Diabetes drug linked to higher heart attack risk

Avandia and competitor drug, Actos, are commonly used diabetes drugs. Avandia has been found having harmful effects since 2007 while Actos seems safer apparently.

2 studies published last week reported serious health warnings. One study, published in June 28 issue of JAMA, reviewed the data of 227,000 patients takng either Avandia or Actos, found that Avandia increased the risk of heart attack, stroke or death by 17%.

The second study, published in the Archive of Internal Medicine, analysed 56 clinical trials involving 35,000 patients confirmed these findings. The reserachers questioned why Avandia is still available on the market and why physicians would prescribe it to diabetics when there are other drugs without these side effects. They called for Avandia to be withdrawn from the market.

However, some doctors said that the evidence is inconclusive.

Source:
1). David Juurlink. "Rosiglitazone and the Case for Safety Over Certainty". JAMA. 2010;304(4):(doi:10.1001/jama.2010.954). free f/t

2). Steven Nissen; Kathy Wolski. "An Updated Meta-analysis of Risk for Myocardial Infarction and Cardiovascular Mortality". Arch Intern Med. 2010;170(14), free f/t

Higher heart attack risk in men with vitamin D deficiency

News source reported that researchers at Harvard analyzed medical records and blood samples from 454 men who had a heart attack or disease and compared them to 900 men who had no history of cardiovascular disease.

They found that men with a vitamin D deficiency (15 nanograms or less per ml of blood) had a higher risk of heart attack than those with a sufficient amount of vitamin D (30 nanograms per ml of blood or more). They concluded "the results further support an important role for vitamin D in myocardial infarction risk"

Source :"25-Hydroxyvitamin D and Risk of Myocardial Infarction in Men - A Prospective Study"
Archieve of Internal Medicine. 2008;168(11):1174-1180.

Red yeast rice extract may be good for the heart

Newspapers reported that a large randomised placebo-controlled trial of 5000 patients showed that the extract of Chinese red yeast rice, XZK, that gives Peking duck its red colour, reduces bad cholesterol that subsequently lowers cardiovascular events in Chinese people who have already experienced a heart attack.

Critics say that although the study provides good evidence of the beneficial effect of the extract, the finding is not surprising because one of the cholesterol-lowering drugs, lovastatin, was originally extracted from yeast rice. They also say that people who are concerned about their risk of heart attack or their cholesterol levels should talk to their GP, who may prescribe them a statin.

Source: "Effect of Xuezhikang, an Extract From Red Yeast Chinese Rice, on Coronary Events in a Chinese Population With Previous Myocardial Infarction." American J of Cardiology 2008; Apr 11 [Epub ahead of print]

Vacuum out blood clots helps heart patients

A Dutch trial enrolled more than 1000 patients with major heart attack and needed emergency angioplasty and assigned them to either conventional PCI ( percutaneous coronary intervention) or thrombus aspiration ( suctioning out the clot ). They found that suctioning out blood clots in blocked arteries could improve blood flow and clinical outcomes in heart attack patients.

An expert said the findings showed what other trials have shown and there were weaknesses in the study. The trial was published in the New England J of Medicine(NEJM).

Source: "Thrombus Aspiration during Primary Percutaneous Coronary Intervention" NEJM 358(6):557-567 ( free full text)

Aspirin resistant may increase heart attack risk

Aspirin is widely used to prevent heart attacks, strokes and blood clot, but the Telegraph reported that a review of 20 studies involving 3000 patients has found 28% do not respond to aspirin and there is no standard test to establish who are resistant to the drug.



The author concluded that "patients who are resistant to aspirin are at a greater risk of clinically important cardiovascular morbidity long term than patients who are sensitive to aspirin" and called for further research. The report was published in the BMJ.



Source: Aspirin "resistance" and risk of cardiovascular morbidity: systematic review and meta-analysis BMJ, doi:10.1136/bmj.39430.529549.BE (published 17 January 2008)

Calcium supplements may increase heart attack risk

The Telegraph reported researchers in New Zealand found that calcium supplements may increase the risk of heart attack in healthy postmenopausal women.

1,471 postmenopausal women of average age 74 were randomly assigned to receive calcium supplement or placebo, followed for 5 years, researchers found heart attacks were more common in the women taking the calcium supplements. The report was published in the BMJ Online, the authors said the results are not conclusive but suggest that high calcium intakes might have an adverse effect on vascular health. Some experts in the field found the conclusion surprising and urged patients not to stop taking the supplements.

Source: "Vascular events in healthy older women receiving calcium supplementation: randomised controlled trial." BMJ 2008:394405257 published online, 15 January 2008 ( full text via Athens)

Aspirin - men's drug?

Aspirin has been linked to many health benefits, but a study which analysed 23 previously published clinical trials for the effect of aspirin in heart attack prevention, involving more than 113,000 patients found that women may be less responsive to aspirin than men for heart protection.


The researchers believe that gender may be one of the main influences on aspirin's protective powers. One UK expert said the finding is "potentially misleading" and that "taking aspirin in the months and years after a heart attack delivered equal benefits to men and women".


Source: "The influence of gender on the effects of aspirin in preventing myocardial infarction"
BMC Medicine 2007, 5:29 ( This is an open access journal article with full text )

Extended benefits of statin therapy

A 15-year Glasgow study showed that patients who had been taking pravastatin for 5 years were still experiencing the benefits 10 years after they stopped taking the drug, with a significant reduced risk of heart attacks and other coronary events.


The extended benefits may be due to the lowering LDL cholesterol by early statin therapy and stabilizing existing plague therefore slowing the progress of coronary heart disease.


Source : "Long-Term Follow-up of the West of Scotland Coronary Prevention Study". NEJM 2007; 357(15):1477-1486 (October 11)

Stressful jobs increase risks of heart disease recurrence

Did you know that job stress was a major predictor of repeated heart attack when compared with other risk afctors such as smoking, alcohol consumption, and high blood pressure?

Previous studies have shown that job strain increases the risk of a first coronary heart disease (CHD) event. According to a new Canadian study of about 980 patients who returned to work after a heart attack, chronic job strain after a first MI was associated with an increased risk of recurrent CHD.

The author said preventive interventions should also take into account the person's work environment and "cardiologists and occupational health services be informed of this finding in order to reduce stressful work for those returning to work after a heart attack".

The ABC News said that workers should learn to manage stress at work to either change their thoughts or to change the situation.

Source: "Job Strain and Risk of Acute Recurrent Coronary Heart Disease Events" JAMA. 2007;298(14):1652-1660

Heart patients unclear when to dial 999

A study shows that many heart patients are not able to tell the difference between angina pain and a heart attack and tend to delay in calling an ambulance when experience chest pain.


In a BMJ "Editorial : Advising patients on dealing with acute chest pain", 335;3-4 ( 6 July 2007), heart experts warn that high-risk patients with heart disease are confused by the varying advice given by different sources on how to use the GTN sprays to relieve their symptoms and when they should call an ambulance. Some high-risk patients may be waiting too long before seeking help as one research showed the average time from onset of symptoms to cardiac rest is 10 minutes.


The authors recommend that high-risk patients need clear guidance on how to distinguish between the symptoms of chest pain and heart attack and wait 5 minutes before calling an ambulance.

Racial differences in care after heart attack

A large study published in the June 13 issue of JAMA has found that black Medicare patients are less likely than white patients to receive blood vessel opening procedures following a heart attack, whether they are admitted to hospitals that provide or do not provide these procedures, but also have higher mortality rates after 1 year.

The authors suggest that "efforts to standardize post-AMI treatment with evidence-based protocols and aggressive risk-factor management are essential to eliminating racial differences in care for AMI and other coronary syndromes."

Read the press release "Black patients less likely to receive certain coronary procedures following heart attack and have higher mortality rates one year later"