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Newsletters January 2010 - Jefferson Cardiology Happenings

What's in this Newsletter:

Women’s Heart Disease and Menopause

For many years it was recognized that women tended to be pro-tected against coronary disease until after menopause. A recently completed study of womens health attempted to examine how menopause affected the future development of coronary disease. This study, the SWAN study, involved the University of Pittsburgh among a handful of other centers and evaluated 3300 minority and Caucasian women. Multiple factors were evaluated in women after their last menstrual period.

The results revealed that total cholesterol and LDL cholesterol (bad cholesterol) rose in the year after their last menstrual period. It was concluded that close monitoring of cholesterol in women entering menopause may help prevent fu-ture coronary events.

Financial Incentives for Health

Recent information from the Philadelphia VA Medical Center reflected how cost may affect patients’ compliance with medications. Specifically, when copayments for prescriptions rose from $2 to $7, a significant number of patients stopped their statin medications.

On the other hand when smokers were compensated for stopping cigarette smoking there was a 15% incidence in cigarette cessation compared to a 5% inci-dence of cigarette cessation in those not compensated. Similarly, pay for for per-formance programs have been used in England to encourage general practitioners to improve quality of care for their pa-tients.

Europe Contributions

A number of interesting papers were presented at the recently completed Scientific Sessions of the European Soci-ety of Cardiology. Relative to our most senior citizens was a study evaluating treatment of blood pressure in octogenari-ans. Comparing those persons treated with medications for high blood pressure with those given placebo (fake medication), definite benefit was noted for the treatment group. Those treated improved total and cardiovascular mortality without a difference in stroke and heart failure.

Other studies evaluating the effectiveness of blood pressure control reinforced the role of combination of medications used to treat high blood pressure. Adding a second drug from a different class of drugs was more effective than doubling the initial medications. The most preferred combinations were diuretic or calcium channel blockers with either an angiotension converting enzyme inhibitor (ACE) or an angiotension receptor blocker (ARB). Goals of treatment may need to be individualized. Some high risk patients may not do well with blood pressure under 120/75.

The GISSI trial from Italy revealed that statin therapy may not be particularly beneficial in treatment of heart failure patients. Yet statins may reduce the inci-dence of atrial fibrillation.

For those patients on Coumadin who seek alternatives, help may be on the way. New blood thinners are being tested that appear as effective as Coumadin and will not require frequent blood testing.

There has been much publicity in the press in recent years about the interaction of proton pump inhibitors such as Prilosec and the blood thinner Plavix. A recent study showed no evidence of in-creased harm when these agents were used together.

It has been widely recognized that few out of hospital cardiac arrest patients will survive. Most of these persons who are effectively stabilized initially will have brain damage. There is promising litera-ture that cooling the brain may reduce mortality and brain damage after cardiac arrest. Several different techniques for cooling the body after cardiac arrest are being evaluated.

Smokers’ Survival After Heart Attack

A recently published study evalu-ated survival after a first heart attack in persons with a history of cigarette smok-ing. Specifically, survival was evaluated in those who never smoked, those who stopped before their first heart attack and persistent smokers. The study also evalu-ated whether there was a difference in survival in persistent smokers to those with reduced cigarette consumption after their heart attack.

Participants in the study were followed from 1992 through 2005. At baseline, smokers tended to be younger, more likely to be male and had a lowerincidence of hypertension and diabetes. The long term outcomes were similar for those who never smoked and those who stopped before their heart attack. Persistent smokers had worse survival than those who reduced their cigarette consumption. For each reduction of 5 cigarettes daily after a heart attack, there was an 18% decline in mortality risk. From this study, there is evidence that never smoking and only limited smoking history similarly reduce future risk after a heart attck. Those who stop smoking after a heart attack do better than those who don’t. Those who significantly reduce their cigarette consumption do better than those who continue their same cigarette habit.

Staff News

We would like to wish a very Happy Birthday to Nancy Carlin, Chrissy Falk and Terry Whitworth! Hope you all enjoy your special day!

Happy New Year!!

All of us here at Jefferson Cardiology would like to wish all of you and your families a very happy, safe and prosperous new year.

A publication of Jefferson Cardiology Association
Alan D. Bramowitz, M.D. | Michael S. Nathanson, M.D. | Gennady Geskin, M.D.

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