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Initial Studies Focus on Stroke, Peripheral Artery Disease, Heart Failure and Diabetes

Tue, 02/21/2012 - 11:45am
The Associated Press

News Highlights:

Among findings posted in the inaugural publication of the American

Heart Association's online-only, free-access scientific journal:

-- The NIH Stroke Scale accurately identifies patients with the highest

risk of death in the first month after stroke.

-- Aspirin works as well as more expensive drugs in combination with a

walking program to treat blocked leg arteries.

-- Heart failure patients do better when they receive several

evidence-based treatments at once.

-- Kidney problems signal the highest death risk for people with type 2

diabetes.

DALLAS, Feb. 21, 2012 (GLOBE NEWSWIRE) -- The American Heart

Association has launched the online-only open-access Journal of the

American Heart Association: Cardiovascular and Cerebrovascular Disease

(JAHA) -- packed with free peer-reviewed research on heart disease and

stroke.

"We envision JAHA as a forum for high quality original articles that

cover the full range of cardiovascular science, including basic

science, translational science, clinical trials and epidemiological

and outcomes research," said Joseph A. Vita, M.D., JAHA editor in

chief.

As with the association's 11 print journals, articles will undergo

rigorous peer review prior to publication. The online format won't

have limits on the length of articles, the number of photos and

illustrations, or the use of color or video. Thus, "authors will be

able to present all aspects of their work," Vita said. Also,

open-access means content will be rapidly and widely accessible,

accelerating the translation of science into practice.

Highlights of the first science published in the new journal include:

Severity of stroke predicts death risk

People with strokes caused by the most severe blockages were more than

12 times likely to die within 30 days of their stroke than people with

the least severe strokes as categorized by the National Institutes of

Health Stroke Scale (NIHSS).

The NIHSS ranks stroke severity on a 0-42 scale, with 0-7 being the

least severe and 22-42 the most severe.

Thirty-day death rates were:

-- 4.2 percent for mild stroke (0-7)

-- 13.9 percent for moderate stroke (8-13)

-- 31.6 percent for severe stroke (14-21)

-- 53.5 percent for extremely severe stroke (22-42)

Researchers collected data from 33,102 fee-for-service Medicare

beneficiaries treated at 404 Get With The Guidelines-Stroke hospitals

between April 2003 and December 2006. Average age was 79, and 58

percent were women. Get With The Guidelines-Stroke is the American

Heart Association/American Stroke Association's hospital-based quality

improvement program that helps healthcare providers to consistently

treat stroke patients according to the most up-to-date evidence-based

guidelines.

No matter what other clinical information is available, stroke

severity is a very strong predictor of death risk after stroke, the

researchers said. Categorizing patients by risk levels can better

target treatments and resources.

The data could help evaluate the performance of centers that treat

stroke patients, researchers wrote in an accompanying editorial.

Aspirin therapy pairs well with walking rehab in patients with blocked

leg arteries

Despite previous concerns, aspirin works as well as clopidogrel in

conjunction with walking rehabilitation for people with blocked leg

arteries, or peripheral artery disease (PAD), according to new

research.

People with PAD often have a condition called intermittent

claudication, which causes pain while walking due to decreased blood

supply to the legs.

During rehabilitation, patients are put on a walking program to help

increase blood flow to their legs and spur the growth of tiny

collateral blood vessels that help supply leg tissues with blood and

oxygen. Improved blood flow should increase pain-free walking time.

Previously, experts believed aspirin was a poor choice for these

patients because its anti-inflammatory properties might block the

development of collateral blood vessels that form to get around the

blockage.

In the study, researchers for the first time examined whether the type

of antiplatelet drug prescribed impacted PAD patients' ability to

increase walking distance during exercise training.

Patients from 21 centers in Germany and Switzerland were randomly

chosen to take low-dose aspirin (116) or clopidogrel (113) during a

one hour/day walking program. Average age was 66, and 24.5 percent

were women.

After 12 weeks, patients on low-dose aspirin could walk pain-free 33.9

percent farther and 35.3 percent longer before it was too painful to

continue. Similarly, patients on clopidogrel could walk 33.3 percent

farther before pain began and 34.9 percent longer before being unable

to continue.

The researchers concluded that low-dose aspirin doesn't diminish the

improvement of pain-free walking gained during a three-month exercise

program.

More evidence-based treatments mean better heart failure survival

Chance of survival for heart failure patients with weakened pumping

ability improves if they use at least four or five of the treatments

suggested in American Heart Association guidelines, according to new

research.

The combination of several key guideline-recommended therapies for

heart failure provided up to an 81 to 90 percent improvement in the

odds of survival over two years.

In an analysis of data from the large prospective study IMPROVE HF,

researchers evaluated how much each treatment contributes to two-year

survival ? individually and in addition to other treatments.

Individually, the greatest improvement in survival was gained by

treatment with beta-blockers and cardiac resynchronization therapy (a

specialized pacemaker that helps coordinate the pumping of the right

and left chambers of the heart). Significant gains were also achieved

with angiotensin-converting enzyme inhibitors/angiotensin receptor

blockers, drugs to reduce blood clotting, implantable

cardioverter/defibrillators and heart failure education.

The use of aldosterone antagonists didn't increase two-year survival,

a finding which requires further study according to the authors.

In combination, every added treatment boosted survival until patients

were taking four to five treatments, with benefits potentially

leveling off (but not diminishing) with additional treatments.

Kidney problems create highest risk of death for patients with

diabetes

Kidney impairment is the strongest predictor of death for diabetic

patients, according to a study of heart and stroke risk factors in

diabetic patients participating in clinical trials.

Having type 2 diabetes adds to the danger posed by other

cardiovascular risk factors, such as high blood pressure, high

cholesterol and impaired kidney function.

By examining data from clinical trials, researchers assessed the death

risk posed by individual factors in people with diabetes. The

researchers compared age, gender, body mass index, glycated hemoglobin

(HbA1c), duration of diabetes, total cholesterol, low density

lipoprotein (LDL) cholesterol, systolic blood pressure, serum

creatinine, smoking status, rate of retinopathy, hypertension ,

history of cardiovascular disease and the presence of proteinuria

(defined by any abnormal excretion of protein in the urine).

The researchers evaluated data on 91,842 patients and 6,837 deaths

occurring in 22 clinical trials. They concluded that mortality rates

varied substantially across these trials.

They also found that decline in kidney function, with or without

presence of protein in the urine, was associated with a higher risk of

death.

???

Statements and conclusions of study authors published in American

Heart Association scientific journals are solely those of the study

authors and do not necessarily reflect the association's policy or

position. The association makes no representation or guarantee as to

their accuracy or reliability. The association receives funding

primarily from individuals; foundations and corporations (including

pharmaceutical, device manufacturers and other companies) also make

donations and fund specific association programs and events. The

association has strict policies to prevent these relationships from

influencing the science content. Revenues from pharmaceutical and

device corporations are available at www.heart.org/corporatefunding.

NR12 -- 1031 (JAHA/Vita)

Additional resources available on the right column of the release:

http://newsroom.heart.org/pr/aha/_prv-american-heart-association-launches-229260.aspx

For Media Inquiries: (214) 706-1173

Maggie Francis (214) 706-1382; Maggie.Francis@heart.org

Cathy Lewis (214) 706-1324; Cathy.Lewis@heart.org

Julie Del Barto (broadcast): (214) 706-1330; Julie.DelBarto@heart.org

For Public Inquiries: (800) AHA-USA1 (242-8721)

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