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Thu, 2014-07-31 14:00 -- OUP Admin

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ESC in Arabia

Nominations requested for eighth edition of Prize

Alcohol and Heart Failure

New Local Associate EHJ Editor: Frank Enseleit

New Local Associate EHJ Editor: Andreas Flammer

Blood sugar levels in Heart Failure

Beta blockers in HF plus AF

Good news for Renal Denervation

HTN improved with Renal Denervation

Heparin in HEAT-PPCI

Drug encapsulation reduces cardiac changes

Rheumatic Heart Disease neglected


The ESC at the 26th Annual Conference of the Saudi Heart Association

One in four adults in Saudi Arabia is set to have a heart attack within the next 10 years, reveals research presented at the 26th Annual Conference of the Saudi Heart Association (SHA), held 13-16 February in Riyadh, Saudi Arabia. The conference features sessions from the European Society of Cardiology (ESC) on hot topics in cardiovascular disease including prevention.

Dr Muhammad Adil Soofi, first author of the prevention & risk factors research and assistant consultant in adult cardiology at Prince Salman Heart Centre, King Fahad Medical City in Riyadh, said: “The majority of people we studied were between 20 and 40 years old. Unhealthy lifestyles start at a young age in the Gulf and people reap the consequences early in life.”

Dr Soofi’s study investigated the prevalence of risk factors for heart disease in more than 4,900 Saudis living in urban areas who were over 20 years old and had no history of heart disease.

Most people in the study (85%) were less than 40 years old and 55% were women.

  • 25% had diabetes
  • 34% had hypertension
  • 25% were smokers
  • 27% were obese
  • 86% were not involved in any physical exercise
  • 19% had dyslipidaemia.

As a result, 26% were at high risk of having an MI or dying from an MI in 10 years, calculated using the Framingham Risk Score.

Diabetes had a major impact on risk. Dr Soofi said: “Diabetes and other risk factors start at an early age in Saudi Arabia. When we looked just at people under the age of 30, we found that 14% were diabetic, 27% were obese, 31% were smokers and 77% were not physically active. So it’s a whole package that will lead to heart disease in a decade. Young Saudis eat more fast food and deep fried items and on top of that do not exercise. Atherosclerosis, obesity and other risk factors set in at a very early stage.”

He continued: “We need to educate the masses on their doorstep using, radio, television and the internet to communicate how to eat healthily, exercise and quit smoking. If the situation remains as it is now, today’s 30 year olds will be a burden on society rather than active contributors by age 50.”

Prof Hani Najm, SHA vice president added: “Healthy lifestyles are a rare occurrence in the Gulf region and bad habits start early. Nearly one-third of teenagers smoke in some areas and the levels are even higher in others. Young people’s addiction to smart phones and social media has turned them into electronic potatoes, today’s version of the couch potato but no longer confined to one room as with television. They have zero intention of being physically active. Governments should have a responsibility to provide free indoor gyms and green spaces for exercise.”

Dr Khalid Al Habib, SHA president, said: “The Gulf States have sophisticated tertiary care for heart disease patients but, alarmingly, we lack primary prevention programmes. These need to start today.”


The 2015 Arrigo Recordati International Prize, call for nominations

The Arrigo Recordati International Prize for Scientific Research has announced the call for nominations for the eighth edition of the award. The International Prize of 100,000 Euros is awarded every two years to a distinguished scientist for his or her commitment and accomplishments in cardiology. In 2015 the Prize will recognize a clinical or basic science investigator who has achieved distinction in the study of secondary prevention and risk reduction strategies for patients with cardiovascular diseases.

The international award was established in 2000 in memory of the Italian pharmaceutical entrepreneur Arrigo Recordati and aims to promote scientific research in the field of cardiovascular disease.

Several International Societies and organizations specializing in Cardiology and Internal Medicine are being invited to nominate candidates that they feel merit the Award. The Prize is open to scientists of all nationalities who work in institutional settings and are not affiliated with a pharmaceutical company or medical device company.

Nominations may only be submitted by an International Society or organization invited to nominate candidates and self-nominations will not be considered. The deadline for nominations for the 2015 award is February 28, 2015. The winner of the Prize will be announced during the European Society of Hypertension (ESH) Annual Meeting in Milan, 12-15 June, 2015.

The 2015 Arrigo Recordati International Prize for Scientific Research Jury is composed of experts who have provided leadership throughout their long careers in the field of secondary prevention and risk reduction strategies for patients with cardiovascular diseases. Jury members for the 2015 edition are: Professor M. John Chapman (Chairman of the Jury), Professor Thomas F. Lüscher and Professor Chris J. Packard.

For more information please visit: www.recordati.com/prize and contact the Organizing Secretariat:
AIM Group International - AIM Congress - Ms Valentina Passalacqua - Phone +39 02 56601.1 - Fax +39 02 56609045 - e-mail: recordatiprize2015@aimgroup.eu


Moderate amounts of alcohol intake linked to reduced risk of heart failure

A large study of nearly 15,000 men and women, just published online in the European Heart Journal [1], shows that drinking up to seven drinks a week in early to middle age is associated with a 20% lower risk of men developing heart failure in the future when compared to people who did not drink at all, and a more modest 16% reduced risk for women.

Dr Alexandra Gonçalves, a research fellow at Brigham and Women’s Hospital, with Dr Scott Solomon, Professor of Medicine at Harvard Medical School and Senior Physician at Brigham and Women’s Hospital, Boston, USA, together with colleagues analysed data from 14,629 people aged between 45-64 years who had been recruited to the Atherosclerosis Risk in Communities Study between 1987 and 1989 in four communities in the USA. They followed the participants for 24-25 years to the end of 2011.

They defined a drink as one that contains 14g of alcohol. During the follow-up period 1271 men and 1237 women developed heart failure. The lowest rate of heart failures occurred in those drinking up to 7 drinks per week.

However, when the researchers looked at death from any cause, there was an increased risk of death of 47% for men and 89% of women who reported consuming 21 or more drinks a week at the start of the study.

Professor Solomon said: “These findings suggest that drinking alcohol in moderation does not contribute to an increased risk of heart failure and may even be protective. No level of alcohol intake was associated with a higher risk of heart failure. However, heavy alcohol use is certainly a risk factor for deaths from any cause.

“The people who were classified as former drinkers at the start of the study had a higher risk of developing heart failure and of death from any cause when compared with abstainers. This could be related to the reasons why they had stopped drinking in the first place, for instance because they had already developed health problems that might have made them more likely to go on to develop heart failure.”

“It is important to bear in mind that our study shows there is an association between drinking moderate amounts of alcohol and a lower risk of heart failure but this does not necessarily mean that moderate alcohol consumption causes the lowered risk, although we did adjust our results to take account, as far as possible, for a variety of other lifestyle factors that could affect a person’s risk,” concluded Professor Solomon.

[1] “Alcohol consumption and risk of heart failure: the Atherosclerosis Risk in Communities Study”, by Alexandra Gonçalves et al. European Heart Journal. doi:10.1093/eurheartj/ehu514


Frank Enseleit, new EHJ Local Associate Editor

Frank Enseleit MD FESC joined the EHJ Editorial Board in 2015 as Local Associate Editor. He is Consultant of the Heart failure and transplantation unit in the Department of Cardiology at the University Hospital in Zürich, Switzerland and also works in the coronary care unit and cath lab at the University Hospital. As university lecturer he has teaching responsibilities to medical students and resident physicians in internal medicine and cardiology.

Dr Enseleit received his medical degree from the University of Mainz, Germany, in 1999. He trained in internal medicine and cardiology at the University of Zürich and at the Cantonal Hospital Glarus, both in Switzerland.

Dr Enseleit has published in such peer-reviewed journals as Circulation, the European Heart Journal, the FASEB Journal, American Journal of Cardiology, Europace and Journal of the American College of Cardiology, and he has also authored and published several book chapters and a textbook on cardiovascular disease. He is also a member of the Editorial board of the European Heart Journal and Cardiovascular Medicine and has published several papers on heart failure and heart transplantation.

Dr Enseleit's research interests focus on vascular protection in the pathogenesis of cardiovascular and renal diseases, similarities between cardiovascular and rheumatologic diseases and the cardiovascular safety of cardiovascular and non-cardiovascular drugs.

During recent years he has attended leadership courses focusing on general management, finance, health care economics, human resources and business strategy. Moreover, he is trained in ethical decision-making in the clinical setting.


Dr Andreas Flammer joins EHJ Editorial Board

Andreas Flammer MD FESC has joined the EHJ editorial board in 2015 as a new Local Associate Editor. A native Swiss, now a staff physician and lecturer at the University Hospital Zurich studied medicine at the University of Basel. His residency was in Internal Medicine and with his interest in cardiovascular research, he was awarded a Fellowship at the University Hospital of Zurich. He focussed on the study of vascular function in different diseases and treatments and became board certified in cardiology.

He joined the Hospital as a junior staff member of the Heart Failure and Transplantation Unit before moving to the USA for a two-year research Fellowship at the Mayo Clinic in 2010. After this “great experience” he returned as a staff member to the University Heart Center in Zurich and University Lecturer, where he still is today.
His main clinical responsibilities and interests are in heart failure and heart transplantation.Dr Flammer’s research focuses on the vasculature with particular interest on the effects of nutrition and more specifically flavanol-rich foods on blood vessels.

Andreas Flammer has produced more than 60 research articles, reviews and book chapters. In 2014 he was awarded the annual research prize of the Swiss Heart Foundation. He is a member of many national and international societies and a Fellow of the European Society of Cardiology.


Blood sugar levels predict risk of early death, hospitalisations and diabetes in Heart Failure patients

New research suggests that people who arrive at hospital emergency departments with acute heart failure should have their blood sugar levels checked on arrival. This simple measure could identify patients at high risk of early death, further hospitalisations, or the development of diabetes.

Results of a large study published online 7 January in the European Heart Journal [1], show that even if someone arrives at hospital in heart failure with no prior diagnosis of diabetes if blood sugar levels are above 6.1 mmol/L they are at higher risk of developing diabetes and early death.

Researchers from the Institute for Clinical Evaluative Sciences (ICES), the Peter Munk Cardiac Centre at the University Health Network, and the University of Toronto, Canada, analysed the outcomes for 16,524 people who arrived at hospital emergency departments in Ontario, Canada, with acute heart failure between 2004 and 2007. The patients were aged between 70-85 years old and 56% (9,275) of them did not have pre-existing diabetes.

The researchers compared the outcomes of the patients against a reference group of patients whose blood glucose levels ranged between 3.9-6.1 mmol/L.

Associate Professor of Medicine, Dr Douglas Lee, a senior scientist at the ICES, who led the research, said: “Among patients without pre-existing diabetes, the majority (51%) had blood glucose levels on arrival at hospital that were within ‘normal’ limits but greater than 6.1 mmol/L. Our results suggest that all such patients should undergo further testing for diabetes before discharge. If their fasting blood glucose is not elevated, then they should be monitored subsequently for the development of diabetes as outpatients.

Among all patients, with and without pre-existing diabetes, blood sugar levels above 9.4 mmol/L increased the risks of hospitalisation by 9-15% for heart failure or cardiovascular causes.

Dr Lee said: “Our findings suggest that the measurement of blood sugar levels in all patients arriving at emergency departments with acute heart failure could provide doctors with useful prognostic information and could help to improve outcomes in these patients.

[1] “Presentation blood glucose and death, hospitalization, and future diabetes risk in patients with acute heart failure syndromes”, by Maneesh Sud et al. European Heart Journal. doi:10.1093/eurheartj/ehu462


Beta-blockers reduce all-cause mortality in heart failure with sinus rhythm but not AF

Beta-blockers lead to a significant reduction in all-cause mortality in heart failure patients with sinus rhythm but not those with atrial fibrillation, according to a study from the Beta-Blockers in Heart Failure Collaborative Group. The individual-patient data meta-analysis included 18,254 patients with heart failure from 10 randomised controlled trials comparing β-blockers with placebo.

Beta-blockers provided significant benefit over placebo in patients with sinus rhythm but not atrial fibrillation in the following outcomes: all-cause mortality, cardiovascular deaths, first cardiovascular hospital admission, death or cardiovascular hospital admission, first heart failure related hospital admission, and cardiovascular death or heart failure related hospital admission. β-blockers had no effect on incident non-fatal stroke in sinus rhythm or atrial fibrillation.

The researchers also found a reduction in incident atrial fibrillation in patients with sinus rhythm who were allocated to β-blockers. While there was no evidence that β-blockers prevent adverse clinical events in patients with heart failure and atrial fibrillation, the therapy appeared to be safe with no increase in mortality or hospital admissions.

The authors concluded that β-blockers should not be used preferentially over other rate control medications and should not be standard therapy to improve prognosis in patients with heart failure and atrial fibrillation.

Read the full paper


New analysis of the SYMPLICITY HTN-3 Trial

Key factors of renal denervation may have contributed to the unexpected outcome.

Results of the SYMPLICITY HTN-3 [1] trial sent shock waves through the cardiology community when they appeared to show that there was no significant difference in patient outcome between renal denervation and a sham procedure in patients with drug resistant HTN. As a result, renal denervation procedures came to a halt. Now, an analysis has shown that the results were probably affected by a number of confounding factors that partially explain the unexpected blood pressure responses.
The analysis, published in the European Heart Journal [2], identified factors in the SYMPLICITY HTN-3 trial, such as variations in the performed procedure and changes in patients’ medications and drug compliance, which may have had a significant impact on the results.
Professor Thomas Lüscher, editor-in-chief of the European Heart Journal, said: “SYMPLICITY HTN-3 resulted in referrals for the procedure drying up completely, making further trials almost impossible. However, in the analysis published in the European Heart Journal, David Kandzari and colleagues shed light for the first time on the interpretation of the results and suggest that in many patients the number of renal denervations was probably insufficient to achieve the proper degree of reduction in blood pressure that previous research had suggested was possible.”

Prof Lüscher, who has co-authored an editorial [3] to accompany Prof Kandzari’s paper, said: “Professor Kandzari’s analysis shows there were significant variations in the way that patients in SYMPLICITY HTN-3 were ablated. His sub-analysis now shows, for the first time, that if patients received 12 or more ablations in the trial, they experienced the same blood pressure reduction as in the earlier, SYMPLICITY HTN-2 trial and as reported by a large number of registries.”
With this new information, new trials can be performed that may provide the evidence needed to back up anecdotal and registry evidence.

A podcast of the editorial by Felix Mahfoud and Thomas Lüscher is available at eurheartj.oxfordjournals.org/podcast and on iTunes.


[1] “A controlled trial of renal denervation for resistant hypertension”, by Deepak L. Bhatt et al. New England Journal of Medicine 2014; 370:1393-1401; April 10, 2014 http://www.nejm.org/toc/nejm/370/15/ ; doi: 10.1056/NEJMoa1402670

[2] “Predictors of blood pressure response in the SYMPLICITY HTN-3 trial”, by David E. Kandzari et al. European Heart Journal. doi:10.1093/eurheartj/ehu441. Published online: http://eurheartj.oxfordjournals.org/content/early/2014/11/13/eurheartj.ehu441

[3] “Renal denervation: simply trapped by complexity?”, by Felix Mahfoud and Thomas Felix Lüscher. European Heart Journal. doi:10.1093/eurheartj/ehu450. Published online: http://eurheartj.oxfordjournals.org/content/early/2014/11/13/eurheartj.ehu450


REDUCE-HTN shows blood pressure reductions with Renal Denervation

The 6 months results of the REDUCE-HTN trial have shown blood pressure reductions with renal denervation in patients with resistant hypertension. The prospective, multicentre, single-arm study tested the safety and efficacy of the balloon-based bipolar Vessix renal denervation system in 146 patients with office systolic blood pressure ≥160 mmHg despite three or more antihypertensive medications at maximally tolerated doses.

Patients receiving the intervention achieved reductions in both office and ambulatory blood pressure. Renal artery safety and renal function results were favourable. There were no acute events that indicated seriously compromised renal artery integrity or cardiovascular complications and less than 6% of patients had serious procedure related adverse events.

Mean eGFR was stable during the 6 months of follow up. The authors concluded that in addition to lifestyle modifications and antihypertensive medications, renal denervation may be a treatment option for some patients with hypertension.

Read the full paper.


HEAT-PPCI shows reduced incidence of major adverse ischaemic events with heparin

HEAT-PPCI was an open-label randomised controlled trial that compared antithrombotic therapy with bivalirudin or unfractionated heparin during primary percutaneous coronary intervention (PPCI). Before angiography, more than 1,800 patients were randomised 1:1 to heparin or bivalirudin then followed up for 28 days.
The use of GP IIb/IIIa inhibitors was reserved for selective bailout use as per European Society of Cardiology guidelines and the rate of use was much the same between groups.

The primary efficacy outcome was a composite of all-cause mortality, cerebrovascular accident, reinfarction, or unplanned target lesion revascularization. The primary safety outcome was incidence of major bleeding.

The primary efficacy outcome occurred in 8.7% of patients in the bivalirudin group and 5.7% of patients in the heparin group (p=0.01). The primary safety outcome occurred in 3.5% of patients in the bivalirudin group and 3.1% of patients in the heparin group (p=0.59).
The study showed that compared with bivalirudin, heparin reduced the incidence of major adverse ischaemic events - in particular acute stent thrombosis and associated reinfarction events – with no difference in bleeding.

The researchers concluded that systematic use of heparin rather than bivalirudin would substantially reduce drug costs.

Read the full paper.


Encapsulation of cancer drugs reduces cardiac damage

Austrian researchers have shown that a new technique which wraps chemotherapy drugs in a fatty cover (liposome) reduces heart damage, in a study presented at EuroEcho-Imaging 2014 in Vienna.

Cardiotoxicity can occur acutely or up to 30 years after chemotherapy and is the second most common cause of death in cancer patients, after secondary malignancy in childhood cancer survivors.

Liposomal encapsulation is a new technique which enables more of the drug to reach the cancer cells because there is less degradation. There are fewer side effects on healthy cells because the fat cover acts as a barrier. The drug stays in the bloodstream longer, allowing higher cumulative doses to be given.
Researchers tested whether non-pegylated liposome encapsulation of the anthracycline doxorubicin (called Myocet) could decrease its cardiotoxicity compared to conventional doxorubicin or epirubicin, another anthracycline.

The study included 24 pigs that were randomised to receive the human dose-equivalent of either Myocet, conventional doxorubicin, or epirubicin in 3 cycles. Cardiac function was assessed by echocardiography and magnetic resonance imaging (MRI) at baseline and follow up (after about 3 months). Laboratory follow up included haematology, renal function, and measurement of troponin and BNP. The epirubicin group was excluded from the final analyses because of low survival levels.
The group receiving Myocet had better diastolic and systolic function in the left and right ventricles, compared to conventional doxorubicin. The Myocet group also had less fibrosis development in the myocardium as shown by MRI and histology staining.


‘Utter neglect’ of rheumatic heart disease revealed by results from global study

Rheumatic heart disease (RHD) – the most common acquired heart disease in children in many countries of the world – is being neglected and poorly treated, according to new findings from the Global Rheumatic Heart Disease Registry (the REMEDY study), just published online in the European Heart Journal [1].

RHD accounts for up to 1.4 million deaths every year, with the highest numbers of people affected by it and dying occurring in low and middle-income countries.
Results from the pilot phase of the REMEDY study, which looked at 3,343 RHD patients attending one of 25 hospitals in 12 African countries, India and Yemen between January 2010 and November 2012, found that:

  • Only 55% of RHD patients were receiving penicillin (or another antibiotic);
  • Oral anti-coagulants were prescribed in 70% of patients with heart problems that would benefit from it, but less than a third of them were receiving the correct therapeutic levels and 20% of pregnant women were on warfarin;
  • Among the 1,825 women of child-bearing age, only 4 % were taking contraceptive measures,

Professor Bongani Mayosi, Professor of Medicine and head of the Department of Medicine at Groote Schuur Hospital and University of Cape Town, South Africa, who led the research, said: “Our findings reflect the utter neglect of RHD in affected countries. Most of the interventions that are not applied, are available and cheap in the countries concerned, and their application will provide the greatest benefit.”

“At present, the primary healthcare systems are not prioritising these simple, but effective measures. RHD is a disease of poverty, neglected by the health ministries in affected countries and by the international community in general.”

The REMEDY study found that the majority of patients with RHD were young, predominantly female and unemployed. The majority had moderate to severe valvular heart disease, further complicated by congestive heart failure, pulmonary hypertension, atrial fibrillation, stroke and infective endocarditis.

Co-author, Professor Salim Yusuf, said: “The World Health Organization has called upon countries of the world to reduce mortality associated with RHD and other non-communicable diseases by 25% by the year 2025 – known as the 25x25 target. The findings of this study not only set the baseline by which to judge progress, but also point to the need to close the gap in the use of evidence-based interventions if the 25x25 target will be achieved for RHD.”

Prof Mayosi concluded: “We plan to launch the full study of 30,000 patients with RHD from 166 endemic countries from 2015 onwards. The full REMEDY study, which will involve contributors from all inhabited continents of the world, will serve as a platform not only for monitoring progress to the achievement of the 25x25 target, but also for trialling new and novel strategies, such as new oral anti-coagulants, for reducing morbidity and mortality in RHD. REMEDY seeks to put an end to rheumatic heart disease in our own lifetime through the application of preventive measures.”


[1] “Characteristics, complications, and gaps in evidence-based interventions in rheumatic heart disease: the Global Rheumatic Heart Disease Registry (the Remedy study)”, by Liesl Zühlke et al. European Heart Journal. doi:10.1093/eurheartj/ehu449


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