The EU Cardiovascular Disease Arena - In Brief An Authoritative Round-up of Trends, Statistics and Clinical Research

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Citation
European Cardiovascular Disease 2006 - Issue 1;2006:2(1):12-13
DOI
http://dx.doi.org/10.15420/ecr.2006.1.12
Plasma Osteopontin Levels Predict Future Cardiovascular Events in Angina Patients

Italian researchers from the University of Pavia have found that increased levels of plasma osteopontin are an independent predictor of future adverse cardiovascular (CV) events in patients with chronic stable angina. The findings, published in the April issue of the European Heart Journal, show the investigators followed almost 800 patients with stable angina for a median of 2.7 years.1 The log-transformed baseline osteopontin level was significantly associated with the composite end-point of non-fatal myocardial infarction (MI) and death from cardiovascular causes (hazard ratio, 1.79). Hypertension, levels of C-reactive protein and statin use were also significantly related to adverse events.

Lead investigator Diego Geroldi remarked that the findings might be of importance, insofar as there is a paucity of biomarkers for use in such patient groups to predict prognosis. Further studies to investigate the relationship between osteopontin, coronary calcium and cardiac prognosis are warranted.

New British Guidelines on Prevention of Cardiovascular Disease Released

New guidelines developed by the British Cardiac Society (BCS), the British Hypertension Society (BHS), Diabetes UK, Primary Care Cardiovascular Society and The Stroke Association have provided suggestions on how to prevent cardiovascular disease (CVD). The guidelines aim to continue to promote a consistent treatment approach to CVD and reduce the risk of non-fatal or fatal CV events to improve quality and length of life in high-risk individuals.

The guidelines primarily target the lowering of cholesterol levels, providing individuals who suffer with existing CVD, diabetes or inherited high cholesterol with an optimal total cholesterol target. If a patient is unable to obtain these optimal levels, they should aim to be as close as possible. Targets have also been set for lifestyle, blood pressure and blood glucose levels. Ôûá

Insufficient Care for European Congenital Heart Disease Patients

Inadequate care is being provided for adults in Europe born with heart disease. Recent research has found that there are too few specialist centres to support their ever-increasing numbers. These shocking findings were reported by Philip Moons and colleagues from Belgium, the Netherlands, Germany and Switzerland after conducting the Euro Heart Survey on Congenital Heart Disease (CHD), the first of its kind in the world.2

Lead author, Dr Moons, Assistant Professor at the Centre for Health Services and Nursing Research of the Catholic University of Leuven in Belgium, commented: "Society has invested a lot towards increasing the life expectancy of these children, but seems less interested when they are grown up."

The survey examined how care is being organised in Europe by analysing data from 71 centres that agreed to fill in questionnaires, and gave the following eight recommendations for optimal adult CHD (ACHD) care:

  • a referral centre must have one, preferably two, cardiologists trained and educated in ACHD care;
  • specialist centres should provide care in connection with paediatric cardiology and/or congenital cardiac surgery;
  • they must treat sufficient numbers and perform sufficient procedures to be effective and maintain high performance levels;
  • general adult cardiac facilities and non-specialist centres should have an established referral relationship with a specialist centre;
  • there should be a minimum of two cardiac surgeons trained in and practising adult and paediatric cardiac surgery;
  • ideally these surgeons should perform 125 operations a year, with 50 being the minimum for ACHD;
  • there should be a fully equipped and specialist staffed electrophysiology laboratory; and
  • there must be at least one nurse specialist trained and educated in the care of ACHD patients.

The report concluded that governments, ministries of health and healthcare providers were under an obligation to provide adequate human and financial resources to meet the increasing needs of the growing population of adults with CHD, and to achieve optimum care.

Dehydration in Infancy Can Result in High Adult Blood Pressure

The results of a study by Debbie A Lawlor of the University of Bristol, UK, and colleagues published in the American Journal of Epidemiology suggest there is an association between dehydration in infancy and higher adult blood pressure (BP).3 Greater sodium retention and a taste for salty foods in infancy resulted in severe dehydration throughout life, the studies suggested.

The developmental plasticity could be explained by natural selection over generations produced by the survival advantage associated with the ability to retain sodium and hence water in the face of severe dehydration. The researchers hypothesise that the retention of sodium in response to environmental conditions may have adverse effects, elevated BP for example, in contemporary populations.

Dr Lawlor's team evaluated 3,964 randomly selected UK women born in the early 20th century. To study the link between climate conditions in infancy and adult BP, the researchers found that those who experienced the hottest and driest summers in the first year of life were more likely to have suffered severe infant diarrhoea and dehydration than those who experienced cooler and wetter summers.

A 1.12mmHg increase in systolic BP in adulthood correlated with every standard deviation over the mean summer temperature in the first year of life. In opposition, every standard deviation of higher mean summer rainfall was linked to a lower systolic BP (-1.65mmHg) in adulthood.

Potential factors such as socioeconomic position or lifestyle risk factors produced no link between the climate variables.

Dr Lawlor's team concluded that the hypothesis would have important public health implications for the reduction of systolic BP and its consequent cardiovascular disease (CVD) outcomes. The importance of avoiding dehydration in infancy is not just for short-term health improvement but also benefits long-term CV health. 

Link Found Between Antiarrhythmic Treatment and Positive Results in Electrical Cardioversion of AF

A recent study by Kunadian Vijayalakshmi and colleagues at the James Cook University Hospital in Middlesbrough, UK shows that prophylactic antiarrhythmic treatment of atrial fibrillation (AF) boosts success of direct current cardioversion in achieving and maintaining sinus rhythm, and amiodarone appears to be more effective than sotalol for long-term maintenance of sinus rhythm.

Researchers randomised 311 patients with AF scheduled for direct current cardioversion to one of the three arms - sotalol, amiodarone or no antiarrhythmic agent before and after cardioversion.

Pharmacologic cardioversion occurred prior to electrical cardioversion in 26% of patients receiving amiodarone and in 19% of patients receiving sotalol. Ninety two per cent of the sotalol group, 81% of the amiodarone group and 74% of patients given no antiarrhythmic treatment achieved sinus rhythm with direct current cardioversion.

A six-month follow-up found that sinus rhythm was maintained in 63% of the amiodarone group, 39% of the sotalol group and 16% of patients taking no antiarrhythmic drug.

During the study period, both antiarrhythmic agents were well tolerated. However, the researchers noted that longer-term treatment with antiarrhythmics needs to be studied, as evidence showed that toxicities can develop over time.

References
  1. Eur Heart J (2006);27: pp. 802-807.
    Crossref | PubMed
  2. Delivery of care for adult patients with congenital heart disease in Europe: results from the Euro Heart Survey, Eur Heart J doi:10.1093/eurheartj/ehi858.
  3. Am J Epidemiol (2006);163: pp. 608-614.
    Crossref | PubMed