Initial Studies Focus on Stroke, Peripheral Artery Disease, Heart Failure and Diabetes
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
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
"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
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
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
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
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
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
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
The researchers concluded that low-dose aspirin doesn't diminish the
improvement of pain-free walking gained during a three-month exercise
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
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
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
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:
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)