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Newsletters September 2010 - Jefferson Cardiology Happenings

What's in this Newsletter:

Avandia Controversy Heats Up

In 1997, a subcommittee of the FDA concluded that the diabetes drug Avandia was associated with an in-creased incidence of cardiac events. May patients were greatly concerned and asked about alternative therapy for their diabetes.

In the August 26 issue of the New England Journal of Medicine, there is an update of evidence linking Avandia to coronary events by the chairman of the 1997 FDA subcommittee mentioned above. There is now increasing evidence linking Avandia to coronary events and a request for federal action is made. Two studies analyzing 10 previous trials re-port a 30-80% greater risk of heart attack with Avandia compared to placebo. There was a greater risk of heart attack with Avandia than other diabetes medi-cations. Analysis of 21 studies from Medicare data bases indicate greater car-diovascular risk for Avandia compared to Actos which belongs to the same dia-betic drug family. Other studies showed no increased cardiovascular risk with Actos. Also, there was a nearly 25% greater risk of a cardiovascular event or death if a patient took Avandia rather than Actos. In recent years, differences in the method of actions of these two drugs have been recognized.

In light of this information, what should be done? Certainly, patients could be taken off Avandia and switched to Actos or other agents. The author of this recent analysis suggests two options for the FDA. The suggestions include stronger warnings coupled with informed consent for those wishing to continue Avandia or removal of Avandia from the market. Time will tell in which direction the FDA moves.

Heart Function and Dementia

A study published in the August 17 issue of Circulation raising the ques-tion of a relationship between cardiac function and brain volumes. An evaluation of a population without a stroke history or dementia was selected to evaluate individual heart pumping capability using MRI technology. The study demonstrated that those persons whose heart pumped the most blood had greater volume of brain tissue compared to those pumping the least blood. Those whose heart function was between the highest and lowest pumping volumes had an intermediate loss of brain volume. Does this mean that reduced cardiac function is an important cause of dementia? Only more research and time will give us the answer to this curious question.

Prevention of Readmission for Heart Failure

Nationally, a major health care expense is repeat hospital admission for the heart failure patient. Studies are on-going to reduce the number and related expense of such hospital readmissions. A recent review evaluated the relation-ship of timing of office visit to repeat admissions. In the study population of 8 patients, 20% had to be readmitted for heart failure within 30 days of discharge. It was observed that those patients seen within one week after discharge had the lowest readmission rate.

Folic Acid to Prevent Coronary Events

Past studies have suggested that folic acid may reduce homocysteine and thereby reduce coronary events. A re-cent study was performed evaluating all randomized studies using folic acid to reduce coronary events between 1966 and 2009. Analysis revealed that folic acid supplementation had no effect on subsequent coronary events or stroke. Lowering of homocysteine levels had no effect on reduction of coronary events or stroke. In fact, it appeared that folic acid has an effect to increase atherosclerosis.

Staff Birthdays

We would like to wish a very Happy Birthday to Barb Radus, billing specialist, Dr. Gennady Geskin, and Dave Ryckman, office manager.

Happy Retirement

We would like to extend a heartfelt thank you and best wishes to Barb Radus who, after 12 years of service in our billing department, recently retired. She will be sorely missed but we wish her all the best in her new endeavors. Thank you for your dedication Barb.

Lemon Poppy Seed Snack Cake

Ingredients:

1 cup all-purpose flour ¼ cup fat-free milk
¼ cup granulated sugar 2 egg whites
1 teaspoon baking powder 3 tablespoons vegetable oil
½ teaspoon baking soda 1 cup (8oz) low fat lemon yogurt
1 tablespoon poppy seeds 1 tablespoon grated lemon peel
1 cup Kelloggs All-Bran 1 teaspoon powdered sugar

Directions:

1. Stir together flour, granulated sugar, baking powder, baking soda, salt and poppy seeds. Set aside.

2. In a large mixing bowl, combine Kelloggs All-Bran cereal, milk, egg whites, oil, lemon peel and yogurt. Let stand for about 5 minutes or until cereal softens. Add flour mixture, stirring only until combined. Spread evenly in 8 x 8 x 2-inch pan coated with cooking spray.

3. Bake at 350 degrees for about 25 minutes or until wooden toothpick inserted in center comes out clean. Cool and dust with powdered sugar before serving.

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