A variety of secondary prevention programs can improve the health
outcomes of patients with coronary artery disease (CAD), even ones
lacking an exercise component, new research shows.

Previous reports have shown a survival benefit for supervised
exercise programs in MI survivors. However, it was unclear if other
types of secondary prevention could also yield a benefit, senior
author Dr. Finlay A. McAlistar, from the University of Alberta
Hospital in Edmonton, Canada, and colleagues note.

As reported in the Annals of Internal Medicine for November 1, the
researchers investigated this topic by conducting a meta-analysis of
data from randomized trials published between 1966 and 2004. A total
of 63 trials with 21,295 CAD patients were included in the analysis.

Three main types of secondary prevention programs were included in
the analysis: programs with a structured exercise component,
programs with risk factor education or counseling, and programs that
featured a combination of both.

All three types of programs cut the risk of death to a similar
extent with reductions ranging from 12% to 28%. They also reduced
the risk of MI from 14% to 38%, although the differences between the
groups were not statistically significant.

Further analysis showed that the programs also improved functional
status and quality of life, although the effect sizes were modest,
the authors note.

"Although the interventions tested in these trials varied
substantially and the trials enrolled highly selected study samples,
secondary prevention programs improve processes of care, coronary
risk factor profiles, and functional status or quality of life," the
researchers state. Further studies are needed to address the long-
term clinical and economic outcomes of such programs, they add.

Ann Intern Med 2005;143:659-672

A new study finds children with brain arteriovenous malformations
(BAVMs) are not at higher risk of intracranial hemorrhage than
adults, as had previously been suspected.

Most hemorrhagic strokes in children are due to BAVMs, Dr. Heather
J. Fullerton of the University of California, San Francisco and
colleagues write in the October issue of Stroke. Half of strokes in
children are hemorrhagic, compared to 20% of strokes in adults.

While children are often considered to be at greater risk of
hemorrhage after BAVM than adults, Dr. Fullerton and her team note,
there is little evidence to support this perception.

To investigate, the researchers compared a series of BAVM cases
treated at two centers, including a total of 1,219 patients, 251 of
whom were children. Their data included 996 person-years of follow-
up for children and 3,260 for adults. Mean duration of follow-up was
3.50 years for adults and 4.03 years for children.

While children were significantly more likely to present with
intracranial hemorrhage (ICH) than adults, the researchers found no
significant difference in the risk of ICH during follow-up between
children and adults. The annual rates of ICH were 2.0% in children
and 2.2% in adults. Multivariate analysis found ICH rates were 90%
lower in children than in adults.

"Our findings suggest that BAVMs in children do not necessarily need
to be treated more aggressively than those in adults," the
researchers write. "However, it is worth noting that although their
annualized risk is similar to adults, their cumulative risk is
greater given their greater number of years left to live."

The reason why hemorrhagic presentation is more likely in children
than adults remains unclear, they add. "Whether these difference
reflect biases versus biologic differences in the BAVMs that present
at younger ages deserves further study."

Stroke 2005;36:2099-2104

Hyperandrogenemia starts early in obese children, and weight loss
leads to decreasing androgen levels, results of a study show. Weight
loss is the "therapy of choice" in hyperandrogenemic obese children,
Dr. Thomas Reinehr who led the study told Reuters Health.

"Obesity is known to be associated with increased androgen
production in adult females, while studies of obese adult males have
linked obesity to low androgen production," explained Dr. Reinehr
from the University of Witten/Herdecke in Datteln, Germany. "There
has been minimal study into the role of androgens in obese children,
and it has, until now, remained unknown whether the (levels) of
these hormones change after obese children lose weight."

As reported in the October Journal of Clinical Endocrinology and
Metabolism, Dr. Reinehr and colleagues compared androgen levels in
273 obese and 79 normal weight children of the same age and pubertal
stage, and studied the effect of weight loss on these hormone
levels. Weight loss was achieved via a 12-month intervention program
that incorporated exercise, behavior and nutrition therapy
consisting of a high-carbohydrate low-fat diet.

The study revealed that obese children, regardless of their gender
or pubertal stage, show significantly higher serum testosterone and
DHEAS levels as compared to children who are lean or normal weight.

In girls, and also in boys who were prepubertal, there was a
positive correlation between body mass index and androgen levels.
However, obese pubertal boys did not demonstrate increased androgen
levels in this study.

According to Dr. Reinehr, "the different origin of androgen
production may explain the gender difference and the difference
between prepubertal and pubertal obese boys."

"Overall, weight loss led to a decrease in testosterone among obese
prepubertal children and pubertal girls," Dr. Reinehr said.
Therefore, "although obesity tends to be associated with an increase
in androgens, this increase is reversible pending weight loss," he
concluded.

J Clin Endocrinol Metab 2005;90:5588-5595

U.S. Medicare officials plan to monitor a new database for more
information about the use of implantable cardioverter defibrillators
at 1,300 U.S. hospitals, the agency said on Thursday.

New data from the American College of Cardiology National
Cardiovascular Data Registry will help the nation's insurance
program for the poor and elderly "learn more about the use" of the
implantable cardioverter defibrillators (ICD), officials said in a
statement.

"The Medicare aggregate data from the ICD Registry will be made
available to the public to better inform patients and physicians on
the most appropriate ICD therapy. Better evidence means better
decisions by doctors and patients," said Medicare chief Mark
McClellan.

Medicare has been using its own database, called QNet, to gather
such information since agreeing to pay for ICDs in January. It will
use the new data in addition to its own information, they said.

Medicare decided to cover ICDs based on a landmark National
Institutes of Health trial, funded by Medtronic Inc, called SCD-
HeFT, that showed they saved lives in a broad group of cardiac
patients.

But the agency still has questions it hopes the new data can help
answer.

"The evidence on benefits of ICD implantation in certain subgroups
was not as strong, and it is important for doctors to get better
evidence on the use of these devices for these patients as well,"
the agency said.

"Many Medicare beneficiaries are older than the patients studied in
SCD-HeFT, and many others who are at high risk of cardiac events do
not closely match the characteristics of the group in which there
was a clear benefit."

An agency spokesman could not immediately comment on how much use of
the new registry would cost.

Officials will start using the new database, developed in part by
the Heart Rhythm Society medical association, on April 1, 2006.

In low risk patients, reduced ejection fraction after myocardial
infarction is not sufficient to justify prophylactic implantation of
a cardioverter defibrillator, a group of cardiologists from
Switzerland contends in the October issue of Chest.

In the 1990s, the Multicenter Automatic Defibrillator Implantation
Trial (MADIT) II showed that prophylactic ICD implantation in
patients with advanced left ventricular dysfunction and remote MI
improves survival and, therefore, "should be considered as a
recommended therapy," lead author Dr. Patrizio Pascale from
University Hospital, Lausanne, explained in comments to Reuters
Health.

"The magnitude of the effect of prophylactic ICD, expressed as the
number of patients needed to treat to prevent one adverse event, is
of particular interest," he said, "due to procedure and device-
related complications, the psychosocial impact of ICD therapy, and
for cost-effectiveness considerations."

The purpose of the current study was to evaluate, in general
practice, current mortality and sudden death rates in survivors of
acute MI who had a significant reduction in ejection fraction (EF,
40% or less).

The study, which included 165 such patients, showed that the
spontaneous risk of arrhythmic death at the present time in
survivors of MI with reduced EF is substantially lower than reported
in the 1990's.

"The strong decrease in the arrhythmic risk implies a proportional
increase in the number of patients needed to treat with a
prophylactic defibrillator to prevent one adverse event," Dr.
Pascale noted. "The risk of arrhythmic death may even be
sufficiently low to limit the detectable benefit of prophylactic ICD
implantation," the researcher said.

Therefore, risk stratification post-MI based on the EF alone "seems
to be inappropriate since, in our study it was shown to have a much
lower impact on mortality compared to the other identified risk
factors."

Specifically, in this series, patients with no previous MI, acute
reperfusion or complete revascularization had 2-year cumulative
mortality rates of 2.5%, 3.9% and 2.3%, respectively. "For such low-
risk patients, benefit expectations for prophylactic ICD has to be
questioned," Dr. Pascale concluded.

Chest 2005;128:2626-2632

Among persons with chronic kidney disease, the prevalence of
cardiovascular risk factors increases with stage of kidney
dysfunction, especially as the glomerular filtration rate (GFR)
falls below 60 mL/min.

"Patients with chronic kidney disease appear much more likely to
need multiple cardiovascular risk factor interventions than those
without chronic kidney disease," Dr. Robert N. Foley from the US
Renal Data System Coordinating Center in Minneapolis told Reuters
Health.

"Finding chronic kidney disease," he added, "should stimulate a
comprehensive search for cardiovascular risk factors, and finding
multiple cardiovascular risk factors should stimulate a search for
chronic kidney disease."

According to a report in the October issue of Mayo Clinic
Proceedings, Dr. Foley and two colleagues determined the prevalence
of nine cardiovascular risk factors in 15,837 adults in the NHANES
III Study (Third National Health and Nutrition Examination
Survey:1988-1994).

They report that nearly two-thirds of subjects (65.4%) had normal
renal function with a GFR of at least 90 mL/min, whereas 27.9% had
stage 2 kidney function with a GFR between 60 to 89.9 mL/min, 6.2%
had stage 3 kidney function with a GFR between 30 to 59.9 mL/min and
0.5% had stage 4 and 5 kidney function with a GFR less than 30
mL/min.

As mentioned, the number of cardiovascular risk factors
progressively increased with the stage of kidney disease. All
subjects with stage 4 and 5 kidney function had two or more cardiac
risk factors, the authors report.

"These associations were unaffected when adjustment was made for
factors typically associated with higher numbers of cardiovascular
risk factors," Dr. Foley said.

In adjusted analyses, subjects with one cardiovascular risk factor
were 3.7 times more likely to have a low GFR and those with two or
more risk factors were 10.4 times more likely to have a low GFR. [

These data, Dr. Foley told Reuters Health, support the notion
that "abnormalities of kidney function are much commoner than
formerly thought. They also suggest that undertreated cardiovascular
risk factors are overrepresented, even in those who would not
typically receive specialist care."

Dr. Andrew Rule of the Mayo Clinic and co-author of a related
editorial told Reuters Health: "This study is important in that it
emphasizes the increased number of cardiovascular risk factors in
persons with chronic kidney disease."

He's concerned, however, that the "actual burden of chronic kidney
disease in the general population may be greatly overestimated" by
the Modification of Diet in Renal Disease (MDRD) equation used in
this and other recent reports.

"The MDRD equation," Dr. Rule explained, "was developed using
clinically diagnosed kidney disease patients and several recent
studies have challenged the accuracy of this equation in other
populations. The problem with the MDRD equation is that GFR
estimates are biased by non-GFR factors such as muscle mass and
protein intake."

Nonetheless, the current data "extend our understanding of the
important overlap between cardiovascular risk factors and chronic
kidney disease," Dr. Rule and co-author Dr. Stephen C. Textor, also
from Mayo Clinic, Rochester, Minnesota, write.

Mayo Clin Proc 2005;80:1270-1277

This may also be helpful.

http://cardiology.ucsf.edu/clinical/eecp/article.html

Good Luck,


Gerald Oros

--- michaeln807 <no_reply@yahoogroups.com> wrote:

> Very informative.  Thank you for your help. -M
>
> --- In heart119@yahoogroups.com, Gerald Oros
> <postman23_2000@y...>
> wrote:
> >
> > Hello Michael:
> >
> > EECP and/or ECP (their competition) offer the
> angina
> > patient the only FDA approved, CMS (Medicare)
> > reimbursed, non-invasive, treatment option that I
> am
> > aware of today. With 35 hours of treatment it will
> > improve Class III or IV angina by at least 1 class
> in
> > 75 to 80 percent of the patients.  An additional
>
> > 10 hours of treatment will significantly reduce
> that
> > segment (number) of patients that were initially
> > non-responders.  Results have been maintained in
> many
> > patients for 3, 4, 5 or more years.
> >
> > It has been my experience that the harshest
> critics of
> > EECP know the least about it.... and you don't
> have to
> > scratch very deep to confirm this.
> >
> > EECP is very inexpensive relative to the popular
> > invasive procedures ($5-6,000.00) and it typically
> > takes 1 hour of treatment, 5 days a week for 7
> weeks.
> > So, being so cheap and taking so long, it may not
> > measure up in financial rewards relative to
> > angioplasties and CABG procedures.  But it is so
> very
> > safe and effective.  You should know that China
> was
> > the first country to perfect this technology.
> They
> > had over 50 different indications for the
> treatment
> > and I have read that well over a million patients
> have
> > been treated with EECP in that country.
> >
> > One feature of EECP is its ability to reverse
> > endothelial dysfunction in many patients who
> receive
> > it.  This is a patient benefit that the invasive
> > procedures cannot replicate.  Go to Google and
> type in
> > EECP  Endothelial Dysfunction and Mayo Clinic.
> There
> > are many references confirming the efficacy of
> > EECP for angina that can be quickly pulled up on
> > Google.
> >
> > Here is a post I submitted elsewhere earlier this
> > evening:
> >
> > I am highly interested in what modern medicine is
> > doing to monitor the endothelial
> function/dysfunction
> > of patients.  There are non-invasive tests and
> medical
> > devices for doing so but I know of no cardiologist
> > personally that has the slightest interest in
> > routinely monitoring and/or treating their
> patient's
> > endothelial dysfunction so as to restore a them to
> a
> > state of vascular homeostasis. And, by doing so,
> > reduce the liklihood of cardiovascular blockages,
> > strokes and MI's.
> > Of course, by doing so, they might encounter far
> fewer
> > clinical events requiring that they immediately
> > perform the invasive procedures by which they earn
> so
> > much of their income.  Is this like a "Catch 22"
> for
> > the cardiovascular community?
> >
> > The issues regarding the legitimacy of EECP, (IMO)
> > have more to do with how the treatment may have a
> > negative impact on the physician's earnings than
> on
> > anything else.  I suspect that if CMS were to
> increase
> > reimbursement by a factor of 10 next Monday
> morning,
> > the cardiology community would totally embrace it
> by
> > evening time.
> >
> > I hope I have addressed your concerns to your
> > satisfaction.
> > Let me know.
> >
> > Gerald Oros
> > Collinsville, IL
> >
> > -- michaeln807 <no_reply@yahoogroups.com> wrote:
> >
> > > I have just recently become familiar with EECP
> and
> > > was curious as to
> > > know other medical professional's opinions on
> the
> > > procedure and if it
> > > is cost efficient for hospitals?  Through my
> > > research, I have seen
> > > mixed opinions on the legitimacy of the
> procedure.
> > > Your ideas are
> > > most appreciated.  Thank you.
> > >
> > > Michael
> > >
> > >
> > >
> > >
> > >
> > >
> >
> >
> >
> >
> >
> >
> >
> > __________________________________
> > Yahoo! FareChase: Search multiple travel sites in
> one click.
> > http://farechase.yahoo.com
> >
>
>
>
>
>





__________________________________
Yahoo! FareChase: Search multiple travel sites in one click.
http://farechase.yahoo.com

Everything you say about invasive cardiologists is true.  Sadly, the
companies pushing EECP / ECP have exactly the same greedy motives.  EECP /
ECP shows results because of the placebo effect (design a double blind trial
for something that squeezes the crap out of ya), and because with no
treatment at all, a large percentage of angina patients will get better as a
result of natural angiogenesis.  And you are dead wrong that there is no
other treatment.  Medical treatment with the proper drugs, and adequate
doses of those drugs, works better than anything else.  There is tons of
evidence to support this contention, some of it unintentional as a result of
countries with socialized medicine that ration invasive procedures.  But
don't trust me, read Dr. Howard Wayne's books.

----- Original Message -----
From: "Gerald Oros" <postman23_2000@...>
To: <heart119@yahoogroups.com>
Sent: Saturday, October 29, 2005 7:26 PM
Subject: Re: [Heart119] EECP


> Hello Michael:
>
> EECP and/or ECP (their competition) offer the angina
> patient the only FDA approved, CMS (Medicare)
> reimbursed, non-invasive, treatment option that I am
> aware of today. With 35 hours of treatment it will
> improve Class III or IV angina by at least 1 class in
> 75 to 80 percent of the patients.  An additional
> 10 hours of treatment will significantly reduce that
> segment (number) of patients that were initially
> non-responders.  Results have been maintained in many
> patients for 3, 4, 5 or more years.
>
> It has been my experience that the harshest critics of
> EECP know the least about it.... and you don't have to
> scratch very deep to confirm this.
>
> EECP is very inexpensive relative to the popular
> invasive procedures ($5-6,000.00) and it typically
> takes 1 hour of treatment, 5 days a week for 7 weeks.
> So, being so cheap and taking so long, it may not
> measure up in financial rewards relative to
> angioplasties and CABG procedures.  But it is so very
> safe and effective.  You should know that China was
> the first country to perfect this technology.  They
> had over 50 different indications for the treatment
> and I have read that well over a million patients have
> been treated with EECP in that country.
>
> One feature of EECP is its ability to reverse
> endothelial dysfunction in many patients who receive
> it.  This is a patient benefit that the invasive
> procedures cannot replicate.  Go to Google and type in
> EECP  Endothelial Dysfunction and Mayo Clinic.  There
> are many references confirming the efficacy of
> EECP for angina that can be quickly pulled up on
> Google.
>
> Here is a post I submitted elsewhere earlier this
> evening:
>
> I am highly interested in what modern medicine is
> doing to monitor the endothelial function/dysfunction
> of patients.  There are non-invasive tests and medical
> devices for doing so but I know of no cardiologist
> personally that has the slightest interest in
> routinely monitoring and/or treating their patient's
> endothelial dysfunction so as to restore a them to a
> state of vascular homeostasis. And, by doing so,
> reduce the liklihood of cardiovascular blockages,
> strokes and MI's.
> Of course, by doing so, they might encounter far fewer
> clinical events requiring that they immediately
> perform the invasive procedures by which they earn so
> much of their income.  Is this like a "Catch 22" for
> the cardiovascular community?
>
> The issues regarding the legitimacy of EECP, (IMO)
> have more to do with how the treatment may have a
> negative impact on the physician's earnings than on
> anything else.  I suspect that if CMS were to increase
> reimbursement by a factor of 10 next Monday morning,
> the cardiology community would totally embrace it by
> evening time.
>
> I hope I have addressed your concerns to your
> satisfaction.
> Let me know.
>
> Gerald Oros
> Collinsville, IL
>
> -- michaeln807 <no_reply@yahoogroups.com> wrote:
>
>> I have just recently become familiar with EECP and
>> was curious as to
>> know other medical professional's opinions on the
>> procedure and if it
>> is cost efficient for hospitals?  Through my
>> research, I have seen
>> mixed opinions on the legitimacy of the procedure.
>> Your ideas are
>> most appreciated.  Thank you.
>>
>> Michael
>>
>>
>>
>>
>>
>>
>
>
>
>
>
>
>
> __________________________________
> Yahoo! FareChase: Search multiple travel sites in one click.
> http://farechase.yahoo.com
>
>
>
>
> Yahoo! Groups Links
>
>
>
>
>
>
>

Very informative.  Thank you for your help. -M

--- In heart119@yahoogroups.com, Gerald Oros <postman23_2000@y...>
wrote:
>
> Hello Michael:
>
> EECP and/or ECP (their competition) offer the angina
> patient the only FDA approved, CMS (Medicare)
> reimbursed, non-invasive, treatment option that I am
> aware of today. With 35 hours of treatment it will
> improve Class III or IV angina by at least 1 class in
> 75 to 80 percent of the patients.  An additional
> 10 hours of treatment will significantly reduce that
> segment (number) of patients that were initially
> non-responders.  Results have been maintained in many
> patients for 3, 4, 5 or more years.
>
> It has been my experience that the harshest critics of
> EECP know the least about it.... and you don't have to
> scratch very deep to confirm this.
>
> EECP is very inexpensive relative to the popular
> invasive procedures ($5-6,000.00) and it typically
> takes 1 hour of treatment, 5 days a week for 7 weeks.
> So, being so cheap and taking so long, it may not
> measure up in financial rewards relative to
> angioplasties and CABG procedures.  But it is so very
> safe and effective.  You should know that China was
> the first country to perfect this technology.  They
> had over 50 different indications for the treatment
> and I have read that well over a million patients have
> been treated with EECP in that country.
>
> One feature of EECP is its ability to reverse
> endothelial dysfunction in many patients who receive
> it.  This is a patient benefit that the invasive
> procedures cannot replicate.  Go to Google and type in
> EECP  Endothelial Dysfunction and Mayo Clinic.  There
> are many references confirming the efficacy of
> EECP for angina that can be quickly pulled up on
> Google.
>
> Here is a post I submitted elsewhere earlier this
> evening:
>
> I am highly interested in what modern medicine is
> doing to monitor the endothelial function/dysfunction
> of patients.  There are non-invasive tests and medical
> devices for doing so but I know of no cardiologist
> personally that has the slightest interest in
> routinely monitoring and/or treating their patient's
> endothelial dysfunction so as to restore a them to a
> state of vascular homeostasis. And, by doing so,
> reduce the liklihood of cardiovascular blockages,
> strokes and MI's.
> Of course, by doing so, they might encounter far fewer
> clinical events requiring that they immediately
> perform the invasive procedures by which they earn so
> much of their income.  Is this like a "Catch 22" for
> the cardiovascular community?
>
> The issues regarding the legitimacy of EECP, (IMO)
> have more to do with how the treatment may have a
> negative impact on the physician's earnings than on
> anything else.  I suspect that if CMS were to increase
> reimbursement by a factor of 10 next Monday morning,
> the cardiology community would totally embrace it by
> evening time.
>
> I hope I have addressed your concerns to your
> satisfaction.
> Let me know.
>
> Gerald Oros
> Collinsville, IL
>
> -- michaeln807 <no_reply@yahoogroups.com> wrote:
>
> > I have just recently become familiar with EECP and
> > was curious as to
> > know other medical professional's opinions on the
> > procedure and if it
> > is cost efficient for hospitals?  Through my
> > research, I have seen
> > mixed opinions on the legitimacy of the procedure.
> > Your ideas are
> > most appreciated.  Thank you.
> >
> > Michael
> >
> >
> >
> >
> >
> >
>
>
>
>
>
>
>
> __________________________________
> Yahoo! FareChase: Search multiple travel sites in one click.
> http://farechase.yahoo.com
>

Hello Michael:

EECP and/or ECP (their competition) offer the angina
patient the only FDA approved, CMS (Medicare)
reimbursed, non-invasive, treatment option that I am
aware of today. With 35 hours of treatment it will
improve Class III or IV angina by at least 1 class in
75 to 80 percent of the patients.  An additional
10 hours of treatment will significantly reduce that
segment (number) of patients that were initially
non-responders.  Results have been maintained in many
patients for 3, 4, 5 or more years.

It has been my experience that the harshest critics of
EECP know the least about it.... and you don't have to
scratch very deep to confirm this.

EECP is very inexpensive relative to the popular
invasive procedures ($5-6,000.00) and it typically
takes 1 hour of treatment, 5 days a week for 7 weeks.
So, being so cheap and taking so long, it may not
measure up in financial rewards relative to
angioplasties and CABG procedures.  But it is so very
safe and effective.  You should know that China was
the first country to perfect this technology.  They
had over 50 different indications for the treatment
and I have read that well over a million patients have
been treated with EECP in that country.

One feature of EECP is its ability to reverse
endothelial dysfunction in many patients who receive
it.  This is a patient benefit that the invasive
procedures cannot replicate.  Go to Google and type in
EECP  Endothelial Dysfunction and Mayo Clinic.  There
are many references confirming the efficacy of
EECP for angina that can be quickly pulled up on
Google.

Here is a post I submitted elsewhere earlier this
evening:

I am highly interested in what modern medicine is
doing to monitor the endothelial function/dysfunction
of patients.  There are non-invasive tests and medical
devices for doing so but I know of no cardiologist
personally that has the slightest interest in
routinely monitoring and/or treating their patient's
endothelial dysfunction so as to restore a them to a
state of vascular homeostasis. And, by doing so,
reduce the liklihood of cardiovascular blockages,
strokes and MI's.
Of course, by doing so, they might encounter far fewer
clinical events requiring that they immediately
perform the invasive procedures by which they earn so
much of their income.  Is this like a "Catch 22" for
the cardiovascular community?

The issues regarding the legitimacy of EECP, (IMO)
have more to do with how the treatment may have a
negative impact on the physician's earnings than on
anything else.  I suspect that if CMS were to increase
reimbursement by a factor of 10 next Monday morning,
the cardiology community would totally embrace it by
evening time.

I hope I have addressed your concerns to your
satisfaction.
Let me know.

Gerald Oros
Collinsville, IL

-- michaeln807 <no_reply@yahoogroups.com> wrote:

> I have just recently become familiar with EECP and
> was curious as to
> know other medical professional's opinions on the
> procedure and if it
> is cost efficient for hospitals?  Through my
> research, I have seen
> mixed opinions on the legitimacy of the procedure.
> Your ideas are
> most appreciated.  Thank you.
>
> Michael
>
>
>
>
>
>







__________________________________
Yahoo! FareChase: Search multiple travel sites in one click.
http://farechase.yahoo.com

EECP is almost certainly utter nonsense.  However, it is preferable to the
overly invasive approach favored by many cardiologists (the guys who never
met a patient who didn't need some kind of invasive procedure, if only an
angiogram).  EECP probably does no real harm, and any success that can be
attributed to it is almost certainly placebo effect.  Proper use of medical
treatment would be preferable to quack cures like EECP, and certainly
preferable to invasive treatment in the vast majority of cases.  If you are
curious, see www.heartprotect.com, and read Dr. Wayne's books. Incidentally,
I am not an MD, and I don't even play one on TV, but I do have personal
experience in this area.

Syd H. Levine
AnaLog Services, Inc.
Phone:  270-276-5671
Telefax:  270-276-5588
E-mail:  analog@...
URL:  www.logwell.com


----- Original Message -----
From: "michaeln807" <no_reply@yahoogroups.com>
To: <heart119@yahoogroups.com>
Sent: Saturday, October 29, 2005 6:18 PM
Subject: [Heart119] EECP


>I have just recently become familiar with EECP and was curious as to
> know other medical professional's opinions on the procedure and if it
> is cost efficient for hospitals?  Through my research, I have seen
> mixed opinions on the legitimacy of the procedure.  Your ideas are
> most appreciated.  Thank you.
>
> Michael
>
>
>
>
>
>
>
>
>
> Yahoo! Groups Links
>
>
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>

I have just recently become familiar with EECP and was curious as to
know other medical professional's opinions on the procedure and if it
is cost efficient for hospitals?  Through my research, I have seen
mixed opinions on the legitimacy of the procedure.  Your ideas are
most appreciated.  Thank you.

Michael

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In healthy human test subjects, infusion of tumor necrosis factor
(TNF) alpha leads to skeletal muscle insulin resistance European and
US researchers report.

"The finding that physiological levels of TNF induce insulin
resistance opens the possibility that TNF may be a target for new
anti-diabetic drugs," senior investigator Dr. Bente K. Pedersen of
the University of Copenhagen told Reuters Health.

Excessive concentrations of TNF-alpha have been implicated in
insulin resistance, but evidence in humans was lacking, Dr. Pedersen
and colleagues note in the October issue of Diabetes.

To investigate further, the researchers studied nine healthy male
volunteers and established that TNF-alpha infusion increases insulin
resistance in skeletal muscle without affecting endogenous glucose
production from the liver.

The levels of TNF-alpha employed, say the investigators, were
slightly higher than those in people with low-grade systemic
inflammation such that caused by type 2 diabetes or cardiovascular
disease. They were considerably lower than those in septic diseases.

The team determined that insulin resistance was increased via
mechanisms involving inhibition of Akt substrate 160 phosphorylation.

Thus, the identification of molecular targets that mediate the
effects of TNF-alpha on insulin signaling and glucose metabolism,
the researchers conclude, "opens the possibility for new therapeutic
strategies for treatment of a global clinical health problem."

Diabetes 2005;54:2939-2945

By testing for cytoplasmic islet-cell antibodies (ICAs) along with
other biomarkers of type 1 diabetes mellitus, researchers have found
that the ability to predict which first-degree relatives are likely
to develop type 1 diabetes themselves is greatly improved, according
to a presentation here at the annual AMA Media Briefing on Diabetes.

The "gold standard" predictive marker for type 1 diabetes, ICA has
lost favor with clinicians because of the semiquantitative nature of
the test and the subjectivity of its interpretation, Dr. Dorothy J.
Becker said during her presentation.

Because they are easier to perform and interpret, radiobinding
assays for detecting autoantibodies to glutamic acid decarboxylase
(GAD)65, neuroendocrine antigen (IA-2) and insulin autoantibodies
have become the preferred screening strategy for identifying
individuals at risk.

To see if there is still a role for testing ICAs in at-risk
individuals, Dr. Becker and colleagues from the University of
Pittsburgh examined a cohort of 1484 first-degree relatives of type
1 diabetes probands treated at Children's Hospital of Pittsburgh
between 1979 and 1984 and followed for up to 22 years. They were
tested for all four autoantibodies.

Individuals testing positive for two of the biochemical markers had
a 14% risk of developing type 1 diabetes after 10 years. However,
among those who were also ICA-positive, the risk was 80% after just
6.7 years.

Identifying risk, Dr. Becker noted, will enable people at risk to
enroll in clinical trials of vaccines or other measures to prevent
or slow the onset of type 1 diabetes.

One currently underway with which Dr. Becker is involved, the Trial
to Reduce Insulin dependent diabetes in the Genetically at Risk
(TRIGR), is testing the theory that feeding infants at risk with
hydrolyzed formula once they are weaned from breast milk will
prevent the disease. Initial studies in diabetic NOD mice have shown
that this early intervention significantly postpones disease onset.

"Ideally, the current concept is to screen with the biochemical
assays, then if they are positive for even one, the ICA should be
measured," she told Reuters Health.

Anyone interested in participating in the TRIGR trial can find more
information at www.TRIGRnorthamerica.org.

An evaluation of HDL by patient subpopulations adds to the risk
assessment of patients with low HDL-cholesterol, according to data
from the Veterans Affairs HDL Intervention Trial.

"Low HDL cholesterol (<40 mg/dL in men and <50 mg/dL in women) is an
important coronary heart disease (CHD) risk factor," Dr. Ernst J.
Schaefer from Tufts University, Boston, told Reuters Health, "and
HDL subpopulations provide even more CHD risk information."

Dr. Schaefer and colleagues evaluated whether determination of HDL
subpopulations provides more power to predict recurrent
cardiovascular disease events than traditional risk factors. Three
hundred ninety-eight subjects had a recurrent cardiovascular disease
event and 1097 did not.

In univariate analyses, HDL-C, apoA-I, and all HDL subpopulations
except pre-alpha-1 were significant predictors of recurrent
cardiovascular events. Pre-beta-1 and alpha-3 were positive risk
factors, the authors report, whereas all other particles and HDL-C
were negative risk factors, the investigators report in the October
issue of Arteriosclerosis, Thrombosis, and Vascular Biology.

HDL alpha-1 was the most significant risk factor for recurrent
cardiovascular events in a forward selection model, with each
standard deviation increase in alpha-1 conferring a 12% decrease in
cardiovascular event risk.

Similarly, logistic regression analyses identified alpha-1 as the
only HDL particles significantly associated with the prevalence of
CHD. In subjects with low HDL-C, each 1 mg/dL decrease in alpha-1
increased the odds of CHD by 13%.

"Very small pre-beta-1 HDL is very efficient in picking up free
cholesterol from macrophages, while the large alpha-1 HDL particles
interact with the liver SRB1 receptor to promote reverse cholesterol
transport," Dr. Schaefer explained.

"At the present time niacin is the best way to raise (alpha-1
levels), but new agents that inhibit the transfer of cholesteryl
ester from HDL to other lipid particles are even more effective in
raising alpha-1 HDL," Dr. Schaefer said.

"This study adds more support to a growing body of epidemiological
data that have demonstrated that large cholesterol-rich HDL
subspecies such as alpha-1 are cardioprotective," write Dr. Vijay
Nambi and Dr. Christie M. Ballantyne from Baylor College of
Medicine, Houston, in a related editorial.

"Identifying and understanding the various steps in HDL metabolism
and quantitative assessment of HDL subspecies will continue to be an
important research area and may provide improved risk assessment and
better surrogates for monitoring therapy," the editorialists
conclude.

Arterioscler Thromb Vasc Biol 2005;25:2013-2015,2185-2191

Patients treated with rescue percutaneous transluminal coronary
angioplasty (PTCA) after failed thrombolysis have excellent long-
term outcomes, according to a new study from a center where the
approach is routine practice.

A substantial proportion of patients do not achieve TIMI grade 3
angiographic flow within 90 minutes of thrombolysis, and while
rescue PTCA has been proposed for these patients, there is little
evidence for its benefits, Dr. Philippe Gabriel Steg of the Hopital
Bichat-Claude Bernard in Paris and colleagues report in the
September issue of the European Heart Journal.

At their hospital, the researchers note, it has been standard
practice since 1988 to perform rescue PCTA in patients with TIMI
grade 0-1 flow 90 minutes after thrombolysis. To investigate the
effectiveness of this approach, the researchers compared long-term
outcomes in a consecutive series of 345 patients treated
successfully with thrombolysis or with rescue PTCA after failed
thrombolysis.

Sixty percent of the patients achieved TIMI 3 flow with
thrombolysis, 9% had TIMI 2 flow and 31% had TIMI 0-1 flow. Hospital
death rate for the patients with TIMI 3 flow was 4.0%.

Among the patients with TIMI 0-1, 85.8% underwent rescue PTCA. The
total hospital death rate was 5.5%. Two of the 10 patients, or 20%,
who failed rescue PTCA died in the hospital, compared to 3.7% of
those for whom the procedure was successful.

Eight years after the procedure, total mortality, cardiac mortality
and several other clinical endpoints were the same for patients who
underwent successful thrombolysis and those treated with rescue PTCA
after failed thrombolysis.

Clinical outcomes and survival are routinely worse among patients
who fail thrombolysis and do not undergo PTCA, the researchers note.

The current observational study cannot prove that rescue PTCA is
superior to conservative management of patients who fail
thrombolysis, but instead should be seen as "showing the excellent
outcome of an approach of emergency angiography after thrombolysis
followed by routine rescue PCI in patients with an occluded infarct-
related artery," the researchers write.

They conclude: "Our data provide additional evidence in favor of a
clinical benefit of routine rescue PTCA."

Eur Heart J 2005;26:1831-1837

A group of neurologists from the Mayo Clinic College of Medicine in
Rochester, Minnesota has developed and validated a new coma scale,
which they say is a reliable and easy-to-use tool that has the
potential to replace the Glasgow Coma Scale (GCS).

The so-called FOUR (Full Outline of UnResponsive) Score consists of
four components -- eye, motor, brainstem, and respiration -- to
determine coma depth. A score of four represents normal functioning
in each category, while a score of zero indicates nonfunctioning.

Dr. Eelco F. M. Wijdicks, a Mayo Clinic neurologist and inventor of
the FOUR score, said the widely adopted GCS has "many drawbacks" and
misses key and elements of a neurological exam of comatose patients.
The inability of the GCS to test brainstem reflexes is an "important
shortcoming," he added.

Dr. Wijdicks and colleagues prospectively studied the FOUR score in
120 ICU patients with diverse acute neurological conditions (not
just trauma) and compared it with the GCS.

They report in the October issue of the Annals of Neurology that the
agreement among raters -- neuroscience nurses, neurology residents,
and neurointensivists -- was "good to excellent." The interrater
reliability of the FOUR score and the GCS was of equal magnitude,
according to the researchers.

In the experience of Dr. Wijdicks and colleagues, "the FOUR score
provides greater neurological detail than the GCS, recognizes a
locked-in syndrome, and is superior to the GCS due to the
availability of brainstem reflexes, breathing patterns, and the
ability to recognize different stages of herniation."

The team also reports that in this study the likelihood of dying in
the hospital was higher for the lowest total FOUR score when
compared with the lowest total GCS score.

"With the FOUR Score, in contrast to the GCS, we can in a far more
detailed way provide the family information on the patient's status
and what the outcome will be," Dr. Wijdicks said.

Ann Neurol 2005;58:585-593

There appears to be a connection between non-cirrhotic hepatitis C
virus (HCV) infection and type 2 diabetes, Italian researchers
report in the October issue of Diabetes Care.

Dr. Alessandro Antonelli of the University of Pisa and colleagues
note that there have been some reports of an association between
type 2 diabetes and HCV but at least one large study did not confirm
this.

To investigate further, the researchers studied 564 patients with
non-cirrhotic HCV, 82 with non-cirrhotic hepatitis B virus (HBV)
infection and 302 matched controls.

Significantly more of the HCV patients (12.6%) had diabetes compared
with the HBV patients (4.9%) and the controls (7.0%).

The data, say the researchers, suggest that HCV-related hepatitis is
associated with diabetes at a stage when liver function is largely
preserved.

They also note that HCV patients with diabetes were significantly
leaner, with a body mass index of 25.7 versus 29.7 for HCV-negative
diabetics. Their LDL cholesterol concentration was also lower (3.2
versus 3.6 mmol/L).

The team calls for investigation of the underlying mechanisms
and "to test whether antiviral therapy for HCV infection may prevent
the appearance of type 2 diabetes."

Diabetes Care 2005;28:2548-2550

Pregnant women who adhere to a cholesterol-lowering diet may
favorably alter their lipid profile and perhaps reduce their risk of
delivering prematurely, Norwegian investigators report in the
October issue of the American Journal of Obstetrics and Gynecology.

"These results indicate that dietary intervention in pregnancy can
modify cardiovascular risk factors in pregnancy and may result in
health benefits for mother and child," Dr. Janette Khoury from
National Hospital in Oslo and colleagues write.

They researched the effects of an antiatherogenic diet on maternal,
cord, and neonatal lipids and pregnancy outcome in 290 nonsmoking
white women ages 21 to 38 years who were pregnant with a single
fetus.

From gestational week 17 to 20 to birth, the women either maintained
their usual diet (the control diet) or adopted a diet rich in fish,
low-fat meats and dairy products, oils, whole grains, fruits,
vegetables and legumes.

Compared with the control diet, the cholesterol-lowering diet led to
a modest reduction in maternal total and LDL-cholesterol levels (p <
0.01). The observed difference in total cholesterol between the two
groups was 8 mg/dL.

Moreover, the cholesterol-lowering diet was associated with a lower
relative risk of preterm delivery. In the intention-to-treat cohort
1 (0.7%) of 141 women on this diet versus 11 (7.4%) of 149 on the
control diet delivered before 37 weeks gestation (RR, 0.10).

In this study, "lowering LDL concentrations, together with other
dietary changes in the intervention group, may have lowered the risk
of premature delivery," Dr. Khoury noted in comments to Reuters
Health.

"A hypothetical explanation for this finding is changes in the
vasculature and the threshold for uterine contractions," she
added. "We found that LDL cholesterol concentrations at baseline
tended to be associated with premature delivery. Thus, the
difference in total and LDL cholesterol observed in our study may
have contributed to the reduction in preterm birth," she said.

Dr. Khoury's team hopes the current results encourage future larger
studies to clarify the role of a cholesterol-lowering diet in the
prevention of preterm delivery in both low- and high-risk
pregnancies.

"Though the intervention diet had no adverse effects, future larger
studies are needed before we can recommend the diet for the
prevention of preterm birth," Dr. Khoury emphasized.

Am J Obstet Gynecol 2005;193:1292-1301

New research confirms that cellular telephones can interfere with
medical equipment, but also reveals that recent technological
advances have changed the electromagnetic interference (EMI)
landscape for the better.

According to a report in the October issue of the Mayo Clinic
Proceedings, researchers tested 16 different medical devices with
six state-of-the-art cellular telephones representing the different
cellular technology protocols currently available, including digital
and analog systems.

Dr. Jeffrey L. Tri and colleagues from the Mayo Clinic College of
Medicine in Rochester, Minnesota found that currently used cellular
telephones, compared with those tested in earlier studies, need to
be held in closer proximity to medical devices before any
interference is observed.

Of 510 tests performed, the incidence of "clinically important"
interferences was low -- 1.2%. EMI was induced in 108 tests or 21.2%
and interference occurred in 7 (44%) of the 16 medical devices
tested.

"Technological changes to either cellular telephones or to medical
devices may continue to mitigate or may possibly worsen EMI," the
authors note. Therefore, "periodic testing of wireless transmitting
devices and medical equipment will be required to provide safe
hospital and clinical environments."

Mayo Clin Proc 2005;80:1286-1290

Elderly patients with non-ST-segment elevation acute coronary
syndromes (NSTE ACS) are less likely to receive recommended care, a
new observational multicenter study shows.

However, Dr. Karen P. Alexander of the Duke Clinical Research
Institute in Durham, North Carolina and colleagues report, patients
over 75 who did receive treatment that followed American College of
Cardiology/American Heart Association (ACC/AHA) guidelines had the
same reduced risk of death as their younger counterparts.

A number of past studies have found frequent underuse of cardiac
drugs in elderly NSTE ACS patients, Dr. Alexander and her team
report in the October 18th issue of the Journal of the American
College of Cardiology.

To determine if the new ACC/AHA guidelines may have changed this
pattern, the researchers compared care in 56,963 patients with NSTE
ACS treated at 443 US hospitals. The patients were stratified into
four groups: younger than 65, 65 to 74, 75 to 84, and 85 or older.
Thirty-five percent of the patients were 75 or older, while 11% were
85 or older.

The new guidelines, Dr. Alexander and her team note, do not offer
different recommendations based on age, "apart from encouraging
attention to comorbidities, preferences, and appropriate dosing of
medications in elderly patients."

Even after controlling for contraindications and comorbidities, the
researchers found, the use of several therapies remained less
frequent in older patients. Elderly patients were less likely to
receive antiplatelet and antithrombin therapy in the first 24 hours
of care, less likely to receive invasive care, and less likely to be
discharged on lipid-lowering agents and clopidogrel.

Specifically, while 92% of patients older than 85 had positive
cardiac markers, only 29.9% were given clopidogrel and 12.8%
received platelet glycoprotein IIb/IIIa inhibitors. After age 65,
less than 50% received invasive care, and that number fell to 11.2%
after age 85.

"A formal test for interaction between treatment and age was
significant because of the larger difference in mortality between
younger and older patients given fewer therapies compared with those
given all therapies," the researchers write. "This indicates a
similar or greater impact of treatment on outcomes in elderly
patients."

Dr. Alexander and her team conclude by noting that clinicians may
be "understandably cautious" about using newer treatments and more
invasive care in their older patients at high risk.

In an editorial accompanying the study, Drs. H. Vernon Anderson of
the University of Texas Health Science Center in Houston and Richard
G. Bach of Washington University Medical Center in St. Louis argue
that physicians should begin to look at elderly ACS patients in
terms of opportunities rather than risks.

"The opportunity score would give an estimate of the benefit to be
gained by a treatment or group of treatments," they
explain. "Patients with higher baseline risks from the underlying
disease, such as the elderly, would have higher opportunity scores
for benefit, even allowing for some of the greater risks from the
treatment."

J Am Coll Cardiol 2005;46:1479-1489

The changes in mitral regurgitation that occur with exercise in
patients with prior MI and left ventricular dysfunction appear to be
independently linked to changes in mitral deformation, new research
indicates.

The findings, which appear in the European Heart Journal for
September, are based on a study of 40 consecutive patients with a
prior MI and an ejection fraction of < 45%. Exercise-
echocardiographic testing was used to evaluate mitral deformation as
well as global left ventricular function and shape.

Exercise-induced changes in effective regurgitant orifice
significantly correlated with coaptation distance, tenting area,
mitral annular diameter, end-systolic sphericity index, and wall
motion score index, Dr. Miodrag Ostojic and colleagues, from the
Clinic Center of Serbia, in Belgrade, Yugoslavia, note.

By contrast, at rest, no association between effective regurgitant
orifice and echocardiographic features was observed, the authors
point out.

On multivariate analysis, exercise-induced changes in mitral
deformation were independently linked to exercise-induced changes in
effective regurgitant orifice.

"As the presence of functional mitral regurgitation in patients with
ischemic left ventricular dysfunction has an adverse prognosis,
increase in severity of mitral regurgitation during exercise can
further unmask those at high risk of poor outcome," the researchers
conclude.

Eur Heart J 2005;26:1860-1865

The prevalence of hospitalization for heart failure (HF) is highest
among black and Hispanic Medicare enrollees, according to
researchers in Atlanta and Miami.

"Little is known about racial or ethnic differences in
hospitalizations for heart failure, the most common hospital
diagnosis for Medicare enrollees," Dr. Janet B. Croft, of the
Centers for Disease Control and Prevention, and colleagues write in
the September issue of the American Heart Journal.

Using data from the Medicare Provider Analysis Record (1990 to
2000), the team examined racial and ethnic differences in the annual
prevalence of HF hospitalization and discharge outcomes among
Medicare beneficiaries.

The overall prevalence of HF hospitalizations increased from 20.3
per 1000 Medicare enrollee in 1990 to 22.1 per 1000 in 2000. The
prevalence was greater among men than women (24.4 versus 20.7 per
1000 enrollees, respectively).

Compared with white enrollees, black enrollees had a 1.5-fold
increased risk of a HF hospitalization and Hispanic enrollees ha a
1.2-fold increased risk. The likelihood of hospitalization for HF
was 0.5 times less likely among Asian enrollees.

Compared with enrollees ages 65 to 74 years, those aged 75 to 84
years were 2.2 times (p < 0.05) more likely to be hospitalized for
HF. Enrollees older than 85 years of age were 4.1 times (p < 0.05)
more likely to have an HF hospitalization.

There was an overall reduction in in-hospital mortality from 9.0% in
1990 to 5.5% in 2000. The team reports that 8.1% of Asians older
than 85 years of age died in the hospital, compared with 7.5% of
whites, 6.8% of Hispanics, and 6.3% of blacks.

"Because Hispanic Americans and the elderly are the fastest-growing
segments of the US population, HF will increase in importance as a
public health concern and will require increased focus on culturally
competent prevention and treatment strategies in the next decade,"
the investigators point out.

"To combat these disparities, national professional and patient
education efforts are needed that focus on developing and
implementing culturally competent prevention and treatment
strategies," Dr. Croft's team concludes.

Am Heart J 2005;150:448-454

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Patients with type 2 diabetes commonly experience regression or
remission of microalbuminuria, especially when blood glucose is
carefully controlled, according to a report in the October issue of
Diabetes.

"We think that we should shift the goal on diabetic patients' care
from the treatment for preventing progression of diabetic
complications to the treatment aiming at remission," Dr. Shin-ichi
Araki from Shiga University of Medical Science, Japan told Reuters
Health. "Our study suggests that we can do it."

Dr. Araki and associates estimated the frequency of remission and
regression of microalbuminuria in 216 patients with type 2 diabetes.

Overall, about half the patients experienced remission of
microalbuminuria at some point during the 6-year study, the authors
report.

Fifty-four percent of the patients had at least a 50% reduction in
microalbuminuria during the study, the results indicate, and only
28% experienced progression of their microalbuminuria to overt
proteinuria.

The use of angiotensin-converting enzyme inhibitors or angiotensin
receptor blockers, lower tertiles of hemoglobin A1c, and lower
tertiles of systolic blood pressure were independently associated
with regression of microalbuminuria, the researchers note.

Similar factors were associated with remission, the report
indicates. The coexistence of more than one independent factor
enhanced the chances of remission or regression.

"This observation should not be construed as indicating that
microalbuminuria is an unreliable indicator," the investigators
write. "Rather, it should be taken to emphasize the importance of
aggressive multifactorial control including glycemic exposure, blood
pressure, and the use of drugs blocking the renin-angiotensin system
as early as possible to prevent progression of diabetic nephropathy
and cardiovascular events."

"Our study does not provide any evidence regarding the beneficial
effect of remission/regression of microalbuminuria on future
outcomes in diabetic patients," Dr. Araki added. "We just suppose
that remission/regression of microalbuminuria will result in
reduction of the incidence of advanced nephropathy or cardiovascular
mortality." The researchers are continuing to follow the study
participants to clarify these points.

Diabetes 2005;54:2983-2987

Postprocedural myocardial perfusion is improved if intracoronary
verapamil is administered early during percutaneous coronary
intervention (PCI) in patients with acute MI, Chinese researchers
report.

The "no-reflow phenomenon," defined as inadequate myocardial
perfusion of an adequately dilated target vessel, is fairly common
among patients undergoing PCI for acute MI, and is associated with
adverse clinical outcomes.

Dr. Shyh-Ming Chen and colleagues at Chang Gung Memorial Hospital in
Taiwan theorized that administration of the calcium channel blocker
would be more effective if administered before the no-reflow
phenomenon occurs.

Their study included 50 consecutive patients prospectively enrolled
between 2001 and 2003 who were undergoing direct PCI within 12 hours
from the onset of an acute MI. Verapamil 50 to 100 g was
administered immediately prior to balloon inflation and at short
intervals during the procedure thereafter.

The 50 control patients had undergone PCI without intracoronary
calcium-channel blocker treatment. None of the patients in either
group experienced cardiogenic shock or were treated with platelet
glycoprotein IIb/IIIa inhibitors.

According to their report in the October issue of Chest, patients
treated with intracoronary verapamil had significantly better
myocardial reperfusion than the control subjects (p = 0.003). TIMI
myocardial perfusion grade 3 was observed in 42% of the verapamil
group and in 14% of the control group (p = 0.004).

During 1-month follow-up, no target vessel revascularizations were
required in either group. There was one death in the verapamil group
and three in the control group, a nonsignificant difference.

Multiple logistic regression showed that treatment with
intracoronary verapamil (odds ratio 0.26; p = 0.001) and pre-PCI
TIMI flow (OR 0.54; p = 0.006) were independent predictors of
myocardial reperfusion.

Chest 2005;128:2593-2598

Mortality after acute MI is significantly increased at US hospitals
that disproportionately serve black patients, according to a report
in the October 25th online issue of Circulation: Journal of the
American Heart Association.

Previous reports have shown that blacks are more likely than whites
to be treated by physicians with less training or at hospitals with
longer times to reperfusion therapy. However, the impact of the
differences on outcomes was unclear.

To investigate, Dr. Jonathan Skinner, from Dartmouth Medical School
in Hanover, New Hampshire, and co-investigators analyzed data from
more than 1 million Medicare patients who were hospitalized for
acute MI between 1997 and 2001.

The study included 4289 hospitals that were rated from 1 to 10 based
on the extent to which they treated black patients. At category 1
hospitals, no black MI patients were seen during the study period,
whereas at category 10 hospitals, about one third of all MI patients
were black.

The hospital category did not have a significant effect on morbidity
or on the severity of infarction. However, 90-day mortality was
significantly higher in category 10 hospitals compared with category
1 hospitals: 23.7% vs. 20.1%.

The difference in mortality between hospitals serving no blacks and
those serving the highest proportion could not be explained by
income, hospital ownership status, hospital volume, census region,
urban status or hospital surgical treatment intensity, the
researchers report.

In a related editorial, Dr. Nancy R. Kressin, from Boston University
School of Public Health, comments that "the evidence to date
suggests a discouraging picture of racial disparities in
cardiovascular care, and Skinner and coworkers' study documents
disparate outcomes associated with segregated care. It is still not
clear what proportion of the life expectancy gap in cardiovascular
disease is explained by disparate care."

Circulation 2005

The findings from a new study indicate that the popular erectile
dysfunction drug sildenafil (Viagra) blocks beta-adrenergic-
stimulated cardiac contractility in humans, according to a report in
the October 25th issue of Circulation.

In an animal study reported earlier this year, Dr. David A. Kass,
from Johns Hopkins Medical Institutions in Baltimore, and colleagues
had shown that sildenafil could reverse the negative effects on
heart muscle weakened by hypertrophy.

"But we had no firm evidence as to whether or how this therapy might
work in the human heart," Dr. Kass said in a statement. "Our latest
research provides firm evidence this drug does indeed have an
important impact on the heart."

The new study involved 35 healthy volunteers who were evaluated for
the cardiac response to dobutamine before and after being treated
with sildenafil or placebo.

The researchers found that sildenafil-treated patients had blunted
dobutamine response in ejection fraction, peak power and end-
systolic elastance changes.

"Knowing more about the effects of sildenafil on heart function will
allow for safer evaluation of its use as a treatment for heart
problems," Dr. Kass noted. "Until now, it was widely thought that
drugs like sildenafil had no effects on the human heart and that its
only purpose was vasodilation in the penis and lungs."

Circulation 2005;112

Compared with tinzaparin, enoxaparin shows greater sustained
benefits in patients with non-ST-segment elevation acute coronary
syndromes, according to researchers in Greece.

Dr. Lampros K. Michalis told Reuters Health that "this is the first
study demonstrating that all low molecular weight heparins are not
equally effective in the treatment of patients with non-ST elevation
acute coronary syndromes and indicating that differences in efficacy
are maintained beyond the early phase."

Dr. Michalis of the University of Ioannina and colleagues previously
conducted a short-term study comparing these low-molecular weight
heparins in acute coronary syndrome patients. The subjects were
given aspirin and were randomized to enoxaparin 100 IU/kg
subcutaneously twice daily or tinzaparin 175 IU/kg once daily for up
to 7 days.

At 7 days, the composite endpoint of death, myocardial infarction or
recurrent angina was reached in significantly fewer enoxaparin
patients (8.6%) than tinzaparin patients (17.9%). At 30 days, the
corresponding proportions were 16.4% and 26.1%, the investigators
report in the September issue of the American Heart Journal.

In the current study, the researchers followed up on 438 of these
patients for 6 months. Dr. Michalis' group found that significantly
fewer enoxaparin patients (25.5%) than tinzaparin patients (44.0%)
had reached the composite triple endpoint. This was also true using
the endpoint of death or MI (2.7% versus 6.9%).

Despite these encouraging results, the researchers note that the
study was relatively small and there was a lack of data regarding
antithrombotic efficacy.

"Larger, double-blind, randomized studies in more diverse
populations are needed to further evaluate differences in efficacy
between various low-molecular weight heparins," they conclude.

Nevertheless, Dr. Michalis added that "in this head-to-head
comparison study, the results indicate a benefit of enoxaparin...as
compared with tinzaparin...that is sustained for at least 6 months
in patients with acute coronary syndromes."

Am Heart J 2005;150:385-391