This Month's Clinical Focus: Cardiology

 Heart Disease Gender Gap Narrows
Middle-aged women have more heart attacks than in past, but are more likely to survive, studies show
Hearts attacks have increased among middle-aged American women in the past two decades, but their chance of survival has improved, two new studies show.

"We found that men still have a higher prevalence than women, but what has happened is that the gap has narrowed," said Dr. Amytis Towfighi, assistant professor of clinical neurology at the University of Southern California, lead author of one of two reports in the Oct. 26 issue of Archives of Internal Medicine. "For women it has increased, for men it has decreased."

 Her study used data from two national surveys conducted from 1988 to 1994 and 1999 to 2004. While 2.5 percent of the men and 0.7 percent of the women reported a history of heart attacks in the earlier survey, 2.2 percent of men and 1 percent of women reported heart attacks in the more recent survey.

The narrowing of the male-female difference is easily explained, Towfighi stated. "Very basically, the risk factors are being better controlled in men than in women."  In men, levels of "bad" LDL cholesterol remained the same between the two surveys, while levels of "good" HDL cholesterol improved. Blood pressure levels improved, and fewer men smoked.

The improvements for women were marginal, with LDL cholesterol levels about the same. The only risk factor that improved in women was HDL cholesterol. Diabetes and obesity increased in men and women, the study found.

"We don't know exactly what is going on in terms of risk factors being better controlled. Women aren't checked as often," Towfighi acknowledged.  Societal changes may play a role, she said. With more women in the work force, she said, their rising rates of obesity and diabetes can be attributed to job demands that limit their ability to exercise and follow dietary rules.

It is no longer assumed that female hormones protect against heart disease, she said. Doctors are paying more attention to heart risk factors in women because "there is a red flag about women not being absolutely protected against heart disease in midlife, as we had thought, and we are aware that more effort must be made to reduce their risk," Towfighi said.

The second study used information from a different data bank listing death rate trends from 1994 to 2006. It found a marked reduction in hospital deaths from heart attacks in all patients, especially among women. For women under 55, the risk of dying dropped by 53 percent, which was the greatest improvement noted. The least reduction, 33 percent, was seen in men under 55.

"Perhaps physicians are paying more attention to the detection and treatment of women with heart disease," Vaccarino said. "It could be the same thing happening in the general public, with women getting more knowledgeable about this."

"Basically, both studies show that there still is a gap between men and women," said Dr. Nieca Goldberg, clinical associate professor of medicine at NYU Langone Medical Center and a spokeswoman for the American Heart Association. "They both show the importance of continuing to pay attention to women's risk of cardiovascular disease and treatment of their heart attacks."

But changing attitudes about women and heart disease may also have had an effect, she said.

 The studies offer some good news for women, Goldberg said. "I'd like to think that's because we have increased the awareness of women themselves. But these two important studies show the need to continue research about reducing women's risk of cardiovascular disease."

(SOURCES: Amytis Towfighi, M.D., assistant professor of clinical neurology, University of Southern California, Los Angeles; Viola Vaccarino, M.D., Ph.D., professor, medicine, director, Emory Program in Cardiovascular Outcomes Research and Epidemiology, Atlanta; Nieca Goldberg, M.D., clinical associate professor of medicine, NYU Langone Medical Center, New York City; Oct 26, 2009 Archives of Internal Medicine)

Study:
Extra heart scan needed to assess heart risk

 A person's long-term risk of heart disease is better assessed by a pair of studies, as performing only one may miss a dangerous buildup of calcium in arteries, said U.S. researchers.

They said about half of all patients in a 10-year study who had normal results on a nuclear stress test known as SPECT were found to have significant buildup of calcium on the walls of their arteries when they did a heart CT.

"Typically, when a patient presents with chest pain and the (SPECT) test result is normal, we tell them everything looks fine, but this may not be the case," Dr. John Mahmarian of the Methodist DeBakey Heart and Vascular Center in Texas, who led the study, said in a statement.

He said if a large amount of calcified plaque is found on artery walls -- something that can't be seen in SPECT imaging -- the patient has a high long-term risk of having a heart attack or stroke. "Based on our findings, using both tests to define risk is better than either test alone," Mahmarian said in a statement.

Nuclear stress tests using single-photon emission computed tomography, or SPECT, examine blood flows to the heart. People with a normal result are generally thought to have less than a 1 percent chance of having a heart attack within a year. Computed tomography or CT scans use special X-ray equipment and sophisticated computers to measure calcified plaque in the heart arteries. These tests can detect varying degrees of blockages in the heart. Both tests expose patients to radiation.

Mahmarian's team followed 1,126 patients with no previous history of coronary artery disease whose doctors had already received both tests. They found people who were deemed low risk by the SPECT test were three times more likely than others to have a heart attack during the study period if they had high calcium scores. For these patients, a high calcium score was an even stronger predictor of having a heart problem than diabetes.

They said people with a normal SPECT who have other risk factors that put them at risk for heart trouble -- such as smoking, high cholesterol, high blood pressure, diabetes or a family history of heart trouble -- would benefit from the extra test.

"We're not recommending doing this to everybody. The patient has to have clinical risks," Dr. Su Min Chang of the Methodist Hospital, who worked on the study, said in a telephone interview.

He said people who get a normal stress test might get a false sense of security. Adding the calcium test could give them a better picture of their long-term risk.

The team did not look at whether the two-test strategy is cost effective but they said such studies are needed.

Imaging tests are a major source of escalating health costs and curbing excessive use of such tests is a major target of health reform in the United States. (Source: Reuters Health, Nov. 2 2009) 

Change your workflow paradigm to transform your clinical trials into rapid, results-oriented studies. Criterium knows resources are precious, time is the enemy, and results are paramount. Our user-friendly technologies improve the efficiencies of all our clinical development services. Our talented, in-house staff is committed to the professional support of our clients needs.

Of particular interest to you would be our experience with CARDIOLOGY.  Criterium has managed many studies in this important area, including:  Acute Myocardial Infarction, CHF, Hypertension, Arrhythmias, Mortality, Angina, Atherosclerosis, Post-CABG and other related studies through all phases.

Get To Know Us!
We have several propriety technology solutions available that are proven to improve your clinical trial results. Contact John Hudak at jmhudak@criteriuminc.com