Gene flaws may protect against heart disease

WASHINGTON: A rare set of genetic mutations found in fewer than one percent of the population may cut the risk of heart disease by 40 percent, researchers said Wednesday.

The findings in the New England Journal of Medicine show how certain flaws in a gene called APOC3 work to reduce a certain type of fat found in blood, known as triglycerides.

About one in 150 people carry one of these four genetic mutations, said the findings based on a study of the DNA of nearly 4,000 people of European and African ancestry.

Normal levels of triglycerides are generally less than 150 milligrams per deciliter (mg/dL).

Among those with any of the four APOC3 mutations, triglyceride levels were around 85 mg/dL."Based on our findings, we predict that lowering triglycerides specifically through inhibition of APOC3 would have a beneficial effect by lowering disease risk," said senior co-author Alex Reiner, a research professor of epidemiology at the University of Washington´s School of Public Health.

Drugs already exist that can lower triglycerides -- which like cholesterol are a type of lipid in the blood -- but these have not been proven to lower the risk of heart disease, perhaps because they don´t lower the lipids enough, researchers said.

Recent studies have also suggested that the long-running effort to improve Americans´ "good" cholesterol, or high-density lipoproteins (HDL), was not the magic bullet against heart disease that some experts had hoped.

"The combination of our genetic results, together with recent clinical trials of drugs that raised HDL levels but failed to prevent heart disease, are turning decades of conventional wisdom on its head," said senior author Sekar Kathiresan, a Broad Institute associate member and director of preventive cardiology at Massachusetts General Hospital.

"It has long been presumed that low HDL is the causal factor in heart disease, and triglycerides are along for the ride.

But our genetic data indicate that the true causal factor may not be HDL after all, but triglycerides.

"Heart disease is the leading killer in the United States, taking nearly 600,000 lives per year.

Diabetic heart attacks, strokes falling: study

5  1

NEW YORK: In the midst of the diabetes epidemic, a glimmer of good news: Heart attacks, strokes and other complications from the disease are plummeting.

Over the last two decades, the rates of heart attacks and strokes among diabetics fell by more than 60 percent, a new federal study shows. The research also confirms earlier reports of drastic declines in diabetes-related kidney failure and amputations.

The drop is mainly attributed to better screening, medicines and care. The improvements came even as the number of U.S. adults with diabetes more than tripled in those 20 years.

"It is great news," said Dr. John Buse, a University of North Carolina diabetes specialist, of the drop in rates.

"The prognosis for folks with diabetes has improved dramatically over the last two decades, at least for those with good access to care," Buse said in an email. He was not involved in the study.

The Centers for Disease Control and Prevention research is reported in Thursday's New England Journal of Medicine.

Diabetes is a disease in which sugar builds up in the blood. The most common form is tied to obesity, and the number of diabetics has ballooned with the rise in obesity. Today, roughly 1 in 10 U.S. adults has the disease, and it is the nation's seventh leading cause of death, according to the CDC.

The obese are already at higher risk for heart attacks and strokes. But diabetics seem to have more narrowing of their blood vessels - a condition that can further foster those problems.

In the 1990s, key studies showed that diabetics could keep their blood sugar, blood pressure and cholesterol under control. The research suggested that vision and heart problems, leg and foot amputations and other diabetes complications were not necessarily inevitable.

Meanwhile, insurance programs expanded coverage of blood sugar monitors and diabetes treatment. Gradually, larger numbers of diabetics were diagnosed earlier and with milder disease.

For the new study, the CDC tallied complication rates from 1990 to 2010 for diabetics ages 20 or older.

During that time, the heart attack rate fell 68 percent, from 141 to 45.5 per 10,000 diabetics, according to hospital records.

The decline was so great that, despite the growing ranks of diabetics, the actual number hospitalized with heart attacks dropped from more than 140,000 to about 136,000.

The stroke rate fell less dramatically - but still declined by more than half, finishing at 53 per 10,000. The heart attack and stroke rates for diabetics are essentially even now, lead author Edward Gregg noted.

The researchers saw declines in hearts attack and stroke rates for non-diabetics as well, but those improvements weren't nearly as big as they were for diabetics.

Amputation rates also fell by more than half. However, like strokes, the actual number increased over the two decades.

The growth in the number of diabetics "wiped out most of the gains" from the declining rates, so the number who ended up in the hospital for strokes or amputations swelled, said Dr. Robert Gabbay, of Boston's Joslin Diabetes Center.

The study also found that the rate of kidney failure dropped by 28 percent. But that wasn't true for all ages - the rate in those 65 and older actually increased, for reasons that aren't clear. That could be a sign diabetics are living longer - long enough to get kidney disease, Gregg speculated.

The researchers also looked at a less common complication, death caused by dangerous levels of blood sugar. The rate of such deaths dropped by 64 percent; the numbers also declined by 18 percent. In 2010, those deaths totaled 2,361.

 

Indian lady dies of heart attack after seeing her brother after 16 yrs

LAHORE: An Indian woman, who came to Pakistan to visit her brother after span of 16 years, has died after a heart attack.

Mahesh Kumar, a resident of Larkana and brother of the visiting woman Sarala Devi, said that the tragic incident occurred when her sister embraced him at upon her arrival at Lahore railway station and started crying with deep emotions after which she suffered fatal heart attack.

Kumar said that her sister’s application for visa to Pakistan had been refused four times and this was the fifth time when the application was accepted and she visited Lahore.

Test accurately rules out heart attacks in the ER

 

WASHINGTON: A simple test appears very good at ruling out heart attacks in people who go to emergency rooms with chest pain, a big public health issue and a huge worry for patients.

A large study in Sweden found that the blood test plus the usual electrocardiogram of the heartbeat were 99 percent accurate at showing which patients could safely be sent home rather than be admitted for observation and more diagnostics.

Of nearly 9,000 patients judged low risk by the blood test and with normal electrocardiograms, only 15 went on to suffer a heart attack in the next month, and not a single one died.

"We believe that with this strategy, 20 to 25 percent of admissions to hospitals for chest pain may be avoided," said Dr. Nadia Bandstein of the Karolinska University Hospital in Stockholm.

She helped lead the study, published in the Journal of the American College of Cardiology and presented Sunday at the cardiology college's annual conference in Washington.

Chest pain sends more than 15 million people to emergency rooms in the United States and Europe each year, and it usually turns out to be due to anxiety, indigestion or other less-serious things than a heart attack. Yet doctors don't want to miss one - about 2 percent of patients having heart attacks are mistakenly sent home.

People may feel reassured by being admitted to a hospital so doctors can keep an eye on them, but that raises the risk of picking up an infection and having expensive care they'll have to pay a share of, plus unnecessary tests.

The study included nearly 15,000 people who went to the Karolinska University hospital with chest pains over two years. About 8,900 had low scores on a faster, more sensitive blood test for troponin, a substance that's a sign of heart damage. The test has been available in Europe, Asia and Canada for about three years, but it is not yet available in the United States.

The patients were 47 years old on average and 4 percent had a previous heart attack. About 21 percent of them wound up being admitted.

Researchers later looked back to see how the blood test and electrocardiogram would have predicted how they fared over the next month.

They figured that in order to find one heart attack in patients like this, 594 would have to be admitted - a huge waste of resources.

A test like this would be "enormously useful," and the study's results are "almost too good to be true," said Dr. Judd Hollander, an emergency medicine specialist at the University of Pennsylvania.

He believes the test should be available in the U.S. and that the amount of evidence that regulators are requiring to approve it is too high.

Dr. Allan Jaffe, a cardiologist at the Mayo Clinic, said the problem is not what the test rules out, but what it might falsely rule in. It's so sensitive that it can pick up troponin from heart failure and other problems and cause unnecessary tests for that.

"I think the strategy long-term will be proven," but more studies underway now in the U.S. are needed to show that, he said.

 

8 Things you need to know about your heart

Heart disease is the leading cause of death in most countries. It is quite important to reveal warning signs as soon as possible in order to prevent further problems. Read up on these 8 key facts and learn how to manage and improve your heart health.

Sleep seven to eight hours to protects your heart
People who sleep less than 6 hours a night show tree times the risk of developing heart disease than those who get seven to eight hours. Sleep helps to regulate insulin activity. Lack of sleep causes your more resistance to insulin that results in higher blood sugar levels and will contribute to heart disease due to weight gain. Exhaustion is another symptom of heart disease that is often ignored in females. If you notice that you are persistently exhausted, even after sleeping well, consult your physician.

Dropping just 10 lbs reduces the risk of heart disease
Sure, weight matters, but your waistline can be an even better indicator of your heart health. Females with waistlines over 40 inches and males with waistlines over 45 inches are at increased risk of heart disease. Studies show that losing even just 10 to 15% of your weight can significantly improve your heart health. And 25 to 55 minutes of aerobic exercise at least four times a week can help to strengthen your heart and reduce bad cholesterol and high blood pressure, especially if combined with a healthy diet.