Monday, September 21, 2009
Smokers finding air becoming rare in which to indulge
Outdoor smoking faces bans in big cities as the largest review to date concludes that public smoking bans reduce heart attacks by 26% annually, and the effects can be measured in as few as six months.
New York City’s health commissioner said a week ago that he wanted to ban smoking at parks and beaches. Mayor Michael R. Bloomberg released a response that he wanted "to see if smoking in parks has a negative impact on people’s health."
Yeah, it does, according to research in the Sept. 29 issue of the Journal of the American College of Cardiology. A systematic review and meta-analysis of 10 reports from 11 geographic locations in the North America and Europe compared heart attack rates before and after public smoking bans. The studies involved 24 million people and observations of the effect of the bans ranged from two months to three years.
Thirty-two states and cities have banned smoking in public places and workplaces. Recently entering into the fray is Rockville, Md., which voted the same night as New York's proposal to ban smoking within 40 feet of city parks and may push for a more comprehensive ban. A nationwide ban on public smoking could prevent as many as 154,000 heart attacks each year, the study concluded.
Steven Schroeder, MACP, director of the Smoking Cessation Leadership Center University of California, San Francisco, said, "Several years ago, the idea that secondhand smoke was harmful to the heart was a theory and one with some controversy attached, but this article moves us from the theoretical to fact and to practice. The reduction in heart attacks associated with public smoking bans is a big deal."
Labels: cardiology, smoking cessation
posted by Ryan DuBosar at
5:00 PM
1 Comments
Saturday, April 25, 2009
This post will not teach you about syncope
I assume that the packed house of internists learned a lot from this morning's session on syncope, but since medical-writer school doesn't include a course on reading electrocardiograms, what I picked up were some jokes about bears.
So here goes: The president wants to decide which law enforcement agency is the best so he releases a rabbit into the woods and sends the CIA, FBI and NYPD to get it. The CIA interviews all the animals, can't find it. The FBI kills everything in the woods, including the rabbit. After the NYPD goes in, a badly beaten bear comes out saying, "Yes, yes, I swear I'm a rabbit." The point was something about how electrophysiology is like the NYPD--you get an answer but it might not be the right one.
Then, presenter Fred Kusumoto, MD, told us about how premature ventricular contractions are like bear poop. If you're hiking in the woods and you see poop, you'd better watch out for a bear. Cleaning up the poop will not make you any less likely to run into a bear. Similarly, studies have found that using medication to get rid of patients' PVCs does not improve mortality.
Labels: cardiology, internal medicine 2009
posted by Stacey Butterfield at
2:38 PM
0 Comments
Thursday, March 19, 2009
A disparity you can do something about
Just about every week, a new study comes out reporting on health disparities between men and women, blacks and whites, etc. Here at ACP Internist, we've discovered that this kind of research tends to attract little interest from our readers--maybe because it seems like the same sad, but inexplicable, story over and over again. No one favors disparities in care and health, but what do you do about them?
But the latest disparity study from the NEJM comes with some solutions. Blacks are vastly more likely to develop heart failure at a young age than whites, the researchers found. They also highlighted three frequent causes: hypertension, obesity, and systolic dysfunction. Control those conditions in young blacks and the disparity in heart failure should decline. Of course, that's easier said than done (if Americans could find a way to control obesity, we'd be looking very different as a country), but it at least gives the health care community something to work on, instead of just more bad news to bemoan.
Labels: cardiology, disparities
posted by Stacey Butterfield at
2:34 PM
1 Comments
Monday, March 9, 2009
Depression linked to cardiac death
Healthy women with severe depression have double the risk of sudden cardiac death, as well as higher risk for fatal coronary heart disease.
Depression and heart disease are linked by cardiovascular risk factors such as high blood pressure, diabetes, high cholesterol and smoking, which are more common among severely depressed women. Possible explanations could be autonomic dysfunction, higher resting heart rates and reduced heart rate variability.
Researchers prospectively studied 63,469 women from the Nurses Health Study with no evidence of prior heart disease or stroke between 1992 and 2004. They used self-reported symptoms of depression and antidepressant use, and then examined those with the most severe symptoms on a mental health index or those regularly using antidepressants. They reported their results in the Journal of the American College of Cardiology.
Low mental health index scores were associated with an increased risk of heart disease, with a hazard ratio of 1.5 after controlling for other risk factors. Sudden coronary death risk was 3.3 times greater in subjects who took antidepressants, more so than the mental health index scores, causing an editorial writer to raise the specter of needing further research into this drug class while emphasizing that the benefits outweigh the risk. As usual, one study raises more questions to answer. In the meantime, doctors should closely monitor patients with depression for risk factors for coronary heart disease.
Labels: cardiology, depression, heart, heart disease, heart failure
posted by Ryan DuBosar at
5:01 PM
0 Comments
Wednesday, February 25, 2009
What's your poison?
While there has been evidence galore that alcohol in moderation may be good for your heart (see this, this and this for a few examples), a new study has raised a serious counterpoint. The study from the Feb. 24 online Journal of the National Cancer Institute found that women who drank even small amounts of alcohol were at higher risk of cancer than those who drank nothing.
To wit, for every extra drink per day, the increase in incidence per 1000 women was 11 for breast cancer, 1 for cancers of the oral cavity and pharynx, 1 for cancer of the rectum, and 0.7 each for cancers of the esophagus, larynx and liver. That adds up to 15 cancers per 1000 women, the journal said. Put another way, the authors estimated that about 13% of cancers of the breast, aerodigestive tract, liver, and rectum could be attributed to alcohol, an editorial noted.
The editorial goes on to say: "From a standpoint of cancer risk, the message of this report could not be clearer. There is no level of alcohol consumption that can be considered safe."
Has it come to this: Hesitating at the wine or beer aisle, as you contemplate whether you'd rather have cancer or heart disease? That's being melodramatic, of course, but what should a PCP tell a patient who asks whether she should be drinking a glass of wine a day "for her heart"?
Labels: alcohol, cancer, cardiology
posted by Jessica Berthold at
9:32 AM
0 Comments
Monday, February 23, 2009
Temper, temper
The stereotypical image of the angry person suddenly clutching his or her chest might have found some physical evidence. Not just stress but strong emotions may lead to potentially lethal ventricular arrhythmias.
Researchers studied 62 patients with implantable cardioverter-defibrillators who underwent monitoring during a mental stress test that asked them to recall a recent situation in which they were angry.
Researchers measured the patients' T-wave alternans (TWA) and then followed them for a mean of 37 months to determine who had arrhythmias that triggered their pacemakers. Patients with higher levels of anger-induced TWA were more likely to trigger their pacemakers--a predictor of heightened risk of up to ten times that of other patients.
Combining exercise tests with mental stress test may help clinicians better select patients likely to have arrhythmia and benefit from a defibrillator, and it might provide insight for patients who can't exercise, researchers wrote in the Journal of the American College of Cardiology.
Naturally, therapies focused on helping patients deal with anger and other negative emotions may help reduce arrhythmias and, therefore, sudden cardiac death in certain patients. It's not the first time anger's been linked to heart disease, but researchers said we are beginning to understand how anger and other types of mental stress can trigger potentially lethal ventricular arrhythmias.
Labels: cardiology, heart, heart disease
posted by Ryan DuBosar at
5:01 PM
0 Comments
Tuesday, November 25, 2008
How depression breaks the heart
It's been known for quite some time that depressed patients have a higher risk of heart problems than those who are mentally healthy. What's been unclear is why-- till now.
A new JAMA study finds that, in depressed patients with coronary heart disease, most of the higher risk of CV events can be chalked up to a lack of exercise.
The study followed more than 1,000 outpatients with CHD for nearly 5 years. Patients reporting symptoms of depression had a 50% greater risk of CV events. Adjusting for comorbid conditions and cardiac disease severity lowered the risk to 31%, but adjusting for lack of exercise pretty much wiped out the association completely (along with a few other "health behaviors," like diet). Put another way, not exercising was associated with a 44% higher rate of CV events-- almost the same as the depression association.
So now the real question is: how do you get those depressed patients to exercise? (Which, by the way, is likely to improve their mood.) That's a whole other study in and of itself. For now, the Mayo Clinic has these tips on motivating depressed patients.
Labels: cardiology, depression, heart, mental health
posted by Jessica Berthold at
4:00 PM
0 Comments
Monday, November 10, 2008
Don't forget your history
Twice today I've heard pleas for doctors to do a better job of collecting family histories. One came as an aside from an audience member at Dr. Oz's lecture, and another from Allen Taylor, MD, who spoke at a seminar about when to order various imaging tests. He was tasked with talking about patients with intermediate risk of heart disease.
Dr. Taylor noted that the classic definition of "intermediate risk" for CAD is 10%-20% on the Framingham, yet this misses some patients because the Framingham doesn't take family history into account. As such, his definition of "at risk" is a patient with a Framingham of 6% or greater and a family history of premature coronary artery disease.
When taking family history, you should go deep, he said. Ask about first and second degree relatives. Ask about the age that relatives developed CAD, and how many relatives had CAD. The more relatives, and the younger those relatives were when they developed CAD, the greater the risk. Especially if they are siblings.
Those deemed at risk by family history should undergo coronary artery calcium testing, he said, especially middle-aged and older patients, for whom it's been shown to be a stronger risk predictor than carotid IMT tests. IMT might make more sense for primary care offices, however, for practical/convenience reasons, he said.
It's really important to identify those at intermediate risk, he noted, because they are a big group-- and also the most likely to improve with therapeutic intervention. It's a message I've heard several times at this conference.
Labels: AHA Sessions, cardiology
posted by Jessica Berthold at
6:30 PM
0 Comments
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