Early Use of Cholesterol Drug Boosts Outcomes After Angioplasty

(HealthDay News) -- Two new studies confirm and expand the usefulness of anti-cholesterol statin medications, both for relatively healthy patients and those treated for heart attack.

In one trial, patients admitted to a hospital with chest pain fared better a month after angioplasty if they got the statin Lipitor soon after admission to the emergency department.

Another study found that doses of the statin Crestor kept cholesterol plaque at bay in the carotid artery, the prime vessel leading from the heart to the brain.

"These two studies provide further evidence that these drugs are very beneficial against atherosclerosis," otherwise known as "hardening of the arteries," said Dr. Robert Bonow, a spokesman for the American Heart Association and chief of the division of cardiology at Northwestern University Medical School, in Chicago.

He was not involved in either of the trials, the results of which were to be presented Sunday at the American College of Cardiology annual meeting, in New Orleans. The Lipitor study is also being published in the March 27 issue of the Journal of the American College of Cardiology, while the Crestor trial results will appear in the March 28 issue of the Journal of the American Medical Association.

Trial after trial has highlighted the heart-healthy benefits and low side effects of statins, which include blockbusters such as Crestor, Lipitor, Pravachol and Zocor.

The two new studies add to that growing pile of research. In the Lipitor study, researchers in Italy first identified 191 patients at risk of heart attack who arrived at the hospital complaining of "unstable angina" (chest pain). The patients were not already taking any chronic statin medication.

According to Bonow, doctors typically prescribe a statin to patients after a heart attack to lower their risk for a second heart attack or serious complication in the days and weeks that follow. Many of these patients will also undergo an artery-opening procedure, such as angioplasty.

But in this study, half of the patients also received Lipitor in the 12-hour period before their angioplasty.

It seemed to have helped. "Even with this short pretreatment, there is improvement in outcomes," said the study's lead author, Dr. Germano Di Sciascio, director of the department of cardiovascular sciences at the University of Rome.

In fact, just 5 percent of patients who received Lipitor shortly before their angioplasty died, had a nonfatal heart attack, or required another invasive procedure within 30 days of angioplasty, compared to 17 percent of those who only got the statin after the procedure.

"I was not surprised, because we had done other similar studies that have shown a lot of good effects of atorvastatin (Lipitor)," Di Sciascio said. "The most important thing is that even a short treatment works, and it works in the unstable patients going for (angioplasty). Thus, atorvastatin needs to be part of the armamentarium of the interventional cardiologist," he added.

Di Sciascio stressed that his team's study was relatively small and should be confirmed by a larger trial before any major shift in cardiac care occurs. And he said that "it is possible that other statins would have the same effect, however, until now, the benefit has been demonstrated only with atorvastatin, which has been the subject of our study."

Bonow agreed that the findings could help change hospital practice. "Many heart attacks occur out of the blue, and people aren't aware that they have a problem, so many aren't already on these drugs," he said. "So, we tend to start them in the hospital before they go home. But this study suggests that we should do it even earlier, as soon as they hit the door."

In the second study, a team led by Dr. John R. Crouse III, of Wake Forest University in Winston-Salem, N.C., compared the effectiveness of Crestor (rosuvastatin) in nearly 900 patients. The patients were relatively healthy, with only "modest" elevations in LDL ("bad") cholesterol and a mild amount of plaque in their carotid arteries.

Patients got either 40 milligrams of Crestor daily or a placebo, and the researchers tracked carotid plaque levels over two years using high-tech ultrasound.

According to the study, daily Crestor treatment "slowed progression" of artery thickening in this important vessel "at all sites and each segment" tested.

"Carotid artery thickness is a good predictor of who's going to have a heart attack as well as a stroke," Bonow noted. "This (study) is further demonstrating that these drugs are very beneficial, because it is reducing the amount of atherosclerosis in the carotid artery and presumably a lot of other arteries, too."

He said the two studies add to the growing evidence that statin medications are an extremely useful therapy for preventing a wide range of cardiovascular ills.

But they are still not for everyone, Bonow said. "There is about a one percent risk of something bad happening with these drugs," he said. "So, you don't want to give them to everyone, because that one percent would add up to a lot of people."

More information
Find out more about statins at the American Heart Association.

Drug Provides Short-Term Relief of Heart Failure Symptoms

(HealthDay News) -- The drug tolvaptan may improve some symptoms and signs of heart failure during hospitalization, but the drug doesn't reduce the risk of re-hospitalization or death, two new studies conclude.

The studies, published in the March 28 issue of the Journal of the American Medical Association, are also being presented at the American College of Cardiology's annual meeting, in New Orleans.

The first study looked at 4,133 hospitalized heart failure patients in Europe, North America and South America who took part in the Efficacy of Vasopressin Antagonism in Heart Failure: Outcome Study With Tolvaptan (EVEREST) trial.

The patients received either 30 milligrams of tolvaptan or a placebo once a day for a minimum of 60 days. After 9.9 months, 25.9 percent of the patients taking tolvaptan had died, compared with 26.3 percent of those in the placebo group.

The combined outcome of cardiovascular death or re-hospitalization occurred in 42 percent of the patients taking the drug and in 40.2 percent of the patients who received the placebo. Both groups had similar rates of clinical worsening of heart failure symptoms and of major adverse events.
"Long-term tolvaptan treatment had no effect, either favorable or unfavorable, on all-cause mortality or the combined endpoint of cardiovascular mortality or subsequent hospitalization for worsening HF [heart failure]," the study authors wrote.

The second study of EVEREST trial patients found that the use of tolvaptan in addition to standard therapy provided short-term (up to seven days) relief of some symptoms and signs of heart failure (such as congestion and breathing difficulty) without causing major side effects.

The patients received the drug or placebo within 48 hours of admission to hospital.

The EVEREST trial was funded by Otsuka Inc.

More information
The American Heart Association has more about heart failure.

Dark Chocolate May Lighten the Load on Arteries

(HealthDay News) -- Delicious nibbles of dark chocolate may also boost the function of vital endothelial cells that line the inside of blood vessels, a new U.S. study suggests.

Cocoa is rich in a group of antioxidant compounds called flavonoids, which are also found in fruits and vegetables, wine and green tea. Research suggests that consumption of foods rich in flavonoids may decrease the risk of cardiovascular disease.

The study, conducted by researchers at the Yale Prevention Research Center in Connecticut, included 45 healthy people with a body mass index (BMI) between 25 and 35 kg/m2. The participants were divided into three groups that ate either eight ounces of cocoa without sugar; cocoa with sugar; or a placebo.

BMI is a measure of body fat based on height and weight. A BMI reading of 25-29.9 is an indicator of overweight, while a reading of 30 or more indicates obesity.

For six weeks, the participants underwent endothelial function testing. This was done by using high frequency ultrasound to measure the ability of the brachial artery (which runs from the shoulder to the elbow) to relax and expand in order to accommodate increased blood flow -- a test called flow mediated dilation (FMD).

The study found that FMD improved significantly (2.4 percent) in the group that consumed cocoa with no sugar, compared with 1.5 percent in the group that ate cocoa with sugar. There was a 0.8 percent decrease in FMD in the group that ate the placebo.

"In this group of healthy adults with BMI between 25 and 35 kg/m2, dark chocolate ingestion over a short period of time was shown to significantly improve endothelial function, leading our team to believe that greater benefit may be seen through a long-term, randomized clinical trial," co-investigator Dr. Valentine Yanchou Njike said in a prepared statement.

"While the findings from this study do not suggest that people should start eating more chocolate as part of their daily routine, it does suggest that we pay more attention to how dark chocolate and other flavonoid-rich foods might offer cardiovascular benefits," Njike said.

The study was expected to be presented March 27 at the American College of Cardiology's Annual Scientific Session in New Orleans.

More information
The American Medical Association outlines lifestyle changes to help reduce the risk of heart disease.

Heart Test Shows Who Needs Implantable Defibrillators

(HealthDay News) -- A new study provides more evidence that a special heart test could give cardiologists guidance on which patients need implanted defibrillators.

The research, which looks at patients who have weak heart muscles but no underlying coronary disease, suggests that the test, known as T-wave alternans, can predict which patients are at highest risk of suffering heart rhythm disorders. They can then get the implanted defibrillators, while the others could potentially avoid the procedure.

Still, more research is needed, said Dr. Andrea Russo, an electrophysiologist at the University of Pennsylvania. "We need more studies that are confirmatory before we start excluding patients from implantable defibrillators," she stressed.

A number of conditions, including viral infections and alcoholism, can weaken parts of the heart even when someone doesn't have clogged arteries. In some cases, there's no apparent cause.
People with this condition -- including some young people -- can suffer from abnormal heart rhythms and die. But doctors often try to boost their chances with implanted defibrillators designed to shock their hearts back into a proper rhythm when necessary.

Doctors have been looking for a way to predict which patients need defibrillators and which would be fine without them. Enter the T-wave test, which Russo said is similar to an EKG.
Patients typically undergo the test, which requires electrodes to be placed on the body, while exercising. According to Russo, it detects whether the heart's electrical system has the rough equivalent of a short circuit that could cause a heartbeat so fast that the heart can't handle it.
In the new study, Italian researchers examined what happened after 446 patients with heart failure -- defined here as moderate heart muscle damage -- were given the T-wave test. None of the patients had significant cardiovascular disease.

The findings were to be presented Sunday at the American College of Cardiology's annual meeting in New Orleans.

Researchers followed the patients for 18 to 24 months, and found that those with an abnormal T-wave test (65 percent of patients) were four times more likely to suffer from cardiac death or life-threatening disruptions in heart rhythm. The study authors suggest the other patients aren't ill enough to need implanted defibrillators.

"Knowing this, we are able to better treat the two-thirds of patients that really need the device," contributing author Dr. Gaetano De Ferrari, of the San Matteo Hospital in Pavia, Italy, said in a statement.

While there have been other studies supporting the T-wave test, cardiologists haven't embraced it, said Dr. Paul Chan, a fellow in cardiovascular medicine at the University of Michigan Medical School. According to him, some cardiologists are worried about the legal ramifications if the test suggests that someone doesn't need a defibrillator and then the patient dies.

Meanwhile, he said, "the ultimate question that hasn't been answered really well is whether or not those patients who screened as normal [would] have any benefit" from getting a defibrillator.
Cost could be another factor: T-wave machines cost about $25,000. However, implantable defibrillators are hardly cheap themselves: by one estimate, they can cost $90,000 over a lifetime.

More information
Visit the Heart Rhythm Society for more on implantable defibrillators.