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MONDAY, Oct. 9 (HealthDay News) -- A two-drug treatment has healed heart muscle in animals after stimulated heart attacks, researchers report.

One drug blocks an enzyme that normally suppresses reproduction of heart cells, while the other encourages the growth of blood vessels, according to a study by researchers at Children's Hospital Boston, a Harvard facility.

But human trials of the treatment can't be expected in the immediate future, said study author Felix Engel, an instructor in pediatrics at the hospital, since work is still on the most basic level.

"I'm interested in the molecular mechanisms, how these drugs work," Engel said. "I'm trying to find other drugs, more efficient drugs, and to develop other therapies that would be capable of acting in humans."

Still, the study does show that it's possible to rescue heart muscle, something that does not occur naturally after a heart attack. Normally, the damaged heart muscle is replaced by scar tissue, which can impair the heart's pumping capacity and lead to life-threatening abnormal heart rhythms.

The findings will be published in next week's issue of the Proceedings of the National Academy of Sciences, and will be available online this week.

A first step in the new research -- a demonstration that heart cells could multiply in a petri dish if a drug blocked an enzyme designated p38 MAP kinase -- was reported last year by Engel and Dr. Mark Keating, who worked on the current experiment but has since left Children's Hospital.

The new trial added a molecule designated FGF1, which stimulates growth of blood vessels, to the treatment given to some of the 120 rats with stimulated heart attacks. Three months later, echocardiograms showed markedly improved heart function in rats who received both drugs. Muscle scarring was minimized, and blood-pumping ability was close to normal. Rats receiving a single drug showed lesser improvement.

One important step now is to develop a method of delivering the treatment to the proper location in the body, Engel said. FGF1 has the potential for serious side effects if it goes to places other than the heart, and the p38 MAP kinase inhibitor has been shown to damage the liver.

"I am working on delivery by using a kind of gel," Engel said. "We can mix the drug with nanofibers. It is a liquid when injected into the heart and then becomes a gel, diffusing over time."

An assessment of the therapy by Dr. Richard T. Lee, an associate professor of medicine at Brigham and Women's Hospital in Boston who did the actual work with the animals, was guardedly enthusiastic.

"There clearly was an effect," Lee said. "The kind of study we did can't prove exactly why there was an effect, but there certainly was a benefit on how the heart performs. It's a long way from doing an experiment to developing something for human use. But the field is young, so we are excited about things that look like they benefit long-term heart function."

What happens now, Lee said, "depends on people in industry and people in the academic world."

More information

Current treatments for a heart attack are described by the National Library of Medicine.

WEDNESDAY, Oct. 11 (HealthDay News) -- The drug nicardipine is effective in reversing a potentially deadly problem that occurs in some patients who have angioplasty, say researchers at Thomas Jefferson University in Philadelphia.

Angioplasty is a procedure to clear arteries that have been clogged or narrowed by plaque. Each year in the United States, about 50,000 patients experience a condition called "no-reflow," after having a successful angioplasty.

In cases of no-reflow, it appears that the obstruction in an artery has been cleared and the artery is open, but there is no blood flow to the heart muscle. No-reflow occurs when plaque that's been dislodged during angioplasty releases chemicals that affect the small blood vessels in the artery, which causes the artery to spasm and prevents blood flow to the heart.

"No-reflow can be a potentially serious complication that places patients at high risk of heart attack or even death," Dr. Michael Savage, director of the catheterization laboratory and associate professor of medicine at Jefferson Medical College, said in a prepared statement.

This study looked at 72 angioplasty patients who developed no-flow and were treated with the calcium channel blocker nicardipine. In 71 of the 72 patients (98 percent), the no-flow problem was reversed. The treatment was well-tolerated, and none of the patients experienced low blood pressure, heart block, or required a temporary pacemaker.

The findings were expected to be published in the November issue of the journal Catheterization and Cardiovascular Interventions.

More information

The U.S. National Heart, Lung, and Blood Institute has more about angioplasty.

TUESDAY, Oct. 10 (HealthDay News) -- Psoriasis sufferers may face an increased risk of having a heart attack, a new study suggests.

The risk appears to be most pronounced among younger patients with more severe forms of the disease, according to a paper appearing in the Oct. 11 issue of the Journal of the American Medical Association.

"This study is really quite important," said Liz Horn, director of research for the National Psoriasis Foundation. "There have been a few other studies, but this one is important because it uses such a large database. This is just one more very important study that gives more evidence."

While more studies are needed to confirm the findings, "the potential is there for someone who has severe psoriasis who is in their 50s or 40s, of having a heart attack," said lead researcher Dr. Joel Gelfand, an assistant professor of dermatology at the University of Pennsylvania School of Medicine, in Philadelphia.

"The relative risk due to severe psoriasis is similar to the relative risk of having a heart attack from having diabetes," he said. "But the absolute risk [to any one person] is low. If you have severe psoriasis and are in your 40s, the risk of having a heart attack due to psoriasis is about one in 600 per year."

Psoriasis is thought to be an autoimmune disorder, occurring when the body inexplicably begins overproducing skin cells. The extra cells pile up on the surface of the skin before they have a chance to mature, creating bright red patches that cause itching, burning and stinging. The disease affects 2 percent to 3 percent of the adult population.

Some previous studies had shown an association between psoriasis and cardiovascular diseases but those studies could not rule out obesity, smoking and other risk factors as the true culprits.

In this study, the authors examined medical records from a large sample of patients aged 20 to 90 in the United Kingdom. The sample included more than half a million controls (people without psoriasis), more than 125,000 patients with mild psoriasis and almost 4,000 with severe psoriasis.

Heart attacks were more common in patients with severe psoriasis (five heart attacks per 1,000 person-years) and mild psoriasis (four heart attacks per 1,000 person-years) compared with the controls (about 3.6 heart attacks per 1,000 person-years).

Individuals who were younger and had more severe disease had the highest relative risk, with a 30-year-old patient with mild disease having a 29 percent greater risk than a person without psoriasis. A 30-year-old patient with severe psoriasis had about triple the risk and a 60-year-old patient with severe disease had a 36 percent increased risk.

It is thought that earlier-onset psoriasis (before age 40) is more severe than later-onset disease (after age 40). About three-quarters of patients will develop psoriasis before they turn 40.

"People with psoriasis have a bigger tendency to smoke, be obese, have high blood pressure and other things we know are risk factors for cardiovascular disease," Gelfand said. "The thing we've done, which hadn't been done before for psoriasis, was to control for these risk factors. We found that psoriasis still increases the risk of having a heart attack."

The common denominator may be inflammation, the researchers said.

"Immune activity is important for establishing atherosclerosis or blockage of the arteries and promoting them to rupture into a heart attack," Gelfand explained. "The same immune cells involved in this are involved in psoriasis. Other diseases, like rheumatoid arthritis -- which share common immune factors -- [also] have an increased risk of heart disease. This is a scientific theory that has been evolving over the last decade or so but still needs additional studies to confirm."

In the meantime, patients with psoriasis should not be alarmed but should see a physician and be screened for cardiovascular risk factors, Gelfand said. And, if you do have risk factors, you should treat them according to current guidelines. This includes stopping smoking and losing excess weight.

"There needs to start being a conversation between patients and physicians about the risk of cardiovascular disease and what psoriasis patients should be doing to decrease risks," Horn said.

"This is really important information," she said. "But it's still very early in understanding what all this means. I do think general health issues about cardiovascular disease and lifestyle modification is probably a good starting place."

"This study is of great concern and it underscores why we believe the National Institutes of Health should be increasing research on psoriasis," Michael Paranzino, president of Psoriasis Cure Now, said in a staement. "Unlocking the apparent link between psoriasis and heart attack risk may help us improve treatments both for psoriasis and heart attack prevention. The 'heartbreak of psoriasis' is supposed to be a tired punch line, not a literal truth."

"This study suggests that estimates of the impact of psoriasis, both in terms of dollars spent and lives lost, may be undercounting the true burden of this disease," Paranzino added. "With NIH funding having doubled over the last decade but psoriasis funding down 20 percent, this study should serve as a wake-up call that increasing psoriasis research funding should become a national priority. One of the key questions that patients need answered is whether aggressive treatment of psoriasis can reduce this increased heart attack risk."

More information

There's more on psoriasis at the National Psoriasis Foundation  .

WEDNESDAY, Oct. 4 (HealthDay News) -- A new Italian study appears to pick a winner from two widely used, expensive drug-coated stents that are used to prop open ailing arteries.

Researchers conclude that Cypher, a wire-mesh stent coated with sirolimus, made by Cordis Inc., is better for patients than a competing stent, Taxus, made by Boston Scientific and coated with another drug, paclitaxel.

The team reported their findings in the October issue of the Journal of the American College of Cardiology.

However, some cardiologists said the finding is less than definitive, adding that the short (one-year) length of the trial doesn't even prove that coated stents are superior to cheaper bare-metal stents.

The real problem is that cardiologists who use stents are reporting an unexpectedly high rate of artery re-closure over time, said Dr. Steven Nissen, chairman of the department of cardiovascular medicine at the Cleveland Clinic and chairman of the American College of Cardiology.

"We need more data on long-term outcome," he said. "I'm calling for a study with a four- or five-year follow-up."

Dr. Bradley H. Strauss, director of interventional cardiology at St. Michael's Hospital in Toronto, wrote an accompanying editorial on the finding. He expressed some confidence that the Cypher stent is, indeed, slightly superior to the Taxus model.

But Strauss also agreed with Nissen that longer, controlled trials are needed, adding that "there still is some basis on which one could say that it is absolutely not clear which [stent] is better."

Another expert, Dr. Sidney Smith, a professor of medicine at the University of North Carolina, concurred that more study is necessary to settle the issue. "What is really needed is a head-to-head study that is randomized. Another thing I'd like to see is follow-up beyond one year," he said.

Surgeons use tiny wire-mesh tubes called stents to help prop open narrowed arteries after angioplasty, an artery-clearing procedure. However, over a period of months or years, patients are often threatened by a process called restenosis -- a re-narrowing of the artery around the stent.

Drug-eluting stents, which cost about $2,000 each, are impregnated with specific medicines that may help prevent this process.

Since their introduction in the late 1990s, the two leading drug-eluting stents -- Cypher and Taxus -- have battled it out in various efficacy trials. Two recent studies, published in September in the New England Journal of Medicine, failed to find a clear-cut winner, although researchers gave a slight edge to the Cypher device.

In this study, cardiologists working at a number of Italian medical centers performed a head-to-head study of the two stents. A total of 1,676 patients received the devices after angioplasty.

The team found that the incidence of major cardiac adverse events in the following year was 9.2 percent for the sirolimus stent and 14.1 percent for the paclitaxel stent.

But Nissen said the study had its flaws.

"First, this is an observational study. The reasons why physicians used one stent over another weren't factored in," he noted. "Some physicians might have a preference for one over the other."

More important, Nissen said, is that the numbers were driven by "soft" endpoints, relatively minor health woes, rather than by significant cardiac events that would be of most concern to patients. "If you read the table, you see that most of the really hard endpoints, such as myocardial infarction [heart attack], don't reach statistical significance," he said.

Finally, the average follow-up per patient was just 290 days, a relatively short period. "We've just heard about problems with these devices in the second and third year," Nissen said. "Something that is superior in the short run might not be superior in the long term."

The only way to determine which stent is best is a longer, large-scale study in which all factors are carefully controlled, Nissen said.

According to Nissen, drug-coated stents remain the device of choice for U.S. cardiologists, holding a 90 percent market share even though they cost substantially more than bare-metal stents. There has been an indication of a slight decline in their use recently, however. In Europe, drug-coated stents have about 50 percent of the market, Nissen noted.

For his part, Strauss said he is "trying to come to a decision" about whether the differences between the two stents seen in the study are "clinically relevant." He believes the difference -- which favors the Cypher stent -- may be relevant, based not only on this study but on previous trials that gave a slight edge to the sirolimus-coated stent.

The difference is most important in smaller arteries, Strauss said, where even a slight blockage can have an important effect, Strauss said. "The difference is enough for me now in smaller vessels to have me shift to the Cypher stent," he said.

However, in his editorial, Strauss added that "there still is need for corroborative support from prospective, randomized multi-center studies or other large single-center experiences" before one stent can be definitively preferred over the other.

For his part, Smith said it was impressive that the study included patients with different problems, such as blockages of smaller blood vessels. But he added that "it's hard to draw conclusions from a registry like this. It certainly is hypothesis-generating, but until a randomized clinical trial is done it will remain in the realm of interesting observations."

Smith is chairman of the American Heart Association/American College of Cardiology Task Force on Practice Guidelines, which may ultimately issue a judgment on which stent is best.

More information

Find out more about drug-eluting stents from the U.S. Food and Drug Administration.