Matters of the heart

[waltky]

Statins' benefits underestimated...

Statins' benefits underestimated, review says
Thu, 08 Sep 2016 - The benefits of the cholesterol-reducing drug statins are underestimated and the harms exaggerated, a major review suggests.

Published in the Lancet and backed by a number of major health organisations, it says statins lower heart attack and stroke risk. The review also suggests side effects such as muscle pain do occur, although in relatively few people. But critics say healthy people are unnecessarily taking medication.

Dummy drug effect

Statins reduce the build-up of fatty plaques that lead to blockages in blood vessels. According to the report authors:

* About six million people are currently taking statins in the UK
* Of those, two million are on them because they have already had a heart attack, stroke or other cardiovascular event
* The remaining four million take statins because of risk factors such as age, blood pressure or diabetes
* Up to two million more should possibly take statins

The Lancet review, led by Prof Rory Collins from the Clinical Trial Service Unit at the University of Oxford, looked at the available evidence for the effects of taking an average 40mg daily dose of statins in 10,000 patients over five years. It suggested cholesterol levels would be lowered enough to prevent 1,000 "major cardiovascular events" such as heart attacks, strokes and coronary artery bypasses in people who had existing vascular disease - and 500 in people who were at risk due to age or other illnesses such as high blood pressure or diabetes.

The review also said randomised controlled trials - where neither patient nor doctor know who is on the real drug and who is on a dummy version - suggested the average dose led to a relatively low level of side effects. In the same 10,000 population, there would be some side effects, including between 50 and 100 cases of adverse events such as muscle pain, it said. Observational studies - where people know they are taking the drug and will have been told of known side effects including muscle pain - had higher rates.

Question marks

[Crepitus]

Well, being as I'm one of the folks who can't tolerate them that kinda sucks for me.

[waltky]

Good place to have a heart attack...

App helps save Seattle cardiac patient
October 20, 2016 — If your heart is going to stop, right outside a hospital is not a bad place for it. And if 41 people within a 330-yard radius have a cellphone app alerting them to your distress, so much the better.

That's what happened in Seattle last week when Stephen DeMont collapsed at a bus stop in front of University of Washington Medical Center. While a medical student rushed over and began chest compressions, a cardiac nurse just getting off her shift was alerted by her phone, sprinted outside and assisted until paramedics arrived. Five days later, DeMont, 60, is walking, smiling and talking about how the PulsePoint app helped save his life.

Stephen DeMont, center, gets a hug from medical student Zach Forcade, right, as nurse Madeline Dahl looks on as they visit DeMont Wednesday, Oct. 19, 2016 at the University of Washington Medical Center, in Seattle. When DeMont collapsed at a bus stop in front of the UW Medical Center days earlier on his morning commute, Dahl was one of 41 people within a 330-yard radius who happened to have a cell phone app alerting them to the emergency. Forcade witnessed the collapse and rushed over to begin chest compressions, as within moments Dahl, a cardiac nurse just getting off her shift in the hospital, was alerted by her phone and sprinted down the sidewalk, assisting until paramedics arrived.

Seattle officials say the rescue shows the potential the free download has for connecting CPR-trained citizens with patients who urgently need their help. It's being used in 2,000 U.S. cities in 28 states. "I put it on my phone yesterday," said DeMont's wife, Debi Quirk, a former registered nurse. "He would not be here as we see him today." Seattle officials hope DeMont's story will help persuade thousands more people to sign up for notifications; so far, about 4,000 people in Seattle have downloaded PulsePoint since the city adopted it earlier this year with financial support from an employee charitable fund at Boeing. The goal is to have 15,000 using it.

Developed by a former fire chief in Northern California, Richard Price, the app works through a city's 911 system. When a call comes in, operators alert people within a certain radius that CPR assistance is needed, along with the location of the nearest portable defibrillator. About 900,000 people around the country have downloaded and carry the app, and 34,000 people have been activated to respond, he said, adding that alerts have been issued in 13,000 cardiac events.

Madeline Dahl, left, looks on as Zach Forcade, right, pulls out his cell phone while Stephen DeMont sits with them while being interviewed at the University of Washington Medical Center Wednesday, Oct. 19, 2016, in Seattle. When DeMont collapsed at a bus stop in front of the UW Medical Center days earlier on his morning commute, Dahl was one of 41 people within a 330-yard radius who happened to have a cell phone app alerting them to the emergency. Forcade, a medical student, witnessed the collapse and rushed over to begin chest compressions, as within moments Dahl, a cardiac nurse just getting off her shift in the hospital, was alerted by her phone and sprinted down the sidewalk, assisting until paramedics arrived.

He came up with the idea in 2009, he said. He was in a restaurant when he heard sirens from his crews at the San Ramon Valley fire department. As he wondered where they were going, they arrived at the restaurant. "The patient was unconscious, unresponsive. I was 20 feet away on the other side of the wall," Price said. "The whole time I was listening to that siren, I could have been making a difference." It occurred to him that at any given time, two-thirds of his staff was off duty — in restaurants, out in the community. If there was a way to alert them to such emergencies by phone, it could save lives, Price said. It's not clear how many lives have been saved thanks to the app. Patient confidentiality laws often prevent hospitals from disclosing a patient's outcome.

MORE

[waltky]

Bypass surgery may be better than stents... Bypass surgery may be better than stents for patients who skip meds October 25, 2016 - For heart disease patients who adhere to optimal medical therapy, outcomes of coronary bypass graft surgery (CABG) and percutaneous coronary intervention (PCI) may not differ, a new study finds.

However, among nonadherent patients, CABG affords better major adverse cardiac event–free survival. When they don’t take their meds as directed, CABG patients are 68 percent more likely to avoid complications than PCI patients. "Therefore, patient compliance with medical therapy may inform clinical decision making and should be incorporated into all future comparative studies of comparative coronary revascularization strategies," the authors write in Circulation October 24th. For patients who do take their meds, however, it matters less which intervention they got – they’re all nearly three times more likely to survive complication-free than those who skip the medications. “The take-home message for patients with coronary artery disease is even if you don't feel any differently when taking the medications, your very survival may depend upon them,” said lead study author Dr. Paul Kurlansky of Columbia University in New York. To assess how medication compliance influences outcomes, the authors followed 973 CABG patients and 2,255 patients who underwent PCI and stent placement, from February to July of 2004. Follow-ups were performed between 12 months and 18 months and starting again in 2009 to monitor both adherence to prescribed medication and to report any circulatory difficulties, including fatal and nonfatal myocardial infarction, or any repeated bypass or angioplasty procedures. Optimal medical therapy included blood thinners (aspirin or one year of double antiplatelet therapy for stent patients), statins to lower cholesterol and beta-blockers to curb high blood pressure and maintain a normal heart rhythm for heart surgery patients. Among patients who adhere to recommended medication therapy, there may not be a clinical benefit for bypass over PCI, the authors say. Patients who got either procedure, left the hospital on aspirin and statins and were still on both medications at all follow-up checkups enjoyed significantly better event-free survival rates than patients who at any point were not on their medication. Some patients may avoid medications due to costs or side effects, but it may also be because they don’t feel sick, Kurlansky said. “Hypertension is usually clinically silent, we cannot feel our cholesterol level, and we don't perceive our platelet reactivity, therefore, to expend money and effort to take medications, some of which may have side effects, in order to feel absolutely no different is, for most people, highly counterintuitive,” Kurlansky said. “This, I believe, is why so many people, even after heart attack or heart surgery, discontinue their medications.” MORE

[waltky]

Using stem cells to regenerate the external layer of a human heart...

Researchers use stem cells to regenerate the external layer of a human heart
January 11, 2017 - A process using human stem cells can generate the cells that cover the external surface of a human heart—epicardium cells—according to a multidisciplinary team of researchers.

"In 2012, we discovered that if we treated human stem cells with chemicals that sequentially activate and inhibit Wnt signaling pathway, they become myocardium muscle cells," said Xiaojun Lance Lian, assistant professor of biomedical engineering and biology, who is leading the study at Penn State. Myocardium, the middle of the heart's three layers, is the thick, muscular part that contracts to drive blood through the body. The Wnt signaling pathway is a group of signal transduction pathways made of proteins that pass signals into a cell using cell-surface receptors. "We needed to provide the cardiac progenitor cells with additional information in order for them to generate into epicardium cells, but prior to this study, we didn't know what that information was," said Lian. "Now, we know that if we activate the cells' Wnt signaling pathway again, we can re-drive these cardiac progenitor cells to become epicardium cells, instead of myocardium cells."

The group's results, published in Nature Biomedical Engineering, bring them one step closer to regenerating an entire heart wall. Through morphological assessment and functional assay, the researchers found that the generated epicardium cells were similar to epicardium cells in living humans and those grown in the laboratory. "The last piece is turning cardiac progenitor cells to endocardium cells (the heart's inner layer), and we are making progress on that," said Lian.

Heart progenitors cells derived from human stem cells can be further specified to heart cells belong to external layer or muscle layer of a human heart.

The group's method of generating epicardium cells could be useful in clinical applications, for patients who suffer a heart attack. According to the Centers for Disease Control and Prevention, every 43 seconds, someone in the United States has a heart attack "Heart attacks occur due to blockage of blood vessels," said Lian. "This blockage stops nutrients and oxygen from reaching the heart muscle, and muscle cells die. These muscle cells cannot regenerate themselves, so there is permanent damage, which can cause additional problems. These epicardium cells could be transplanted to the patient and potentially repair the damaged region." During their study, the researchers engineered the human stem cells to become reporter cells, meaning these cells expressed a fluorescent protein only when they became epicardium cells. "We treated the cells with different cell signaling molecules, and we found that when we treated them with Wnt signaling activators, they became fluorescent," said Lian.

Another finding, he said, is that in addition to generating the epicardium cells, the researchers also can keep them proliferating in the lab after treating these cells with a cell-signaling pathway Transforming Growth Factor Beta (TGF) inhibitor. "After 50 days, our cells did not show any signs of decreased proliferation. However, the proliferation of the control cells without the TGF Beta inhibitor started to plateau after the tenth day," said Lian. The team will continue working together to further their research on regenerating endocardium cells. "We are making progress on that inner layer, which will allow us to regenerate an entire heart wall that can be used in tissue engineering for cardiac therapy," said Lian.

http://medicalxpress.com/news/2017-0...layer.html#jCp

[waltky]

Whenever Granny tells Uncle Ferd his g/f is too fat to sit onna sofa - he gets all discombobulated...

Brain activity 'key in stress link to heart disease'
Thu, 12 Jan 2017 - Constant stress could be a key factor in raising the risk of a heart attack, say researchers.

The effect of constant stress on a deep-lying region of the brain explains the increased risk of heart attack, a study in The Lancet suggests. In a study of 300 people, those with higher activity in the amygdala were more likely to develop cardiovascular disease - and sooner than others. Stress could be as important a risk factor as smoking and high blood pressure, the US researchers said. Heart experts said at-risk patients should be helped to manage stress.

A woman stressed at work

Emotional stress has long been linked with an increased risk of cardiovascular disease (CVD), which affects the heart and blood vessels - but the way this happens has not been properly understood. This study, led by a team from Harvard Medical School, points to heightened activity in the amygdala - an area of the brain that processes emotions such as fear and anger - as helping to explain the link.

The researchers suggest that the amygdala signals to the bone marrow to produce extra white blood cells, which in turn act on the arteries causing them to become inflamed. This can then cause heart attacks, angina and strokes. As a result, when stressed, this part of the brain appears to be a good predictor of cardiovascular events. But they also said more research was needed to confirm this chain of events.

Inflammation insight

[waltky]

Dual-use anti-cancer drug could help to regenerate heart tissue...

Cancer drug could promote regeneration of heart tissue
February 3, 2017 - An anticancer agent in development promotes regeneration of damaged heart muscle 0- an unexpected research finding that may help prevent congestive heart failure in the future.

Many parts of the body, such as blood cells and the lining of the gut, continuously renew throughout life. Others, such as the heart, do not. Because of the heart's inability to repair itself, damage caused by a heart attack causes permanent scarring that frequently results in serious weakening of the heart, known as heart failure.

For years, Dr. Lawrence Lum, Associate Professor of Cell Biology at UT Southwestern Medical Center, has worked to develop a cancer drug targeting Wnt signaling molecules. These molecules are crucial for tissue regeneration, but also frequently contribute to cancer. Essential to the production of Wnt proteins in humans is the porcupine (Porcn) enzyme, so-named because fruit fly embryos lacking this gene resemble a porcupine. In testing the porcupine inhibitor researchers developed, they noted a curiosity. "We saw many predictable adverse effects -0 in bone and hair, for example 0- but one surprise was that the number of dividing cardiomyocytes (heart muscle cells) was slightly increased," said Dr. Lum, senior author of the paper, and a member of UTSW's Hamon Center for Regenerative Science and Medicine. "In addition to the intense interest in porcupine inhibitors as anticancer agents, this research shows that such agents could be useful in regenerative medicine."

(From left) Dr. Rhonda Bassel-Duby, Dr. Lawrence Lum, Huanyu Zhou, Dr. Jesung Moon, and Dr. Wei Tan.

Based on their initial results, the researchers induced heart attacks in mice and then treated them with a porcupine inhibitor. Their hearts' ability to pump blood improved by nearly twofold compared to untreated animals. The study findings were published online this week in Proceedings of the National Academy of Sciences. "Our lab has been studying heart repair for several years, and it was striking to see that administration of a Wnt inhibitor significantly improved heart function following a heart attack in mice," said Dr. Rhonda Bassel-Duby, Professor of Molecular Biology and Associate Director of the Hamon Center for Regenerative Science and Medicine.

Importantly, in addition to the improved pumping ability of hearts in the mice, the researchers noticed a reduction in fibrosis, or scarring in the hearts. Collagen-laden scarring that occurs following a heart attack can cause the heart to inappropriately increase in size, and lead to heart failure. "While fibrotic responses may be immediately beneficial, they can overwhelm the ability of the heart to regenerate in the long run. We think we have an agent that can temper this fibrotic response, thus improving wound healing of the heart," said Dr. Lum, a Virginia Murchison Linthicum Scholar in Medical Research and Associate Director of Basic Research at the Harold C. Simmons Comprehensive Cancer Center.

Additionally, Dr. Lum said, preliminary experiments indicate that the porcupine inhibitor would only need to be used for a short time following a heart attack, suggesting that the unpleasant side effects typically caused by cancer drugs might be avoided. "We hope to advance a Porcn inhibitor into clinical testing as a regenerative agent for heart disease within the next year," Dr. Lum said.

https://medicalxpress.com/news/2017-...issue.html#jCp

[waltky]

Granny tells possum to eat his spinach so's he'll be strong like Popeye...


Human Heart Cells Grown on Spinach Leaves
March 27, 2017 - Spinach is known as a super food for its nutritional value, but a new experiment reveals another power of the green leaf.

Researchers say they’ve grown beating human heart cells on spinach leaves, using the vascular network of the plant to transport fluids. The finding could eventually lead to being able to grow working human cardiac tissue that could one day be used to replace heart cells damaged by heart attacks. “Plants and animals exploit fundamentally different approaches to transporting fluids, chemicals, and macromolecules, yet there are surprising similarities in their vascular network structures,” said researchers from Worcester Polytechnic Institute (WPI), the University of Wisconsin-Madison, and Arkansas State University-Jonesboro. “The development of decellularized plants for scaffolding opens up the potential for a new branch of science that investigates the mimicry between plant and animal.”

Researchers say they've grown human heart cells on spinach leaves

The breakthrough is important because so far, bioengineering such as 3-D printing, can’t replicate the complex system of blood vessels in the human body that deliver the oxygen, nutrients, and essential molecules required for proper tissue growth. For the experiment, researchers first stripped plant cells from spinach leaves and passed beads the size of human blood cells through the leftover vascular system and seeded the spinach veins with human cells that line our blood vessels. “We have a lot more work to do, but so far this is very promising,” said Glenn Gaudette, PhD, professor of biomedical engineering at WPI and corresponding author of the paper. “Adapting abundant plants that farmers have been cultivating for thousands of years for use in tissue engineering could solve a host of problems limiting the field.”


Researchers added that other plants have been shown to offer the same kind of promise, including parsley, Artemesia annua (sweet wormwood), and peanut hairy roots. “The spinach leaf might be better suited for a highly vascularized tissue, like cardiac tissue, whereas the cylindrical hollow structure of the stem of Impatiens capensis (jewelweed) might better suit an arterial graft. Conversely, the vascular columns of wood might be useful in bone engineering due to their relative strength and geometries,” the authors wrote.

A time lapse view shows plant cells being removed from spinach leaves, leaving behind the leaf's vascular system.

Using plants could also be economical. “By exploiting the benign chemistry of plant tissue scaffolds,” researchers wrote, “we could address the many limitations and high costs of synthetic, complex composite materials. Plants can be easily grown using good agricultural practices and under controlled environments. By combining environmentally-friendly plant tissue with perfusion-based decellularization, we have shown that there can be a sustainable solution for pre-vascularized tissue engineering scaffolds.” The paper, “Crossing kingdoms: Using decelluralized plants as perfusable tissue engineering scaffolds” is published online in advance of the May 2017 issue of the journal Biomaterials.


http://www.voanews.com/a/mht-human-h...s/3783513.html

[waltky]

Bacteria Could Help Heart Attack Sufferers...

Oxygen-Producing Bacteria Could Help Heart Attack Sufferers
June 15, 2017 - Photosynthetic bacteria and light may offer hope to heart disease patients, a new study suggests.

Researchers at Stanford University say that after injecting the bacteria into the hearts of rats with cardiac disease and using light to start photosynthesis, they were able to increase the flow of oxygen, improving heart function. “The beauty of it is that it’s a recycling system,” said Joseph Woo, senior author of the study. “You deliver the bacteria, they take up carbon dioxide, and with energy from the light, they form oxygen.”


The findings could help many who have a condition called cardiac ischemia, which restricts blood flow and the delivery of oxygen to the heart muscles. “We thought there is an interesting relationship in nature,” Woo said. “In nature, humans exhale carbon dioxide and plants convert it back to oxygen. During a heart attack, the muscle is still trying to pump. There’s carbon dioxide but no oxygen. We wondered if there were any way to use plant cells and put them next to heart cells to produce oxygen from the carbon dioxide.”

Photosynthetic cyanobacteria could help patients suffering from heart disease, according to a new study.

At first, the researchers tried to use spinach and kale cells, but the chloroplasts, the structures where photosynthesis occurs, were not stable enough to live outside the plant. “So we kept looking around,” Woo said, saying the next option was photosynthetic bacteria called cyanobacteria because it is “more rugged” and could survive with heart cells in a petri dish.


After that, Woo and his team injected cyanobacteria into the beating hearts of anesthetized rats, comparing the oxygen levels among rats with their hearts exposed to light and rats that did not have light shined on their hearts. “The group that received the bacteria plus light had more oxygen and the heart worked better,” Woo said, adding that the bacteria “dissipated” in about 24 hours. Improved cardiac function lasted at least four weeks, he said. “This is still very preliminary,” Woo said. The study was published in the journal Science Advances.


https://www.voanews.com/a/mht-cyanob...s/3901770.html

See also:


Aspirin Linked to Higher Risk of Serious Bleeding in the Elderly
June 13, 2017 — People who are aged 75 or older and take aspirin daily to ward off heart attacks face a significantly elevated risk of serious or even fatal bleeding and should be given heartburn drugs to minimize the danger, a 10-year study has found.

Between 40 percent and 60 percent of people over the age of 75 in Europe and the United States take aspirin every day, previous studies have estimated, but the implications of long-term use in older people have remained unclear until now because most clinical trials involve patients younger than 75. The study published on Wednesday, however, was split equally between over-75s and younger patients, examining a total of 3,166 Britons who had suffered a heart attack or stroke and were taking blood-thinning medication to prevent a recurrence. Researchers emphasized that the findings did not mean that older patients should stop taking aspirin. Instead, they recommend broad use of proton pump inhibitor heartburn drugs such as omeprazole, which can cut the risk of upper gastrointestinal bleeding by 70 to 90 percent. While aspirin — invented by Bayer in 1897 and now widely available over the counter — is generally viewed as harmless, bleeding has long been a recognized hazard.


Peter Rothwell, one of the study authors, said that taking anti-platelet drugs such as aspirin prevented a fifth of recurrent heart attacks and strokes but also led to about 3,000 excess-bleeding deaths annually in Britain alone. The majority of these were in people older than 75. "In people under 75, the benefits of taking aspirin for secondary prevention after a heart attack or stroke clearly outweigh the relatively small risk of bleeding. These people needn't worry," Rothwell said. "In the over-75s the risk of a serious bleed is higher, but the key point is that this risk is substantially preventable by taking proton pump inhibitors alongside aspirin."

Packages of aspirin fill the shelves of a drugstore

Faculty of Pharmaceutical Medicine President Alan Boyd, who was not involved in the study, said it had been considered that the benefits of aspirin outweighed the risks of bleeding in all patients and that the new research would force a reappraisal. Rothwell, director of the Center for Prevention of Stroke and Dementia at Oxford University, and his colleagues found that the annual rate of life-threatening or fatal bleeds was less than 0.5 percent in under-65s, rising to 1.5 percent for those aged 75 to 84, and nearly 2.5 percent for over-85s.


Because the majority of patients studied were taking low-dose aspirin, rather than more modern anti-platelet drugs such as clopidogrel or AstraZeneca's Brilinta, the study could not draw conclusions about combined drug use. However, a commentary in The Lancet medical journal, where the study was published, noted that patients on dual anti-platelet therapy were known to have a higher risk of bleeding than those on monotherapy and that the research showed the need for regular evaluation of older patients.


https://www.voanews.com/a/aspirin-li...y/3899590.html

[waltky]

Rare Surgical Infection at New Orleans Children's Hospital...

Child Heart Patients Treated for Rare Surgical Infection
September 12, 2017 — At least a dozen children who had heart surgery at Children's Hospital New Orleans between late May and July have infected incisions, apparently from contaminated equipment.

The hospital's chief medical officer says the infections were linked to a machine that regulates a patient's temperature during heart surgery. Dr. John Heaton says the machine was replaced and patients are responding to intravenous antibiotics.


He says a handful who haven't shown symptoms will see doctors this week, to make sure. Heaton says the hospital's paying for treatment and related costs, such as parents' hotel rooms and meals.

An operating room is seen through a window at a sanitizing station in New Orleans.

The Centers for Disease Control and Prevention describes the bacteria in question as common in water, soil and dust. It says contaminated medical devices can infect the skin and soft tissues under the skin.


https://www.voanews.com/a/child-hear...n/4025731.html