Heart News and Notes

Not for the merely diabetic, either. Patients who have already had a coronary event should definitely take daily aspirin. The question is whether patients who are at risk but have not had a coronary event should take aspirin to prevent one.

The answer, as reported late this August to the European Society of Cardiology (ESC), is “No.” In a study in Scotland of 3350 patients whose low ankle-brachial index (ratio of blood pressure in the leg and arm) indicated atherosclerosis and high risk of heart attack, those who took aspirin had just as many coronary events as those who had a placebo, and had more major hemorrhage events.

At the same conference two experts independently cited similar results from studies last year of use of aspirin for diabetes patients. One pointed out that diabetes increases not only the risk of heart disease but also the risk of bleeding. Aspirin is recommended for such patients even if they have not had a heart event, but the studies showed no preventive effect.

Capsaicin is the active ingredient in chili peppers that gives them their heat. It’s also the active ingredient in several over-the-counter creams used to relieve pain, such as arthritis pain.

Research on mice at the University of Cincinnati has shown that applying capsaicin to certain areas of their skin triggers a protective reaction that reduces heart muscle death during a heart attack. A similar effect occurs when a small incision is made on the abdomen. The researchers sugggest that the skin not only provides physical protection for the body but also sends nerve signals that arouse system-wide protective action. This mechanism might explain the effect of acupuncture.

Pending further study, rubbing capsaicin cream on your belly if you have a heart attack is not recommended.

More from the ESC 2009 Congress: When Iceland banned public smoking nationwide in June 2007, a research group found that ACS (acute cardiac syndrome, which includes unstable angina as well as full heart attack) dropped 21 percent in the next five months - in men, not women.

Another group, after Italy banned public smoking in January 2005, saw a 6 percent decrease in hospital admissions for coronary events in the next 30 months, affecting men and women under 70. Supposedly older people spend less time in smoky places.

A meta-study reported last month in Circulation found that smoking bans in public spaces in Europe and North America were followed by an overall drop in heart attacks of 17 percent a year later, and 36 percent three years later, compared with places with no such bans.

Four decades ago - more exactly, 1967 to 1970 - a British research group examined some 19,000 men aged 40 to 69 who worked in civil service in London and classified them according to three cardiac risk factors: smokers or non-smokers, high or low blood pressure, and high or low cholesterol. Twelve years ago the survivors - about one-fourth of the group - were examined again. The results of a 38-year followup were published last month in BMJ.

Life expectancy at age 50 was 10 years shorter for those who had all three risk factors at the start of the study than for those who had none. Among those who were reexamined, about two-thirds of the smokers had quit almost immediately. The average difference between the high and low group for both blood pressure and cholesterol had dropped by two-thirds. These were the survivors; we don’t know about the others.

All three of the risk factors studies are modifiable, and all affect life expectancy. The researchers concluded that we can make changes, and the changes can add years to our lives.

A research group in Denmark - looking for measures of heart disease risk other than BMI and waist/hip ratio - measured the thighs of 2,816 people and reached a surprising conclusion. Those with bigger thighs had fewer coronary events in the next ten years, and lower mortality from all causes in the next 12.5 years - up to about 60 cm (23.6 inches). Bigger thighs than that gave no benefit.

Experts are debating the meaning of these results. Thin thighs might be a sign of prediabetes. Low muscle mass might be a risk factor, or scarce subcutaneous fat might be related to poor metabolism of glucose or lipids. And maybe a ratio of thigh size to body size would have been more useful.

The Mediterranean diet is like ours upside down: lots of vegetables, fish and olive oil, all of which we tend to avoid. But both diets share coffee, which contains caffeine. Caffeine at high levels has been associated with ventricular arrhythmias, but less is known about diet and atrial arrhythmia.

An Italian research group compared 400 patients at their first diagnosis of atrial fibrillation (AF) with 400 controls. The AF patients drank more coffee and followed the Mediterranean diet less closely, consuming more red meat and full fat milk products. They had a smaller intake of antioxidants, more from coffee and less from wine, fruits and vegetables. Total calorie intake was about the same in both groups.

The researchers concluded that higher caffeine intake is associated with a higher risk of AF. They also noted that AF is more likely to develop when someone who doesn’t habitually drink coffee starts to consume large quantities.