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Author Interview: Luis Nombela-Franco, MD
Hospital Universitario Puerta de Hierro-Majadahonda. Madrid, Spain
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Publication:
Ventricular Arrhythmias Among Implantable Cardioverter Defibrillator Recipients for Primary Prevention: Impact of Chronic Total Coronary Occlusion (VACTO Primary Study)
Luis Nombela-Franco, Cristina Daniela Mitroi, Ignacio Fernández Lozano, Arturo García-Touchard, Jorge Toquero Ramos, Victor Castro Urda, Jose Antonio Fernández Diaz, Elena Perez Pereira, Paula Beltrán Correas, Javier Segovia, Gerald S. Werner, Javier Goicolea Ruigomez, and Luis Alonso Pulpón
Circ Arrhythm Electrophysiol. 2011;CIRCEP.111.968008
published online before print December 28 2011
doi:10.1161/CIRCEP.111.968008
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What are the main findings of the study?
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The purpose of the study was to evaluate the prognostic importance of chronic total coronary occlusion (CTO) in the occurrence of ventricular arrhythmias in patients with an implantable cardioverter-defibrillator (ICD) for primary prevention of sudden cardiac death.
We found that the presence of at least one CTO in a major coronary artery was associated with a higher rate of ICD therapy and mortality after median follow up of 26 months.
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Were any of the findings unexpected?
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The rate of device therapy in CTO group was 26% after 2 years of follow-up, compare to 9% in the non-CTO group.
The presence of a CTO (HR 3.5, p=0.003) and age (HR 1.3 per 5-y increase, p=0.015) were the only independent predictors of ICD therapy in the multivariable analysis.
Thus, those with CTOs had more than twice the risk of experiencing ventricular arrhythmias. Surprisingly, the rate of ICD delivery in CTO group is similar to the rate in ICD recipients for secondary prevention indication, which puts them in a high risk subgroup for sudden cardiac death.
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What should clinicians and patients take away from this study?
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The findings support that CTO is a strong predictor for the occurrence of ventricular arrhythmias in ICD recipients for primary prevention indication, and it could be a differentiating factor to select ICD candidates.
Therefore physicians could have a better way to differentiate between those who are at higher risk of device therapy and those who are in a lower risk.
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What recommendations do you have for cardiology health care providers as a result of your study?
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This is an observational study from a single center, so it could be useful as hypothesis generating.
Thus, it would be important to confirm our results in a cohort from a different hospital. Additionally, we can explore the impact of a CTO in a different population such as ICD candidates for secondary prevention indication.
And finally, none of the CTO patients underwent CTO recanalization after ICD implantation, so we could not evaluate a possible benefit of revascularization in ventricular arrhythmias occurrence.
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Featured Angina| Acute Coronary Syndrome and Heart Disease Interviews
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Author Interview: Claes Held MD
Associate professor at Uppsala Clinical Research Center and the
Cardiology department at Uppsala University Hospital in Sweden
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Publication:
Physical activity levels, ownership of goods promoting sedentary behaviour and risk of myocardial infarction: results of the INTERHEART study
Eur Heart J first published online January 11, 2012 doi:10.1093/eurheartj/ehr432
2012 doi:10.1093/eurheartj/ehr432
Claes Held, Romaina Iqbal, Scott A. Lear, Annika Rosengren, Shofiqul Islam,James Mathew, and Salim Yusuf
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What are the main findings of the study?
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The main findings are he following:
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It is well known that physical inactivity is a risk factor for developing cardiovascular disease.
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Our study shows that being physically active reduces the risk of having a heart attack.
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Older studies have mostly studied people in the developed countries. This study which has a global perspective and includes 52 countries from all continents, shows that physical inactivity reduces the risk also in both low- middle-and high-income countries.
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We also found that ownership of a car and TV was associated with a more than doubled risk of being sedentary and that in low- and middle income the risk for a heart attack was increased with 27 %.
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We can however, not conclude from this study that there is a causal relationship but it is an interesting finding.
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Were any of the findings unexpected?
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We looked at the relationship between physical activity both at work and during leisure time.
A bit surprising was that people with heavy physical labor did not have a reduction in the risk of heart attacks, whereas people with both mild and moderate intensity did.
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What should clinicians and patients take away from this study?
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The main findings above and also that physical activity with duration below the recommended 30 minutes/day does seem to prevent from heart attacks as well although not as much as when you do it according to guidelines.
This may be a comfort to those who are completely sedentary and feel that it would be a too big step to move to the 30 minutes/day right away.
All PA does a good job for the heart as compared to not doing anything at all!
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What recommendations do you have for cardiology health care providers as a result of your study?
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It would be interesting to follow up on the ownership of car and TV and do a prospective study to see if the theory holds true.
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Publication:
Short Telomere Length, Myocardial Infarction, Ischemic Heart Disease, and Early Death
- Maren Weischer, Stig E. Bojesen, Richard M. Cawthon, Jacob J. Freiberg,
Anne Tybjærg-Hansen, and Børge G. Nordestgaard
Arterioscler Thromb Vasc Biol. 2011;ATVBAHA.111.237271published online before print December 22 2011, doi:10.1161/ATVBAHA.111.237271 |
What are the main findings of the study?
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One in four Danes have reduced telomere length, that is, increased cellular ageing, and a 25% increased risk of early death and a 50% increased risk of heart attack.
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Were any of the findings unexpected?
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Yes, previous smaller studies have suggested much larger risk increases for early death and heart attack, while we found more modest risk estimates.
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What should clinicians and patients take away from this study?
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A possible prospect of the study is a simple blood test done by the general practitioner, which will reveal a person’s telomeric length and thereby the cellular wear and age.
If the celluar wear is more than expected by age alone, this could be a "wake-up call" suggesting for the patient that now is maybe the time to stop smoking and lose weight.
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What recommendations do you have for cardiology health care providers as a result of your study?
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We need to know if smoking and obesity is the direct cause of reduced telomeric length and thereby increased cellular wear, and whether decreased telomeric length is a direct cause of heart attack and early death.
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Angina | Heart Disease Resourses
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Amazon.com 's Editorial Reviews
Angina: New Ways to Treat
Chronic Chest Pain
Part of the award winning public television series Healthy head
/Healthy Mind. It's one of the scariest medical symptoms for people who are generally healthy: a tightening, painful feeling in the chest known as Angina. In some cases this chest pain can be a serious warning that requires immediate treatment. But for the millions of people with chronic, stable angina the discomfort is something that can be readily managed with a variety of treatments. In this program we take a look at what generally causes angina, what can be done to prevent it and how it can be effectively treated with lifestyle changes, innovative drug therapies and medical procedures.
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Amazon.com Editorial Review:
Philips HeartStart Home Defibrillator (AED)
Be prepared for the unexpected.
When sudden cardiac arrest (SCA) strikes, the electrical system of the heart short circuits, causing the heart to quiver rather than pump in a normal rhythm. It typically results in the abnormal heart rhythm know as ventricular fibrillation (VF). It usually happens without warning and the majority of people have no previously recognized symptoms of heart disease. And it most often happens at home. For the best chance of survival from SCA caused by VF, a defibrillator should be used within 5 minutes. Yet, less than 1 in 20 people survive largely because a defibrillator does not arrive in time.
Just as seat belts or airbags do not save every life in a traffic accident, a defibrillator will not save every person who suffers a sudden cardiac arrest. Yet many lives could be saved if more people could be reached more quickly.
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