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Newsletters June 2011 - Jefferson Cardiology Happenings

What's in this Newsletter:

Benefit of Walking For Older Persons

The benefits of walking for older persons were recently evaluated in a study published in the Journal of the American College of Cardiology Imag-ing. In this study, 212 adults, ages 60-72, without cardiovascular disease were evaluated for their ability to dilate their coronary arteries thereby increasing coronary blood flow. Results demonstrated that those walking one hour or more daily developed more coronary dilation than less active people. Thus, this study strongly supports the benefits for older patients of walking one hour daily.

Bariatric Surgery Does Not Improve Survival

A recently published study in the Journal of the American Medical Asso-ciation provided controversial results. Past studies from Sweden demonstrated that bariatric surgery for weight loss improved patient survival, reduced complications of obesity and improved quality of life. A recent study from the Durham VA Medical Center questioned the survival benefit.

This study included 850 veterans in a number of VA hospitals with gastric bypass surgery from January 2000 to December 2006. The patients were 74% male and the median age was 49.5 years. When examined closely, bariatric surgery did not reduce mortality over a seven year period compared with a similar population that did not receive surgery. However, a well done Swedish study required 13 years of follow-up to demonstrate survival benefit. Despite the question of improved survival, many persons may choose bariatric surgery as this may be the only method of proven weight loss for them. Also, bariatric surgery may reduce complications of obesity and improvement of life. The long term effects on survival of newer procedures including laparoscopic stom-ach banding may take years to clarify.

Coffee and Women Cardiac Patients

A study recently published in the American Journal of Nutrition evaluated the risk of coffee and cardiac risk in women. Nearly 12,000 retired woman nurses with a history of heart disease or stroke were followed including some who were observed for over 20 years. Those who regularly drank caffeinated coffee were no more likely to die over the observation period than non coffee drinkers. Nevertheless, some persons may be protected by genetics regarding the effects of coffee while others who do not metabolize caffeine well may be at risk. Person with poorly controlled high blood pressure should speak with their doctors about caffeine intake.

Coumadin vs. Pradaxa

In the past year, a new drug, Pradaxa, has been released for use in protecting patients with atrial fibrillation against stroke. Traditionally, Coumadin has been used for this purpose but re-quires frequent blood tests to measure effectiveness and risk for bleeding. The new medication does not require such blood tests and has a uniform level of activity.

The RE-LY study was done to compare the two drugs. Coumadin dosage was tested at least once monthly and dosage was determined by results of these blood tests. Pradaxa was given at either 110mg or 150mg twice daily. All patients involved had permanent or periodic atrial fibrillation. The study patients had sufficient risk for possible stroke due to atrial fibrillation. The Coumadin patients were in proper range only 64% of the time. After 2 years, 21% stopped Pradaxa and 16.6% stopped Coumadin.
Stroke occurred in 1.5% per year of Pradaxa patients on 110mg twice daily and 1.1% per year on at the 150mg twice daily dose. With Coumadin, the risk was 1.5% per year. Death rates were better in the patients taking 150mg Pradaxa at 2.28% per year and 2.69% per year with Coumadin. The results were worse at the 110mg Pradaxa dose with death 2.43% per year. Over all bleeding was similar comparing Cou-madin and Pradaxa at 150mg twice daily.

In conclusion, it was judged that Pradaxa at 150mg twice daily was supe-rior to Coumadin in reducing stroke with a similar bleeding risk. At the 110mg dosage, Pradaxa and Coumadin had similar results for stroke prevention. This data may be questioned as many of the Coumadin patients had their protime often checked only once monthly. Perhaps tighter Coumadin testing and dosing might have led to similar effec-tiveness for Coumadin.

Happy Father’s Day!!

We at JCA would like to wish all the fathers of our practice a very happy and safe Father’s Day!

Pork Tenderloin Medallions and Balsamic Reduction

1 tablespoon olive oil 1 tablespoon shallots
1 garlic clove, minced 1 cup balsamic vinegar
1 ½ teaspoons sugar 1 teaspoon chopped fresh rosemary
1 teaspoon Dijon mustard ½ teaspoon salt
1 (1 pound) pork tenderloin, cut into 12 slices ½ teaspoon fresh ground black pepper
Cooking Spray

1. Heat oil in saucepan over medium-high heat. Add shallots and garlic; sauté 2minutes. Add vinegar, sugar, rosemary and Dijon mustard; cook until reduced to ½ cup.
2. Heat a large skillet over medium-high heat. Coat pan with cooking spray. Sprinkle pork with salt and pepper. Place pork in pan; cook 2 minutes on each side. Add balsamic reduction; cook 1 minute, turning pork to coat. (Serving size: 3 pork medallions and 2 tablespoons reduction)

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

Jefferson Hospital Medical Building
Suite 403, Coal Valley Road
P.O. Box 18285

Belle Vernon Office
1533 Broad Ave
Belle Vernon, Pa 15012