Heart
Brand-Name Drugs Do Not Appear Superior to Generic Drugs for Treating Cardiovascular Diseases
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Contrary to the perception of some patients and physicians, there is no evidence that brand-name drugs are clinically superior to their generic counterparts, according to an article in the December 3 issue of JAMA, which examined studies comparing the effectiveness of generic vs. brand-name drugs for treating cardiovascular diseases.
“The problem of rising prescription drug costs has emerged as a critical policy issue, straining the budgets of patients and public/private insurers and directly contributing to adverse health outcomes by reducing adherence to important medications. The primary drivers of elevated drug costs are brand-name drugs, which are sold at high prices during a period of patent protection and market exclusivity after approval by the Food and Drug Administration (FDA),” the authors write. To control spending, many payers and clinicians have encouraged substitution of inexpensive bioequivalent generic versions of these drugs after the brand-name manufacturer’s market exclusivity period ends.
Some patients and physicians have expressed concern that generic drugs may not be equivalent in their effectiveness. “Brand-name manufacturers have suggested that generic drugs may be less effective and safe than their brand-name counterparts. Anecdotes have appeared in the lay press raising doubts about the efficacy and safety of certain generic drugs,” the authors note.
Women with Mitral Valve Prolapse Are Treated Less Aggressively than Men and May be at High Risk
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Disturbing evidence of higher mortality and lower surgery rates in women versus men with mitral valve prolapse and severe leakage may be related to the complexity of evaluating the condition’s severity in women, according to findings of a Mayo Clinic study published this month in the Annals of Internal Medicine.
Mitral valve prolapse affects approximately 150 million people worldwide and often requires cardiac surgery, preferably valve repair rather than replacement, to restore life expectancy of patients with severe leakage, says senior author Maurice Enriquez-Sarano, M.D., a cardiologist at Mayo Clinic. Cardiac valves allow the heart to move blood forward without leakage. Mitral valve prolapse occurs when the leaflets and supporting cords of the mitral valve have excessive tissue and weaken, leading to leakage (regurgitation), he says.
Previous studies on mitral valve disease have examined several sex-based differences, discovering, for example, that mitral valve prolapse is more common in women than men, and that more men than women undergo mitral valve surgery.
Treating depression seen important in heart failure
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Depression increases the risk of death in patients with heart failure, but the risk apparently disappears with antidepressant use, according to a study.
“Recent studies suggest that the use of antidepressants may be associated with increased mortality (death) in patients with cardiac disease,” Dr. Christopher M. O’Connor, of Duke University Medical Center, Durham, North Carolina, and colleagues note in the medical journal Archives of Internal Medicine.
“Because depression has also been shown to be associated with increased mortality in these patients, it remains unclear if this association is attributable to the use of antidepressants or to depression.”
Diabetic women more likely to die after heart attack
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Women younger than age 65 with diabetes tend to have worse cardiovascular risk profiles than diabetic men of the same age, leading to higher death rates following a heart attack, research shows.
“The female advantage with fewer cardiovascular events than in men at younger ages is attenuated once a woman has the diagnosis of diabetes,” Dr. Anna Norhammar and associates report.
They sought to identify gender-related differences in prognosis, risk factors, or treatment among 25,555 patients younger than age of 65 treated for heart attack between 1995 and 2002. In this cohort, 23 percent were women and 21 percent of women and 16 percent of men were previously diagnosed with diabetes.
Heart problems often worse in diabetic women
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Women younger than 65 with diabetes tend to have worse heart problems than diabetic men of the same age, leading to higher death rates following a heart attack, the results of a Swedish study indicate.
“The female advantage with fewer cardiovascular events than in men at younger ages is attenuated once a woman has the diagnosis of diabetes,” Dr. Anna Norhammar and associates write in the journal Heart. In fact, they add, “the risk is increased about twofold in men and up to four times in women.”
Their goal in the current study was to identify gender-related differences in prognosis, risk factors, or treatment among 25,555 patients younger than 65 years old who were treated between 1995 and 2002 for a heart attack.
Pregnancy study finds strong association between two antidepressants and heart anomalies
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Women who took the antidepressant fluoxetine during the first three months of pregnancy gave birth to four times as many babies with heart problems as women who did not and the levels were three times higher in women taking paroxetine.
Although some of the conditions were serious, others were not severe and resolved themselves without the need for medical intervention, according to a three-country study in the November issue of the British Journal of Clinical Pharmacology.
Researchers have advised women taking the drugs to continue unless they are advised to stop by their doctor or consultant. But they are being urged to give up smoking, as the study also found that more than ten cigarettes a day was associated with a five-fold increase in babies with major heart problems.
Hypertension Develops Early, Silently, in African-American Men
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Young and healthy African-American men have higher central blood pressure and their blood vessels are stiffer compared to their white counterparts, signs that the African American men are developing hypertension early and with little outward sign, according to a new study. While the study found that central blood pressure—the pressure in the aorta, near the heart—was higher in the African-American men, the study found no difference in brachial blood pressure—measured on the arm—between the two groups.
Taken together, the findings suggest that hypertension (high blood pressure) may be developing undetected in young African-American men and that measuring central blood pressure may be a better means of detecting the problem as it develops.
“Central blood pressure holds greater prognostic value than conventional brachial blood pressure as central pressure more aptly reflects the load encountered by the heart,” the authors explained. “Thus, brachial blood pressure may neglect important information on cardiovascular burden and response to therapy in African-American men.”
New European guidelines on heart attack management put emphasis on speed of action
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New European guidelines issued today on the management of heart attack emphasise speed of action and the importance of “reperfusion” therapy to restore blood flow to the heart and improve survival rates. “A well-functioning regional system of care… and fast transport to the most appropriate facility is key to the success of the treatment,” state the guidelines, which have been developed by a Task Force of the European Society of Cardiology (ESC).
Professor Frans Van de Werf (Leuven, Belgium), chairman of the Task Force, describes the guidelines as “important” and says their broad uptake and adoption would make a “huge difference” to heart attack survival rates.
The new guidelines cover management of a common type of classical heart attack known as STEMI (ST-segment elevation acute myocardial infarction), a reference to its appearance on an ECG. Around one-third of all acute coronary events are diagnosed as STEMI.
More US women are surviving heart attack
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While men still fare better, fewer younger women are dying in the hospital after an acute heart attack than in the recent past, U.S. researchers said on Wednesday.
Earlier studies had found women under 55 died at about twice the rate of men of the same age who had an acute heart attack.
But those differences have narrowed, falling about 80 percent in the past 10 years, said Dr. Viola Vaccarino of Emory University in Atlanta, who presented her findings at a meeting of the American Heart Association in New Orleans.
“There is still a gap, but it is closing,” Vaccarino said in a telephone interview.
Risks seen in opposite-sex heart transplants
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Men and women who get heart transplants are more likely to die when the donor was of the opposite sex, U.S. researchers said on Wednesday.
The cause is not clear but could be due to size differences in the heart—men’s tend to be larger—or certain hormonal and immunological factors, according to researchers from Johns Hopkins University in Baltimore.
Patients who got a heart transplant from a donor of the opposite sex had a 15 percent higher risk of death compared to those whose donor was the same sex, they told an American Heart Association meeting in New Orleans.
Exercise improves quality of life for heart failure patients
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Heart failure patients who regularly exercise fare better and feel better about their lives than do similar patients who do not work out on a regular basis, say researchers at Duke University Medical Center.
The findings, reported today at the annual meeting of the American Heart Association’s Scientific Sessions 2008, go a long way toward addressing concerns about the value of exercise for the nation’s five million patients with heart failure. They also raise important policy questions for the country’s Medicare program and other insurers.
“Past studies have sent mixed signals about the merit of exercise for patients with heart failure. The HF-ACTION study (A Controlled Trial Investigating Outcomes Exercise TraiNing) shows that exercise is not only safe for patients, but also helps to improve the quality of their lives, overall,” says Kathryn Flynn, PhD, a health services researcher at Duke Clinical Research Institute (DCRI) and lead author of the study.
HF-ACTION is the largest clinical trial to date examining the value of exercise in the treatment of heart failure. Investigators enrolled 2331 patients with moderate to severe heart failure at 82 sites throughout the U.S., Canada and France from 2003 to 2008.
Researchers present new theory that may lead to effective heart failure treatments
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Do the biological underpinnings of heart failure share more in common with cancerous tumors than other cardiovascular diseases?
Research presented at American Heart Association meeting may show why heart failure treatments fail
A team of Medical University of South Carolina (MUSC) researchers and cardiologists are presenting a number of studies at the American Heart Association conference that point toward new treatments for heart failure patients.
According to the American Heart Association, more than 5 million Americans are living with heart failure, and 550,000 new cases are diagnosed each year. It is a chronic disease that has no cure and typically worsens rapidly.
Obese kids’ artery plaque similar to middle-aged adults
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The neck arteries of obese children and teens look more like those of 45-year-olds, according to research presented at the American Heart Association’s Scientific Sessions 2008.
“There’s a saying that ‘you’re as old as your arteries,’ meaning that the state of your arteries is more important than your actual age in the evolution of heart disease and stroke,” said Geetha Raghuveer, M.D., M.P.H., associate professor of pediatrics at the University of Missouri Kansas City School of Medicine and cardiologist at Children’s Mercy Hospital. “We found that the state of the arteries in these children is more typical of a 45-year-old than of someone their own age.”
Researchers used ultrasound to measure the thickness of the inner walls of the neck (carotid) arteries that supply blood to the brain. Increasing carotid artery intima-media thickness (CIMT) indicates the fatty buildup of plaque within arteries feeding the heart muscle and the brain, which can lead to heart attack or stroke.
Exercise is safe, improves outcomes for patients with heart failure
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Working out on a stationary bicycle or walking on a treadmill just 25 to 30 minutes most days of the week is enough to modestly lower risk of hospitalization or death for patients with heart failure, say researchers from Duke Clinical Research Institute (DCRI).
The findings stem from the HF-ACTION trial (A Controlled Trial Investigating Outcomes Exercise TraiNing), the most comprehensive study to date examining the effects of exercise upon patients with heart failure. The study was reported today as a late-breaking clinical trial at the American Heart Association’s Scientific Sessions 2008 by Christopher O’Connor M.D., director of the Duke Heart Center and principal investigator of the trial, and David Whellan, M.D., of Thomas Jefferson University, co-principal investigator.
HF-ACTION enrolled 2331 patients at 82 study sites throughout the U.S., Canada and France. Patients were randomized into a group that received usual care or to a group that received usual care plus an exercise training program that began under supervision but then transitioned to home-based, self-monitored workouts.
Clinical Guideline on Prevention of Cardiovascular Disease and Diabetes in Patients at Highest Risk
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Clinical Guideline on Prevention of Cardiovascular Disease and Diabetes in Patients at Highest Risk Released
The Endocrine Society has released a new clinical practice guideline for the primary prevention of cardiovascular disease and type 2 diabetes in patients at metabolic risk. The guideline appears in the Journal of Clinical Endocrinology & Metabolism (JCEM), a publication of The Endocrine Society.
There is growing evidence that many patients who develop cardiovascular disease or diabetes have a pre-existing metabolic risk. This risk includes conditions such as enlarged waist circumference, hypertension, and elevated plasma glucose levels. The presence of three of more such conditions should alert a clinician to a patient at metabolic risk, said Dr. James Rosenzweig, director of diabetes services in the Section of Endocrinology, Diabetes and Nutrition at Boston Medical Center, and chair of the task force that developed this guideline.
“The dramatic increase in the incidence of patients at risk for cardiovascular disease and diabetes throughout the developed and developing world requires physicians and other care providers to be aware of the risk factors for these conditions and identify patients at risk in order to initiate treatment,” said Dr. Rosenzweig. “This guideline was developed for just this purpose.”
