NEWS

News - Beta Blockers

The recommendation by NICE that these drugs should no longer be regarded as first line treatment for hypertension is long overdue.  The CTT has long advocated this change.  Hypertension is a condition in which the resistance to blood flow through the body is increased.  The logical drugs to use are those which reverse this high resistance. e.g., (except in low renin hypertension, renal artery stenosis and kidney disease):- ACE inhibitors (perindopril, ramipril etc), or angiotansin II receptor inhibitors (losartan, valsartan etc), or in any hypertension:- alpha blockers (doxazocin), calcium channel blockers (verapamil, amlodipine etc).  Beta blockers to not lower resistance and cause side effects such as lethargy, depression, impotence and cold extremities; they should not be given to patients with asthma, arterial disease of the legs or mini-strokes, all of which are made worse.  Beta blockers should still be given in patients where there is excessively high heart rate not controlled by a calcium channel blocker.  They are also still indicated for angina and heart attack patients.  The CTT also advocates the abandonment of thiazide diuretics as treatment for high blood pressure.  These cause abnormal concentrations of salts in the blood and abnormal kidney function tests, leading to an increased burden on the NHS with referrals to kidney centres.  Treatments for high blood pressure need to be tailored to individual patients according to their particular requirements.

News - Ivabridine (Percorolan) has now been launched

A preview at the British Cardiac Society meeting in Glasgow in April 2006, indicated that there would soon be an anouncement of the launch of ivabridine (trade name "Procoralan"). This drug slows the heart rate by affecting an electric current in the sinus node. The sinus node in the atrium of the heart is the normal pacemaker that sets the heart (pulse) rate. Slowing the heart rate relieves chest pain in stable angina. At present, this is usually done with a beta-blocker, but beta-blockers can cause trouble in people with general arterial disease, and can exacerbate asthma; this will not happen with ivabradine. Ivabridine will not be suitable for angina patients who also have atrial fibrillation and some other heart rhythm disturbances.

Guidelines for prevention of coronary thrombosis

These are published in “Heart” December 2005, volume 91, supplement V

A group of articles describes the dangers of the obesity and type 2 diabetes epidemics, that predispose to coronary thrombosis and other arterial disease.  These are published in “Nature Medicine” January 2006, volume 12, number 1.

People diagnosed with depression are at an increased risk of developing coronary heart disease (CHD) later in life, according to a new study.

A team of researchers from the Karolinska Institute in Sweden have found that people diagnosed with depression – especially those between 25 and 50-years-old – are at an increased risk of developing CHD later in life, even when socioeconomic status and gender was taken into account.  The CTT has pioneered the spread of knowledge about how the anti-depressant drugs called SSRIs (serotonin re-uptake inhibitors) protect against coronary thrombosis.  The Karolinska team recommend maintenance anti-depressant treatment, even after apparent recovery from depression.  The CTT would say that this treatment should be in the form of an SSRI.

Advanced technology for cardiac surgery?

Researchers in the US have developed a technique, which involves taking two cell types from a patient's vein and skin and feeding them into a culture dish to produce proteins over six to eight weeks.  This raises speculation that Heart bypass patients may, in future be able to benefit from the use of new biologically engineered blood vessels, grown from a person's own cells.

Getting kids off crisps

Fast food carts across the UK will be plying 240,000 crisp packets to children – but instead of the snack munched in their millions by children, the packets will be filled with goodies to get kids interested in healthy eating.

More benefits from aspirin

Aspirin can significantly lower the death rates of post-menopausal women with heart disease, according to new findings.

News on Diet

1. TREATMENT OF HEART ATTACKS

Considerable progress has been made in very rapid transfer of patients after a heart attack to a catheter laboratory for insertion of tubes (catheters) into the coronary arteries which are then cleared of clot.  This is clearly a better treatment than a “clot-busting” drug (thrombolytic).  However, the logistics preclude this being adopted in sparsely populated areas of the country.

2. BAD FOOD IS NOT EVIDENT FROM THE LABEL

Felicity Lawrence’s book “Not on the Label”(Penguin Books 2004) deserves to be read by all. We no longer trust what we eat. We lurch instead from food scare to food scare while farming is in crisis around the world. A handful of retailers and food manufacturers exert unprecedented control over what we eat and where we buy it. We have come to depend on processed food that is routinely adulterated.

In a series of undercover investigations tracking some of the most popular foods we eat at home, Felicity Lawrence travels from farms and factories to packhouses and lorry depots across the world. She discovers why beef waste ends up in chicken, why a third of apples are thrown away, why bread is full of water and air. She meets the hidden armies of migrant workers exploited throughout Britain on whom our supermarkets depend. And she shows how obesity, blighted environmentally ravaged fields in Europe and starving smallholders in Africa are all intricately related aspects of our newly globalised, industrialised system of twenty-first-century food production.

3. A CALL FOR A VARIED, OMNIVOROUS, NATURAL DIET

Desmond Morris, author of “The Naked Ape” and “The Naked Woman” writes in Healthspan Magazine (March 2005) on “The evolution of diet”. His picture of the evolution of the human does not go on, as did a recent lecture at the “Scottish Cardiovascular Forum”, to the new species, “Homo Adepatum” (Obese Man!!). He points out that humans evolved to make maximum benefit from an omnivorous diet, containing amino acids that are not obtainable from vegetable food. (He might have added a point made in Felicity Lawrence’s book, that without the essential fatty acids present in fresh meat and fish, but not in junk food, the brain cannot develop (the brain is an organ which depends on fat for its function)). The hunter/gatherer mode of food acquisition depended on a physiology that could withstand a feast-or-famine mode of existence. With the relatively modern phenomenon of constant guaranteed food supply, mostly carbohydrate, this physiology leads to obesity with its consequent risk of cardiovascular disease.

Desmond Morris says. “What are we to make of all the new food fads we read about in the papers? It seems to me, as a biologist, that there are three answers. First, ignore tham all and eat as wide a variety of foodstuffs as possible. That is our evolutionary, genetic heritage. Second, if we wish to lose or gain weight, simple eat a little more or a little less and take exercise. But when eating more or less, ensure that the variety of foodstuffs consumed is maintained. Third, avoid over-indulgence in any one particular kind of food or drink. Too much of any one thing is unnatural and can be dangerous”

CTT Research News

Success from grant to Miss Julie Brittenden

Success from small grant to Professor DA Lane

A donation from the CTT in 2000 towards the purchase of a high pressure liquid chromatography (HPLC) apparatus enabled this group to perform much research leading to the publication of 21 scientific papers by 2003.

Other Research News

• In the July issue of European Heart Journal, Juan Viles-Gonzales et al write:-

  “Atherothrombosis, characterised by atherosclerotic lesion disruption with superimposed thrombus formation, is the major cause of acute coronary syndromes (ACS) and cardiovascular death. It is the leading cause of mortality in the industrialised world.

  Atherosclerosis is a diffuse process that starts early in childhood and progresses asymptomatically through adult life. Later in life, it is clinically manifested as coronary artery disease, stroke, transient ischaemic attack, and peripheral arterial disease. From the clinical point of view, we should envision this disease as a single pathologic entity that affects different vascular territories”.

These authors also review available antithrombotic therapy including a number which are newly available. Without exception, these treatments carry a risk of bleeding, the major cause of complication and death due to such treatment. The Coronary Thrombosis Trust regards it as unsatisfactory in that some lives should not be lost due to treatment that saves more lives. The research in new treatments sponsored by the Coronary Thrombosis Trust is restricted to antithrombostic effect via platelet inactivation without bleeding. Please help us achieve this goal by making a donation.

• In “Hyperlipiemia Expert Column”, Medscape Cardiology, Scott M Grundy writes:-

“Metabolic Syndrome....also termed insulin resistance........is a growing clinical challenge. ......... Weight gain predisposes individuals to 2 pivotal components of metabolic syndrome: obesity and insulin resistance”. This condition is a major cause of atherothrombosis. Read more about dietary methods to prevent and combat metabolic syndrome in A Healthy Diet.

• An article in the January 2003 New Scientist (p-36-39) reminds people that half the sufferers from heart attacks due to coronary heart disease (CHD) have normal cholesterol levels in the blood. There are more fundamental things going on in CHD than problems from raised cholesterol – see atherosclerosis and lipids in our Questions and Answers section.

• Ximelagatran is a new anticoagulant with similar action to warfarin, but it does not require laboratory control of dosage as does warfarin. This was reported at the joint meeting of the British Atherosclerosis Society and the British Society for Haemostasis and Thrombosis. Detailed current and projected antithrombotic treatments can be obtained from the web site or by email.

• From the American Heart Association: 'Atkins is quickest diet' by Emma Morton. Slimmers lose weight faster on the Atkins Diet than on low-fat plans, two American research teams claimed yesterday. They said the low-carbohydrate regime slashed levels of “bad” cholesterol and blood fats linked to heart disease. A study at Duke University in North Carolina found that Atkins dieters lost an average of 26lbs over six months, compared with low-fat dieters who lost only 14lbs. The results were backed by research in Philadelphia.

• Superior Yield of the New Strategy of Enoxaparin, Revascularization and Glycoprotein IIb/IIIa Inhibitors. In a high-risk population treated with an early invasive management strategy, enoxaparin was not superior to, but at least as effective as, heparin in the overall population. American College of Cardiology Annual Scientific Session 2004.

• WATCH: Warfarin and Antiplatelet Therapy in Chronic Heart Failure Trial. This is the largest trial to date comparing aspirin, warfarin, and clopidogrel as antithrombotic treatment in heart failure against a primary composite endpoint of all-cause mortality, nonfatal MI, and nonfatal stroke.