Less severe first heart attacks linked to decline in coronary heart disease deaths



New research has revealed that women with a history of serious mental illness are much more likely to have babies that are stillborn or die within the first month of life. The researchers from the Centre for Women’s Mental Health at Manchester University say the risk of stillbirth and newborn deaths from any cause, was

Full Post: History of serious mental illness linked to stillborn babies

The severity of first heart attacks has dropped significantly in the United States - propelling a decline in coronary heart disease deaths, researchers reported in Circulation: Journal of the American Heart Association.

“This landmark study suggests that better prevention and better management in the hospital have contributed to the reduction in deaths,” said Merle Myerson, M.D., Ed.D., lead author of the study, cardiologist and director of the Cardiovascular Disease Prevention Program at St. Luke’s-Roosevelt Hospital of Columbia University in New York City.

“Better control of risk factors for heart disease, such as blood pressure and cholesterol as well as improvements in hospital management may lessen the severity if somebody has a heart attack,” Myerson said. “We also considered whether people had less severity because they got to the hospital sooner, but that was not the case.”

The study extends previous findings from the Atherosclerosis Risk in Communities (ARIC), an ongoing epidemiologic study that includes data from four areas - Forsythe County, N.C., including Winston-Salem; Washington County, Md., including Hagerstown; and the suburbs of Minneapolis, Minn. and Jackson, Miss. Both whites and African-Americans were included in the study.

In a previous analysis of ARIC data gathered from 1987 to 1994, researchers found a decrease in many, but not all indicators of severity. Myerson and colleagues included an extra eight years of data, covering 10,285 patients, ages 35 to 74, who were discharged from the hospital diagnosed with a definite or probable first-time heart attack from Jan. 1, 1987 through Dec. 31, 2002. The new findings show a more consistent picture with a clear decline in severity of heart attacks.

Researchers assessed severity based on patients’ electrocardiogram (ECG) findings, the levels of enzymes in the blood associated with heart muscle damage and hemodynamic abnormalities related to blood flow and blood pressure.

Adjusted for age, sex and race, the new findings included:

  • A significant drop occurred in the proportion of patients who had major ECG abnormalities, including an average 1.9 percent per year decline in initial ST-segment elevation, a 3.9 percent decline per year for a new (subsequent) Q-wave, and 4.5 percent per year decline for any major Q-wave.
  • The average percentage of patients with abnormal biomarkers dropped 0.7 percent, a modest but statistically significant decline.
  • Hemodynamic factors (forces involved in blood circulation) showed mixed results. For example, the percentage of patients with cardiogenic shock dropped 5.7 percent per year. But the proportion with systolic blood pressure of 100 mm Hg or less was unchanged, and the percentage with an abnormal pulse rate - less that 60 or more than 100 beats per minute - increased moderately.
  • The results for men, women and African Americans paralleled the study’s overall results.
  • There was some evidence of possible race-related differences between whites and African Americans in new Q-waves and the percent of decline in confirmed heart attacks, which dropped more in whites.
  • The percentage of patients who arrived at the hospital in less than two hours after symptom onset remained at approximately 33 percent; there was no significant change over the study time period.
  • These new findings demonstrate that there has been a decrease in heart attack severity and an increased survival among first-time heart attack sufferers; both of which can help to explain the decline in deaths from coronary heart disease.

“The reduction in severity of first-time heart attacks, along with other factors, has impacted on the declining number of deaths from coronary heart disease” Myerson said. “This tells us that better primary prevention as well as better care for those with acute heart attacks is working. Attributing the reduction in severity to specific causes will be an important next step so effective strategies can be reinforced and public health policies can be better directed.”

Co-authors are: Sean Coady, M.A.; Herman Taylor, M.D.; Wayne D. Rosamond, Ph.D.; and David C. Goff Jr., M.D. Individual author disclosures are available on the manuscript.

The National Heart, Lung, and Blood Institute funded the ARIC study.

http://www.americanheart.org/

Link




Despite substantial progress in the diagnosis and treatment of heart attack patients, prevention of recurrent heart attacks continues to be a major clinical challenge. A new study showed that patients who suffered a non-fatal heart attack within the first three months of hospitalization for chest pain had a significantly higher risk for dying or having

Full Post: Heart attack prevention within three months after hospitalization significantly averted future attacks



Continuously measuring blood pressure may help predict heart disease and related deaths among individuals with treatment-resistant hypertension, while blood pressure readings taken in a medical office do not appear to predict future heart risks, according to a report in November 24 issue of Archives of Internal Medicine. About 10 percent to 30 percent of individuals

Full Post: Blood pressure readings taken at medical office do not appear to predict future heart risks



People who have been diagnosed with panic attacks or panic disorder have a greater risk of subsequently developing heart disease or suffering a heart attack than the normal population, with higher rates occurring in younger people, according to research published in Europe’s leading cardiology journal, the European Heart Journal. The study found that people who

Full Post: Panic attacks or panic disorder linked to higher risk of heart problems



In recent years, women, particularly younger women, experienced larger improvements in hospital mortality after myocardial infarction than men, according to a new study. Over the last decade some studies showed that younger women, but not older ones, are more likely to die in the hospital after MI than age-matched men. A team of researchers led

Full Post: Sex differences narrow in death after heart attack



A new national study has shown that nearly 75 percent of patients hospitalized for a heart attack had cholesterol levels that would indicate they were not at high risk for a cardiovascular event, according to current national cholesterol guidelines. Specifically, these patients had low-density lipoprotein (LDL) cholesterol levels that met current guidelines, and close to

Full Post: New insight and intervention ideas to help reduce the number of heart attacks