The outcome of in-hospital ventricular fibrillation (VF) in children
is better if the VF is the initial pulseless rhythm and not
subsequent to a different dysrhythmia, according to a report in The
New England Journal of Medicine for June 1.

Cardiac arrest stemming from VF or ventricular tachycardia (VT) is
less common in children than adults. Moreover, the impact of the
timing of these dysrhythmias during arrest in children was unclear.

To investigate, Dr. Robert A. Berg, from the University of Arizona
in Tucson, and colleagues analyzed data on 1005 consecutive
pediatric patients logged in an in-hospital cardiac-arrest registry.
The study focused on the 272 patients with a documented VF or VT
during the arrest.

VF or VT was the initial arrest rhythm in 104 patients and the
subsequent rhythm in 149 patients. For the remaining 19 patients,
the timing of VF or VT was unclear and they were excluded from
further analysis.

The hospital survival rate was 35% with initial VF/VT, compared with
just 11% for subsequent VF/VT, the report indicates. Arrest patients
who never developed VF or VT had a survival rate of 27%.

"The results emphasize the importance of early ECG monitoring during
resuscitation, because the shockable rhythms of VF or VT occurred in
more than 25% of these children," the authors state.

The findings also indicate that many children with cardiac arrest
can have good outcomes. "Even though the outcomes were worse among
patients with subsequent ventricular fibrillation or tachycardia
than in the other groups, more than 10 percent of these children
survived to hospital discharge," they add.

N Engl J Med 2006;354:2328-2339

I'm sending this because 6 months ago my doctor ordered $1,000.00
worth of tests for my heart health and that I should go see a
cardiologist. I could not regulate my heartbeat or breathing at the
time and was exhausted. After a week of this new breatkthrough in
stem cell science, I was back to normal and saved myself a lot of
money and suffering. Madalyn


OPEN LETTER FROM DR. FRED:  Dear Friends,

My son Dallas who has a Masters in Neuroscience, called me from Johns
Hopkins University last week excited about the latest research he has
studied regarding Adult Stem Cell Physiology.

He read about a new company and their product StemEnhance which has
been shown to dramatically increase circulating Adult Stem Cells in
30 minutes by 25 - 35%  and to travel to areas of the body where they
are most needed.  This is considered a breakthrough in this field.
StemEnhance - a fresh water botanical extract  - has been created and
researched over the past 5 years, and it is now patented and approved
for use.

He examined their double-blind lab results... Click here for a
synopsis of this study:
http://www.stemtechprelaunch.com/specsheet.pdf  Very impressive
indeed.

Do you know what this means? The possibilities for dramatic healing,
regeneration, and increased longevity in virtually every organ,
tissue, and / or system in the body are astounding. The anecdotal
reports are flooding in right now around the country, and they are
like nothing I've heard before. For the past week I personally
consumed some of the samples of this product.  At first was a bit
skeptical, since I've ingested so many different 'miracle' / hyped-up
products in my life that ultimately left me disappointed.

Within 60 seconds I felt this elevated feeling. An energetic,
vibrant, expansive, and clear sensation in my head area especially,
but also in my whole body. Obviously, I don't have a lab in my home
to draw blood and do a stem cell analysis right in my kitchen....;o)
But I trust that the above research was clean, well-designed, and
valid.
In just 4 - 5 days taking 4 - 6 capsules per day I'm sleeping better,
much less joint pain and stiffness, feel more energy and greater
overall well-being.  I'm optimistic about this stuff at this point.
And feel this product is already impactful, and looking forward to
the long-term results as well.

As I see it "Adult Stem Cell Enhancers" will be the next ultra-huge
wave hitting the nutritional marketplace.  This will not be some new-
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double-blind laboratory studies are impeccable, very impressive, and
will certainly catch the interest of the scientific community, mass
media, and general public.

Visit the web-site at: www.Rejuvenation.StemTechHealth.com
415-388-1447

Drinking coffee reduces the risk for cardiovascular disease,
according to the results of a study following more than 41,000 women
for 15 years, which was reported in the May issue of the American
Journal of Clinical Nutrition.

"Coffee is the major source of dietary antioxidants," write Lene
Frost Andersen, MD, from the University of Oslo in Norway, and
colleagues. "The association between coffee consumption and risk of
death from diseases associated with inflammatory or oxidative stress
has not been studied."

In the Iowa Women's Health Study, 41,836 postmenopausal women aged
55 to 69 years at baseline were followed up for 15 years. For this
analysis, women with cardiovascular disease, cancer, diabetes,
colitis, and liver cirrhosis at baseline were excluded, leaving
27,312 remaining participants, resulting in 410,235 person-years of
follow-up and 4265 deaths. The primary end point was disease-
specific mortality.

The fully adjusted model revealed that, similar to the relation of
coffee intake to total mortality, the hazard ratio of cardiovascular
death was 0.76 (95% confidence interval [CI], 0.64 - 0.91) for
consumption of 1 to 3 cups/day, 0.81 (95% CI, 0.66 - 0.99) for 4 to
5 cups/day, and 0.87 (95% CI, 0.69 - 1.09) for 6 or more cups/day.
For death from other inflammatory diseases, the hazard ratio was
0.72 (95% CI, 0.55 - 0.93) for consumption of 1 to 3 cups/day, 0.67
(95% CI, 0.50 - 0.90) for 4 to 5 cups/day, and 0.68 (95% CI, 0.49 -
0.94) for 6 or more cups/day.

"Consumption of coffee, a major source of dietary antioxidants, may
inhibit inflammation and thereby reduce the risk of cardiovascular
and other inflammatory diseases in postmenopausal women," the
authors write.

Study limitations include possible reverse causality and residual
confounding.

"Our results are consistent with a protective effect of intake of 1 -
  3 cups of coffee per day on total death and death from
cardiovascular and other inflammatory diseases in a group of
postmenopausal women," the authors conclude. "If our observation is
reproduced in other studies and proves to be causal, the
implications are considerable, being that coffee is the second most
widely consumed drink worldwide."

The authors have disclosed no relevant financial relationships.

Am J Clin Nutr. 2006;83:1039-1046

Inclusion criteria were postmenopausal women aged 55 to 69 years at
baseline without heart disease, nonˇVskin cancer, diabetes, chronic
colitis, or liver cirrhosis.
Excluded were women who gave implausible total energy intakes and
who left more than 30 items blank in the 127-item food frequency
questionnaire.
In the food frequency questionnaire, participants were asked how
frequently on average during the previous year they had consumed a
cup of coffee.
There was a question for regular and one for decaffeinated coffee.
The frequency responses were never, 1 to 3 cups/month, 1 cup/week, 2
to 4 cups/week, 5 to 6 cups/week, 1 cup/day, 2 to 3 cups/day, 4 to 5
cups/day, and 6 or more cups/day.
The 3-month test-retest reliability of coffee consumption was 0.95
and the correlation of intake between the food frequency
questionnaire and five 24-hour recalls was 0.82.
The type of coffee consumed was likely to be predominantly
percolator in the early part and filter coffee in the latter part of
the study.
Deaths were identified by annual linkage of cohort identifiers to
the statewide death records.
There were 4265 deaths by 15 years.
Cause of death was assigned by the single underlying cause given by
state health departments using the International Classification of
Diseases, Ninth Edition and International Classification of
Diseases, Tenth Edition codes.
Cancers and injuries were considered noninflammatory diseases.
Cardiovascular disease deaths were considered inflammatory and
separately analyzed from other inflammatory disease deaths.
The deaths due to inflammatory diseases other than cardiovascular
disease were infectious diseases (170 deaths), chronic
neurodegenerative disease (105 deaths), diabetes (35 deaths),
chronic lower respiratory disease (265 deaths), chronic liver
disease and cirrhosis (23 deaths), chronic renal failure (12 cases),
rheumatic disease (32 deaths), digestive diseases (15 cases), and
other respiratory tract diseases (49 cases).
Analysis was performed using a minimally adjusted (smoking, age, and
alcohol intake) and a full-adjusted model (accounting for other
confounding variables, including body mass index; waist-hip ratio;
education; use of vitamins; supplements; physical activity; intake
of grains, red meat, fish, and seafood; and total fruit and
vegetable consumption).
The mean coffee consumption in the cohort was 2.7 ˇÓ 2.0 cups daily,
of which 1.7 cups were regular and 1.5 cups decaffeinated coffee.
Higher coffee consumption was strongly associated with cigarette
smoking and greater alcohol intake.
In the adjusted model, the respective hazard ratios for total deaths
were 0.85 and 0.81 for 1 to 3 and 4 to 5 cups of coffee daily.
A U-shaped association was found between coffee intake and death
from cardiovascular disease (P for trend .005), and the hazard
ratios were 0.76, 0.81, and 0.87 for 1 to 3, 4 to 5, and 6 or more
cups daily, respectively.
Deaths from cancer showed no association with daily coffee
consumption.
Deaths from all causes other than cardiovascular disease showed a
slight decrease in risk with increasing coffee intake with the
hazard ratios 0.80, 0.76, and 0.79 for 1 to 3, 4 to 5, and 6 or more
cups daily.
An inverse association was found between coffee intake and 713
deaths from inflammatory diseases with hazard ratios of 0.72, 0.67,
and 0.68 for 1 to 3, 4 to 5, and 6 or more cups daily, respectively.
No significant association was found between coffee intake and death
from injury or other causes.
Excluding the first 2 years of death did not alter the findings.
Pearls for Practice
Coffee consumption in postmenopausal women is associated with a U-
shaped mortality curve with lowest mortality in women consuming 1 to
3 cups of coffee daily and the highest mortality in those who drink
no coffee.
An inverse association is seen between coffee intake and nonˇV
cardiovascular disease inflammatory disease in postmenopausal women,
but no association is seen with cancer and injury deaths.

What are you using in terms of drug eluting stents?  I understand
that one works really well and one actually is killing people due to
deflation issues.  Just curious your expereince.


--- In heart119@yahoogroups.com, dr_allen_wang <no_reply@...> wrote:
>
> Compared to balloon angioplasty alone, use of stents in
reperfusion
> therapy in patients after acute myocardial infarction (MI) is
> associated with improved in-hospital outcomes, researchers report.
>
> The results suggest "that all patients who present with an acute
> heart attack should receive a stent rather than balloon
angioplasty
> alone," senior investigator Dr. David L. Brown told Reuters
> Health. "Treatment with a stent reduced the risk of dying in the
> hospital by 50%."
>
> In the April 1st issue of the American Journal of Cardiology, Dr.
> Brown and colleagues at the State University of New York-Stony
Brook
> School of Medicine note that although clinical trials have shown
the
> superiority of the stent approach, it's not known whether this
holds
> good in community-based practice.
>
> To investigate, the researchers retrospectively examined data on
> more than 6000 patients in New York State who, between 1998 and
> 1999, presented within 23 hours of acute MI and underwent
> percutaneous coronary intervention. During this time period, drug-
> eluting stents were not in use.
>
> Stents were placed in 87% of patients. Those who received stents
> were younger (61 versus 62 years) and were more likely to be male
> (33% versus 29%). They were all less likely to have had a history
of
> hypertension and diabetes and to have a creatinine level of 2.5
> mg/dl or beyond (0.8% versus 2.0%).
>
> Stent use was associated with a significant reduction length of
stay
> (5.9 versus 8.1 days), major cardiovascular events (4.1% versus
12%)
> and in-hospital mortality (3.5% versus 9.3%).
>
> After adjustment, stent use was associated with a 50% decrease in
> the risk of in-hospital mortality compared to balloon angioplasty
> alone. The researchers note that although drug-eluting stents were
> not studied, this should not have affected these short-term
findings.
>
> "The major benefit of drug-eluting stents," they point out, "is
the
> decrease in restenosis months after implantation."
>
> Am J Cardiol 2006;97:977-980
>

What are you using in terms of drug eluting stents?  I understand
that one works really well and one actually is killing people due to
deflation issues.  Just curious your expereince.


--- In heart119@yahoogroups.com, dr_allen_wang <no_reply@...> wrote:
>
> Compared to balloon angioplasty alone, use of stents in
reperfusion
> therapy in patients after acute myocardial infarction (MI) is
> associated with improved in-hospital outcomes, researchers report.
>
> The results suggest "that all patients who present with an acute
> heart attack should receive a stent rather than balloon
angioplasty
> alone," senior investigator Dr. David L. Brown told Reuters
> Health. "Treatment with a stent reduced the risk of dying in the
> hospital by 50%."
>
> In the April 1st issue of the American Journal of Cardiology, Dr.
> Brown and colleagues at the State University of New York-Stony
Brook
> School of Medicine note that although clinical trials have shown
the
> superiority of the stent approach, it's not known whether this
holds
> good in community-based practice.
>
> To investigate, the researchers retrospectively examined data on
> more than 6000 patients in New York State who, between 1998 and
> 1999, presented within 23 hours of acute MI and underwent
> percutaneous coronary intervention. During this time period, drug-
> eluting stents were not in use.
>
> Stents were placed in 87% of patients. Those who received stents
> were younger (61 versus 62 years) and were more likely to be male
> (33% versus 29%). They were all less likely to have had a history
of
> hypertension and diabetes and to have a creatinine level of 2.5
> mg/dl or beyond (0.8% versus 2.0%).
>
> Stent use was associated with a significant reduction length of
stay
> (5.9 versus 8.1 days), major cardiovascular events (4.1% versus
12%)
> and in-hospital mortality (3.5% versus 9.3%).
>
> After adjustment, stent use was associated with a 50% decrease in
> the risk of in-hospital mortality compared to balloon angioplasty
> alone. The researchers note that although drug-eluting stents were
> not studied, this should not have affected these short-term
findings.
>
> "The major benefit of drug-eluting stents," they point out, "is
the
> decrease in restenosis months after implantation."
>
> Am J Cardiol 2006;97:977-980
>

Poor physical performance is associated with an increased risk of
dementia and Alzheimer's disease, according to a report in the
Annals of Internal Medicine for May 22. The new findings suggest
that diminished motor function precedes the onset of cognitive
impairment.

"Identifying signs associated with progression to dementia would
assist in predicting the development of dementia and has important
implications for interventions to slow the progression to these
devastating illnesses," Dr. Eric B. Larson, from the Group Health
Cooperative in Seattle, and colleagues write.

In a prospective cohort study, the researchers assessed physical
performance in 2288 subjects, 65 years of age and older, and then
followed them from the mid-1990s through October 2003 for incident
dementia and Alzheimer's disease. Four tests were used to measure
physical performance and focused on walking, chair-to-stand time,
standing balance, and grip strength.

A total of 319 subjects developed dementia during follow-up,
including 221 with Alzheimer's disease, the researchers report.

With higher physical function scores (>10 points), the age-specific
incidence rate of dementia was 17.4 per 1000 person-years, whereas
with lower scores (10 points or less), the rate was 53.1 per 1000
person-years.

For each 1-point drop in the physical function score, the risks of
dementia and Alzheimer's disease rose by 8% and 6%, respectively. In
addition, the Cognitive Ability Screening Instrument scores fell by
0.11 point per year with each 1-point reduction in the baseline
physical function score.

In subjects without apparent cognitive impairment, gait slowing and
poor balance appeared to be risk factors for dementia. By contrast,
in subjects with possible cognitive impairment, poor grip strength
was predictive of dementia.

"These findings suggest that gait slowing and poor balance might
relate to dementia and may occur during an earlier stage before
cognitive impairment is apparent, and that poor handgrip might
relate to dementia during a later stage when cognitive impairment
has occurred," the authors note.

Arch Intern Med 2006;166:1115-1120

Canada's health ministry on Friday warned individuals with
hypertension, heart disease or abnormalities, arthrosclerosis or
hyperthyroidism not to take drugs used to manage attention deficit
hyperactivity disorder (ADHD).

Health Canada said that in rare cases, patient with these conditions
could suffer "rare heart-related side effects" from these drugs. In
a statement, it warned people who are already taking these drugs not
to stop before consulting their physician.

"All ADHD drugs stimulate the heart and blood vessels... The effects
are usually mild or moderate, but in some patients this stimulation
may -- in rare cases -- result in cardiac arrests, strokes or
death," said Health Canada.

Reviewers at the U.S. Food and Drug Administration (FDA) have been
working for months to analyze reports of sudden deaths, heart
attacks and strokes and psychiatric symptoms, such as
hallucinations, in patients who took these drugs.

In March, a panel of U.S. medical advisors called for new
information about heart risks to be added to labeling for ADHD
medications but stopped short of recommending tougher measures.

The drugs mentioned by Health Canada include:

* Adderall XR, made by Britain's Shire Pharmaceuticals Group Plc

* Concerta, made by Johnson & Johnson

* Ritalin and Ritalin SR, made by Novartis AG

* Dexedrine, made by GlaxoSmithKline Plc

* Strattera, made by Eli Lilly and Co.

The B-type natriuretic peptide (BNP) cut-point for diagnosing acute
heart failure should be lowered for obese patients, according to a
report in the May issue of the American Heart Journal.

"Patients who are heavy have lower BNP levels than those who are
not," Dr. Alan S. Maisel from University of California at San Diego,
told Reuters Health. "While most heavy patients with heart failure
have levels much above 100 pg/mL, we should not really rule out the
diagnosis unless the level is under 50."

Dr. Maisel and colleagues prospectively evaluated differential cut-
points for BNP in diagnosing acute heart failure across body mass
index levels in 1586 patients with suspected heart failure to
determine whether alternative cut-points could improve the diagnosis.

The mean BNP levels among patients with heart failure decreased from
643 pg/mL in lean patients to 462 pg/mL in overweight/obese
patients, and to 247 pg/mL in severely/morbidly obese patients, the
authors report.

Using a BNP cut-point of 100 pg/mL for the entire population
resulted in a sensitivity of 90% and a specificity of 79% for
diagnosing acute heart failure, the results indicate, but for
severely/morbidly obese patients this cut-point yielded a
sensitivity of only 77% and a high false-negative rate.

To achieve 90% sensitivity in the different body-mass index groups,
the BNP cut-point would have to be raised to 170 pg/mL in lean
patients and lowered to 54 pg/mL in severely/morbidly obese
patients, the researchers note.

"While I believe there is already enough evidence to consider the
lower cut-points, I am confident further diagnostic studies where
BNP is used will shed further light on this," Dr. Maisel said.

Am Heart J 2006;151:999-1005

Treatment with the selective endothelin A receptor antagonist
sitaxsentan improves exercise capacity and WHO functional class in
patients with pulmonary artery hypertension (PAH), researchers
report in the May 16th issue of the Journal of the American College
of Cardiology.

In an earlier study, sitaxsentan had shown efficacy, but the 300 mg
dose used had an unacceptable safety profile, Dr. Robyn J. Barst of
Columbia University College of Surgeons and Physicians, New York and
colleagues note. Among the side effects were elevated hepatic
transaminases.

To further investigate what might be an optimal dose, the
researchers randomized 247 patients with PAH to sitaxsentan 50 mg,
sitaxsentan 100 mg, placebo or open-label bosentan

After 18 weeks, patients in the sitaxsentan 100 mg group had a
significantly improved 6-minute walking distance and World Health
Organization functional class compared with patient in the placebo
group. Treatment was generally well tolerated. However, the 50 mg
dose of sitaxsentan was subtherapeutic.

The incidence of elevated hepatic transaminases was 3% for
sitaxsentan and 11% for bosentan, but the researchers point out that
the study was not powered to detect differences between bosentan and
sitaxsentan

They conclude that the 100-mg dose improves function in PAH patients
and has "a low incidence of hepatic toxicity."

J Am Coll Cardiol 2006; 47:2049-2056

Up to 2 years of exposure to particulate air pollution — more
commonly called soot — can raise the risk of death for patients
with heart failure, chronic obstructive pulmonary disease (COPD),
diabetes, or inflammatory disorders such as rheumatoid arthritis,
according to the first such study to follow hospitalized patients
discharged alive for specific diseases.

"While previous studies have found that long-term exposure to air
pollution is associated with increased mortality, we found that all
the effect seems to occur within the first 2 years," said coauthor
Joel Schwartz, PhD, professor of environmental epidemiology at the
Harvard School of Public Health in Boston, Massachusetts.

"What that means is that we if clean up the air, we will see
improvements [in risk for death] right away — not 20 years from
now," Dr. Schwartz told Medscape.

For the study, presented here at the American Thoracic Society
International Conference, the researchers used Medicare hospital
discharge data from 34 US cities to examine whether subparticles in
the air were associated with survival. The patients, who had been
admitted between 1985 and1999, were followed for as long as 15 years.

Specifically, the researchers looked at particulate matter (PM10)
particles smaller than 10 microns in aerodynamic diameter, or about
one-seventh the width of a human hair, that can easily travel into
the respiratory tract, Dr. Schwartz said.

The study showed that each increase of 10 µg/m2 of PM10 over 2 years
increased the risk of death by 32% for patients with diabetes, by
28% for patients with COPD, by 27% for patients with congestive
heart failure, and by 22% for people with inflammatory diseases such
as rheumatoid arthritis or lupus.

"Overall, several hundreds of thousands of deaths each year in the
United States are due to such pollution," Dr. Schwartz pointed out.

Jonathan Samet, MD, professor and chair of the department of
epidemiology at the Bloomberg School of Public Health at Johns
Hopkins in Baltimore, Maryland, said the findings are consistent
with previous research showing that particulate matter is associated
with an increase in mortality rates.

That said, "now [Dr. Schwartz] has narrowed it down and showed that
even a few years of exposure can make a difference," Dr. Samet told
Medscape. "By November, we are looking to even further tighten our
controls on particulate matter [and research such as this is
crucial]."

But Dr. Schwartz was pessimistic. He said that the proposal that the
Environmental Protection Agency has suggested for November "is not a
tightening of air pollution controls, against the advice of its own
scientific advisors. While they can still change their minds,
whether they will is another thing," he told Medscape.

So what should be done? One way to reduce particulate matter levels
to is put scrubbers on coal-burning power plants, he said. In
addition, catalysts should be required for diesel engines, according
to Dr. Schwartz.

"London just refitted all its buses with catalysts," Dr. Schwartz
said. "The technology is there but we're not doing it. We could and
save many, many lives in a relatively small number of years."

ATS 2006 International Conference: Abstract B16. Presented May 22,
2006

A new study presented here at the American Thoracic Society
International Conference shows that middle-aged women who sleep 5 or
fewer hours each night weigh an average of 2.5 kg more than those
who sleep for at least 7 hours.

"Sleep deprivation has important effects on a patient's health, so
clinicians should really ask their patients about their sleep
habits," said study presenter Sanjay Patel, MD, an assistant
professor of medicine at Case Western Reserve University in
Cleveland. "Getting a good's night sleep has already been shown to
have effects on diabetes and heart disease and now we see it affects
weight as well."

Dr. Patel told Medscape that previous studies had already shown that
women, men, and children who sleep less tend to weigh more than
those who sleep more. But what had not been clear, he explained, is
whether the loss of sleep caused the weight gain or vice versa.

The prospective database of the Nurses Health Study offered an
opportunity to answer the question, Dr. Patel said. For the current
analysis, the researchers studied 68,183 women, aged 40 to 65 years,
who were first asked about their typical night's sleep in 1986. As
part of routine questionnaires every 2 years for the next 16 years,
they were also asked to report their weight.

In addition to weighing more at baseline, the women who slept less
tended to gain more weight over time, Dr. Patel reported. After
adjustment for age, those who slept for 5 or fewer hours per night
gained 1.5 kg more during the next 10 years than those who slept at
least 7 hours per night (P < .001).

After adjusting for other factors including smoking, snoring,
caffeine and alcohol intake, medication, and menopausal status,
those who slept for 5 or fewer hours per night gained 0.7 kg more
during the next 10 years than those who slept at least 7 hours per
night (P < .001).

Put another way, the researchers found that the women sleeping 5 or
fewer hours per night were 32% more likely to experience major
weight gain, defined as an increase of 33 lb or more, and 15% more
likely to become obese during the 16-year study period than the
women who slept at least 7 hours per night.

In addition, women who slept for 6 hours were 12% more likely to
have major weight gain and 6% more likely to become obese compared
with women who slept at least 7 hours per night.

One of the most surprising findings, Dr. Patel said, was that the
women who slept less actually ate less as well.

"A study from the University of Chicago suggested that healthy
people who get less sleep may eat more because of changes in levels
of the hormones leptin and ghrelin. But this was not the case," Dr.
Patel pointed out.

"We don't really understand why sleep deprivation predicts weight
gain at this point, but it could be that because they are more
tired, the women are less likely to exercise ˇX become couch
potatoes, if you will," Dr. Patel suggested. "Or, sleeping
deprivation may cause changes in a person's basal metabolic rate."

Safwan Badr, MD, chief of pulmonary medicine at Wayne State
University in Detroit, Michigan, said that like many other findings
of the prospective Nurses Health Study, these results ˇ§should have
a very important impact on medical practice.

ˇ§The practicing physician really needs to stress to her patient
that getting a good nightˇ¦s sleep is not just a luxury,ˇ¨ Dr. Badr
told Medscape. ˇ§Itˇ¦s a mandatory way to improve your health.ˇ¨

ATS 2006 International Conference: Abstract C88. Presented May 23,
2006

Women with type 2 diabetes have an 80% increased risk of colorectal
adenoma compared with non-diabetics, a team from Washington
University in St. Louis, Missouri, reported here at Digestive
Disease Week 2006.

Also, diabetes plus obesity more than doubles the risk of colorectal
adenomas, and of adenomas found at more advanced stages, compared
with the risk in non-obese non-diabetic women.

Dr. Jill E. Elwing and colleagues studied 100 women with type 2
diabetes and 500 non-diabetic women who were undergoing screening
colonoscopy.

The mean age of the diabetic group was 60 years, 41% were Caucasian,
and 10% had a first-degree relative with colorectal cancer. Mean
body mass index was 34.4, and 29% were on insulin.

The non-diabetic control group was comparable in hormonal status.
The mean age was 59 years, 68% were Caucasian, mean BMI was 28.5 and
7% had a first-degree relative with colorectal cancer.

Any adenoma, or advanced adenoma that was either villous or
tubulovillous and that was greater than 1 cm in size, or any high-
grade dysplasia met the definition of adenoma in this study.

The rate of any adenomas was 37% among the diabetic women compared
with 24% among the non-diabetics. This translated to an odds ratio
of 1.80. Diabetics had a rate of advanced adenomas of 14% compared
with 6% in non-diabetics, for an odds ratio of 2.4.

Obese women with diabetes had an odds ratio of 2.6 for any adenoma
and 3.5 for advanced adenoma, compared with non-obese non-diabetics.

"Estrogen is known to affect the rate of colorectal cancer growth,
so we controlled for estrogen status," Dr. Elwing pointed out in
comments to Reuters Health.

As for the possible cause for the link between diabetes and
colorectal adenoma, "hyperinsulinemia may be the reason," she
said. "Insulin itself is a growth factor. It may have a direct pro-
neoplastic effect, or it may act indirectly, through growth factor-
1."

The US Food and Drug Administration (FDA) and Bayer Pharmaceuticals
Corporation have warned healthcare professionals against inadvertent
parenteral administration of contents from nimodipine capsules
(Nimotop), according to an alert sent yesterday from MedWatch, the
FDA's safety information and adverse event reporting program.

The error may occur when capsule contents are extracted into a
syringe for administration via nasogastric tube in patients unable
to swallow. To minimize this risk, the syringe should be
labeled "Not for IV Use."

Intravenous administration of capsule contents has resulted in
deaths and serious adverse events, including cardiac arrest,
cardiovascular collapse, hypotension, and bradycardia.

The FDA notes that clinically significant hypotension may require
cardiovascular support with pressor agents. Prompt use of specific
treatments for calcium channel blocker overdose is advised.

Nimodipine is indicated for oral administration to improve
neurologic outcome by reducing the incidence and severity of
ischemic deficits in patients with subarachnoid hemorrhage from
ruptured intracranial berry aneurysms regardless of postictal
neurologic condition (ie, Hunt and Hess grades 1 through 5).

Additional information regarding use of nimodipine may be obtained
by contacting the manufacturer's communications department at 1-800-
288-8371.

Healthcare professionals are encouraged to report nimodipine-related
adverse events to the FDA's MedWatch reporting program by phone at 1-
800-FDA-1088, by fax at 1-800-FDA-0178, online at
http://www.fda.gov/medwatch, or by mail to 5600 Fishers Lane,
Rockville, MD 20852-9787.

The angiotensin II receptor blocker telmisartan increases caloric
expenditure and protects against weight gain in rats fed a high-fat,
high-carbohydrate diet, researchers report in the May issue of
Hypertension.

"Our findings," senior investigator Dr. Theodore W. Kurtz told
Reuters Health, "are consistent with the results of a preliminary
clinical study from Japan in which telmisartan also reduced visceral
fat accumulation and improved glucose tolerance in patients with the
metabolic syndrome."

"This raises the possibility," he added, "that some antihypertensive
drugs may be useful not only for treating high blood pressure, but
also for treating the metabolic disturbances that often go hand in
hand with hypertension."

Specifically, Dr. Kurtz of the University of California, San
Francisco and colleagues found that rats given telmisartan, but not
those fed valsartan, which lacks the peroxisome proliferator-
activated receptor gamma partial agonist activity of telmisartan,
had lower absolute food intake.

Telmisartan also increased expression of genes known to play
important roles in mitochondrial energy metabolism, as well as
reducing the accumulation of visceral fat and decreasing adipocyte
accumulation to a much greater extent than valsartan.

Dr. Arya M. Sharma, author of an accompanying editorial, told
Reuters Health that the work "clearly opens a new perspective on the
metabolic effects of telmisartan in humans."

Dr. Sharma of McMaster University, East Hamilton, Ontario went on to
observe that "the potential role of this compound in weight
maintenance or even the prevention of weight regain may deserve
further evaluation."

Hypertension 2006;47:1003-1009

The alpha-glucosidase inhibitor voglibose can help reduce
postprandial hypotension, Japanese researchers report in the May 9th
issue of Neurology.

Lead investigator Dr. Takahiro Maruta of Kanazawa University and
colleagues note that reduced blood pressure after a meal is common
in the elderly and in those with conditions such as Parkinson's
disease and diabetes mellitus. It can increase the risk of falls and
coronary events.

To examine the effect of voglibose on postprandial hypotension, the
researchers studied 48 elderly subjects including those with
Parkinson's disease, multiple system atrophy and diabetes as well as
elderly and younger controls with no autonomic disorder.

Within 2 hours of 75-g glucose loading, blood pressure fell by more
than 20 mm Hg in 72.7% of the Parkinson's patients, all of those
with multiple system atrophy, 27.3% of the patients with diabetes,
23% of the elderly controls and none of the younger controls.

Following voglibose administration, there was a significant
reduction in this drop in blood pressure. Without voglibose the mean
drop was 41.5 mm Hg; with voglibose, it was 21.0 mm Hg. There was
also a reduction in the duration of postprandial hypotension under
the two conditions (52.3 minutes versus 17.3 minutes).

Summing up Dr. Maruta told Reuters Health, "Many people suffer from
symptoms due to hypotension. Our research should cast some light on
ways to help them."

Neurology 2006;66:1432-1434

Here is a practical approach to hypertension. Check this site:
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[Non-text portions of this message have been removed]

Ghrelin is involved in the control of glucose homeostasis, but not
in obesity, according to a report in the May issue of Cell
Metabolism.

Ghrelin and leptin both act on feeding centers in the brain to
regulate energy balance, the authors explain, but mice lacking
ghrelin have normal appetites.

Dr. Roy G. Smith and colleagues from Baylor College of Medicine,
Houston, Texas used ghrelin- and leptin-deficient mice to
investigate the interrelated physiological roles of ghrelin and
leptin.

In leptin-deficient mice, the ablation of ghrelin did not reduce
body weight or fat content, the authors report. Deletion of ghrelin
did, however, enhance glucose-dependent insulin release and increase
insulin sensitivity, the results indicate.

Ablation of ghrelin in obese and lean mice reduced the expression of
uncoupling protein-2, which regulates ATP production and thereby
influences insulin release, the researchers note.

"Collectively," the investigators conclude, "our data are consistent
with the notion that ghrelin is a neuromodulatory sensor that
controls whole body metabolism according to nutrient intake and body
composition by linking the growth hormone/insulin-like growth factor-
1 axis with glucose sensing, beta cell function, and fat
mobilization."

Cell Metabolism 2006;3:379-385

Users of nonsteroidal anti-inflammatory drugs (NSAIDs) have a small
increased risk of first hospitalization for heart failure (HF),
researchers from Spain report. They also found that for patients
with pre-existing HF, NSAIDs may lead to worsening HF, triggering
hospital admission.

This increased risk may have "considerable public health impact,"
particularly among the elderly, the population most at risk for HF,
notes the study team in a report in the journal Heart posted online
today.

Dr. Consuelo Huerta and colleagues compared NSAID use among 1,396
individuals aged 60 to 84 with first hospital admission for non-
fatal HF (cases) and a random sample of 5,000 controls.

Fourteen percent of cases were current NSAID users compared with 10%
of controls. NSAIDs were primarily used for osteoarthritis.

With current NSAID use, the overall risk of a first hospitalization
for HF was 1.3 after controlling for major confounding factors,
report Dr. Huerta and colleagues from Centro Espanol de
Investigacion Farmacoepidemiologica in Madrid.

Relative risks for HF hospitalization associated with use of
individual NSAIDs ranged from 1.1 with diclofenac to 3.4 for
indomethacin. "No effects of dose and duration were evident.

The risk of HF hospitalization was associated with known etiologic
risk factors including hypertension, diabetes, renal failure, heart
disease, and anemia. Obesity, smoking, alcohol use, and recent
hospitalizations and specialists' visits -- two indicators of
greater comorbidity -- were also associated with an increased risk
of HF hospitalization.

However, a prior diagnosis of HF was the main independent risk
factor triggering a first hospitalization for HF, with a relative
risk of 7.3. NSAID users with prior HF had a relative risk 8.6 for
hospitalization, compared with no NSAID use and no prior HF.

Summing up, the investigators say these results, overall,
are "compatible with results from published epidemiological studies
indicating that NSAIDs exacerbate symptoms of HF leading to
hospitalization among susceptible patients, such as those with a
history of cardiovascular disease, in particular previous HF, but
also that NSAIDs trigger the risk of HF hospitalization in patients
without a history of clinical HF."

Heart 2006

A majority of patient care providers involved in the care of
terminally ill patients have requested deactivation of either a
pacemaker or an implantable cardioverter defibrillator (ICD), a new
survey shows. However, almost 50% of those providers are
uncomfortable ordering deactivation of a pacemaker, and more than
31% are uneasy about ordering the deactivation of an ICD. Paul S.
Mueller, MD, from the Mayo Clinic College of Medicine in Rochester,
Minnesota, presented the results here at the annual meeting of the
Heart Rhythm Society from a survey on patient care providers'
attitudes toward deactivating pacemakers and ICDs in terminally ill
patients.

"There is an increased prevalence of patients dying of noncardiac
diseases who also have pacemakers or ICDs," Dr. Mueller told
Medscape. "Yet guidelines for deactivation of devices in the
terminally ill do not exist and published experience of this issue
is limited," he noted.

Dr. Mueller and colleagues distributed an anonymous Web-based survey
to Heart Rhythm Society members and field representatives of 2
device manufacturers during the spring of 2005. The survey consisted
of 76 yes/no and multiple-choice questions, and a section for
written comments.

Of 4473 individuals who received the survey, 787 (18%) completed the
questionnaire, including 325 Heart Rhythm Society members (13%) and
462 field representatives (23%). Of respondents, 64% were women, 70%
had been in the medical field for more than 10 years, and 23% were
physicians.

More than 69% of respondents reported that they had cared for a
patient for whom they or another physician had ordered deactivation
of a pacemaker on at least 2 to 6 separate occasions. Almost 85% of
respondents had cared for a patient for whom they or a physician had
ordered deactivation of an ICD on at least 2 to 6 separate
occasions. In addition, approximately 60% of respondents reported
that they had personally deactivated a pacemaker and about 81% had
deactivated an ICD in these circumstances.

Respondents reported that device industry representatives were the
most likely personnel to deactivate a device, followed by
cardiologists, nurses, and electrophysiology technicians,
respectively. "One question we didn't ask," Dr. Mueller said, "was
who is present during deactivation. So it's very possible that
physicians or nurses are present, but industry reps have the most
know-how to deprogram the devices. Still, it's rather remarkable
that other technicians or nurses haven't been taught how to do this."

The survey revealed that more than 63% of respondents thought there
was an ethical distinction between deactivating a pacemaker and
deactivating an ICD. Almost 90% of the respondents considered
pacemakers to be a life-sustaining treatment, while only 52%
considered ICDs to be life-sustaining. In addition, 18.5% of
respondents considered deactivation of a pacemaker to be euthanasia
or physician-assisted suicide, whereas only 2% considered
deactivation of an ICD to be such.

"The difference in attitudes between deactivating a pacemaker and an
ICD probably has to do with the fact that a pacemaker-dependent
patient can die within minutes after the pacemaker is deactivated,"
Dr. Mueller commented to Medscape. "There is a greater comfort level
[among patient care providers] with deactivating an ICD where a
patient probably will not die right away."

While about 58% of respondents felt a psychiatric evaluation is
warranted sometimes or always before granting a patient request for
deactivation of a pacemaker, only 37% felt an evaluation was
necessary before deactivating an ICD. Despite these statistics, very
few respondents (less than 7%) had ever requested a psychiatric
evaluation in either circumstance.

The survey also questioned respondents about how important fears
regarding inappropriate or poorly tolerated shocks were in granting
requests to deactivate an ICD. More than 89% thought this issue was
important or very important.

In their concluding remarks, Dr. Mueller and colleagues stated that
the variance in practice patterns suggests that "additional research
and practice guidelines are needed to address these issues."

Alberto Interian, MD, who moderated the presentation, commented to
Medscape that "[the survey] brings to light a problem that
cardiologists and electrophysiologists have to deal with more and
more. We are seeing more terminally ill patients that have devices
in them and the question comes up ˇX should these devices be turned
off to spare the patients suffering? In certain patients, these
devices are keeping them alive." Dr. Interian is director of
electrophysiology at the Miller School of Medicine, University of
Miami in Florida. He was not associated with the study.

Dr. Interian said that physicians must address deactivation of
pacemakers and ICDs in the same manner as withdrawing or withholding
other life-sustaining treatments. "The patient has to be competent
and give consent, or have a legal guardian appointed. Physicians
then have to meet and educate the patient or legal guardian, and the
patient's family."

Echoing the sentiments of Dr. Mueller and colleagues, Dr. Interian
noted, "The problem is we don't have definite national guidelines on
this. There are guidelines set by the ethics committees of
individual institutions, but when it comes to a national policy
level, there is a lot of vagueness."

The study was independently funded. Coauthor David L. Hayes, MD, is
on the medical steering committee of Medtronic and on the medical
advisory board of Guidant and St. Jude Medical. The remaining
authors report no relevant financial relationships.

Heart Rhythm Society 2006: Session AB26-6. Presented May 18, 2006

Patients with less severe symptoms of heart failure may be as likely
to benefit from cardiac resynchronization therapy (CRT) as those
whose symptoms are more severe, according to a subset analysis from
the Cardiac Resynchronization Therapy ˇX Heart Failure (CARE-HF)
program. John G. F. Cleland, MD, from the University of Hull,
Kingston-Upon-Hull, United Kingdom, presented the findings here at
the annual meeting of the Heart Rhythm Society.

CARE-HF, a multicenter randomized trial, demonstrated that compared
with medical therapy, CRT significantly reduced morbidity and
mortality in patients with New York Heart Association (NYHA) class
III/IV heart failure patients, left ventricular ejection fraction
less than 35%, and evidence of cardiac dyssynchrony (Cleland et al,
N Engl J Med. 2005). Noting that CRT is currently indicated in
patients with moderate to severe heart failure symptoms, left
systolic dysfunction, and a prolonged QRS interval, Dr. Cleland told
Medscape that he and his colleagues "wanted to investigate to what
extent CRT is treating cardiac dysfunction and to what extent it's a
symptomatic therapy." He and his colleagues suggested that patients
with less severe symptoms might also benefit if they have the same
severe underlying disease.

In the present analysis, patient symptomatology was assessed by
investigator-assigned NYHA class at baseline and 18 months, and by
patient self-assessment of NYHA class at baseline and 3 months.
Other methods of symptom assessment included the EuroHeart Failure
Survey Questionnaire and EQ5D at baseline and 3 months, and the
Minnesota Living with Heart Failure Questionnaire at baseline, 3,
and 18 months.

The primary end point for the study was death or unplanned
hospitalization for a major cardiovascular event. The mean duration
of the study was 29.4 months. The study was also extended to a mean
duration of 36.4 months for a primary end point of all-cause
mortality.

CARE-HF enrolled a total of 813 patients in investigator-assigned
NYHA class III or IV heart failure. Of the overall patient cohort,
783 provided self-reported symptoms at baseline, including 175
patients (22%) who assessed themselves as NYHA class I/II, the
remaining 608 patients assessed themselves as NYHA class III/IV.
According to Dr. Cleland, this suggests that patients' self-
assessment did not always agree with the investigators' assessment.

Dr. Cleland reported that there were statistically significant (P
= .0001) symptom differences between the self-assessed groups.
Moderate/severe breathlessness was reported in 29% of NYHA class
I/II patients vs 56% of NYHA class III/IV patients. Moderate/severe
fatigue was reported by 22% of NYHA class I/II patients vs 49% of
NYHA class III/IV. Similarly, patients who identified themselves as
NYHA class III/IV were more likely to believe they were in poor
health than patients who assessed themselves as NYHA class I/II (58%
vs 31%, respectively). The NYHA class III/IV group also reported a
greater decrease in quality of life compared with the NYHA class
I/II group (P = .001).

However, there was no statistically significant difference for left
ventricular end-systolic volume, left ventricular ejection fraction,
and severity of mitral regurgitation between the self-assessed NYHA
class I/II and class III/IV groups. However, the self-assessed NYHA
class I/II patients did have lower levels of NT-probrain natriuretic
peptide (BNP) and better glomerular filtration rates.

Dr. Cleland and colleagues found that the effect of CRT on death or
hospitalization for a major cardiac event, all-cause mortality, and
investigator-assigned NYHA class at 18 months was similarly
beneficial for both self-assessed groups. In addition, hazard ratios
(HRs) comparing CRT recipients who had less severe symptoms with the
medical therapy control group showed benefits from CRT for shortness
of breath (HR = 0.64), fatigue (HR = 0.55), and health (HR = 0.70).
These were similar to the benefits seen in patients with more severe
symptoms of heart failure, although quality of life improved more in
patients with severe symptoms who had CRT (HR = 0.53) than in
patients with less severe symptoms (HR = 0.76).

Commenting on the results of the analysis, Randall Starling, MD,
MPH, the session moderator, told Medscape, "My own personal bias all
along is that it makes sense to put this [CRT] device into a patient
who is NYHA class II, but that doesn't fall within the current
regulatory labelling for this device in the United States. What will
be extremely convincing to me is when the results of clinical
studies come out that actually show in that patient population that
they derived remodelling benefit ˇX objective changes in left
ventricular anatomy."

"Basically, heart failure symptoms are a poor guide to the long-term
benefits of cardiac resynchronization therapy," Dr. Cleland told
Medscape. "CRT can be a good treatment with advanced cardiac
dysfunction whether a patient is symptomatic or not. It is a disease-
modifying intervention. We think that there are benefits beyond
symptomatic improvement."

The study was funded by a grant from Medtronic.

Heart Rhythm Society: Session AB43-1. Presented May 19, 2006

The cyclooxygenase 2 (COX-2) inhibitor celecoxib (Celebrex) appears
to slightly raise blood pressure, but the effect is not as large as
that associated with the use of nonselective nonsteroidal anti-
inflammatory drugs (NSAIDs) such as ibuprofen or naproxen, according
to a meta-analysis of more than 44,000 patients.

"Hypertension was more prevalent in patients given celecoxib than
those given placebo, which didn't raise blood pressure at all," said
chief investigator William B. White, MD, from the University of
Connecticut School of Medicine in Farmington.

But in studies that compared celecoxib to nonselective NSAIDs, "the
other NSAIDS raised blood pressure more," Dr. White told Medscape.
He presented the findings here at the American Society of
Hypertension 21st annual scientific meeting.

The COX-2 drugs have been a cause of concern since one such drug,
rofecoxib (Vioxx), was voluntarily removed from the market in
September 2004 due to an increased risk of heart attacks among
people who took the drug daily for more than 18 months. Then another
such agent, valdecoxib (Bextra), was pulled from the US market after
the Food and Drug Administration (FDA) said risks for cardiac,
stomach, and skin problems outweighed its benefits.

That left celecoxib as the only COX-2 drug on the market. But even
it was forced by the FDA to carry strict new warnings alerting
physicians and patients that it elevates the risk of myocardial
infarction and strokes.

Meanwhile, other studies showed that nonselective NSAIDs may also
increase the risk of myocardial infarction in people with arthritis.
So physicians have been urging all involved to weigh their
individual risks when choosing an analgesic.

Due to the controversy surrounding the use of the COX-2 agents and
NSAIDs, Dr. White's study, which was originally scheduled to be
featured in a press conference here, was removed from its agenda.
Reporters were, however, permitted to attend his general
presentation to meeting attendees.

The meta-analysis included 41 trials comparing celecoxib either to
other NSAIDs or placebo for disorders ranging from osteoarthritis to
Alzheimer's disease.

Of the total, 24,933 patients received celecoxib at doses ranging
from 50 to 800 mg/day, 13,990 received the NSAIDs naproxen,
diclofenac, ibuprofen, ketoprofen, or loxoprofen, and 4057 received
placebo.

In the studies comparing celecoxib to placebo, 1.1% of people taking
celecoxib developed hypertension or aggravated hypertension compared
with 0.7% of patients receiving placebo (P = .023). Also, 0.2% of
celecoxib-treated patients developed cardiac failure vs less than
0.1% of those receiving placebo (P = .046). Edema was also more
prevalent in the celecoxib group: 2.0% vs 0.9% in the placebo group
(P < .001).

But in the studies comparing celecoxib to the other NSAIDs, just
1.5% of those receiving celecoxib developed hypertension or
aggravated hypertension compared with 2% of those receiving NSAIDs
(P = .002). The risk of heart failure was 0.1% in the celecoxib
group and 0.2% in the NSAID group, a nonsignificant difference (P
= .056). More edema was also seen in the patients receiving NSAIDs:
3.0% vs 2.4% in the celecoxib group (P = .001).

Dr. White said that a subanalysis showed that the dose of celecoxib
did not affect the results. "While celecoxib at all doses yielded a
higher rate of high blood pressure than placebo, it was still very
low," he said.

As for how the drugs may increase blood pressure, Dr. White
said, "When patients get a COX-2 inhibitor or an NSAID, there's a
blockage of salt and water excretion in the first 2 days or so. That
can lead to a rise in blood pressure and the development of edema."

The study received no funding from industry, Dr. White added.

Billy Arant Jr., MD, from the University of Tennessee College of
Medicine in Chattanooga, said the study provides important new
information for physicians to share with their patients when
weighing the risks and benefits of using the popular
painkillers. "It's data that were not available on such a large
scale until this point," he told Medscape.

That said, there remains an important analysis that has yet to be
performed, Dr. Arant added. "We need to look at how many of these
patients were on antihypertensive medications and how the drugs
fared in this group vs those not on medication.

"Patients who already had hypertension may have lost control of
their blood pressure when on the drugs and people with normal blood
pressure may have developed hypertension over time. Being on blood
pressure medication could possibly be protective and affect the
results. The fact that they now have this large data set will allow
such an analysis," Dr. White said.

ASH 21st Annual Scientific Meeting: Abstract 54. Presented May 18,
2006

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Adolescents with prehypertension, defined as blood pressure in the
90th to <95th percentile, are at increased risk for developing overt
hypertension in as few as 2 years, according to study findings
presented here Friday at the annual meeting of the American Society
of Hypertension.

The results indicate that roughly 7% of teens with prehypertension
will progress to fixed hypertension each year.

"In adults, current blood pressure is known to be the strongest
predictor of future blood pressure," senior author Dr. Bonita
Falkner, from Thomas Jefferson University in Philadelphia, told
Reuters Health. "Less is known about the association in adolescents
due to a limited amount of follow-up data and the individual
variability in blood pressure seen in this age group."

The present study involved an analysis of data for 8533 adolescents
entered in the National Childhood Blood Pressure database. The
subjects had blood pressure measurements taken on two occasions, two
years apart.

Based on the initial measurement, subjects were placed into one of
three blood pressure groups: normal (<90th percentile by age, sex,
and height), prehypertensive (90th to <95th percentile), and
hypertensive (at least 95th percentile). The researchers then looked
at how the group distributions changed at 2-year follow-up.

In boys, 5% of those who had normal blood pressure at the first
measurement were hypertensive by the second measurement, while 31%
of those who were hypertensive at the first measurement were
hypertensive at the second. In girls, the corresponding figures were
4% and 26%. Fourteen percent of boys and 12% of girls who were
prehypertensive initially moved to the hypertensive group at follow-
up.

This trend was still apparent, even though just one blood pressure
measurement was taken at each sitting, the report indicates.

In boys, BMI played a role in predicting future blood pressure. "The
boys who either stayed hypertensive or became hypertensive were the
ones who had a high BMI initially or who gained weight in the 2-year
interval," she added.

In girls, age was a predictor of blood pressure at follow-up. "The
older the girl was with high blood pressure at initial measurement,
the more likely they would still have high blood pressure at follow-
up," Dr. Falkner said.

"The findings indicate that children with high blood pressure
readings are at increased risk for hypertension," Dr. Falkner
emphasized. "This age group is a good entry point for preventive
interventions known to have a beneficial effect, such as weight
reduction, physical activity, and dietary changes."

Using an extracorporeal hemoperfusion adsorbing column during
coronary angiography effectively removes most of the contrast medium
used during the procedure before it reaches the kidneys, according
to Japanese researchers. The device, they write in the May 2nd issue
of the Journal of the American College of Cardiology, could sharply
remove the incidence of contrast-induced nephropathy.

In experiments in swine, Dr. Ichiro Michishita of Yokohama Sakae
Kyosi Hospital and Zenzo Fujii of Yamaguchi University inserted 8-F
suction catheters into the coronary sinuses via the femoral vein.
Venous blood was transferred into a 500 ml extracorporeal contrast-
adsorbing column during contrast angiography.

The investigators infused 155 ml of contrast medium into the
coronary arteries of eight swine during angiography. Five had the
contrast filtered through the adsorbing column for 90 minutes and
three did not.

Mean iodine removal rate was 49.4%. The area under the curve of
Iodine concentration was 60% less in the study animals than in
controls. There were no adverse effects as a result of the
extracorporeal treatment.

"Contrast-induced nephropathy is the third leading cause of hospital-
acquired nephropathy," the researchers note. They believe the
contrast removal system "may have potential in human patients with
pre-existing renal insufficiency, diabetic nephropathy or many risk
factors who are undergoing percutaneous coronary intervention for
complicated lesions."

J Am Coll Cardiol 2006;47:1866-1870

Mayo Clinic clinicians warn that the risks of replacing a pulse
generator device, which can be significant, may outweigh the risks
of leaving it in place, despite a manufacturer's advisory to recall
the device.

At the Heart Rhythm Society's 27th Annual Scientific Sessions, held
this week in Boston, Dr. David L. Hayes of the Mayo Clinic,
Rochester, Minnesota, presented data on 732 pulse generator
replacements performed at the Mayo Clinic between January 2000 and
November 2005. Devices removed included pacemakers, implantable
cardioverter defibrillators (ICDs) and cardiac resynchronization
therapy devices (CRTs).

Of the 732 replacements, 570 were performed electively in the
medical team's anticipation of device failure from battery depletion
or other cause and 162 were replaced in response to the
manufacturer's device recall.

There were nine complications in the total 732 device replacements
(1.24%) that required a second replacement. Complications included
infection in five cases, hematoma in three cases and incision
dehiscence in one case.

Manufacturer's predicted device failure rates ranged from 0.017% to
1.83%. Dr. Hayes said that rate "would be considered carefully" in
assessing the need to replace a device under recall.

"We would replace the pacemaker if the risks outweigh the benefits
when we're presented with an advisory," Dr. Hayes told Reuters
Health. "If that patient is very pacemaker-dependent, we may leave
it. If the risk outweighs the benefits according to the recall
statistics, we may replace it."

"We can't decrease the complication rate. We already take measures
to minimize it as much as possible," Dr. Hayes explained. "This rate
(1.24%) is for our practice. Another study may find a different
complication rate."

"We have to consider each patient independently...Know your center's
complication rate and explain the risks and benefits to help
patients make a decision," he advised.

Higher body mass index (BMI) results in a more than 2-fold increase
in the recurrence of either paroxysmal or persistent atrial
fibrillation, according to a subanalysis of the Canadian Trial of
Atrial Fibrillation (CTAF). Jean-Marc Raymond, MD, from the Montreal
Heart Institute, presented the findings here at the Heart Rhythm
2006: the 27th Annual Scientific Sessions of the Heart Rhythm
Society.

"There is increasing evidence that implicates obesity as a risk
factor for new-onset atrial fibrillation," Dr. Raymond told meeting
attendees. "But we wanted to investigate whether BMI also modulates
the risk of recurrence in patients already diagnosed with paroxysmal
or persistent atrial fibrillation."

The prospective, multicenter, randomized CTAF compared the effects
of amiodarone vs sotalol or propafenone for the prevention of
recurrent atrial fibrillation. For their analysis, Dr. Raymond and
colleagues studied 61 patients enrolled in the CTAF study at the
Montreal Heart Institute between 1996 and 1999.

The majority of these patients (62%) were men, mean age was 64.5
years, and the average BMI was 29.5 kg/m2.

More than half (52%) of the patients had a history of hypertension,
21% had coronary artery disease, and 15% had valvular disease at
baseline. Twenty-one percent had a left ventricular ejection
fraction of less than 40% and mean left atrial size was 43.1 mm.

Of this patient cohort, 62% were randomized to amiodarone, 28%
received propafenone, and 21% received sotalol in the overall study.

Dr. Raymond and colleagues defined the beginning of the study as 21
days after randomization, at which time, they noted, electrical
cardioversion would have been performed as necessary. The study's
primary end point was the length of time to a first confirmed
recurrence of atrial fibrillation lasting longer than 10 minutes.

Researchers reported that 43% of patients had a recurrence of atrial
fibrillation, with a mean time to recurrence of 142 days. The
patients who had no recurrence of atrial fibrillation (57%) were
followed for 425 days. Total mean time to recurrence for all
patients was 303 days.

When assessing the effects of BMI on recurrence of atrial
fibrillation, Dr. Raymond and colleagues found that patients with a
BMI of more than 27 kg/m2 were more likely than patients with a BMI
less than 27 kg/m2 to have a recurrence of atrial fibrillation
during a mean follow-up time of 14.3 months (log rank, P = .044). In
addition, when controlling for age and other risk factors, a BMI
higher than 27 kg/m2 was an independent predictor of recurrence of
atrial fibrillation (hazard ratio, 2.8; 95% confidence interval,
1.1 - 7.5; P = .03777).

"This represents a greater than 2-fold risk of recurrence when
compared with patients with a BMI less than 27," Dr. Raymond stated.

"We had noticed that in the clinic patients with recurrent atrial
fibrillation had higher BMIs," Dr Raymond told Medscape in an
interview. "If there is a link between recurrent atrial fibrillation
and obesity, then there is a modifiable risk factor that can be
treated." He added that sleep apnea, diet, and autonomic tone may
also be contributing factors for atrial fibrillation in obese
patients.

"We have suspected that there is a relationship between obesity and
atrial fibrillation, and this study helps confirm that," Abraham
Kocheril, MD, the presentation moderator, commented to Medscape. "As
data shows, there will be a doubling of the obesity rates [in the
United States] by 2050. We also know that the incidence of atrial
fibrillation in this country is rising and very little has been done
to address this epidemic." Dr. Kocheril is head of cardiac
electrophysiology at the Carle Heart Center, University of Illinois
College of Medicine at Urbana-Champaign. He was not involved in the
study.

"We don't really know yet if losing weight will decrease the
recurrence of atrial fibrillation." Dr. Raymond told
Medscape. "However, there are case reports that show that patients
who lose weight do have a decrease of recurrence of atrial
fibrillation, so weight loss should be a primary focus in these
patients."

Dr. Kocheril cautioned that although weight loss is beneficial,
exercise should be moderate in patients with atrial
fibrillation. "We've seen in other studies that excessive exercise
can predispose to atrial fibrillation, so it's best to advise a
middle-ground approach in these patients," he said.

This study was independently funded. The authors report no relevant
financial relationships.

Heart Rhythm 2006: Session AB15-6. Presented May 18, 2006

A limited deceleration capacity of heart rate is a strong predictor
of mortality after MI, new research shows. In fact, it is more
accurate in predicting death than left ventricular ejection fraction
(LVEF) or standard measures of heart rate variability.

Previous reports have linked decreased heart-rate variability with a
poor prognosis following MI, but the clinical usefulness of current
variability measures is limited. Part of the problem is that overall
measures of heart-rate variability do not distinguish between heart
rate deceleration, mediated by vagal effects, and acceleration,
mediated by sympathetic effects.

In the present study, reported in the May 20th issue of The Lancet,
Dr. Georg Schmidt, from Technische Universitat Munchen in Germany,
and colleagues used a signal-processing algorithm to differentiate
heart rate deceleration from acceleration on Holter readings.

The researchers hypothesized that deceleration capacity would be a
better predictor of outcomes in post-MI patients than acceleration
capacity, overall heart-rate variability or LVEF. Deceleration was
quantified in 1455 post-MI patients and then deceleration capacity
was used to predict prognosis in two separate groups with about 600
post-MI patients in each group.

In both confirmation cohorts, deceleration capacity was a stronger
predictor of death following MI than was LVEF or overall heart-rate
variability. The authors found deceleration capacity to be a
particularly strong correlate of death among subjects with preserved
LVEF.

"Deceleration capacity substantially improves risk prediction in
survivors of acute MI," the authors conclude. Further studies,
however, are needed to determine if interventions based on the use
of this parameter actually improve clinical outcomes, they add.

Lancet 2006;367:1674-1681

Intravitreal injection of triamcinolone is a useful adjunct to laser
panretinal photocoagulation for proliferative diabetic retinopathy,
suggest results of a small case series. Triamcinolone injection
reduces neovascularization and macular thickening, investigators
from Italy report in the May Archives of Ophthalmology.

Panretinal photocoagulation is "the mainstay" of treatment for
proliferative diabetic retinopathy, Dr. Francesco Bandello and
associates from University of Udine note, "and its suppressive
effect on retinal neovascularization has been well documented."

However, in up to one-third of cases, new vessels continue to grow
despite initial treatment, they point out, and, in these cases,
vitreous hemorrhage and macular edema may lead to visual loss and
prevent complete laser treatment.

Their series included nine patients with proliferative diabetic
retinopathy in both eyes. The team treated one eye with intravitreal
triamcinolone before panretinal photocoagulation and other eye with
panretinal photocoagulation alone (control eye).

At 9 and 12 months, "both leakage due to retinal new vessels and
macular thickening were significantly reduced in the combined
treatment group compared with control eyes," the team reports.

"In addition, best-corrected visual acuity improved in injected eyes
while it was slightly reduced in control eyes at 9 months," they
also report.

Intravitreal triamcinolone, the authors conclude, "seems a promising
adjuvant" treatment to panretinal photocoagulation in that it may
permit a more complete laser treatment while minimizing the risks
for exudative complications, progression of disease, hemorrhage, and
decreased vision.

Although there were no serious complications of triamcinolone
occurred in the current series, the authors say further studies are
needed to assess the efficacy and safety of this approach.

Arch Ophthalmol 2006;124:643-650

Muraglitazar, a dual (alpha/gamma) peroxisome proliferator-activated
receptor activator, appears to be more effective than pioglitazone
in lowering glucose levels in type 2 diabetics who are inadequately
controlled with metformin monotherapy, researchers report in the May
issue of Diabetes Care.

Along with improving glycemic control, muraglitazar also appears to
improve the lipid profile in these patients, Dr. Ralph A. DeFronzo
of the University of Texas Health Sciences Center at San Antonio and
colleagues note.

To compare the effects of muraglitazar with those of pioglitazone,
the researchers evaluated 1159 type 2 diabetes patients inadequately
controlled by metformin. The subjects continued with metformin and
were randomized to muraglitazar 5 mg or pioglitazone 30 mg daily.

The investigators note that 45 mg per day is the maximally effective
dose of pioglitazone, so the lower dose employed, may have
influenced the results.

The patients were treated for 24 weeks. One patient in each group
dropped out of the study. Seven hundred sixty-two patients continued
treatment to complete a 26-week extension trial.

At 24 weeks, the mean AIC fell by 1.14% in the muraglitazar group,
significantly more than the 0.85% drop seen in the pioglitazone
patients.

At 12 weeks muraglitazar reduced mean plasma triglycerides by 28%
compared with 14% for pioglitazone. Corresponding reductions for
apolipoprotein B were 12% and 6% and for non-HDL cholesterol, 6% and
1%. Muraglitazar increased HDL cholesterol by 19% versus 14% for
pioglitazone.

By week 50, the muraglitazar group had a 2.5 kg weight gain compared
with a 1.5 kg weight gain in the pioglitazone group. In addition,
11.6% of the muraglitazar group and 8.9% of the pioglitazone group
reported at least one edema related adverse event.

Over the course of the study, five patients in the muraglitazar
group and two patients in the pioglitazone group had heart failure.
Given the low incidence, the team suggests that this may not be of
clinical significance. However, they recommend monitoring patients
for signs of edema and congestive heart failure.

The researchers conclude that 5 mg muraglitazar resulted in "greater
improvements in A1C and lipid parameters than a submaximal dose of
30 mg pioglitazone when added to metformin."

Diabetes Care 2006;29:1016-1023