Heart News and Notes

Tomatoes were once thought to be poisonous. Tomato leaves still are. Current handbooks say its solanine content is harmful and potentially lethal (though one handbook says the toxic dose is “at least a pound”).

Harold McGee, writing as “The Curious Cook” in The New York Times, says experience and studies say otherwise. Solanine is a potato alkaloid; commercial tomatoes contain tomatine, according to Dr. Mendel Friedman of the USDA. Dr. Friedman fed tomatine to lab animals and found that not only did it pass through the gut practically unabsorbed, but (like Zetia, but cheaper) it took cholesterol with it. The lab animals wound up with less LDL (“bad” cholesterol). The raw leaves smell rank, but McGee cites chefs who use them in sauces to “punch up” the flavor.

Before cooking up a mess of tomato greens, I would want to know the “therapeutic window” - how much I’d need to be effective and how much would be toxic. Drug manufacturers can afford the thorough tests needed to get this data, but since there’s little profit in tomato leaves, we may never know.

Hannah Clark was diagnosed with heart failure at eight months, and as her condition deteriorated she received a heart transplant at age two. She is now 16 and living a normal life - with her own heart, not the transplant!

The transplant was from a five-month old infant, too small to replace her heart, so it was put in alongside her own heart, both hearts taking blood from the same veins and pumping it into the same arteries. In the next four years both hearts became stronger, but then the donor heart developed EBV-PTLD, a malignancy due to a virus. The dose of immunosuppressant drugs was lowered, but then the donor heart began to fail due to rejection. The donor heart had to be removed - but by that time her own heart could function alone.

Moral of the story: immunosuppression doesn’t always have to last a lifetime. Sometimes “unloading” a failing heart enables it to recover.

Two new studies, published last month in JAMA, confirm that following any or all of six behaviors can help your heart.

One, using data from the Nurses’ Health Study, found that normal BMI, regular vigorous exercise, DASH diet, moderate drinking, minimal use of pain relievers, and taking folic acid reduced the risk of high blood pressure by 80 percent. Only 0.3 percent did all six, but any one alone helped.

The other, based on the Physicians’ Health Study, found that following at least four of normal weight, never smoking, exercise, moderate drinking, eating cereals, and eating fruits and vegetables halved their risk of heart failure.

Mortality for Medicare patients within 30 days after heart attack is below 7 percent at some hospitals, but nearly 30 percent at others, according to a recent study. Mortality after heart failure, and readmission rates, vary similarly. Curiously, hospitals in the Northeast tend to have lower mortality but higher readmission rates.

Another study looked at how often defibrillation was started within two minutes after in-hospital cardiac arrest, and found that it varied from one-fortieth to one-half of events. Of course survival rates were affected. The variation could not be explained by any known “best practice” factors.

Still another study found that some procedures for CT angiography, which screens for calcification in the coronary arteries, expose patients to ten times as much radiation as other protocols. The calculated risk of cancer varies accordingly from 14 to 300 cases per hundred thousand.

Hospital Compare has been posting 30 day mortality data from Medicare on the World-Wide Web since 2007. It recently added 30 day readmission data. Look for it at http://www.hospitalcompare.hhs.gov.

Local laws, insurance rules, and public misconceptions bar emergency medical service (EMS) workers from best use of resuscitation for out-of-hospital cardiac arrest. Less than half of teams follow AHA guidelines to stop CPR, and not take the patient to a hospital, after 20 to 30 minutes without pulse.

Medicare won’t fully reimburse the ambulance team for their half-hour of work unless they carry the dead victim to a hospital. Some state laws require transport to a hospital instead of CPR at the scene. Laypersons overestimate the survival rate, at about 60 to 70 percent, not the actual 7 percent.

Result: survival after out-of-hospital cardiac arrest is about one in four in Seattle, vs. one per thousand in Detroit. Seattle does not practice “scoop and run,” with paramedics trying to apply CPR in an ambulance at 90 miles per hour with lights and sirens blaring.

African-Americans are more likely than whites to have high blood pressure, and less likely to respond to beta blockers as a treatment for heart failure. Two studies published last month show that it isn’t race, but specific gene variants found more often in one race than another, that make the difference.

One study found specific genes that affect blood pressure that occurred in both racial groups but occurred more often in one group than another. The research is slow and difficult because many genes are involved, none of which by themselves have much effect.

The other study found, as one result, a gene variant that is common in African-Americans, but rare in whites, that acts as a beta blocker. Beta blocking drugs appear to be ineffective because they have nothing to add.