Indoor Air Pollution And Cardiovascular Disease Risk

A team of scientists from Denmark and Sweden discovered that indoor air polluted with tiny particles that are breathed in and get into the bloodstream
affected the performance of blood vessels, and potentially increased the risk of cardiovascular disease, in elderly people. When the air quality was improved using
filters, their blood vessels worked much better.


The study is published in the American Journal of Respiratory and Critical Care Medicine and was the work of Dr Steffen Loft of the Institute of
Public Health, Department of Environmental Health, Copenhagen, in Denmark, and colleagues.


Scientists already knew that exposure to air pollutants such as the microscopic particles emitted in various types of vehicle, industrial and power plant
exhaust
fumes increased risk factors for cardiovascular disease. This is probably because the endothelial cells that line the walls of all blood vessels
become damaged by the tiny particles once they get into the bloodstream. This study extends that knowledge to indoor air quality.


Loft and colleagues investigated the effect of air particles on three markers of blood vessel health: microvascular function (MVF), oxidative stress, and
inflammation.


They recruited a total of 21 non smoking elderly couples, aged between 60 and 75, to take part in a randomized, double blind, crossover study of two exposure
episodes lasting 48 hours each, both in their homes.


This meant the couples were randomly selected to be exposed either to filtered air first and then to non-filtered air, or the other way around. Double blind
meant that neither the couples nor the scientists who assigned them to their groups knew which exposure came first: filtered or non-filtered air. All the
couples were in good health and lived near busy roads. The exposure was controlled by putting air purifiers in their homes, with and without an air filter
fitted inside.


When the air filter was fitted, it created an exposure in the range of 2,533 to 4,058 particles per cm3. Without the filter the exposure ranged from 7,718
to 12,988 particles/cm3. The concentration, diameter range and mass range, as well as the chemical properties of the particles in the air were also
monitored at all times.


The researchers measured MVF by assessing the artery tone of a finger after applying a blood pressure cuff on the arm (arm ischemia). They also took blood samples to measure a
range of blood materials to assess oxidative stress and inflammation, including hemoglobin, red blood cells, platelets, coagulants, C-reactive protein, and
many others.


The results showed that:

Filtered air significantly improved MVF by 8.1 per cent.

The diameter of the air particles (smaller than 2.5 micrometers) and their mass, had a greater effect than their total number concentration.

MVF was also significantly linked to being exposed to particles containing iron, potassium, copper, zinc, arsenic, and lead.

After applying a test of statistical significance, none of the other biomarkers (oxidative stress and inflammation) varied significantly with particle
exposure.


The researchers concluded that:















"Reduction of particle exposure by filtration of recirculated indoor air for only 48 hours improved MVF in healthy elderly citizens, suggesting that this may
be a feasible way of reducing the risk of cardiovascular disease."


Endothelial cells line the walls of all blood vessels throughout the body from the smallest capillary to the largest artery . They are involved in lots of
important jobs from controlling blood flow, reducing clotting, keeping arteries clear, reducing swelling and forming new blood vessels. They also control
the movement of blood materials like white blood cells into and out of the bloodstream, and in some organs like the kidneys and the brain, they act as a
blood filter.


Endothelial dysfunction therefore affects all these aspects of the cardiovascular system, and often results in atherosclerosis, where arteries get clogged up
with plaques and then swell (and sometimes burst) with the resulting inflammation. This also narrows the arteries and stops the blood getting to the organ
concerned, for instance as in a heart attack.


"Indoor Particles Affect Vascular Function in the Aged: An Air Filtration-based Intervention Study."

Elvira Vaclavik Br?¤uner, Lykke Forchhammer, Peter M??ller, Lars Barregard, Lars Gunnarsen, Alireza Afshari, Peter W??hlin, Marianne Glasius, Lars Ove Dragsted,
Samar Basu, Ole Raaschou-Nielsen, and Steffen Loft.


American Journal of Respiratory and Critical Care Medicine Vol 177. pp. 419-425, (2008).

First published online October 11 2007 as doi:10.1164/rccm.200704-632OC


Click here for Abstract.

Cardiovascular Disease Not Prevented By Supplementation With Vitamins E Or C

The risk of cardiovascular events is not reduced by vitamin E or vitamin C supplements, as determined in a large, long-term randomized study of male physicians, according to an article released on November 9, 2008 in JAMA to coincide with the scientific presentation of these findings at the current American Heart Association (AHA) meeting.



Vitamin supplements are a common form of medication in the United States, and according to background information in the article, most adults here have taken them in the last year. There has been previous research into the roles played by vitamin E and vitamin C in heart disease. "Basic research studies suggest that vitamin E, vitamin C, and other
antioxidants reduce cardiovascular disease by trapping organic free
radicals, by deactivating excited oxygen molecules, or both, to prevent
tissue damage." Previous observational studies have indicated that both vitamin E and vitamin C were related to various cardiovascular disease prevention.



In the Physicians' Health Study II, Howard D. Sesso, Sc.D, M.P.H., and
colleagues from Brigham and Women's Hospital, Harvard Medical School
and School of Public Health and VA Boston Healthcare System, Boston, 14,641 male physicians were evaluated for the effects of vitamin E and vitamin C supplements on cardiovascular event incidence. A the inception of the study in 1997, the subjects were 50 years or older, and at low risk for cardiovascular disease. Of the total, 5.1% (754) physicians had cardiovascular disease. Each subject was randomized to recieve 400IU of vitamin E every other day or a placebo; each patient was also randomized to receive 500mg of vitamin C daily or a placebo.



The subjects were followed up for an average of 8 years, during which there were 1,245 confirmed major cardiovascular events. Of these, 511 heart attacks (myocardial infarctions), 464 strokes, and 509 cardiovascular deaths were experienced -- with some men experiencing more than one event. During the follow up period, 1,661 men died.



When comparing the supplemented groups to the placebo, neither vitamin E nor vitamin C had any effects on cardiovascular event incidence. The authors also note: "Neither vitamin E nor vitamin C had a significant effect on total
mortality, but vitamin E was associated with an increased risk of
hemorrhagic stroke." 



The authors conclude that vitamin E and vitamin C supplementation should not be indicated for prevention of cardiovascular disease in this group. "In this large, long-term trial of male physicians, neither vitamin E
nor vitamin C supplementation reduced the risk of major cardiovascular
events. These data provide no support for the use of these supplements
for the prevention of cardiovascular disease in middle-aged and older
men," they write. 



Vitamins E and C in the Prevention of Cardiovascular Disease in Men: The Physicians' Health Study II Randomized Controlled Trial

Howard D. Sesso; Julie E. Buring; William G. Christen; Tobias Kurth; Charlene Belanger; Jean MacFadyen; Vadim Bubes; JoAnn E. Manson; Robert J. Glynn; J. Michael Gaziano

JAMA. 2008;300(18):2123-2133.

Click Here For Journal



Written by Anna Sophia McKenney

Ranexa(R) Added To New ACC/AHA Guidelines On Unstable Angina/Non ST-Elevation Myocardial Infarction (UA/NSTEMI)

CV Therapeutics,
Inc. (Nasdaq: CVTX) announced today that new guidelines, developed jointly
by the American College of Cardiology Foundation and the American Heart
Association and published in this week's issue of Circulation, state that,
"ranolazine may be safely administered for symptom relief after UA/NSTEMI."



Ranexa(R) (ranolazine extended-release tablets) is indicated for the
treatment of chronic angina in patients who have not achieved an adequate
response with other antianginal drugs, and should be used in combination
with amlodipine, beta-blockers or nitrates. The product has not been
determined by regulatory authorities to be safe and effective for any other
use.



About CV Therapeutics



CV Therapeutics, Inc., headquartered in Palo Alto, California, is a
biopharmaceutical company focused on applying molecular cardiology to the
discovery, development and commercialization of novel, small molecule drugs
for the treatment of cardiovascular diseases.



CV Therapeutics' approved product, Ranexa(R) (ranolazine
extended-release tablets), is indicated for the treatment of chronic angina
in patients who have not achieved an adequate response with other
antianginal drugs, and should be used in combination with amlodipine,
beta-blockers or nitrates.



CV Therapeutics' clinical and preclinical drug development candidates
and programs, including regadenoson, which is being developed for potential
use as a pharmacologic stress agent in myocardial perfusion imaging
studies, and CVT-6883, which is being developed as a potential treatment
for cardiopulmonary diseases. Regadenoson and CVT-6883 have not been
determined by any regulatory authorities to be safe or effective in humans
for any use.



Except for the historical information contained herein, the matters set
forth in this press release, including statements as to treatment
guidelines, are forward-looking statements within the meaning of the "safe
harbor" provisions of the Private Securities Litigation Reform Act of 1995.
These forward-looking statements are subject to risks and uncertainties
that may cause actual results to differ materially, including operating
losses and fluctuations in operating results; capital requirements;
regulatory review and approval of our products; special protocol assessment
agreement; the conduct and timing of clinical trials; commercialization of
products; market acceptance of products; product labeling; concentrated
customer base; and other risks detailed from time to time in CV
Therapeutics' SEC reports, including its Quarterly Report on Form 10-Q for
the quarter ended June 30, 2007. CV Therapeutics disclaims any intent or
obligation to update these forward-looking statements.


CV Therapeutics, Inc.

cvt

Evolution Of Optimal Below-Knee Stents Revealed

Choosing the type of endoluminal treatment for infrapopliteal artery lesions can be controversial. Bioabsorbable stents are a new means
to attempt to prevent vessel recoil and eliminate the presence of permanent metal implant.


It is thought the absence of a metallic
implant may permit positive remodeling with lumen enlargement to compensate for the development of new lesions.


Koen Deloose, M.D., Vascular Surgeon at AZ Sint-Blasius Hospital, Dendermonde, Belgium, presented his study, which randomized 117
patients with chronic limb ischemia and with 149 lesions to implantation of an absorbable metal stent, or AMS (60 patients, 74 lesions)
versus a stand-alone percutaneous transluminal angioplasty, or PTA (57 patients, 75 lesions).


The 30-day complication rate was 5.3%
(3/57) and 5.0 % (3/60) in patients randomized for PTA alone and PTA followed by AMS implantation, respectively.


On an intentionto-treat basis, the 6-month angiographic patency rate at for the lesions treated with AMS (31.8 %) was significantly inferior (p=0.013) to those treated with PTA (58.0 %).


Although the present study indicates that the AMS technology can be safely applied, it did
not demonstrate efficacy in long-term patency over standard PTA in the infrapopliteal vessels.


Initial studies show AMS to be a
safe technique, bet design modifications are needed and further studies should be performed before being widely adopted..but the
future looks positive.


VEITH SYMPOSIUM - New York, November 19th to 23rd


Now in its fourth decade, VEITH SYMPOSIUM provides vascular surgeons, interventional radiologists, interventional cardiologists and other vascular specialists with a unique and exciting format to learn the most current information about what is new and important in the treatment of vascular disease. The 5-day event features rapid-fire presentations from world renowned vascular specialists with emphasis on the latest advances, changing concepts in diagnosis and management, pressing controversies and new techniques.


VEITHsymposium is sponsored by Cleveland Clinic, Cleveland, OH.


veithsymposium


Source

Pauline T. Mayer

ptmhcm

Coronary Heart Disease: Spotting The Culprit(s) Is The Way Towards Prevention, UK

In the sumptuous main hall of the Wills Memorial Building, Bristol
University, almost 500 people - mostly laypersons with a percentage of international
scientists and researchers - attended last Sept. 18, the public lecture "Who
nearly killed Sir Ranulph Fiennes?". The lecture was organized by the Bristol Heart
Institute in collaboration with the Bristol University, and took place during the joint
meetings of the European Vascular Genomics Network (EVGN, evgn/),
and the 4th European Meeting on Vascular Biology and Medicine (EMVBM). An event
that gathered more than 400 experts, among cardiologists and diabetes researchers,
hematologists, thrombosis scientists, gene therapists and oncologists.


Placing himself in the role of the witty investigator Hercule Poirot, Professor Andrew
Newby, President of the European Vascular Biology Organization (EVBO) and British
Heart Foundation Professor of Vascular Cell Biology at Bristol University's Bristol Heart
Institute, led the audience through arteries and veins, along a fantastic journey inside
a human organism in the process of developing coronary artery disease. He
interrogated likely culprits and, eventually, got to the solution of the case.


"People underestimate the role that the environment or life-style factors play in the
development of coronary artery disease" commented Professor Newby who is also
EVGN co-Director. "The purpose of this lecture was to show them the real damage
caused by this disease. Unfortunately, once altered, some of the biochemical
pathways that keep our organism alive and healthy are hardly ever restorable. Hence
the importance of prevention and of public awareness".


Beginning his journey with the description of the early signs of coronary disease,
Professor Newby opened a number of more technical windows on the actors on the
stage. He dissected the structure of atherosclerotic plaques and highlighted the role of
monocytes and macrophages in the dramatic changes that occur inside the blood
vessels microenvironment. All the take-home messages were clear-cut and the whole
presentation hit the target.


"We really need events like this one" pointed out Professor Gianni Angelini, Chairman
of the Bristol Heart Institute, founded in 1995, that soon become an international
centre of excellence for carrying out interdisciplinary cardiovascular research able to
bridge the void between clinical and basic science. "Untile recently there were little
contacts between BHI and the public opinion. Then we realized the importance of
establishing a solid dialogue with the population, aimed at keeping people informed on
our activities and at receiving individual feedbacks on their health. Therefore, two
years ago we decided to organize public lectures on a regular basis". The contacts
between the BHI and the population are not mere words: four times a year, infact, all
the patients treated at the BHI receive a Newsletter that keeps them up to date on
the most recent progress in the field. "We also send the patients a questionnare -
explains Professor Angelini - asking them to inform us on their health status, and
their availability to be enrolled in future trials".


With 230 scientists, over 1000 peer-reviewed papers since 2000 and research
fundings of 56 million Pounds coming from 160 separate grants, the Bristol Heart
Institute has become "??¦ an umbrella that gathers the major clinical Institutions and
research groups, to strenghten the link between basic research and clinical
applications".



Why mentioning Sir Ranulph Fiennes? "Because he is a symbol of hope and personal
involvement" said Professor Andrew Newby. "Sir Ranulph Fiennes, "The world's
greatest living explorer" according to the Guinness book of records, agreed to become
patron of the Bristol Heart Institute in 2005. In 2003, he underwent emergency heart
surgery at Bristol Royal Infirmary when he suffered a heart attack just before
boarding a plane at Bristol airport. 3 months after his double-bypass operation he ran
7 marathons on 7 continents in 7 days, to raise money for the British Heart
Foundation (for which he is also an ambassador)".



The European Vascular Genomics Network (EVGN) is the first Network of excellence
on cardiovascular disease funded by the European Commission under the 6th
Framework Programme "Life sciences, genomics and biotechnology for health"
(Contract Number: LSHM-CT-2003-503254).


The Conference is supported by an unrestricted educational grant from Laboratoires
SERVIER.


evgn/

Many Blackout Patients Misdiagnosed With Epilepsy

Anyone with unexplained blackouts can now access a new checklist to help them and their doctors reach a correct diagnosis. The Blackouts Checklist will be useful for millions, as nearly half of the UK population will suffer blackouts at some stage in life.1 Supporting the launch of this campaign is Sir Roger Moore, patron of STARS, the blackouts charity. The Blackouts Checklist, endorsed by the Department of Health, is available from STARS at stars.uk.


Sir Roger fronted an appeal on BBC Radio 4, on Sunday 18 March, on behalf of STARS. Sir Roger commented, "I was lucky, having blacked out on stage I received excellent and rapid medical attention, and I now have a pacemaker which kicks in whenever my heart rhythm requires a correction. Thousands of sufferers aren't so lucky."


Blackouts triggered by cardiovascular irregularities can appear similar to epileptic seizures and are often misdiagnosed as such.1 These blackouts happen when blood supply to the brain is interrupted,2 this is known medically as syncope [SIN-koh-pee]. Blackouts are much more likely to be due to syncope than epilepsy.3 Despite this, the condition is relatively unknown, and it is estimated that over a third of patients diagnosed with epilepsy may have been misdiagnosed.1


Many blackout patients never see a heart rhythm specialist and become diagnosed incorrectly. Sir Roger added, "This checklist is what anyone who has had a blackout should use, as it could save years of confusion, fear and the tragedy of misdiagnosis."


Blackouts can also be a first symptom of a fatal irregular heart rhythm,4 which causes over 100,000 deaths every year in the UK.5 Many of these lives could be saved with appropriate diagnosis and treatment.6 Despite these arrhythmias (heart rhythm disorders) being the leading single cause of death in the UK,7 there are fewer than 70 heart rhythm specialists in the whole country8 - not even one for every ten thousand sufferers.6


"A failure to realise that blackouts are much more likely to be due to syncope than epilepsy can frequently lead to misdiagnosis of epilepsy. Also, a "faint", (the commonest cause of syncope), can be abrupt, can be accompanied by twitching and jerking, injuries and incontinence, just like epilepsy" - explained Dr Adam Fitzpatrick, a Cardiologist and Heart Rhythm Specialist from the Manchester Heart Centre. "It is really important that patients provide as much accurate information as possible when they see their doctor, and always attend with an eye-witness wherever possible. Another valuable contribution is video. Increasingly, the use of video-phones for recording an attack is adding huge value. The Blackouts Checklist is exactly what we need patients to use as a guide when seeking an accurate diagnosis and effective treatment."















Trudie Lobban, founder of STARS, added, "When patients are empowered with important information they can help their doctor better understand the symptoms and nature of their blackouts. This can help avoid a long list of referrals, misdiagnosis and inappropriate treatment before an accurate diagnosis is secured."


Patients and parents can access a copy of the checklist from stars.uk.


A download of Sir Roger Moore's BBC Radio 4 appeal (broadcast on Sunday 18 and repeated on Thursday 22 March 2007), is accessible at bbc.co.uk/radio4.


STARS was founded by Trudie Lobban in 1993 after her daughter Francesca was diagnosed with Reflex Anoxic Syncope with the support of Prof. J Stephenson, Consultant Paediatric Neurologist - Royal Hospital for Sick Children, Glasgow.


STARS aims to alleviate the effects of, and provide support and information on, syncope to those in distress as a result of these blackouts, whether suffered by themselves or as a member of the family group.


STARS patrons include Sir Roger Moore, Twiggy and celebrity chef John Burton Race. Sir Roger and John Burton Race have both suffered from syncope and have pacemakers fitted.


References


1. Petkar, S., Jackson, M., Fitzpatrick, A. Management of blackouts and misdiagnosis of epilepsy and falls. Royal College of Physicians Journal : vol 5 : September/October : Conference reports


2. European Society of Cardiology, Guidelines on Management (Diagnosis and Treatment) of Syncope,
Update 2004 escardio


3. Fitzpatrick, A; Cooper P. Diagnosis and Management of Patients with Blackouts. Heart 2006; 92: 559-568


4. STARS Syncope Handout


5. Arrhythmia Alliance data on file


6. Department of Health, National Service Framework, Arrhythmias and Sudden Cardiac Death,
Chapter Eight, 4 March, 2005. Link here.


7. Heart Rhythm UK hruk.uk


8. Arrhythmia Alliance Annual UK Heart Rhythm Congress, September 2006 - retrieved from heartrhythmcharity.uk on 7 March 2007


stars.uk

Different Treatment Options In Chronic Coronary Artery Disease

Sometimes cardiologists and cardiac surgeons can agree! There is often disagreement between the professions of cardiology and cardiac surgery about the proper therapy for coronary artery disease (CAD) and this can harm the patient. In the current edition of Deutsches Arzteblatt International, an interdisciplinary team of authors consisting of cardiologists and cardiac surgeons provides answers to the question of when a bypass operation (ACB) and when percutaneous coronary intervention (PCI) is effective (Dtsch Arztebl Int 2009; 106(15): 253-61). Martin Russ, Jochen Cremer and coauthors show that ACB and PCI are of equivalent value and can be placed in a complementary treatment plan.


The authors not only consider the results of randomized controlled studies, but extend their overview to the analyses of registries, which provide complementary data.


Thus PCI or ACB is advisable in those patients who still suffer from angina pectoris under drug treatment or for whom relevant ischemia has been demonstrated by non-invasive methods. According to the authors, the main indication for aortocoronary bypass surgery is when the proportion of ischemic myocardia is at least 10%. A bypass operation can greatly improve the symptoms in the intermediate and long term. Severe comorbidity, such as renal failure or chronic obstructive pulmonary disease, support the use of PCI rather than ACB.


In critical constellations, the decision about the procedure to be used should be shared by cardiologists and cardiac surgeons, who must consider the patient's expectations, as well as the advantages and disadvantages in the short and long term.