Heart Disease & Stroke - Progress (cont.)

MRI promises to provide a way to detect people at high risk of having a heart attack or stroke and to initiate treatment to stabilize the plaques and reduce the chance that a blood clot will form.

5. Heart cells recover thanks to left ventricular assist device.

The heart tissue of people with congestive heart failure can recover some of its function through treatment with what is called a left ventricular assist device (LVAD). The LVAD takes over the pumping action of the left side of the heart for patients with severe heart failure who are awaiting heart transplantation. Heart muscle cells, called myocytes, were found to recover their ability to contract and relax as a result of the heart's being supplemented by the LVAD. The heart cells had been obtained from patients who had been on LVADs but who were given heart transplants. In another study, scientists describe how they had weaned five patients from the LVAD. When they were placed on the LVAD, all had diagnosed irreversible end-stage heart failure. But their heart function was dramatically modified during the LVAD treatments. As a result, they did not need a heart transplant.

6. Tobacco's effects from fewer than 10 cigarettes daily.

About 13,000 men in the United States, Europe and Japan were monitored for 25 years. For men who had smoked 10 or more cigarettes a day, the risk of death from heart disease or lung cancer rose to 80 percent more than for men of the same age who did not smoke. However, what was perhaps even more stunning was the finding that men who had smoked fewer than 10 cigarettes daily had a 30 percent higher risk of death from heart disease or lung cancer than men of the same age who did not smoke. Smoking even "a few" cigarettes is clearly quite dangerous.

7. Impact of diet and exercise on blood cholesterol levels.

New research characterized people for whom a low-fat diet is most often effective in lowering elevated levels of "bad" cholesterol (low-density lipoprotein, or LDL). Individuals who benefited most from the effects of a low-fat diet, it was found, were those who had been at the highest risk for heart attack and stroke.

A low-fat diet effectively lowered the abnormally high LDL levels in people who have inherited what is called the E-4 variant of apolipoprotein E, a genetic variant that is typically associated with high LDL. About 15 percent of the population have the E-4 variant.

A low-fat diet was also effective in people who have a form of LDL that is called "pattern B." People with "pattern B" LDL characteristically have abnormally low levels of "good" cholesterol (high-density lipoprotein or HDL), which can rise to normal as a result of diet. About 25 percent of the population have "pattern B" LDL.

Diet should therefore usually be tried first before cholesterol- lowering drugs because diet can be effective in many people, especially those at particularly high risk. To lower LDL level, exercise should be added to the diet. Increased physical activity enhances the effects of a low-fat diet in reducing LDL levels. Exercise and diet should ideally be paired.

8. Education of people with heart symptoms to go to the emergency room.

Community campaigns have been designed to teach people about heart attack symptoms and the need for rapid action. The goal is to reduce the time people delay seeking emergency care for heart attacks because, the quicker that people seek treatment, the greater their chances of surviving the heart attack and reducing damage to the heart.

A study was conducted in 20 cities in the U.S. Half of the cities were sites of the community education campaign. In the remainder, the educational program was not conducted. In the cities with the education, more people with heart attack symptoms came to the emergency department. There also was a 10 to 15 percent increase in the number of people choosing to call Emergency Medical Service. In most U.S. cities, one-half to two-thirds of those with possible heart attack arrive in the emergency room by other means than by Emergency Medical Service, a particularly dangerous situation.

9. Epidemic of cardiovascular disease and stroke.

The way age-adjusted death rates from heart attack and stroke are calculated has been updated. Age-adjustment works like a currency so that different populations can be compared (or the same populations can be compared) over time to determine trends.

The new age-adjusted death rates have been adjusted to the age- distribution of the U.S. population in the year 2000, replacing the old standard that was based on the age-distribution of the 1940 population. The U.S. population in the year 2000 has more older people than the 1940 population. As a result, heart disease and stroke death rates adjusted to year 2000 are much higher than those adjusted to 1940 standard.

10. Nobel Prize for the discovery of nitric oxide (which relaxes blood vessels).

The discovery of nitric oxide and its function is one of the most important in the history of cardiovascular medicine. The 1998 Nobel Prize in Physiology or Medicine was awarded to three American scientists -- Robert F. Furchgott, Louis J. Ignarro and Ferid Murad -- for their discoveries concerning nitric oxide as a signaling molecule in the cardiovascular system.

Nitric oxide, a colorless gas, makes blood vessels dilate (widen) by relaxing the muscles in the vessel wall. Nitric oxide is therefore a key component in blood pressure. Levels of nitric oxide normally rise when someone is in a stressful situation. A lack of nitric oxide in the bloodstream, or a lack of reactivity by the blood vessels to nitric oxide, can narrow the vessel, thus raising the blood pressure. High blood pressure is a major risk factor for both heart disease and stroke.

For more, please visit the High Blood Pressure Center.

Last Editorial Review: 2/1/2005