Smokers' arteries stiffen twice as fast as those of nonsmokers, possibly increasing their risk for myocardial infarction, stroke and other problems, according to a study published in the Journal of the American College of Cardiology (JACC).
For the study, researchers at Tokyo Medical University evaluated the brachial-ankle pulse wave velocity--the speed at which blood travels from the heart to the brachial artery, the main blood vessel of the upper arm and the faraway ankle--of 2,054 Japanese adults across five to six years. They found that the annual change in velocity was higher in smokers than nonsmokers, signaling that smokers had stiffer arteries. In addition, the study determined that smokers' medium- and large-sized arteries stiffened at double the rate as those of nonsmokers. The researchers also identified a dose-response relationship between cigarette consumption and accelerated arterial stiffening.
Commenting on the findings, an associate professor of medicine and cardiology at New York City-based Mount Sinai Medical Center notes that the results emphasize the cumulative nature of smoking-induced damage and suggests that physicians use the findings when urging patients to quit smoking (Tomiyama et al., JACC, May 2010 [subscription required]; Edelson, HealthDay, 4/26).
As reported in today's Daily Briefing, gene-expression profiling may be a safer and more effective method to test for heart transplant rejection than the traditional biopsy technique, a study in NEJM finds.
Currently, endomyocardial biopsies--in which providers insert a catheter through a neck vein to snip a small piece of heart tissue--is the standard method of monitoring organ rejection in cardiac transplant recipients. However, biopsies may be uncomfortable for patients and are associated with rare but potentially serious complications, according to the study.
Noting these drawbacks, researchers from Stanford University Medical Center conducted a study to test the effectiveness of a new, noninvasive technique known as AlloMap, which examines 11 genes to determine the likelihood of a rejection episode. For the study, the researchers assigned 602 patients who had a heart transplant six months to five years earlier to undergo either routine biopsies or gene testing.
After an average 19-month follow-up that assessed patients for rejection, graft dysfunction, death or a new transplant, the researchers found that 14.5% of patients who received genetic testing had experienced at least one of those events, compared with 15.3% of individuals who underwent biopsies. The groups' two-year mortality rates were also similar, at 6.3% among those who had genetic testing and 5.5% among those who had biopsies.
However, the genetic testing group had fewer rejection episodes--34 compared with 47 in the biopsy group. Additionally, the genetic testing group's satisfaction scores increased across the study, while scores in the biopsy group remained stagnant. The researchers note that their study was limited because it did not include patients who had recently undergone transplant surgery; therefore, the patients were at a lower risk of rejection.
The findings call into question the frequency of testing for rejection episodes, writes a deputy editor at NEJM in an accompanying editorial. He notes that among the genetic testing group, only six of the 34 rejection episodes were found through test results, while the rest were identified through symptoms or an echocardiogram, the Los Angeles Times reports (Pham et al., NEJM, 4/22; Jarcho, NEJM, 4/22; Pollack, Times, 4/22 [registration required]; Maugh, Los Angeles Times "Booster Shots," 4/22 [registration required]).
Eating large amounts of sugar may hurt cardiac health, according to research published in JAMA.
For the study, researchers from the Emory University School of Medicine in Atlanta analyzed the dietary habits of 6,113 adults between 1999 and 2006 and grouped them based on their sugar intake and cholesterol levels; the highest sugar-intake group consumed 46 teaspoons per day, compared with three teaspoons daily among the lowest sugar-intake group. On average, nearly 16% of individuals' daily caloric intake came from sugar, compared with about 11% in the late 1970s.
The highest sugar consumers--those who got 25% or more of their daily calories from sugar--were more likely to have higher risk factors for heart disease, such as lower levels of good cholesterol and higher levels of triglycerides, compared with individuals whose sugar intake accounted for 5% of their daily caloric intake.
Although efforts to promote cardiovascular health have focused on low-fat and low-cholesterol diets, the researchers say their findings demonstrate a need to reassess dietary recommendations and further investigate how carbohydrates and sugars influence heart health (Welsh et al., JAMA, 4/21 [subscription required]; Smith, MedPage Today, 4/20; Steenhuysen, Reuters, 4/20; Edelson, HealthDay, 4/20).
In hopes of reducing the incidence of cardiovascular disease, The Institute of Medicine (IOM) has recommended that the U.S. Food and Drug Administration (FDA) set stricter standards for the amount of salt that food manufacturers, restaurants, and food service companies can add to their products. In the report, the IOM advises the FDA to gradually reduce the maximum amount of salt that can be added to food and drinks so that consumers are less likely to notice the change in taste. The FDA has yet to decide whether they will place limits on the amount of salt that can be added to food, drinks and meals or adopt alternative strategies to reduce salt intake.
One approach that has proved to be successful in the United Kingdom is to develop partnerships with food manufactures. More specifically, the Consensus Action on Salt and Health group and the Food Standards Agency encouraged food manufacturers to voluntarily reduce the amount of sodium added to food and to provide information about salt content at the point of purchases. The agencies complemented these efforts with education campaigns that emphasized the risks of excessive sodium consumption and encouraged consumers to examine salt content on packaging. This multi-pronged and collaborative approach has proved highly successful, daily salt intake has declined by 10 percent (from 9.5g to 8.5g) since 2003.
Today's Daily Briefing reports that CMS on Monday issued its proposed inpatient prospective payment system (IPPS) rule for fiscal year (FY) 2011, which would reduce average inpatient payments by 0.1%, or $142 million, Modern Healthcare reports.
The proposed rule assumes a market basket update of 2.4% in FY 2011--a slight increase compared with the FY 2010 level--for the 3,500 acute care facilities that submit data on quality measures under the IPPS system; hospitals that do not submit data on quality measures would receive a 0.4% market basket update. However, the agency also calls for a 2.9 percentage-point adjustment to recoup the estimated excess spending in FY 2008 and FY 2009 related to changes in hospital coding practices.
Additionally, the proposed FY 2010 IPPS rule would add 45 new quality measures, 10 of which would be added to the existing set of measures that hospitals must report to receive the full market basket update. Meanwhile, the remaining 35 quality measures would be considered in determining hospitals' FY 2013 update, according to a CMS release.
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Local hospitalizations for cardiovascular and respiratory conditions dropped by between 30% and 40% after restaurants in Toronto, Canada, implemented a smoking ban, according to a study published in the Canadian Medical Association Journal.
To determine the effectiveness of the smoking ban, researchers from the University of Toronto analyzed admission rates at Toronto hospitals between January 1996 and March 2006, a period that covered three years before the smoking ban was implemented and two years after the final phase of implementation. Specifically, the researchers identified hospitalizations for three cardiovascular conditions (myocardial infarction (MI), angina and stroke) and three respiratory conditions (asthma, chronic obstructive pulmonary disease, and pneumonia or bronchitis). The researchers also tracked three gastrointestinal conditions and assessed hospitalizations in communities without smoking bans to serve as controls.
Across the 10-year study, the researchers found that crude rates of admission for the cardiovascular and respiratory conditions dropped by 39% and 33%, respectively. However, implementation of smoking bans in other settings did not affect hospital admission rates, according to MedPage Today.
The researchers did not find any significant changes in hospital admissions for cardiovascular, respiratory or the three control conditions in communities without a smoking ban.
Although the study cannot prove that smoking bans caused hospital admissions to drop, the researchers say the findings reinforce the "value" of such bans and legitimize legislative efforts to further reduce exposure to secondhand smoke (Naiman et al., Canadian Medical Association Journal, 4/12; Bankhead, MedPage Today, 4/12; Kennedy, Toronto Star, 4/13).
Uninsured Americans and individuals under financial strain are more likely to delay seeking emergency treatment for myocardial infarction (MI) compared with those who are insured and financially secure, according to a study published in JAMA.
For the study, researchers examined data on 3,721 MI survivors who were admitted to 24 U.S. hospitals between 2005 and 2008. Overall, nearly 62% of patients studied were insured without financial concerns, 19% were insured but had financial concerns and 20% were uninsured.
Nearly half of uninsured individuals waited more than six hours from symptom onset before visiting the hospital, compared with 39% of insured individuals who did not have financial concerns. Financial concerns also affected when patients sought treatment, as nearly 45% of insured individuals who worried about paying for care waited more than six hours before going to the hospital, while roughly 34% waited two hours.
Noting that treatment becomes less effective six hours after MI occurrence, the researchers say these delays may contribute to the estimated 45,000 deaths annually attributed to lack of insurance. Furthermore, decisions to delay treatment may spur rehospitalizations and contribute to burgeoning health care costs. Additionally, the researchers posit that if some patients delay MI treatment due to insurance or financial status, they may also delay treatment for other common medical conditions, including stroke, pneumonia and appendicitis.
Although expanding access to coverage under recently enacted health reform legislation may prompt more individuals to seek immediate emergency care, expanding coverage without reducing costs will do little to alter patients' decisions to delay treatment, a cardiologist at Saint Luke's Mid America Heart Institute in Missouri, and a study author, notes. Specifically, he says that insurance companies may cost-shift under reform and raise consumer costs, which may be prohibitive to those with insurance if care is not made more affordable (Smolderen et al., JAMA, 4/14 [subscription required]; Healy, Los Angeles Times, 4/14 [registration required]; Bavley, Kansas City Star, 4/13).
About one in four surveyed cardiologists said fear of potential malpractice lawsuits prompted them to order cardiac catheterizations for their patients, even if such tests were not clinically necessary, according to a study in Circulation.
For the study, researchers from Maine Medical Center surveyed 598 cardiologists about the tests and treatments they might recommend for hypothetical cardiac patients. The researchers then scored the physicians on how aggressively they were inclined to treat the patients. The physicians also were asked about why they would recommend a cardiac catheterization; about 24% of the cardiologists said they had recommended a test in the prior 12 months out of a non-clinical fear of malpractice lawsuits, and about 27% said they ordered the test because they thought their colleagues also would do so. Most physicians, however, reported that they were not influenced by the prospects of financial gain or by their patients' requests.
Using Medicare records, researchers found that the physicians who prescribed more aggressive treatment were more likely to practice in regions with high medical costs and higher test rates. Fears over possible malpractice lawsuits were significantly associated with the regional differences, the study's lead author said, which may suggest that physicians' behavior in specific geographic regions may be "a target for intervention."
Researchers hope the findings offer insight into how physicians' attitudes and practices relate to regional variations in health tests and medical costs nationwide (Lucas et al., Circulation, 4/13 [subscription required]; Nano, AP/Hartford Courant, 4/13; Hobson, Wall Street Journal "Health Blog," 4/13 [subscription required]).