Cardiovascular Disease

The following articles have the tag Cardiovascular Disease

High LDL-C may not predict MI in CKD

AN AUSTRALIAN expert has urged caution in interpreting research that indicates LDL cholesterol is not an accurate marker of myocardial infarction (MI) risk in patients with chronic kidney disease (CKD).

Aspirin warning in diabetes

ASPIRIN offers no benefit for primary prevention of cardiovascular disease in type 2 diabetes patients and may even increase the risk of coronary heart disease, a study shows.

‘Healthy’ but obese is a transient state

A THIRD of young people who are obese but ‘metabolically healthy’ will transition to a metabolically unhealthy state over time, Australian data shows.

Indigenous care plans rising

INCREASING numbers of Aboriginal and Torres Strait Islanders with chronic diseases have a GP management plan as part of their treatment, a report shows.

FH cascade screening more efficient than universal tests

CASCADE screening for familial hypercholesterolaemia (FH) would be more efficient and acceptable in Australia than universal screening of children, according to an expert.

Mum's weight affects vascular health of offspring

NEWBORN babies born to women with high BMI have aortic wall thickening independent of their birthweight, Australian research shows.

Aussies struggling to limit salt intake

THE American Heart Association (AHA) has reaffirmed its message that sodium intake should be limited to less than 1500mg per day – but Australian experts say the public is struggling to get below 2300mg.

Controversial review backs restricting sugar

ADVICE to restrict sugar intake should be a routine part of clinical care, particularly when patients are being counselled about cardiovascular (CV) risk, a provocative review suggests.

Chinese who adopt Western fast food diet increase CVD risk

CHINESE Singaporeans who regularly eat Western-style fast food are at increased risk of type 2 diabetes and dying from cardiovascular disease (CVD), research suggests.

Dark chocolate treatment for metabolic syndrome

CHOCOHOLICS can take heart from a Melbourne study finding 100g daily of the good stuff could prevent cardiovascular events in people with metabolic syndrome – and it’s cost-effective.

A positive outlook on life can protect your heart

OPTIMISTIC people appear to be at a reduced risk of heart attacks, strokes and other cardiovascular events, according to a review of more than 200 studies.

Plastic chemical linked to heart disease

A European study has provided new evidence that the commonly used plastic chemical bisphenol-A (BPA) is linked to heart disease.

Dietary guidelines likely to be ignored

UPDATED national healthy eating guidelines have been released at the same time as a survey of GPs showed Australians commonly ignore lifestyle advice.

In the battle of the hearty drinks, wine trumps milk

IN WHAT may be a win for wine lovers over teetotallers, research has shown polyphenols don’t benefit the heart if consumed in milk. While it has been posited that polyphenols in red wine are behind the well-known reduction in cardiovascular disease risk among people who consume moderate amounts of the beverage, clinical study findings have been inconsistent. Dutch researchers took 61 people with a mean age of 61 years and borderline high blood pressure and gave them dairy drinks, which contained either a placebo or polyphenols from red wine, daily. Those who drank the antioxidants consumed ...

Heart patients missing out on cheap therapies

CHEAP therapies for cardiovascular disease are being underused despite their effectiveness in preventing mortality, a study shows. Researchers estimate about 60% of patients with heart disease and up to half of people who have had a stroke might not be taking any of the inexpensive, recommended preventative drugs. The four main classes examined in the prospective study were antiplatelets, beta-blockers, ACE inhibitors and statins. In the largest study of its kind, Canadian researchers looked at the use of these therapies among nearly 154,000 patients in 17 countries. Antiplatelets were taken by one quarter of patients, beta-blockers ...

Farmers need educating in emergency medicine

CARDIAC risk factors are rife among farming men and women but few know the best thing to do when experiencing acute chest pain, a pilot study shows. The study of 186 farming men and women from 20 agricultural communities in rural Victoria found 74% of the women and 61% of the men were overweight or obese. Around half of the respondents had hypertension and a fasting blood glucose level equal to or more than 5.5 mmol/L. When asked to name their nearest emergency department (ED), one in 10 nominated health services or towns where no ED ...

More cholesterol in an egg yolk than in a monster-sized burger

CHOLESTEROL in food sources such as eggs is not harmless, say Canadian physicians, who are concerned about a lack of awareness of the dangers of dietary cholesterol. In fact, a large egg yolk contains more dietary cholesterol (215-275 mg) than super-sized US burgers such as the KFC Double Down (150 mg) or Hardee’s Monster Thickburger (210 mg), they wrote in the Canadian Journal of Cardiology. “We wanted to put cholesterol into perspective, as there’s been a widespread misconception developing… that consumption of dietary cholesterol and egg yolks is harmless,” the authors said. Because statins lower cholesterol more ...

Pre-eclampsia: The CVD connection

Is pre-eclampsia a one-off event or a signal for future cardiac disease for mothers and children? Leigh Parry asks if we should monitor these groups more closely in later life.

Black cohosh linked to episodes of complete heart block

The herbal ingredient black cohosh (Cimicifuga racemosa) should be considered as a possible cause of unexplained cardiac conduction disturbance, cardiologists believe. Queensland cardiologists Drs Scott McKenzie and Atifur Rahman described a case where a woman was hospitalised due to syncope and investigations revealed she was having episodes of complete heart block. The patient had no history of cardiac symptoms but had been taking a preparation containing black cohosh for two weeks. Bradycardia is a widely listed side-effect of black cohosh in non-academic literature, the authors said. While black cohosh was useful for treating menopausal symptoms, they warned it ...

Multivitamin use linked to lower MI risk

DEBATE looks set to reignite over the benefits of multivitamins, with a study finding they substantially reduced the risk of myocardial infarction (MI). A Swedish population-based cohort study found women with no history of CVD who took multivitamins had a 27% lower risk of MI over 10 years compared to those taking no supplements. The apparent protective effect was stronger for women taking multivitamins combined with other supplements; however, there was no benefit seen in those taking dietary supplements alone. The findings are likely to prove controversial, with previous research delivering mixed verdicts on the benefits ...

The need for sleep

Just what is the optimal amount of sleep and how does too little or too much affect us? Lynnette Hoffman finds out.

Lower BP raises risk in pre-existing CAD

A J-CURVE effect, whereby those with the highest and lowest blood pressure levels are both at increased risk of cardiovascular events, has been confirmed in patients with coronary artery disease (CAD), researchers say. A US study of 10,000 patients with CAD, randomised to receive either 80 mg or 10 mg atorvastatin, found an increased risk of death from coronary heart disease or non-fatal myocardial infarction at both low and high BP targets. The authors say it confirms earlier findings and questions the dictum that “with blood pressure, lower is always better”. The CV risk was less with ...

Bosses should do more to keep us healthy, say employees

NEARLY a third of employees believe their workplace hinders their ability to lead a healthy lifestyle, according to an international survey by the World Heart Federation. The survey of 4000 people in four countries also revealed the vast majority - 91% - believed employers should be responsible for creating a healthy work environment. The research was conducted in India, Poland, Mexico and Portugal. The federation's senior science officer, Dr Kathryn Taubert, said with many workers spending more than half their waking hours at work "the workplace is the ideal setting to encourage behaviour changes to minimise ...

The rising rate of AF

A decade ago, atrial fibrillation was considered an emerging epidemic – has it now reached its peak? Kate Woods looks at the rise and rise of AF.

Pharmacists can assist in CVD risk management

PHARMACISTS can play a key role in managing cardiovascular disease (CVD) risk factors, according to a new research project conducted as part of the Fourth Community Pharmacy Agreement. Under the Pharmacist Assessment of Adherence Risk and Treatment in Cardiovascular Disease (PAART CVD) project, 10 pharmacists were trained in CVD risk factor management and facilitating patient lifestyle modification. A total of 70 patients aged 50-74 years taking medication for high blood pressure or cholesterol were then invited to participate in monthly sessions with the trained pharmacists on risk factor reduction. Patients involved in these prevention strategies reduced their CVD ...

Study links low-dose NSAIDs to stroke risk in healthy population

EXPERT opinion remains divided on risks versus benefits of NSAIDs, after research shows even low doses may raise the risk of stroke in healthy individuals. The findings, building on earlier work linking NSAIDs to cardiovascular (CV) mortality, have prompted calls for diclofenac to be withdrawn. The Danish study, presented recently at the European Society of Cardiology congress, reviewed data from more than a million patients prescribed an NSAID. Diclofenac use increased the risk of stroke by 86%, while ibuprofen increased it by 28 per cent. There was a dose-dependent relationship with both drugs. David Henry, ...

Do genes affect clopidogrel?

REPORTS that people who carry a certain genetic allele have an impaired response to clopidogrel have been challenged by new research. A US and Canadian study of 5059 patients with acute coronary syndrome found those carrying the CYP2C19 loss-of-function allele did not experience impaired safety or efficacy with clopidogrel when compared to the general population. A number of recent studies had found clopidogrel was less effective in these patients, leading the US Food and Drug Administration to issue a black box warning on the use of the drug by these patients. Similar results were reported among ...

Hypertensive label is more stressful than having raised BP

IGNORANCE is bliss when it comes to high blood pressure (BP), a new study suggests. British researchers found that having a diagnosis of hypertension was inherently stressful when compared to those unaware their BP was high. In a study of 33,000 adults, those with diagnosed hypertension had a 57% increased risk of being psychologically distressed compared to those with normal BP. Unaware patients with hypertension had no such elevated risk, suggesting that the stress resulted from the diagnosis itself, rather than increased BP. The authors said the finding suggested that it is the labelling of individuals ...

Aspirin's acid test

Aspirin – it might be good for secondary prophylaxis in heart disease, but should it be routinely recommended for primary prevention of cardiovascular conditions?

Migraine with aura an independent CV death risk

MIGRAINE with aura can now be regarded as an independent risk factor for cardiovascular and all-cause mortality. An Icelandic study, including 18,725 middle-aged people, found migraineurs with aura had a 27% increased risk of cardiovascular-related death compared with non-migraineurs. After 26 years follow-up, they also had a 21% increased risk of all-cause mortality. There was no such increased risk among those with non-migraine headache or migraine without aura. The association remained after adjusting for other risk factors. “Migraine with aura was an independent risk factor for cardiovascular and all-cause mortality in both men and women, but ...

Antidepressant unsuccessful in heart failure

THE use of an SSRI in patients with heart failure and depression has failed to show a significant reduction in depressive symptoms or improvement in cardiovascular status. US researchers randomised 469 patients with heart failure and major depressive disorder to either sertraline (50-200 mg a day) or a matching placebo. After 12 weeks, both groups recorded similar reductions in depression severity and improvements in cardiovascular outcomes. About 69% of patients in both groups recorded some level of cardiovascular improvement. Professor Henry Krum, director of the Centre of Cardiovascular Research and Education in Therapeutics at Monash University, ...

Women outdo men in high LDL-C level

AUSTRALIAN women have, on average, higher cholesterol levels than men, according to the largest cholesterol study undertaken in general practice. The findings reinforce calls for greater public awareness of female cardiovascular health. The study, which included 200,000 patient records, found four out of five women aged 45 to 64 years had LDL-C levels greater than 2.5 mmol/L and 34% had HDL-C levels below 1 mmol/L.The average total cholesterol of middle-aged women was 5.5 mmol/L. This compared to an average of 5.3 mmol/L for middle-aged men. The average total cholesterol for women of all ages was also slightly higher than that ...

Ca supplements out for osteoporosis: experts

CALCIUM supplements may raise the risk of myocardial infarction (MI) and their role in the management of osteoporosis should be reconsidered, experts say. Their comments follow publication of a meta-analysis of 11 randomised controlled trials, finding that calcium supplementation raised MI risk by 30% in over-40s. The data had previously sparked controversy when presented at the World Congress of Internal Medicine in Melbourne in March (MO online, 26 March). Senior author Ian Reid, an endocrinologist and Professor of Medicine at the University of Auckland, told MO the increased cardiovascular risk with calcium “swamps the potential benefits ...

Lower BP no benefit in diabetes and CAD

LOWER blood pressure targets for patients with diabetes and coronary artery disease (CAD) may not achieve their aim of improving cardiovascular outcomes. A US secondary analysis of 6400 patients with diabetes and CAD has challenged 2008 Australian Heart Foundation guidelines recommending BP targets of less than 130/80 mmHg in patients with diabetes and/or coronary heart disease. There was little difference in the rate of cardiovascular events between those maintaining systolic BP under 130 mmHg and those with “usual” control (130/80 mmHg to 145/85 mmHg). And when extended follow-up data was included, those in the tighter controlled ...

Clopidogrel cleared for acute coronary syndrome

CLOPIDOGREL remains the first choice anticoagulant for all patients with acute coronary syndrome, Australian experts believe, despite recent regulatory warnings over its use by those with certain genetic polymorphisms. The US Food and Drug Administration (FDA) warned earlier this year about the drug’s use by patients with genetic polymorphisms that decrease CYP2C19 function, diminishing the effectiveness of clopidogrel and increasing the risk of cardiovascular events. Professor David Hare, a cardiologist at Melbourne’s Austin Hospital, believed it was reasonable to continue following current guidelines recommending a daily dose of 75 mg of clopidogrel due to the “low frequency” ...

Drugs battling diabetes but ‘losing the war’

THE limitations of drug treatments as a panacea for type 2 diabetes must be recognised if the global burden of the disease is to be reduced, The Lancet says. In a special issue last week, the journal reported that since 2000 the number of people with diabetes had more than doubled to 285 million globally. “The fact that type 2 diabetes, a largely preventable disorder, has reached epidemic proportions is a public health humiliation,” an editorial said. It called for “imaginative” responses involving physical activity and attention to diet rather than focusing on medical intervention alone. ...

Anxiety a predictor for cardiac death

ANXIETY can be confirmed as an independent risk factor for coronary heart disease (CHD) and cardiac mortality, Australian experts say, after a meta-analysis found it was strongly associated with these outcomes. The review of 20 prospective studies, including 249,846 ‘healthy’ persons, found those with anxiety disorders had a 26% higher risk of CHD and a 48% higher risk of cardiac mortality. The results were independent of demographic variables, biological risk factors and health behaviours. The findings were further bolstered by a Swedish study of 49,321 men followed for 37 years, which found those with anxiety at ...

Heart attack risk rises with air pollution level: study

HIGHER levels of air pollution increase the risk of having a cardiac arrest outside of hospital, Australian researchers say. After identifying 8434 cases through the Victorian Cardiac Arrest Registry over four years and excluding those with obvious causes, the Monash University researchers obtained air pollution concentrations for the day of arrest. They found an increase of 4.26 μg/m3 in particulate matter (PM) air pollution was associated with a 3.6% increased risk of having an out-of-hospital cardiac arrest. The effect persisted for two days following an increase in PM. Those aged 65-74 were most susceptible to PM ...

Higher HDL-C could offer cancer protection

ELEVATED high-density lipoprotein cholesterol (HDL-C) levels are associated with a significant reduction in cancer risk, research shows. A meta-analysis of 24 randomised controlled trials found raised HDL-C levels significantly lowered cancer risk after adjusting for conventional risk factors, including low-density lipoprotein cholesterol, age, BMI, diabetes, sex and smoking. After an average of five years’ follow-up, the authors estimated that every 0.55 mmol/L increment in HDL-C translated into a 36% lower risk of developing cancers, including lung and liver. The meta-analysis compared the incidence of cancer in 76,265 patients receiving statin treatment with average HDL-C levels of 2.57 mmol/L, ...

Doubts over serum acid-CVD risk link

DOUBTS have been cast over previous reports that serum uric acid concentrations are an independently prognostic marker of cardiovascular disease (CVD) or all-cause mortality in patients with type 2 diabetes. An Australian observational study of 1268 patients with type 2 diabetes revealed serum uric acid levels more than 0.40 mmol/l were not an independent predictor of CVD or all-cause mortality when compared with concentrations of 0.28 mmol/l or less, after an average of 10 years. Previous studies had indicated a positive association between high serum uric acid concentrations and risk of CVD mortality. Professor Tim Davis, ...

Beta-blockers benefit COPD patients

BETA-BLOCKERS are not only safe for patients with COPD, but may reduce exacerbations and mortality, which contrasts with previous concerns they might provoke bronchospasm and induce respiratory failure. A Dutch 10-year observational study of 2230 general practice patients with COPD has found that those using beta-blockers had mortality and exacerbations reduced by nearly a third compared with patients who had not received them. The reduction in mortality and exacerbations was still around 35% even after adjusting for age, current and former smoking, history of cardiovascular disease, hypertension, diabetes and use of other cardiovascular drugs. Professor Christine ...

Beta-blockers benefit COPD patients

Toothbrushing linked to cardio-vascular disease prevention

ENCOURAGING good oral hygiene may have the added benefit of reducing the risk of death from cardiovascular disease. Evidence shows those who rarely brush their teeth have a 70% increased risk of a cardiovascular event. A study of dental habits among nearly 12,000 people in Scotland showed those who reported brushing their teeth less than once a day were more likely to die from cardiovascular disease than those who brushed twice a day. This was after adjusting for risk factors such as BMI, smoking, dental visits, hypertension and family history. While the mechanisms remained unclear, the ...

CV risk equations are ‘inaccurate’ for elderly

OLDER patients would benefit from new cardiovascular disease [CVD] absolute risk calculators, Australian experts say, as current risk tools underestimate their risk of cardiovascular death. A recent study by a group of Australian cardiologists compared the predictive ability of three risk equations for absolute cardiovascular risk in 6083 hypertensive patients with an average age of 72. The results showed that the Framingham, Pocock and Dubbo cardiovascular risk equations were all, at best, “modest” predictors of risk of myocardial infarction, coronary heart disease, stroke or CVD morbidity or mortality in elderly patients with hypertension. The Framingham risk ...

Renal function a key predictor of death risk

RENAL function tests should be more widely used in clinical practice, experts say, as evidence continues to build on their efficacy as predictors of mortality risk. An international meta-analysis has confirmed that estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (ACR) measures are independent predictors of mortality risk in the general population. The meta-analysis of 21 studies from 14 countries (including Australia) found an eGFR of less than 60 mL/min/1.73 m2, and an ACR of 1.1 mg/mmol or more, predicted a higher risk of all-cause and cardiovascular death independent of cardiovascular risk factors, and of each ...

Fibrates: new lease of life in CV protection

MORE widespread use of fibrates has been advocated by Australian cardiologists who say there is now enough evidence of their benefit in the prevention of cardiovascular events in high-risk patients. While there had been inconsistent findings from previous studies, leading to some hesitation about their use, an Australian meta-analysis of 18 trials has found that using fibrates leads to a 10% reduction in major cardiovascular events and a 13% reduction in coronary events. Fibrates also reduced the risk of albuminuria progression by 14% and appeared to be safe, with no significant increase in drug-related adverse events. ...

Fibrates found to offer CVD protection

THE uncertainty surrounding the role of fibrates in the prevention of cardiovascular disease may be a step closer to being clarified as Australian experts find that fibrates significantly reduce the risk of cardiovascular events. Their review and meta-analysis of 18 trials found use of fibrates led to a 10% reduction in major cardiovascular events and a 13% reduction in coronary events. Fibrates also reduced the risk of albuminuria progression by 14% and were not associated with a significant increase in drug-related adverse events. There was no reduction in stroke however, and no statistically significant effect on ...

CRP screens may identify risk of premature death

SCREENING for elevated C-reactive protein (CRP) levels could identify patients at risk of premature death, new research suggests. The Danish study in 10,388 participants found elevated CRP levels (over 3 mg/L) were associated with a two-fold increased risk of mortality from cardiovascular disease, cancer and other causes compared to CRP levels less than 1 mg/L after 16 years’ follow-up. “However, this does not appear to be a causal association for [CRP] per se but more likely reflects association of hidden, potentially fatal inflammatory disease with increased all-cause mortality,” the authors said. It had been unclear whether ...

Doctors left in limbo over clopidogrel-PPI safety

CONCERNS remain over the concurrent use of clopidogrel and PPIs with conflicting findings leaving clinicians uncertain of the safety profile of the therapies in combination. The latest findings, from a US retrospective cohort study, show those treated with clopidogrel plus any PPI had a 93% higher risk of rehospitalisation for MI compared with patients with similar cardiovascular risk factors treated with clopidogrel alone. The 1033 patients in the study had at baseline been discharged from hospital after a MI or coronary stent placement. However, the findings contrasted with those of a recent UK review of ...

Fish oil linked to increased bleeding risk

PATIENTS taking fish oil may be at increased risk of bleeding and should be advised to stop the supplements in the lead-up to elective surgery, the TGA has recommended. High-dose supplements should also be discontinued in people at high risk for haemorrhagic stroke, according to a recent update from the new Advisory Committee on the Safety of Medicines. It replaces the Adverse Drug Reactions Advisory Committee (ADRAC). Although fish oils were largely safe and had an array of potential benefits, there was some concern about their anticoagulant properties which warranted caution, the update said. “Anecdotally, it ...

Maternal diabetes history is cardioprotective in women

WOMEN with type 2 diabetes and a maternal family history of the disease have a significantly lower risk of cardiovascular disease than those with no familial history, an Australian study shows. The latest instalment from the Fremantle Diabetes study found a familial history of diabetes conferred a 37% reduced risk of death from all causes and cardiac death, and a 68% reduced risk of incident MI in women with type 2 diabetes. Maternal family history had no effect on male patients and paternal history of diabetes was not associated with any clinical differences. A total of ...

GP software needs CVD absolute risk tool

PRACTICE software must be upgraded in order to narrow significant gaps between cardiovascular disease (CVD) ‘absolute risk’ assessment in primary care and evidence-based guidelines, experts argue. Findings from the AusHEART study revealed large evidence-practice gaps remained in primary and secondary prevention of CVD in older Australians. The study of 322 GPs, examined the management of 15-20 consecutive patients aged 55 years or older and found GPs’ estimates of risk among patients without established CVD agreed with a guideline-based estimate in 47% of cases. Only 34% of high-risk patients without established CVD were receiving a ...

Women significantly underestimate CVD risk

MANY women remain unaware that cardiovascular disease (CVD) is the leading cause of death among females, research reveals. A US survey of 2300 women found that although more women were aware that CVD was their leading cause of death than in the previous survey in 1997, almost half were not. And there were substantial misconceptions about what to take or what to do in an emergency. A substantial percentage of respondents also subscribed to unproven and ineffective preventive therapies, such as antioxidants, multivitamins and special vitamins (such as vitamin C), in the belief they were cardioprotective. ...

Mortality high in non-alcoholic fatty liver disease

THE risks associated with non-alcoholic fatty liver disease (NAFLD) may be far greater than previously thought, with research showing patients who have the condition are at significantly higher risk of dying than the general population. After an average follow-up of 21 years, Swedish researchers found patients with NAFLD had a 69% increased risk of death, primarily from cardiovascular disease, extrahepatic malignancies and liver disease, when compared to the general population. Amongst 256 patients with elevated liver enzymes who underwent liver biopsies between 1980 and 1984, fatty liver was detected in 143 and 118 were diagnosed with NAFLD. ...

Breastfeeding may protect against cardiovascular disease

THE advantages of breastfeeding may extend beyond the known benefits for babies and mothers, with evidence now revealing mothers who do not breastfeed are up to five times more likely to have aortic calcification than those who have breastfed. Failure to breastfeed was associated with an increased risk of a range of markers of subclinical cardiovascular disease, including carotid plaque and larger carotid adventitial diameters in middle-aged women, researchers showed. The study included nearly 300 women aged 45-58 years, who were free of clinical cardiovascular disease and who self-reported their lactation history. Previous studies had ...

Australian study backs aspirin in high-risk diabetes

EXPERTS have expressed concerns at reports that aspirin should not be used for primary prevention of cardiovascular disease in patients with diabetes. They say, rather than advising against aspirin use, more should be done to specify which patients would benefit from its use. The comments follow a new Australian study, which found substantial overall mortality reductions from low-dose aspirin, especially in men and those aged 65 years and older. Researchers followed 651 patients with type 2 diabetes, drawn from the Fremantle Diabetes Study, for a mean 11 years. They found that regular aspirin use led to ...

Regular walnut intake reduces cardiac risk in type 2 diabetes

A WALNUT-RICH diet may reduce cardiovascular disease risk in patients with type 2 diabetes, research shows. A US study in 24 patients aged 30-75 years with type 2 diabetes found those randomised to a diet enriched with 56 g of walnuts daily had significantly improved endothelial function compared with those on a walnut-free diet after eight weeks. A walnut-rich diet was associated, but not significantly, with lower cholesterol and low-density lipoprotein cholesterol levels, as well as increased glucose levels. Weight, HbA 1c levels and insulin sensitivity also failed to change significantly in the walnut cohort. ...

CVD prevention needed after high BP in pregnancy

WOMEN diagnosed with pre-eclampsia or gestational hypertension are at significantly increased risk of developing premature cardiovascular disease and should be targeted for preventive interventions, researchers say. In the largest prospective study of its kind, researchers have demonstrated continuing high cardiovascular risk for the estimated one in 10 women who have hypertensive disorders in pregnancy. The study of more than 15,000 women in Norway showed those with gestational hypertension or pre-eclampsia were likely to have higher BMI, blood pressure and unfavourable lipid profiles up to 16 years later. The researchers also showed repeated bouts of pre-eclampsia put ...

Women’s CV risk is rising as men’s risk decreases

GREATER recognition of cardiovascular risk factors among women is needed, experts say, as they continue to experience a higher relative cardiovascular mortality in mid life. A US study found myocardial infarction prevalence had increased among midlife women (aged 35 to 54 years) over the past two decades, a period in which its prevalence had declined among similarly aged men. The authors said a greater emphasis on vascular risk factor control in midlife women “might help mitigate this worrisome trend”. However, a second US study did find hospital myocardial infarction mortality rates halved in women younger than ...

Absolute CVD risk guide to close gaps in management

EXPANDING the 45 Year Old Health Check to allow five-yearly screening of all healthy adults aged 40-74 years would address gaps in cardiovascular risk management, experts say. The proposal follows the release of data showing GPs continue to focus on individual risk factors and a shift towards management of absolute cardiovascular risk should be a priority. “An absolute risk strategy identified people with mild and moderate abnormalities of a number of factors that, in combination, substantially increase their risk,” the authors wrote in the MJA . The national cross-sectional survey evaluated the CVD assessment and ...

Large thighs cushion CVD risk

WOMEN – and men – around the world have finally been given reason to celebrate having larger thighs after a study found bigger thighs protect against cardiovascular disease and premature death. Danish researchers found, among 2800 men and women, those with thighs measuring 60 cm or less in circumference had an increased risk of premature death, cardiovascular and coronary heart diseases. Those with the lowest recorded circumference (46 cm) had more than twice the mortality risk of those with a 55 cm measurement. The researchers said too little muscle or subcutaneous fat in the lower limbs might ...

Mild glucose intolerance in pregnancy raises cardiovascular risk

EVEN mild glucose intolerance during pregnancy can raise a woman’s future risk of cardiovascular disease, according to a large retrospective cohort study. Canadian researchers compared more than 13,000 women with gestational diabetes and 70,000 women who had an abnormal glucose challenge test and required an antepartum oral glucose tolerance test (OGTT), with 350,000 women whose glucose challenge test result was normal and who had no need for an OGTT. They found that, over 12 years, women with gestational diabetes had a 66% higher risk of cardiovascular disease compared with those who did not have an OGTT. ...

GPs best placed to spot depression in cardiac patients

ALMOST three-quarters of patients with cardiovascular disease are not being diagnosed or treated for depression, experts say, and Australian cardiologists believe GPs are best placed to identify and treat depression in patients with cardiovascular disease. A nationwide survey examined beliefs and practices in relation to depression screening, diagnosis, treatment and referral among 511 cardiologists. Lead author, Andrew Stewart, a cardiology research fellow at the Austin Health department of cardiology in Melbourne, said 20% of patients with a myocardial infarct and 30% of heart failure patients had symptoms of depression. “Despite this, greater than 70% of cardiac ...

Push for subsidised fish oils now evidence is conclusive

A BLANKET approach to using daily fish oil supplements for both primary and secondary prevention of heart disease has been backed by a major international review. The evidence of the health benefits of fish oils containing omega-3 polyunsaturated fatty acids (PUFAs) is now so comprehensive that experts are calling for their inclusion under the PBS. The US reviewers examined 30 years of retrospective epidemiologic evidence and randomised controlled trials and said the evidence was so conclusive that they could recommend minimum daily targets of 500 mg of omega-3 PUFAs for those without cardiovascular disease and 800-1000 mg ...

Marker offers new approach to assessing CVD risk

LIPOPROTEIN(A) concentrations are being identified as an independent marker for risk of coronary heart disease (CHD), ischaemic stroke and non-vascular mortality, and may take on an important diagnostic role in the future, experts say. A collaboration of international lipids experts has reviewed data from 36 cohort and case-control studies, and concluded lipoprotein(a) (Lp[a]) was continuously, independently and modestly associated with risk of CHD and stroke. The review, including data from 126,334 patients, found a 13% greater risk of CHD per 3.5-fold higher than usual Lp(a) concentration, after adjustment for age, sex, lipids and other conventional risk factors, ...

Rising PTH levels a clue to cardiovascular risk

RISING parathyroid hormone (PTH) levels may be a modifiable risk factor for cardiovascular disease, as research has revealed even high normal levels are associated with an increased risk of death from cardiovascular causes. A Swedish cohort study of 958 men (average age 71 years) found that over nine years they had a 38% greater cardiovascular mortality for each standard deviation increase in plasma PTH levels. After adjusting for those without previous cardiovascular disease and for those with normal parathyroid hormone levels (<6.8 pmol/L), the association remained. Professor Rebecca Mason (PhD), an endocrine physiologist at the Bosch ...

Evidence lacking for routine use of aspirin in diabetes

GUIDELINES recommending primary prevention of cardiovascular disease using aspirin in patients with diabetes are not backed by evidence and its routine use should be avoided, experts say. Writing in the MJA , Australian experts raised concerns over guidelines issued by authorities such as the RACGP and the NHMRC, which recommend 75-325 mg/day of aspirin in people with diabetes unless contraindicated. They say current guidelines for aspirin as a primary prevention in these patients have been extrapolated from evidence showing efficacy in secondary prevention of CVD events. “There is still no clinical trial evidence to support ...

Tailor HbA1c targets to individual patients

A NEW era of managing patients with diabetes may soon arrive with the development of individualised HbA 1c targets based on factors such as disease duration, medications and other comorbidities. Debate over appropriate HbA 1c targets has been prompted in the past year by the findings of three major trials that investigated the risks and benefits of intensive glycaemic lowering in all patients. Speaking at the recent RACP Congress in Sydney, Clinical Associate Professor Wah Cheung, co-director of the Centre for Diabetes and Endocrinology Research at Westmead Hospital, Sydney, said new guidelines developed ...

Risk reckoning

Are the days of basing cardiovascular risk calculations on a 1940s US study numbered? Catherine Hanrahan reports. IN 1947, researchers launched one of the most ambitious epidemiological studies ever undertaken. They recruited more than 5000 volunteers in the US town of Framingham, Massachusetts, to help them identify the causes of cardiovascular disease. At the time, the average Framingham Joe smoked 20 cigarettes a day, walked rather than drove to work, and got his weekly exercise mowing the lawn. He spent time watching his new television – the genesis of generations of couch potatoes – ...

Breastfeeding reduces mothers’ CVD risk

BREASTFEEDING protects mothers against cardiovascular disease later in life, data from the Women’s Health Study suggests. Women who had lactated for more than 12 months were 10% less likely to have developed cardiovascular disease than parous women who had never breastfed. Lactation did not protect against obesity. Data was collected from 139,681 postmenopausal women with a median age of 63 years who had at least one live birth. The findings were adjusted for sociodemographic factors, lifestyle variables, BMI and family history. Obstetrics and Gynecology 2009; 113:974-82

Lifestyle programs lacking

MANY patients at high risk of cardiovascular disease may be missing out on effective lifestyle modification programs. Professor Mark Harris, of the department of general practice at the University of NSW, said only one in five patients at high risk of coronary heart disease and other lifestyle-related conditions were offered referrals to lifestyle modification programs. Patients can be referred to programs such as the AGPN-administered Lifestyle Modification Programs through item 713 (the 40-49 year old type 2 diabetes risk evaluation) or item 717 (45-49 year old health check). Current MBS data shows 6957 patients were referred ...

Study casts doubt on depression screens in CVD

THE value of screening for depression in patients with cardiovascular disease (CVD) has been questioned by research showing the use of antidepressants or cognitive behavioural therapy did not improve CVD outcomes. A Canadian meta-analysis of 11 studies found that, while there were “modest” improvements in depressive symptoms among patients treated with these therapies when compared to placebo or standard care, there was no resulting improvement in cardiac outcome. The findings questioned the widespread recommendation for screening for depression among CVD patients, the authors said. The review did not find definitive evidence for or against the recommendations, they ...

The realities of risk perception

IF we accurately perceive our risk of a future problem, then it follows that we would implement behaviours to try to protect ourselves from this risk. For example, if we perceive that wearing a seat belt reduces the risk of serious injury in a car accident, then we are more likely to wear it. Does this translate to other areas of our health? If we perceive that we are at risk of cancer from smoking, do we stop smoking? Not always. WOMEN AND RISK PERCEPTION Research shows that women do not accurately perceive ...

Plastics pose a disease risk

FOOD Standards Australia New Zealand (FSANZ) will not be reviewing its current advice that the average daily absorption of bisphenol A (BPA) from food and drink packaging is safe. This is despite the latest research linking the chemical to an increased risk of diabetes and cardiovascular disease. A cross-sectional analysis of almost 1500 US adults found those with higher urinary BPA concentrations were 39% more likely to have either of these conditions compared to those with lower concentrations. Higher concentrations were also associated with abnormal liver enzyme levels. No positive association with other common diseases such as ...

Campaign for absolute risk model in CVD

CARDIOVASCULAR groups have united to campaign for the introduction of a national program focusing on the use of ‘absolute risk’ as an alternative to current risk assessment in cardiovascular disease. The National Vascular Disease Prevention Alliance – made up of the National Stroke Foundation, the Heart Foundation, Diabetes Australia and Kidney Health Australia – has proposed an Australian-specific ‘absolute risk’ assessment program, which would be implemented in general practice. The call follows publication of a study that found more than 80% of patients at high risk of cardiac, stroke and vascular diseases were not receiving the ...

World report - 29 August 2008

• INDIA HEART DISEASE ALERT EXPERTS have warned an expected sharp rise in cardiovascular disease in India will wreak havoc on the country’s healthcare system and productivity. The World Health Organization has estimated India will have 60% of the world’s heart disease patients by 2010, and the disease burden of CVD, stroke and diabetes will cost the country $237 billion by 2015. The epidemic has been blamed on the adoption of Westernised lifestyles, increased stress and rampant tobacco use. The Indian government will introduce a pilot program in 10 districts focused on heart ...

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Cardiovascular Disease