Heart Disease Associated with Diabetes, Shorter Life Span

06/13/07 Information for Caregivers, Prevention, Research, General

CHICAGO — People living with diabetes face double the risk of cardiovascular disease, a study reported in the June 11 issue of Archives of Internal Medicine.

The study concluded that men and women with diabetes at age 50 and older appear not to live as long overall. Furthermore, statistics suggest they do not live as many years without cardiovascular disease, than individuals without diabetes. In fact, the face double the risk of the disease.

"Having diabetes at age 50 years and older represents not only a significant increase in the risk of developing cardiovascular disease and mortality but also an important decrease in life expectancy and life expectancy free of cardiovascular disease," the authors write. "Prevention of diabetes is a fundamental task facing today's society, with the aim to achieve populations living longer and healthier lives," they conclude.

Oscar H. Franco, M.D., D.Sc., Ph.D., of University Medical Center Rotterdam, the Netherlands, and Unilever Corporate Research, Sharnbrook, England, and colleagues used data from the Framingham Heart Study, a group of 5,209 men and women age 28 to 62 years recruited between 1948 and 1951 and followed for more than 46 years. The researchers selected three follow-up periods of 12 years each that began in 1956 to 1958, 1969 to 1973, and 1985 to 1989. Participants were followed during each of the three periods until they developed cardiovascular disease or died, and their diabetes status was measured again at the beginning of each interval.

Source: Arch Intern Med. 2007;167:1145-1151.

Black Patients Less Likely To Receive Certain Coronary Procedures Following Heart Attack

06/13/07 Information for Caregivers, Treatment Options, Research, General

CHICAGO - Black Medicare patients are less likely than white patients to receive blood vessel opening procedures following a heart attack, and experience higher mortality rates at one year, according to a study in the June 13 issue of JAMA.

Racial differences in care after acute myocardial infarction, or heart attack, appear most marked for the use of invasive and costly technologies, such as coronary revascularization (restoration of adequate blood supply to the heart, such as with a bypass or angioplasty procedure). Few studies have examined patterns of care for heart attack patients admitted to hospitals with and without revascularization services.

"… the current study provides evidence that racial differences in the use of revascularization after heart attack are of similar magnitude for patients admitted to hospitals with and without full revascularization capability and persist even for patients transferred from hospitals without full invasive cardiac services to hospitals providing these services," wrote the authors.

The researchers found that black patients admitted to hospitals without revascularization services were less likely to be transferred to a hospital with revascularization services within two days (7.4 percent vs. 11.5 percent) and within 30 days (25.2 percent vs. 31.0 percent) of admission. The likelihood of transfer for black patients admitted to hospitals without revascularization was 22 percent lower compared with that of white patients.

Black patients admitted to hospitals with or without revascularization services were about 30 percent less likely to undergo revascularization than white patients (34.3 percent vs. 50.2 percent and 18.3 percent vs. 25.9 percent). Even among patients who were transferred to hospitals with revascularization services, blacks remained 23 percent less likely to undergo revascularization after adjusting for other clinical factors that may influence the use of revascularization.

While the adjusted risk of death was 9 percent lower for blacks during the first 30 days after admission to hospitals with revascularization and 10 percent lower in hospitals without revascularization, risks were higher thereafter. Between 30 days and one year after their initial admission, blacks had a 12 to 26 percent higher adjusted risk of death.

"These differences could be due to unmeasured clinical or socioeconomic factors, patient preferences, or unmeasured aspects of medical decision making but are unlikely to be related to differences in access to hospitals performing revascularization procedures," the authors wrote.

Ioana Popescu, M.D., M.P.H., of the VA Medical Center and the University of Iowa Carver College of Medicine, Iowa City, and colleagues assessed racial differences in patterns of care and risk of death for heart attack patients who were admitted to hospitals with and without revascularization services. The study included 1,215,924 black and white Medicare beneficiaries age 68 years and older, admitted for a heart attack between January 2000 and June 2005 to 4,627 U.S. hospitals with and without revascularization services.

NASA Technology Helps Detect and Treat Heart Disease and Strokes

06/06/07 Information for Caregivers, Diagnosis, Prevention, Research, General

PASADENA, Calif., June 6 /PRNewswire-USNewswire/ -- NASA space technology is helping doctors diagnose and monitor treatments for hardening of the arteries in its early stages, before it causes heart attacks and strokes.

Hospitals and doctors around the country are using ArterioVision software initially developed at NASA's Jet Propulsion Laboratory (JPL), Pasadena, Calif., along with a standardized, painless, non-invasive ultrasound examination of the carotid artery, which carries blood from the heart to the brain.

A standard carotid ultrasound measures plaque and blood flow within the artery. When an ultrasound is used with the software, the test measures the thickness of the inner two layers of the carotid artery -- the intima and media. Medical Technologies International, Inc. (MTI) of Palm Desert, Calif., patented the ArterioVision software.

Arterial thickening provides the earliest evidence of atherosclerosis, or hardening of the arteries, the beginning stage of a disease process that leads to heart disease and stroke. Doctors can use this carotid intima media thickness (CIMT) measurement to calculate the age of the patient's arteries, which does not always match the patient's calendar age.

"You may look and feel one way on the outside, but your arteries actually could be much older than one realizes," said Dr. Howard N. Hodis of the Keck School of Medicine at the University of Southern California, Los Angeles. "Once patients see how thick their arteries are, there is much more incentive for them to change their lifestyle with dietary modification and exercise," he said. "Physicians also can use the test to monitor and change current medications."

The U.S. Food and Drug Administration has approved the new diagnostic tool, called the ArterioVision CIMT procedure. Robert Selzer, MTI chief engineer, worked in JPL's Image Processing Laboratory for 15 years, where the technology was developed that ultimately led to the software used in ArterioVision.

"This is such a precise method of examining the carotid artery. It can distinguish between 256 shades of gray at a subpixel level," Selzer said. "You need that kind of detail to help catch heart disease as early as you can, often before there are any outward symptoms."

During the test, a patient lies on an examination table while a technician applies gel to the neck to image the carotid arteries, located on both sides of the neck near the skin's surface. The technician uses an ultrasound machine while following a patented protocol to capture specific images of the carotid artery wall. Using the ArterioVision software, the physician generates a CIMT measurement and a report that identifies the patient's risk profile when compared to people of the same gender and age.

"It is exciting to see this NASA-funded technology grow in sophistication over the years and help in the battle against one of the nation's leading health issues," said Ken Wolfenbarger, Innovative Partnerships Program manager at JPL. The American Heart Association says heart disease is the leading cause of death in the United States, while strokes are third, behind all forms of cancer.

Gary F. Thompson, chairman and chief executive officer of MTI, says the test is near and dear to his heart -- literally and figuratively. "I was the first male in my family to reach 50, so I decided to celebrate by running the Los Angeles marathon, but I had a heart attack halfway through it and couldn't finish," Thompson said. "None of the non-invasive tests that I had prior to the marathon detected my silent heart disease, and I knew there had to be something better out there."

The California Institute of Technology, Pasadena, which manages JPL for NASA, licensed the ArterioVision device to MTI. For more information about ArterioVision, visit: http://www.i-mti.com.

Study Finds Cardiovascular Patients Lag in their Treatments

06/04/07 General, Research, Treatment Options, Information for Caregivers

A study has found a startling trend among cardiovascular disease sufferers in Australia: many patients stop taking their medication after the first six to 24 months of starting treatment.

According to the study "Medicines for cardiovascular health: are they used appropriately?" conducted by The Australian Institute of Health and Welfare, 10 to 25 percent of patients abandoned their medication six months after starting cardiovascular treatment regimen. A year and a half later, the number of patients no longer taking their medication increased dramatically. At 24 months, 21 to 47 percent of patients had stopped prescribed treatment.

"This may represent a significant lost opportunity to prevent cardiovascular disease or delay its progression and complications, with medicines known to be effective," said Susana Senes, a member of the institute's cardiovasclar disease and diabetes unit, in a news release.

When patients are noncompliant, in other words, when they disregard the advice or instructions of their health care providers, proven treatments become ineffective. Noncompliance is especially concerning in cases of cardiovascular disease since medications used to treat or prevent the condition are prescribed for long-term or extended use.

With some conditions, such as high blood pressure and high cholesterol, patients stop taking their medicine because they show no symptoms. Some patients do not understand their condition fully or may not believe they are benefitting from the treatment. Other patients stop taking their medication because of inadequate follow-up planning, or poor communication with their health professional.

Luckily, those obstacles can be easily avoided. Patients can consult with their doctors about their condition and treatment, and ask questions so they understand the long-term plan for cardiovascular disease treatment and prevention, and stay on track.

The study also found that Australian doctors are doing more to utilize existing treatments. The number of prescriptions of cholesterol-lowering agents, some blood pressure-lowering medicines, clot preventing medicines, and beta-blocking agents used to combat heart failure for cardiovascular patients has steadily increased since 2000.