Heart News and Notes

The American Heart Association recently issued a scientific statement recommending that all heart disease patients should be screened regularly for depression. Patients after a heart attack are about three times more likely than the general population to be depressed, and depressed heart patients are about twice as likely to have a second heart attack within two years. The statement is endorsed by the American Psychiatric Association and was praised by Dale Briggs, Executive VP of Mended Hearts, Inc.

Two simple questions can exclude depression or can tell whether a longer nine-question screening is warranted. The authors noted that while untreated depression is known to lead to worse outcomes, there is no direct evidence that treating depression improves outcomes,

Another AHA scientific statement recommended urgent care to reduce the death rate after sudden cardiac arrest. Restoring a pulse is not enough; the heart and brain can be damaged, inflammation can occur, and the underlying disease condition remains. Among the recommendations are 12 to 24 hours of therapeutic hypothermia (lowered body temperature), immediate catheterization after heart attack, and implanting an ICD.

Drug coated stents avoid the restenosis - growth of tissue inside the stent - that can occur in bare metal stents. But they have another hazard: late stent thrombosis - blood clots forming inside the stent and blocking the artery. To prevent this, patients with these stents need dual antiplatelet therapy - usually Plavix and aspirin - for at least one year.

A new stent coated with a novel polymer - designed to reduce the risk of clotting - might avoid the need for dual antiplatelet therapy. In a test in Italy, 55 patients who received the stent stopped dual antiplatelet therapy after 30 days (as recommended for bare metal stents) with no thrombosis after one year, and results were otherwise good. The test is too small to be conclusive.

Bioabsorbable stents are drug coated stents made of a nonmetallic organic material that is slowly absorbed into the artery wall and ultimately disappears. The don’t avoid the need for dual antiplatelelet therapy, but they could eventually allow the artery to function as though it had never been stented. A small test with thirty patients showed good results after two years. More patients are scheduled to be enrolled in the trial, but a much larger trial would be needed to get conclusive results.

Stem cells taken from a patient’s own bone marrow and infused into a heart damaged by a heart attack were tested in 13 studies, with a total of 811 patients, examined in a review published last month. Left-ventricle ejection fraction improved by an average of 3 percent - not much, but statistically significant.

There was a lot of variation among the 13 studies. Results appeared to be better with higher doses and when infusion occurred within seven days after the heart attack. Greater improvement was seen in patients who started with a lower ejection fraction. But the few trials that followed up beyond six months showed no evidence of long term benefit.

More detailed studies of how to use stem cells might show better improved outcomes, according to the authors of the review.

Bisphenol A is an additive with many applications, including polycarbonate and the epoxy lining of food cans. Polycarbonate is a clear plastic used for baby bottles, sports bottles, glasses (both kinds, eye and drinking), and bullet-resistant windows, among others. It is thought to mimic estrogen and may have other physiological effects.

NHANES (the National Health and Nutrition Examination Survey, 2003-2004) detected bisphenol A in the urine of most participants. Higher levels were associated with more self-reported disease. A level one standard deviation above the average was associated with 63 percent more heart disease, 40 percent more heart attacks, and 39 percent more diabetes.

Canada calls bisphenol A a “toxic chemical” and is taking steps to limit exposure. Meanwhile, should you avoid canned food, or polycarbonate wineglasses? Not yet clear.

Plavix and aspirin are “antiplatelet” agents used, often in combination, to reduce the risk of heart-stopping blood clots. But they carry a risk of gastrointestinal (GI) complications, including ulcers and stomach bleeding.

Three societies - American College of Cardiology, American Heart Association, and American College of Gastroenterology - issued an “expert consensus document” last month recommending proton pump inhibitors (PPI), such as Prevacid, Prilosec or Nexium, as the best way to minimize the risk.

The statement also recommended that daily aspirin should not exceed 81mg and noted that all NSAIDS increase the GI risk. Patients with a history of ulcers should be treated for Helicobacter pylori (a probable cause of ulcers) if appropriate. Cardiologists should consult other physicians before prescribing antiplatelet drugs.