CRP? Fuggedaboutit.

Big news from JAMA today: High C-reactive protein (CRP) levels don't appear to cause heart disease. Cardiologists have debated for years about whether patients should have their CRP levels routinely screened as a risk factor for CV disease, and whether CRP should be targeted therapeutically. The authors of the JAMA genetics study say nope:

"In summary, our mendelian randomization study of more than 28,000 cases and 100,000 controls found no association of variants in the CRP locus and CHD, arguing against a causal role for CRP in atherosclerosis. Moreover, this study suggests that development of therapeutic strategies targeting specific reductions in plasma levels of CRP are unlikely to be fruitful," the researchers write in their article.

I'm sure this study won't be the final word on the subject, but it's a strong argument toward trending back to the basics: Using BP levels, obesity, smoking, cholesterol and family history as risk factors for CHD. Plus ca change...

Labels: c-reactive protein, heart disease

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posted by Jessica Berthold at 9:46 AM   2 Comments

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

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posted by Ryan DuBosar at 5:01 PM   0 Comments

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

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posted by Ryan DuBosar at 5:01 PM   0 Comments

More surgical procedures occurring outside of hospitals

More and more surgical procedures are being performed in freestanding ambulatory centers as opposed to hospitals, according to the recently released 2006 National Survey of Ambulatory Surgery by the CDC's National Center for Health Statistics. The rate of visits to freestanding ambulatory surgery centers increased by 300% between 1996 and 2006, while at the same time the rate of visits to hospitals remained virtually unchanged.

Other notable findings from the survey include:

• Females had significantly more ambulatory surgery visits
  than men.
• Although the majority of visits had only one (56.3%) or two (28.5%) procedures performed, 2.6% had five or more procedures performed.
• Frequently performed procedures on ambulatory patients included endoscopy of large intestine, endoscopy of the small intestine, extraction of lens, injection of agent into spinal canal, and insertion of prosthetic lens.

There are many more interesting statistics in the CDC's Winter Quarterly Fact Sheet, which focuses on heart disease.

Labels: heart disease, hospital medicine, statistics, surgery

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posted by Janet Colwell at 8:46 AM   0 Comments