Friday, March 13, 2009

Improved lifestyle management required for patients with CHD

How the heart handles anger seems to predict who's at risk for a life-threatening irregular heartbeat.

Negative emotions like hostility and depression have long been considered risks for developing heart disease, and deaths from cardiac arrest rise after disasters such as earthquakes.

But research released Monday goes a step farther, uncovering a telltale pattern in the EKGs of certain heart patients when they merely recall a maddening event - an anger spike that foretold bad news.

In already vulnerable people, "anger causes electrical changes in the heart," said Dr. Rachel Lampert, a Yale University cardiologist who led the work. When that happens even in the doctor's office, "that means they're more likely to have arrhythmias when they go out in real life."

The third EUROASPIRE survey, led by Imperial College London, was carried out in 2006-2007 in 22 countries, to explore whether the prevention of heart disease had improved since earlier studies.

It involved 2392 patients, each of whom had either been treated for heart disease (for example, undergoing a bypass) or had been admitted to hospital following a heart attack. They were interviewed at least 6 months after this episode.

The "substantial increase" in the use of drugs since the first study was carried out in 1995/1996 is described by researchers as "futile" because of the failure to invest in prevention.

Overall, the proportion of patients who smoke has remained the same since the first study was carried out, when researchers identified a high rate of risk factors that could be tackled to prevent repeat illness.

Levels of obesity increased from 25% 38%. The proportion of patients with raised blood pressure remained similar at 60.9%. However the proportion with raised cholesterol fell from 94.5% to 46.2%. The frequency of self-reported diabetes mellitus increased from 17.4% to 28%.

The researchers said: "These time trends show a compelling need for more effective lifestyle management of patients with coronary heart disease".

In examining cardiovascular prevention guidelines in daily practice in eight European countries, investigators observed many adverse lifestyle trends, including increases in obesity, diabetes mellitus, and smoking in younger female subjects, as well as no improvements in blood-pressure management.

The findings, published in the March 14, 2009 issue of the Lancet, highlight a continuing gap between standards set in cardiovascular disease prevention guidelines and clinical practice, according to investigators.

"The European healthcare systems are dominated by acute care, medical technology, devices, and pharmacological treatments," write lead investigator Dr Kornelia Kotseva (Imperial College London, UK) and colleagues. "Lifestyles are judged as private issues. However, lifestyle programs could be an integral part of healthcare provision and health insurance plans. All patients with coronary heart disease would benefit from access to a comprehensive cardiovascular prevention and rehabilitation program. To salvage the acutely ischemic myocardium without addressing the underlying lifestyle causes of the disease is futile; we need to invest in prevention."

In an editorial accompanying the published study [2], Drs Mette Brekke and Bjørn Gjelsvik (both from University of Oslo, Norway) called the results of the EUROASPIRE studies "discouraging." They note that recommendations for lifestyle changes are increasingly emphasized in cardiac rehabilitation and secondary risk prevention, including advice to stop smoking, make healthy food choices, and become physically active.

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