Heart News and Notes

Gum disease is known to be associated with atherosclerosis, as well as CRP (a marker for inflammation) and certain bacteria. Last month an Italian research team showed that just cleaning and tartar removal can reverse artery blockages.

The study was small: 35 people with mild to moderate periodontal disease. At 6 and 12 months after treatment, the thickness of the carotid artery wall (as measured by echo Doppler) had been reduced from about 0.5 mm to about 0.4 mm, and blood tests showed that bacterial load and CRP level had been significantly reduced.

The researchers are repeating the study with more subjects with wider ranges of gum disease and artery blockage, but they note that ultimately a randomized trial will be needed. Meanwhile, brush your teeth twice a day, floss daily, and see your dentist regularly.

A study published last month in CMAJ, based on a Canadian registry of stent patients, confirms that drug coated stents are safer than bare metal stents at least for the first year, but the relative safety for three years after stent implantation is not so clear.

According to MedPage Today, “by the end of year three, the relative risk of death or repeat revascularization was more than twice as great for drug-eluting stents,” but “the long-term survival for drug-eluting stents was favorable overall.” Articles on other sites were just as confusing.

A commentary article on the CMAJ website made some good points:

• Drug-coated stents are safer at least in the short term.

• The long-term safety of drug-coated stents needs more study.

• Drug-coated stents might look worse because they were given to sicker patients.

• Nobody yet knows how long Plavix should be taken after implanting a drug-coated stent.

PREDIMED is a long-term study of the effects of diet on heart disease prevention, with about 9000 subjects randomly assigned to either a Mediterranean diet plus olive oil, a Mediterranean diet plus mixed nuts, or a low fat diet. It will be completed in 2010.

A group in Spain, looking at some preliminary data, found that the percent of subjects who had a cluster of risk factors called metabolic syndrome decreased most among the nut eaters and least in the low-fat dieters.

Eating nuts appeared to lower different risk factors by small amounts, rather than any particular component, and did not cause weight gain.

Sixty years ago a study found that men with high resting heart rates were more likely to develop high blood pressure. Now a group in Japan, following a group of healthy subjects for 20 years, found that those whose resting heart rate was 80 or more beats per minute were twice as likely to become obese and five times as likely to develop diabetes.

The cause might be an overactive sympathetic nervous system, which induces the “fight or flight response” by raising the heart rate and increasing insulin resistance to hold more energy-providing glucose in the blood.

Beta blockers slow the heart rate, but they might not help. Studies have shown that they increase the risk of diabetes.

Six years ago a study called ALLHAT showed that a diuretic was better than newer drugs for treating high blood pressure. Recent studies show that for some patients using two drugs is more effective than one. But last month, a large randomized study called ACCOMPLISH found that a combination of benazepril (an ACE inhibitor) with amplodipine (a calcium channel blocker) was so much better than benazepril combined with a diuretic that the trial was stopped early.

Both two-drug treatments achieved excellent blood pressure control. However, heart disease events occurred slightly but significantly less often in the group that added a calcium channel blocker to the ACE inhibitor.

Why is a diuretic best when used alone but not in a combination? One reason might be that the diuretic used in ACCOMPLISH is less potent, but more often used today, than the one that was used in ALLHAT.

New research in the UK on “psychological distress,” including depression and anxiety, supports the US study we reported last month on how depression affects heart health. Both studies found that psychological distress increases the risk of cardiac events, not by way of any mysterious biochemical pathway, but by undermining healthy habits.

For the British study, a survey measured psychological distress in 6576 men and women and blood tests assessed medical risk factors. They were then followed for about seven years. During this time the roughly 15 percent who had been identified as psychologically distressed had a 54 percent higher risk of heart disease events.

Statistical analysis showed that behavior accounted for most of this difference. The distressed subjects smoked more and were less active. Smoking accounted for 40 percent of the difference in risk, physical activity for 22 percent, high blood pressure for 13 percent, and CRP for 6 percent. Alcohol intake accounted for only 2 percent.