30- YEAR STUDY OF PCI PATIENTS SHOW THOSE THAT QUIT SMOKING LIVE LONGER THAN THOSE WHO CONTINUE TO SMOKE AND LONG-TERM ALL-CAUSE MORTALITY RATES OF QUITTERS ARE SIMILAR IN THE END TO THOSE OF NONSMOKERS

A 30-year study of patients who underwent successful percutaneous coronary intervention (PCI) shows that those who quit smoking appear to live longer than those who continue to smoke, according to a study published online July 29, 2013, ahead of print in the American Journal of Cardiology. Furthermore, long-term all-cause mortality rates of quitters are similar in the end to those of nonsmokers.

Investigators led by Ron T. van Domburg, PhD, of Erasmus Medical Center (Rotterdam, The Netherlands), analyzed life expectancy for 856 consecutive patients who underwent PCI between 1980 and 1985 and for whom 30-year follow-up data, including self-reported smoking status at 1 year, were available. Patients were divided into 3 groups:

• Nonsmokers
• Quitters
• Persistent smokers

Quitters Win in the End:

Overall, there were 14,977 patient-years of follow-up (median 19.5 years). The self-reported smoking rate fell from 61% prior to PCI to 36% at 1 year.

The cumulative 30-year survival rate was higher among those who quit smoking, as was life expectancy, which showed a 2-year advantage for quitters (table 1).

Table 1. Survival and Life Expectancy:

	Persistent Smokers (n = 287)	Quitters (n = 210)	P Value
30-Year Survival	14%	29%	0.005
Life Expectancy, years	16.4	18.5	< 0.0001

Quitters had similar all-cause mortality rates compared with nonsmokers, and both of these groups had lower mortality than persistent smokers (adjusted HR 0.57; 95% CI 0.46-0.71 and adjusted HR 0.42; 95% CI 0.34-0.52, respectively).

Other independent predictors of long-term all-cause mortality were:

• Multivessel disease (adjusted HR 1.45; 95% CI 1.19-1.75)
• Previous MI (adjusted HR 1.27; 95% CI 1.06-1.53)
• Hypertension (adjusted HR 1.37; 95% CI 1.14-1.64)

Dated Yet Relevant:

According to the study authors, although all the PCI procedures were performed in the pre-stent era, the findings are in agreement with prior research showing substantial reductions in all-cause mortality and nonfatal myocardial reinfarctions with smoking cessation in patients with coronary heart disease.

“Although it remains to be seen to what extent smoking cessation will benefit current patients, there are no indications that the unfavorable effect of smoking can be made undone using novel treatment methods,” they write. “In addition, it has been shown that stent placement compared with balloon angioplasty benefits only on target vessel revascularization, not mortality.”

The authors acknowledge, however, that complete information was not obtained in all patients. Additional limitations include the reliance on self-reported smoking data and the capturing of information at only 1 year post-PCI and no further, they note.

Importance of Natural History:

In a telephone interview with TCTMD, Ajay J. Kirtane, MD, SM, of Columbia University Medical Center (New York, NY), said longitudinal studies such as this one are important because “so much of what we do is based upon 30-day, and 1-year outcomes. Even the COURAGE trial was only 4.6 years of follow up, so it’s really important to look at longer data . . . because in some respect they represent actuarial tables that show us the natural history of these patients.”

Additionally, he said it reaffirms that patients can reverse some of the smoking-related damage by quitting.

“So many times you talk with patients and they think that because they’ve been smoking so long there is nothing they can do,” Dr. Kirtane said. “But data like these reiterate the fact that probably for all but the heaviest of smokers, stopping can drop you back down to a baseline risk equivalent with people who never smoked. That gives patients hope and it’s important.”

He said the data are “one more thing in my toolbox to convince patients they should stop smoking.”

Quoting Old Data Not Justifiable:

But Morton J. Kern, MD, of the University of California, Irvine (Irvine, CA), told TCTMD in a telephone interview that while hard data showing survival advantages of quitting are helpful, getting patients to make a life change is far more complicated.

“The more ammunition you have, the better. But honestly, most people are not swayed by these kind of data,” he commented. “You can tell them [smoking] is one of the highest risk factors for stent thrombosis, restenosis, etcetera. After they have had a heart attack, it’s a little easier to convince them because they’re scared and sometimes they do need that wake-up call. But if they are not hurting enough or sick enough, it’s tough.”

Dr. Kern said he typically speaks with the family about the importance of quitting as a way of invoking “peer pressure.”

He dismissed the importance of the study data, however, saying it is “ludicrous” to try to generalize pre-stent PCI outcomes to a modern population. “Stents changed the landscape of PCI and in the pre-stent era, all of the outcomes are totally different from what we see today,” Dr. Kern said. “I don’t see how you can justify quoting from data that are this old.”

Study Details:

All PCI procedures were performed with balloon angioplasty only. The mean age of the patients was 56.2 years, and most (80%) were men.

POSTED BY:  Steven Almany M.D.

HEART HEALTHY RECIPE- RICE PUDDING

Delicious Rice Pudding

                                                   Vegetable oil spray

                                                   2 c.  skim milk, heated

                                                   2 c.  cooked rice

                                                   1/3 c.  sugar

                                                   1 ½  tsps.  vanilla

                                                   ¼  tsp. nutmeg

                                                   ½  tsp. cinnamon

                                                   Egg substitute equivalent to 1 egg

  

Preheat oven to 350.  Lightly spray a 1 quart ovenproof casserole with vegetable oil.  Place ingredients in order listed in a bowl.  Stir to mix well.  Pour into prepared casserole and cover.  Set casserole in a larger pan.  Add hot water to pan to a depth of 1 inch.  Bake casserole 1 hour.  Serve warm or cover and refrigerate to serve cold.       

  

Nutrition Information:  1/6  recipe

Calories 152, Total Fat 0 g,  Cholesterol 2  mg, Sodium 63  mg, Carbohydrate 32 g,

Protein 5 g

HOW CAN I KEEP A SUCCESSFUL LOW CARBOHYDRATE DIET?

Mediterranean Diet...

Low carbs can be part of a successful and palatable diet.  One example is the Mediterranean Diet (easy to research on the Internet).  this reduces carbs by >50% and replaces them with a diet rich in fruits and vegetables, beans and lean protein (especially fish).  It has been successful in reducing CAD event rates in populations as well as weight control.  Many parts of the world use it.

POSTED BY:  Steven Ajluni, MD.

HEART HEALTHY RECIPE- SHRIMP, AVOCADO and SPINACH SALAD

Shrimp, Avocado and Spinach Salad

                                                                         2 tsp. sugar

½ tsp. dried tarragon, crumbled

¼ tsp. dry mustard

¼ tsp. seasoned pepper

6 T. red wine vinegar

1 ½ tsp. olive oil

8 c. fresh spinach, washed, stemmed, torn into bite-size pieces

½ avocado, peeled, pit removed, cut into ¾ in. pieces

½ lb. cooked shrimp, patted dry

6 medium mushrooms, cleaned, sliced ¼ in. thick

                                                                         ½ medium red onion, peeled, thinly sliced and                                                                                     separated into rings

In a small bowl or jar with a tight-fitting lid, combine the sugar, tarragon, mustard and pepper.  Add the red wine vinegar and olive oil, then whisk, or cover the jar with the lid and shake, until the sugar is dissolved.  Refrigerate until ready to use.

In a large salad bowl, combine the spinach, avocado, shrimp, mushrooms and onion.  Remove the dressing from the refrigerator, whisk or shake again, and pour over  the salad.  Toss gently to coat.  Serve immediately.

Nutrition Information:  per 1/6 recipe

Calories 163, Total fat 6 g, Saturated fat 1 g, Cholesterol 111 mg, Sodium 218 mg, Carbohydrate 13 g, Fiber 4.5 g,  Sugar 3g,  Protein 16 g 

WELCOMING MICHELLE FORCINA, PA-C AND DAWN MITCHELL, ACNP

Beaumont Michigan Heart Group would like to welcome two new physician extenders...

Michelle Forcina, Physician Assistant
Dawn Mitchell, Nurse Practitioner 

They will be joining our mid-level team of Cheryl Vincent, A.P.R.N.; Anita Juriga, A.P.R.N; Howard Hollinger, P.A.-C.; Debra Goodall, A.P.R.N; Mariann Graham, Nurse Clinician; and Lilly Paciorkowski, Nurse Clinician.

Michelle comes to us with a background in Cardiac Electrophysiology.  She has primarily worked with Electrophysiologist and Device Clinics for the last seven years. She will be office based and seeing patients out of Beaumont's Michigan Heart Rhythm Group, working closely with our device specialist Jan Halash and Amy Douglas as well as Drs. Cragg, Williamson and Kutinsky.

Dawn has worked for William Beaumont Hospital in several different capacities over the last 30 years and we are lucky to have her as part of our team.  Her main focus for the last 20 years has been Cardiology where she has learned the many different arenas it has to offer.  Dawn will primarily be seeing patients in the hospital however will most likely also see patients in the office as space and time allow.

We are very fortunate to have found these two wonderful additions to our team.  They look forward to meeting you and we hope you look forward to meeting them.

Thank you!
The Beaumont Michigan Heart Group Physicians

LIPID-LOWERING DRUGS ARE ASSOCIATED WITH MINOR INCREASED RISK OF DIABETES AND NO EVIDENCE OF CANCER

LONDON, UK — An analysis of nearly a quarter million individuals treated with statin therapy in 135 randomized, controlled clinical trials has shown that the lipid-lowering drugs are associated with a small increased risk of diabetes, but there was no evidence of an increased risk of cancer^[1].

Overall, statins were well tolerated, according to the investigators, with the analysis indicating no evidence of an increased risk of myalgia, myopathy, or rhabdomyolysis. Head-to-head comparison showed that pravastatin and simvastatin had the lowest risk of adverse events vs atorvastatin and rosuvastatin (Crestor, AstraZeneca).

"At the population level, mortality and cardiovascular benefits of statin therapy greatly overweigh its potential harms--even taking into account the recent finding that statin use is associated with a modest increase in diabetes incidence," write Dr Huseyin Naci (London School of Economics and Political Science, UK) and colleagues in their analysis published online July 9, 2013 in Circulation: Cardiovascular Quality and Outcomes. "At the individual level, however, there may be a risk of exposing a large group of individuals to the (primarily minor) harms of statin therapy for the benefit of a smaller number of individuals."

As a class, statins were associated with a 9% increased risk of diabetes compared with patients treated with placebo (odds ratio 1.09; 1.02–1.16). In the placebo-controlled trials, the risk of diabetes was higher with rosuvastatin. However, this finding was not confirmed in the drug-level meta-analysis, in which there was no difference in risk of diabetes between statins.

Overall, there was no increased risk of cancer among statin-treated patients vs those who received a comparator drug, including placebo, and there was no evidence of any differences in risk with individual statin

POSTED BY: Steven Almany M.D.

HEART HEALTHY RECIPE- HEART SMART BURGERS

By mixing equal portions of lean ground beef and ground turkey, the amount of fat in these tasty burgers drops significantly and can be included in a heart healthy diet.

Heart Smart Burgers

                                                                       ½  lb. ground round beef

                                                                       ½  lb. ground turkey breast

¼  c. diced green onions

                                                ¼  c. diced green pepper, seeded

¼  tsp. Mrs. Dash seasoning

2 egg whites, beaten

1 T. Worcestershire sauce

1 tsp. prepared mustard

8 onion slices

4 tomato slices

1 c. alfalfa sprouts

4 whole wheat hamburger buns

Preheat grill.  Mix the meats in a large bowl and add the onion, pepper, seasoning, egg whites, Worcestershire sauce and mustard.  Mix thoroughly.  Divide the mixture into 4 portions and form into patties.  Cook patties over the grill at least 8-10 minutes until well done (turkey needs to be cooked thoroughly).  Flip only once when the juice emerges from the upper side of the burger. 

Serve on whole wheat buns with onion, tomato and alfalfa sprouts.

Nutrition Information: per burger

Calories 273, Total fat 11 g, Saturated  fat 3.5 g, Cholesterol 42 g, Sodium 365 mg, Carbohydrate 24 g, Fiber 1.5 g, Sugar 4 g, Protein 19 g  

WHY DOES PROCARDIA CAUSE EDEMA?

The cause of edema in calcium channel blocker medications is due to the decrease in arteriolar resistance.  The resistance change is not seen in the veins, so the pressure in the capillary beds is increased, thus causing fluid shift into the tissues, resulting in edema.

POSTED BY:  Steven Ajluni, MD

HEART HEALTHY RECIPE- CINNAMON FRENCH TOAST

Cinnamon French Toast

                                                                                                                                                                                                                            Egg substitute equivalent to 2 eggs

1 tsp. sugar

½ tsp. vanilla extract

¼ tsp cinnamon

Dash nutmeg

6 slices firm-textured thinly sliced bread

Vegetable oil spray

Place all ingredients except vegetable oil spray and bread in an 8x8-inch baking pan.  Stir to mix well. 

Lightly spray a nonstick skillet with vegetable oil and place over medium heat.  Dip one bread slice into egg mixture and turn gently to other side.  Remove from pan and place in preheated skillet.  Cook until brown on one side.  Flip and brown on other side.  Repeat with remaining slices of bread, spraying skillet with vegetable oil before adding next slice.

Serve with light syrup, fruit spread or dusting of powdered sugar.

Nutrition Information:  per 2 slice serving (without topping)

Calories 161, Total fat 2 g, Saturated fat 0 g, Cholesterol 2 mg, Sodium 335 mg, Carbohydrate 28 g, Protein 8 g, Fiber – varies according to bread used (see packaging)

HEART LIGHT...A NATION WIDE NEW TRIAL AT BEAUMONT OFFERS HOPE TO THOSE THAT SUFFER FROM ATRIAL FIBRILLATION!

EKG of Atrial Fibrillation

Heart Light is an exciting National Research Trial using new technology to treat Paroxysmal Atrial Fibrillation.  William Beaumont Hospital is one of only 22 centers in the United States to offer this trial also one of the highest for enrollment.   Michigan Heart Group's own Dr. Kutinsky is the principle investigator at Beaumont.

The technology is called Cardio Focus, an endoscopic laser balloon system used to isolate the pulmonary veins and cure Paroxysmal Atrial Fibrillation.  The technology is cutting edge for many reasons, first the operator can visualize how and where the treatment is being directed and second it has increased efficacy and success for curing Atrial Fibrillation.  If you want more information or are interested in seeing if you are eligible for the trial, please visit, www.cardiofocus.com.  The deadline for applications is October 1st.