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Monday, April 30, 2012


The Los Angeles Times (11/14, Roan) "Booster Shots" blog reports, "Two or more sugar-sweetened drinks a day have been associated with a larger waist and a higher risk of heart disease in adult women, according to research released" at an American Heart Association meeting. Researchers found that "women ages 45 to 84 who drank at least two sugar-sweetened drinks a day -- such as soda or flavored waters with added sugar -- were nearly four times as likely to develop high triglycerides as women who drank one or fewer of those beverages."

HealthDay (11/14, Mann) reports, "What's more, women who drank two or more sodas a day also had more belly fat, but not necessarily more weight."

POSTED BY: Steven Almany M.D.

Friday, April 27, 2012


MedPage Today (3/3, Bankhead) reported, "Several biomarkers predicted the severity of acute kidney injury (AKI) after cardiac surgery more quickly than did serum creatinine," according to a study published online March 1 in the Journal of the American Society of Nephrology. "Elevated levels of urinary and plasma neutrophil gelatinase-associated lipocalin (NGAL) -- a biomarker of structural renal tubular injury -- conferred more than a seven-fold likelihood of severe injury after heart surgery," the study found. What's more, "patients with high levels of interleukin-18 or an elevated urinary albumin-to-creatinine ratio (ACR) were three times more likely to have severe injury than patients who had low levels of the biomarkers," researchers reported.

POSTED BY: Steven Almany M.D.

Tuesday, April 24, 2012


The FDA today added "important safety changes" to the labeling for some widely used statins.

These products, when used with diet and exercise, help to lower a person’s low-density lipoprotein cholesterol. The products include: atorvastatin (Lipitor, Pfizer), fluvastatin (Lescol, Novartis), lovastatin (Mevacor, Merck), lovastatin extended-release (Altoprev, Shionogi), pitavastatin (Livalo, Kowa/Eli Lilly), pravastatin (Pravachol, Bristol-Myers Squibb), rosuvastatin (Crestor, AstraZeneca) and simvastatin (Zocor, Merck). Combination products include: lovastatin/niacin extended-release (Advicor, Abbott Laboratories), simvastatin/niacin extended-release (Simcor, Abbott Laboratories) and simvastatin/ezetimibe (Vytorin, Merck/Schering-Plough Pharmaceuticals).

“We want healthcare professionals and patients to have the most current information on the risks of statins, but also to assure them that these medications continue to provide an important health benefit of lowering cholesterol,” said Mary H. Parks, MD, director for the division of metabolism and endocrinology products in the Office of Drug Evaluation II in FDA’s Center for Drug Evaluation and Research.

The FDA put forth the following changes to statin labels:
  • The drug labels have been revised to remove the need for routine periodic monitoring of liver enzymes in patients taking statins. The agency now recommends that liver enzyme tests should be performed before starting statin therapy, and as clinically indicated thereafter. The FDA has concluded that serious liver injury with statins is rare and unpredictable in individual patients, and that routine periodic monitoring of liver enzymes does not appear to be effective in detecting or preventing this rare side effect. Patients should notify their healthcare professional immediately if they have the following symptoms of liver problems: unusual fatigue or weakness; loss of appetite; upper belly pain; dark-colored urine; yellowing of the skin or the whites of the eyes. 
  • Certain cognitive effects have been reported with statin use. Statin labels will now include information about some patients experiencing memory loss and confusion. These reports generally have not been serious and the patients’ symptoms were reversed by stopping the statin. However, patients should still alert their health care professional if these symptoms occur. 
  • Increases in hyperglycemia have been reported with statin use. The FDA is aware of studies showing that patients being treated with statins may have a small increased risk of increased blood sugar levels and of being diagnosed with type 2 diabetes mellitus. The labels will now warn healthcare professionals and patients of this potential risk. 
  • Healthcare professionals should take note of the new recommendations in the lovastatin label. Some medicines may interact with lovastatin, increasing the risk for muscle injury (myopathy/rhabdomyolysis). For example, certain medicines should never be taken (are contraindicated) with lovastatin including drugs used to treat HIV (protease inhibitors) and drugs used to treat certain bacterial and fungal infections.

Reporting side effects to the FDA is important, according to the agency. Healthcare professionals and patients should report any side effects associated with statin use to FDA MedWatch program.


Friday, April 20, 2012


Stress: It can propel you into "the zone," spurring peak performance and well-being. Too much of it, though, strains your heart, robs you of memory and mental clarity and raises your risk of chronic disease.

How do you get the benefits—and avoid the harmful effects?

By learning to identify and manage individual reactions to stress, people can develop healthier outlooks as well as improve performance on cognitive tests, at work and in athletics, researchers and psychologists say.

The body has a standard reaction when it faces a task where performance really matters to goals or well-being: The sympathetic nervous system and the hypothalamus, pituitary and adrenal glands pump stress hormones, adrenaline and cortisol, into the bloodstream. Heartbeat and breathing speed up, and muscles tense.

What happens next is what divides healthy stress from harmful stress. People experiencing beneficial or "adaptive" stress feel pumped. The blood vessels dilate, increasing blood flow to help the brain, muscles and limbs meet a challenge, similar to the effects of aerobic exercise, according to research by Wendy Mendes, an associate professor in the department of psychiatry at the University of California, San Francisco, and others.

The body tends to respond differently under harmful or threatening stress. The blood vessels constrict, and "you may feel a little dizzy as your blood pressure rises," says Christopher Edwards, director of the behavioral chronic pain management program at Duke University Medical Center. Symptoms are often like those you feel in a fit of anger. You may speak more loudly or experience lapses in judgment or logic, he says. Hands and feet may grow cold as blood rushes to the body's core. Research shows the heart often beats erratically, spiking again and again like a seismograph during an earthquake.

Another hallmark: "Can you turn it off? Or are you a prisoner of your mind?" says Martin Rossman, an author on healing and stress and a clinical instructor at the University of California, San Francisco, Medical School. People under harmful stress lose the ability to re-engage the parasympathetic nervous system, which drives the body's day-to-day natural functions, including digestion and sleep. While individuals vary in how long they can tolerate chronic stress, research shows it sharply increases the risk of insomnia, chronic disease and early death.

Home builder Carl Weissensee used to be "addicted to stress," he says. Managing thousands of details and multiple risks for each of the multimillion-dollar houses he builds, he spent years rushing around with "one foot off the ground 20 hours a day, running the same scenarios through my mind time and time again, and being unable to put it aside," says Mr. Weissensee, 58, of Mill Valley, Calif.

In an important marker of harmful stress levels, his agitation disrupted his life. "I would sleep four to six hours a night, and even that wasn't good sleep." His wife complained, and his young daughter painted a small rock for him with the words, "You work too much."

A heart attack, followed by problems with cardiac arrhythmia, forced him to find the line between good stress and bad. "I don't believe it's possible to do a good job without a certain amount of stress. It's necessary to get things done," he says.

He has brought it down to a healthy level by using relaxation techniques, including deep breathing and guided imagery—lying still and imagining stressful tasks turning out well. After seeing Dr. Rossman, reading his book and doing one of his relaxation CDs daily, Mr. Weissensee learned to acknowledge his worries instead of recycling them in his head, then practice "skipping over" them and telling himself that "everything works out in the end," he says. He has managed to stabilize his heart condition without large doses of medication.

People who say their stress level is an 8, 9 or 10 on a 10-point scale, where 1 is 'little or no stress' and 10 is 'a great deal of stress.'
2007 32%
2008 30
2009 24
2010 24
2011 22
Source: American Psychological Association and Harris Interactive

"By practicing over and over, I seem to be changing the path my thoughts take from, 'I'm doomed,' to, 'Things will be OK,' " he says. "My goal is to worry just enough to do my job well."

That kind of positive attitude tends to produce good stress, based on research by Dr. Mendes and others. In a study of 50 college students, some were coached to believe that feeling nervous or excited before a presentation could improve performance. A control group didn't receive the coaching. When the students were asked to make a speech about themselves while receiving critical feedback, those who received the coaching showed a healthier physiological response, leading to increased dilation of the arteries and smaller rises in blood pressure than the control group.

In a similar study, students who received the same coaching before taking graduate-school entrance exams posted higher scores on a mock test in the lab and also on the actual exam three months later, compared with controls, according to a study co-authored by Dr. Mendes and published last year in the Journal of Experimental Social Psychology. They also posted higher levels of salivary amylase, a protein marker for adrenaline that is linked to episodes of beneficial stress.

People react differently to everyday stress. At-home or mobile biofeedback devices can detect spikes in the heart rate. Hand-held thermometers also can be used to note when the temperature of one's hands falls below 95 degrees, says Kenneth Pelletier, a clinical professor of medicine at both the University of Arizona School of Medicine and the University of California School of Medicine, San Francisco.

Toronto psychologist Kate Hays tells patients to imagine a stress scale "ranging from 1, where you're practically asleep, to 10, where you're climbing off the ceiling." Then, she asks them to recall a past peak performance and figure out where their stress at that moment would have ranked. Many people say 4 to 6, but responses range from 2 to 8, says Dr. Hays, who specializes in sports and performance psychology. That becomes their personal stress-management target.

For most people, hitting that target requires new skills. With practice, though, they can learn to relax completely in a few seconds, says Dr. Pelletier.

In addition to thinking positively about stressors, deep abdominal breathing and training in meditation and mindfulness, or regulating one's own mental and physical states, help moderate stress.

All have been shown in research to help heal such chronic problems as heart disease, according to a 2010 research review co-authored by Bonnie Horrigan, director of public education for the Bravewell Collaborative, Minneapolis, a nonprofit that advocates integrating health and medical care. When Ford Motor Co. tested various ways of helping employees with chronic back pain several years ago, corporate medical director Walter Talamonti says, training in reducing harmful stress to healthy levels was linked to reductions in employees' pain and medication use.

Dr. Edwards is seeing 15% to 20% annual increases in patients at his pain clinic seeking biofeedback and other help with stress and stress-related ailments. As many as 35% of them actually want to generate more good stress; many are referred by counselors, parents or coaches.

Many workplace wellness programs have also begun coaching people to hit "the optimal performance zone"—with enough stress "to be stimulating, to focus you, to challenge you" without taking a physical toll, says Dr. Pelletier.

Taken from WSJ on Jan 24 2012, Written by: Sue Shellenbarger

Tuesday, April 17, 2012


Atrial Fibrillation May Be Linked To Memory Problems In Some Patients.
WebMD (2/28, Mann) reports that research published in the in the Canadian Medical Association Journal suggests "that some people with" atrial fibrillation (AF) "who also have other heart disease risks may be more likely to develop memory problems."

HealthDay (2/28, Preidt) reports, that investigators "analyzed data from two trials that included over 31,000 people in 40 countries, aged 55 and older." Study "participants had heart disease or diabetes and some organ damage stemming from these diseases." The researchers "used a common screening test known as the mini-mental state examination (MMSE) to assess the participants' mental function at the start...and over the course of the study."

HeartWire (2/28, Nainggolan) reports that "AF was associated with cognitive decline (hazard ratio 1.14), new dementia (HR 1.30), loss of independence in performing activities of daily living (HR 1.35), and admission to long-term-care facilities (HR 1.53)." The findings "were consistent among participants with and without stroke or receiving antihypertensive drugs," according to the researchers.


Friday, April 13, 2012


The Newark (NJ) Star-Ledger (2/8, Augenstein) reports, "Although doctors have been using the so-called transradial method" for cardiac procedures "for about two decades, it has only recently caught on in the US" The Star-Ledger adds, "David Holmes, the president of the American College of Cardiology and a professor of Medicine at the Mayo Clinic College of Medicine, said he expected the wrist approach to become more and more prominent as the technology and the training develops." Dr. Holmes said the method is "clearly being used more and more frequently. Younger cardiologists think of this as a new skill to be learned."


Tuesday, April 10, 2012


HeartWire (2/7, Stiles) reports, "Therapeutic hypothermia can help preserve the brain during cardiac arrest, so maybe it could protect organs throughout the body in other conditions that threaten their blood supply-such as cardiogenic shock," argues "a viewpoint published the Journal of the American College of Cardiology." The JACC article "surveys the available, mostly preclinical evidence for just such a systemic protective effect from induced hypothermia." The authors of the viewpoint article write that therapeutic hypothermia "merits further study as a potential novel treatment for post-MI cardiogenic shock and could represent the next measurable advance in survival after MI


Friday, April 6, 2012


Expert panel of the National Heart, Lung, and Blood Institute has recommended that all children be screened for familial hyperlipidemic conditions once between ages 9-11 and again between 17-21.

Since most available research on treating hyperlipidemic to lessen vascular risk (primary prevention) was done on adults, this issue is still controversial as the risk-benefit ratio for treating children remains unknown. I do believe that the take home message remains that aggressive screening and treatment in patients with 2 risk factors (one of which is the hyperlipidemia) is of value, and that it is reasonable to start screening higher risk families at an early age.


Tuesday, April 3, 2012


Recent data from the Simplicity II Trial on renal denervation demonstrates that RF ablation techniques in renal arteries can disrupt the autonomic nerve conduction that surrounds theses arteries and could be very effective in treating hypertension non pharmacologically. A cardiac function substudy from this trial (Mathias Brandt, JACC, 3/6/12) now demonstrates reductions in left ventricular hypertrophy and improvements in diastolic function as early as 1 month after the procedure, with additional improvements at 6 months. This could translate into an improved prognosis in hypertensive heart disease as parameters such as degree of LVH (muscle mass) and biomarkers like proBNP, correlate strongly with prognosis in this condition.

Future refinements of this technique, further longitudinal followup of these patients to gauge the durability of these results over time should add greatly to our understanding of where this fits in our treatment algorithms for hypertensive heart disease. Other emerging technologies that modulate the neurohormonal components of hypertension may add to this data base. Designing these studies carefully to keep track of variables such as those studied by Brandt et al, as well as a host of other biochemical and clinical variables should emerge over time and provide us insight into this exciting field.



Michigan Heart Group has a Physician Liaison on staff to assist with questions, concerns or problems you, your staff or your patients may have with our office.

Stacie Batur is available Monday through Thursday at (248) 267-5050 (x6509). She is often between two buildings or visiting referring physician offices. If you get her voice mail, please leave a message and she will call you back shortly. If you need to speak to her immediately you can reach her on her cell phone at (248) 765-4466.