient satisfaction with care, and patient-rated quality of care. They found that an average of one additional indicator for each patient was associated with significantly lower mean LDL levels but not with A1C, SBP or HDL levels.
Ackermann RT, Thompson TJ, Selby JV et al. Diabetes Care 2006; 29(9): 2108-13