Study Finds CV Risk Even With Short-Term NSAID Use

By Peggy Peck, Executive Editor, MedPage Today


There is no "safe" duration for NSAID use in patients with a history of myocardial infarction, according to an analysis of data from more than 83,000 patients -- use of NSAIDs after MI increased the relative risk of death or second MI by as much as 45%.

Moreover, the common NSAID diclofenac (Voltaren, Cataflam) was associated with a 3.52 HR for death during the first week of use, according to Anne-Marie Schjerning Olsen, MB, of Copenhagen University Hospital in Gentofte, Denmark, and colleagues.

That's a higher risk of death at the initiation of treatment than was seen with rofecoxib (Vioxx), which was withdrawn from the market in 2004, they wrote online in Circulation, Journal of the American Heart Association.
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Psoriasis and Cardiovascular Disease and Diabetes

Early Morning MIs Have Larger Infarcts

The time of day at the onset of myocardial infarction plays a significant role in the size of the infarct based on levels of cardiac enzymes, with the largest infarcts being seen with onset in the early morning hours, a retrospective study found.

Broader View Urged for Seniors' CV Care

Consumer Reports Is Rating Heart Bypass Surgical Groups - NYTimes.com

Image via CrunchBaseby Denise Grady
Medical groups that perform heart bypass surgery are now being rated alongside cars and toaster ovens in Consumer Reports.


In most parts of the country, data-based ratings of doctors are not available to patients. Only a few states, including New York, provide them.

The magazine published ratings of 221 surgical groups from 42 states online on Tuesday and will print them in its October issue. Groups are rated, not individual doctors. The groups receive one, two or three stars, for below average, average or above average. The scores were based on complication and survival rates, whether the groups used the best surgical technique and whether patients were being sent home with certain medicines that research has shown to be beneficial after this type of surgery.

For now, the information is available only to people who subscribe to Consumer Reports online or buy the magazine. But within a few months, the ratings should be posted and freely available to the public at the Web site of the Society of Thoracic Surgeons (www.sts.org/), said Dr. Fred H. Edwards, the chairman of quality and research for the society, and medical director for cardiothoracic surgery at the University of Florida in Jacksonville. The society, which has been tracking surgeons’ performance since 1989, gave the information to Consumer Reports. More than 90 percent of the nation’s heart surgery programs participate in the society’s registry.
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HDL Loses Power After LDL Lowering MedPage Today

By Charles Bankhead, Staff Writer, MedPage Today

The predictive value of HDL cholesterol all but disappeared with treatment-induced low levels of LDL, according to a new analysis of data from a large trial of lipid-lowering therapy.

Among patients treated with rosuvastatin (Crestor), the usual inverse association between HDL levels and vascular risk lost its statistical significance. Neither baseline (P=0.82) nor on-treatment (P=0.97) HDL levels predicted the risk of clinical events, Paul M. Ridker, MD, of Harvard, and colleagues reported online in The Lancet.

In contrast, HDL levels in placebo-treated patients had a significant association with subsequent events both at baseline (P=0.0039) and during randomized treatment (P=0.0047).

"Our data should not reduce enthusiasm for measurement of HDL-cholesterol concentration as part of an initial cardiovascular risk assessment," Ridker and his co-authors wrote in conclusion. "As shown here among those allocated to placebo, HDL cholesterol was a powerful inverse risk predictor.

"However, these primary prevent data and recent secondary prevention data from [other] trials provide little evidence to support the hypotheses that HDL cholesterol levels predict risk of vascular events in the setting of high-dose statin therapy."

In multiple randomized clinical trials, statin therapy has consistently led to large, statistically significant reductions in cardiovascular events. The benefits have been observed in both primary- and secondary-prevention trials, the authors wrote.

However, in every trial, residual risk has remained among patients assigned to statin therapy. One possible explanation for the residual risk is low levels of HDL.

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Low Vitamin D Linked To The Metabolic Syndrome In Elderly People

from Medical News Today

A new study adds to the mounting evidence that older adults commonly have low vitamin D levels and that vitamin D inadequacy may be a risk factor for the metabolic syndrome, a condition that affects one in four adults. The results were presented at The Endocrine Society's 92nd Annual Meeting in San Diego.

"Because the metabolic syndrome increases the risk of diabetes and cardiovascular disease, an adequate vitamin D level in the body might be important in the prevention of these diseases," said study co-author Marelise Eekhoff, MD, PhD, of VU University Medical Center, Amsterdam.

The researchers found a 48 percent prevalence of vitamin D deficiency. The study consisted of a representative sample of the older Dutch population: nearly 1,300 white men and women ages 65 and older.

Nearly 37 percent of the total sample had the metabolic syndrome, a clustering of high blood pressure, abdominal obesity, abnormal cholesterol profile and high blood sugar.

Subjects with blood levels of vitamin D (serum 25-hydroxyvitamin D) lower than 50 nanomoles per liter, considered vitamin D insufficiency, were likelier to have the metabolic syndrome than those whose vitamin D levels exceeded 50. That increased risk especially stemmed from the presence of two risk factors for the metabolic syndrome: low HDL, or "good" cholesterol, and a large waistline.

There was no difference in risk between men and women, the authors noted.

The study included subjects who were participating in the Longitudinal Aging Study Amsterdam. Although the data were from 1995 and 1996, Eekhoff said they expect that vitamin D inadequacy remains prevalent among whites in the Netherlands.
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Testosterone Gel Linked to Risk of MI and Stroke from MedPage Today

By Joyce Frieden, News Editor, MedPage Today

Applying topical testosterone appears to raise the risk of cardiovascular events including myocardial infarction, atrial fibrillation, and stroke in older men with limited mobility, a study has found.

Compared with men who had lower levels of circulating testosterone, men with testosterone levels in the highest quartile more than doubled their risk of cardiovascular events, (HR 2.4; P=0.05), wrote Shalender Bhasin, MD, of Boston University, and colleagues in a study published online June 30 by the New England Journal of Medicine.

"Testosterone gel ... was associated with a greater frequency of adverse events, particularly cardiovascular, respiratory, and dermatologic events," the authors wrote. "The divergence between the [testosterone gel and placebo gel] groups in the incidence of cardiovascular adverse events was maintained over the six-month intervention period and did not diminish during the three-month observation phase that followed the intervention period."

The pattern of adverse cardiovascular events associated with testosterone therapy was considered by the data and safety monitoring board to be of sufficient concern to warrant termination of the trial before the target number of 252 patients had been enrolled.

Testosterone did, however, increase strength and improve mobility -- the primary endpoint of the trial. The men randomized to transdermal testosterone improved leg and chest press strength and improved stair-climbing power while carrying a load compared with controls.

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Quality of HF Care Not Better Despite Shorter Stays - from MedPage Today

By Todd Neale, Staff Writer, MedPage Today

Although hospital length of stay and inhospital mortality are decreasing for older patients with heart failure, that doesn't necessarily mean quality of care is improving, a large observational study showed.

From 1993 to 2006, length of stay and inhospital mortality significantly decreased in the U.S., but postdischarge mortality and 30-day readmission rates increased -- by a relative 49% and 17%, respectively;Journal of the American Medical Association.
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Older Age Boosts Mortality Risk with Cardiac Devices - from MedPage Today

By Charles Bankhead, Staff Writer, MedPage Today

Hospital mortality increased significantly in patients 80 or older who received implantable cardioverter-defibrillators (ICDs) or cardiac resynchronization therapy (CRT), illustrating a need for better candidacy criteria for this age group, an analysis of a large database suggested.

Compared with patients younger than 80, patients ages 80 to 85 had almost twice the inhospital mortality risk, and that risk tripled in patients older than 85 according to an article in the April 12 Archives of Internal Medicine.

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Cardiovascular Risk Declines When Vitamin D Is Normalized

by Shelley Wood

Adding heft to the hypothesis that vitamin-D deficiency is linked to cardiovascular disease, a new study has found that people with low vitamin-D levels who managed to normalize their levels were significantly less likely to develop cardiovascular events over up to six years of follow-up.

The study was presented as a poster by Dr Tami L Bair (Intermountain Medical Center Heart Institute, Murray, UT) earlier this week at the American College of Cardiology (ACC) 2010 Scientific Sessions.

According to coauthor Dr Joseph B Muhlestein (Intermountain Medical Center Heart Institute), the study looked at baseline and subsequent vitamin-D levels in 9491 subjects with known vitamin-D deficiency, rechecked their vitamin D, then compared subsequent rates of death, coronary artery disease, MI, heart failure, stroke, and renal failure among those who managed to bring up their vitamin-D levels with those who remained vitamin-D deficient. A cut point of <30 ng/mL was used to define vitamin-D deficiency.
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BP Variation Predicts Stroke Better than Mean Values - from MedPage Today

By John Gever, Senior Editor, MedPage Today

Blood pressure variability over time, not merely its average level, is a powerful risk factor for stroke, myocardial infarction, and other cardiovascular events, researchers said.

Moreover, some antihypertensive drugs are better than others at controlling blood pressure variability, according to three new reports in the Lancet journals, all by Peter M. Rothwell, MD, PhD, of John Radcliffe Hospital in Oxford, England, and colleagues.

The researchers reported that:
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Psoriasis Comorbidity Increases over Time - MedPage Today

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By Charles Bankhead, Staff Writer, MedPage Today

Patients with psoriasis have multiple comorbid conditions that tend to worsen over time, data from a review of medical records showed.

At baseline, psoriasis patients had significantly higher rates of hypertension than non-psoriasis controls (14.9% versus 11.9%, P<0.0001), cardiovascular disease (CVD)(3.9% versus 3.1%, P=0.0151), depression (3.7% versus 2.8%, P=0.0077), diabetes (6.3% versus 5.0%, P=0.0471), and hyperlipidemia (15.2% versus 11.5%, P<0.0001).

Psoriasis patients also had a numerically greater prevalence of obesity (0.6% versus 0.2%), and the differences between the two groups increased during four years of follow-up, researchers reported at the American Academy of Dermatology meeting here.

Differences increased the most for depression, hyperlipidemia, and obesity.

"The trends [are] all going directionally in the same way, and the point spread between the groups continues to widen over time," Alexa Kimball, MD, of Harvard, told colleagues.
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Medical News: Diabetes Risk of Statins Outweighed by Heart Benefit - in Cardiovascular, Dyslipidemia from MedPage Today

By John Gever, Senior Editor, MedPage Today

Statin drugs raise the risk of diabetes significantly, but the danger appeared puny compared with their cardiovascular benefits, researchers found in a meta-analysis.
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Diabetes Plus Schizophrenia Increases Risk of Heart Disease - in Meeting Coverage, IDF from MedPage Today

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By Kate Johnson, Contributing Writer, MedPage Today

When diabetes is complicated by a diagnosis of schizophrenia, the risk of cardiovascular events increases, but when those events occur, the patient is less likely to undergo revascularization, researchers reported here.

In a retrospective study of more than 126,000 patients with diabetes -- including 2,952 with diabetes and schizophrenia -- patients who were dually diagnosed were about 20% more likely to have cardiovascular disease, but 49% less likely to undergo revascularization than patients diagnosed with diabetes or schizophrenia alone, Lauren Bresee, MSc, of the University of Alberta School of Public Health, reported at the International Diabetes Federation World Congress of Diabetes.
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