Heart News and Notes

JUPITER, a trial published last month in the New England Journal of Medicine, showed that giving Crestor (rosuvastatin) to elderly patients with normal cholesterol, no known heart disease, and elevated levels of CRP (a general marker of inflammation) resulted in less heart disease and all-cause mortality in the next two years.

The implication - that statins should be given to patients with normal cholesterol and no evident heart disease - has not been widely accepted. An article in The New York Times, among other criticisms, pointed out the way subjects were screened, which may have biased the results. The trial was sponsored by AstraZeneca, makers of Crestor.

ALLHAT, a study completed in 2002, showed that generic diuretics are just as effective as costly new drugs in lowering high blood pressure. As noted in an article in The New York Times late last month, it has had little effect on prescribing practices. The article focused on aggressive marketing by drug makers - even taking doctors out sightseeing when the ALLHAT results were presented at a conference.

Some day, but not yet, a pacemaker might be powered by the beating of the heart instead of a replaceable battery.

In an experiment reported last month at the American Heart Association Scientific Sessions 2008, a device consisting of two bladders and a microgenerator, mounted on the end of a lead, was implanted at the end of the right ventricle of a pig’s heart. It generated about one-sixth as much power as a pacemaker would need.

The experimenters see the result as a “proof of concept” and expect that better materials for the microgenerator will generate more power.

People who eat more eggs and high-fat dairy products have more heart failure, while people who eat more whole grains have less, according to a study at the University of Minnesota published last month in the Journal of the American Dietetic Association.

Another study, published October in Circulation, identified three diet patterns across 52 countries and compared the associated risks of heart attack:

• Prudent: lots of fruits and vegetables, 30 percent lower risk.

• Oriental: lots of tofu, soy and other sauces, no association with risk.

• Western: lots of fried foods, salty snacks, eggs and meat, 35 percent higher risk.

Both studies were observational studies, so there was no proof that the diet actually caused the result.

In a small study presented last month at the American Heart Association Scientific Sessions, enjoyable music increased blood flow; so did watching a funny video or listening to a relaxation tape, but not as much, while anxiety-producing music decreased it slightly. A group led by Dr. Michael Miller at the University of Maryland, which previously showed that laughter had positive effects, did the study.

But keep the music away from your pacemaker or defibrillator. Earphones contain magnets, which can interfere with an implanted device even if the earphones are not plugged in, according a report at the same meeting of tests of eight brands .

Earphones are safe when worn on the ears, but should not be kept in an upper front pocket or hung around your neck.

Many heart patients are depressed, and it is well known that depressed patients are at higher risk for another heart attack. But a review of existing studies, published in the November 12 Journal of the American Medical Association, found that while treating depression relieves depression, there is no evidence that it lowers heart attack risk.

Nonetheless, another study, published November 26 in the same journal, suggests how depression might cause increased heart risk. Over 1000 patients were followed for almost five years, and a questionnaire was used to assess behavioral factors such as physical activity, taking their medication, and smoking. When the behavioral factors were included in the statistical analysis, the association with depression disappeared.

The most significant factor was physical inactivity. Physical inactivity is a known risk factor for heart disease, and depressed patients might be less likely to engage in physical activity.

When clocks are set forward in March, the risk of heart attack increases by 5 percent during the next three weekdays, while it decreases by 1.5 percent for one day after the clocks are set back in October, according to a study in Sweden published in the October 30 New England Journal of Medicine.

The researchers suggest that these effects are caused by losing an hour of sleep when the clocks are set ahead, and gaining sleep when they are set back. The positive effect in the fall is small because both shifts disrupt the sleep pattern.

The authors go on to conjecture that the known increase in heart attack risk on Mondays is due to a similar cause: people tend to sleep later on weekends, but since they have to get up early on Monday anyway, they get less than their normal amount of sleep on Sunday night.