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Br J Cardiol 2017;24:15–16 Leave a comment
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Blood test predicts silent heart disease risk

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A high-sensitivity blood test could be used to predict which patients are at risk of myocardial infarction according to new research funded by the British Heart Foundation (BHF) and carried out by the Universities of Glasgow and Edinburgh.

The study, published recently in the Journal of the American College of Cardiology (doi: 10.1016/j.jacc.2016.10.020), shows the troponin test could also be a more effective way of assessing future heart disease risk than blood pressure or cholesterol.

In the study of over 3,000 men with high cholesterol but no history of heart disease, the team found that changes in blood levels of a high-sensitivity troponin test from Abbott Diagnostics accurately predicted the risk of MI or dying of coronary heart disease up to 15 years later.

Troponin improved the prediction of coronary heart disease risk adding to traditional markers, such as cholesterol levels and blood pressure. If borne out in larger, more diverse studies, doctors may be able to use the troponin test to determine which patients are most likely to develop coronary heart disease.

Low levels of bad cholesterol well-tolerated in cardiac patients

Heart disease patients taking PCSK9 inhibitors to achieve very low levels of cholesterol do not experience an increase in adverse events, including memory impairment or nervous system disorders, but may have an increased risk of cataracts, according to a recent study in the Journal of the American College of Cardiology (doi: 10.1016/j.jacc.2016.11.037).

Researchers pooled data from 14 randomised, controlled studies that included 5,234 patients treated with the PCSK9 alirocumab for up to two years. They looked for the occurrence of adverse events in patients who achieved two or more consecutive low-density lipoprotein (LDL) cholesterol values of less than
25 mg/dL (0.65 mmol/L) or less than 15 mg/dL (0.39 mmol/L). An LDL level of 25 md/dL was used because it has been suggested to be the level needed for normal cell function. The overall incidence of adverse events was similar in patients taking alirocumab compared to placebo.

“The safety of these new drugs is critical to patients who have no other means by which to control their life-threatening high cholesterol,” said lead author Dr Jennifer Robinson (Director, Preventive Intervention Center, University of Iowa, USA). “The long-term effects of very low levels of LDL cholesterol are under evaluation in ongoing large clinical trials,” she added.

Mildly excessive body iron stores increase risk of type 2 diabetes

Even mildly elevated body iron contributes to the prevalence and incidence of type 2 diabetes, according to research from the University of Eastern Finland (URN:ISBN:978-952-61-2300-4).

Body iron predicted the risk of type 2 diabetes. There was a slight variation in the risk of type 2 diabetes over a wide range of serum ferritin (sF) concentrations that reflect body iron stores, with a marked increase in the risk observed at high normal range of sF concentrations in men (>185 µg/L).

The thesis investigated the risk of type 2 diabetes over a wide range of body iron stores, as well as whether iron depletion toward mild iron deficiency offers protection against type 2 diabetes risk.

“This study provides a new body of evidence that mildly elevated body iron is an important risk factor of glucose metabolism derangement, which contributes to the increase in the prevalence and incidence of type 2 diabetes,” Dr Aregbesola concludes.

‘Stop smoking’ taster sessions inspire smokers to seek help quitting

Offering smokers a taster session at an NHS Stop Smoking Service and explaining their personal risk of developing smoking-related diseases doubles their likelihood of attending a stop smoking course, according to a recent study in The Lancet (doi: 10.1016/S0140-6736(16)32379-0).

In the trial, 4,384 smokers from across England were either given a routine referral letter or a new personalised letter explaining their individual risk of smoking-related diseases and offering them a stop smoking taster session. The personalised letter included information about how much their risk would reduce if they quit smoking immediately. The calculations were based on information from the person’s medical records.

Six months after receiving the letter, those who had the personalised letter were more than 1.5 times more likely to have gone without a cigarette for a week (9% compared with 5.5%). Those who didn’t attend the Stop Smoking Service were least likely to have quit for a week (4.4% of those who received the personalised letter and 4.9% of those who had the routine letter).

Of those who took up the offer and attended the taster session, and also subsequently attended the Stop Smoking Service, 28.7% achieved seven-day abstinence.

Report highlights national trends in heart disease treatments

Over 93% of heart attack patients are receiving stents within the guideline-recommended threshold of 90 minutes after arriving at the hospital, with the median time to stenting only 59 minutes, according to a broad report on trends in heart disease care from the American College of Cardiology’s National Cardiovascular Data Registry published in the Journal of the American College of Cardiology (doi: 10.1016/j.jacc.2016.12.004).

The authors of the report said the registry data provide unique perspectives into the care and outcomes of heart disease care in the USA and illustrate the strength of national quality programs, like NCDR, in advancing the effectiveness and safety of treatments for heart disease patients.

“We were able to report on the care and outcomes of patients undergoing common cardiovascular procedures, including percutaneous coronary interventions, implantable defibrillators, and interventions for congenital heart disease as well as for patients with acute heart attacks,” NCDR Management Board Chair and lead author Dr Frederick A Masoudi said. “In some cases, hospitals are consistently providing excellent care; the registries, however, allow us to identify those aspects of care where the cardiovascular clinical community can improve.”

Bluetooth blood glucose meters in development

A bluetooth blood glucose monitoring meter is being developed by Roche Diabetes Care to communicate with Medtronic’s insulin pump system.

It will be based on the Accu-Chek Guide platform, which Roche hopes to also integrate into a digital diabetes app, through a partnership with the digital diabetes company mySugr.

Exercise improves arterial health in childhood

Moderate-to-vigorous activity in childhood was associated with better arterial health already in childhood according to a study from the University of Eastern Finland in collaboration with the University of Cambridge.

The study found that in children aged six to eight years, the threshold value for sufficient exercise was 68 minutes of physical activity at the level of at least 5 METs, and 26 minutes of physical activity at the level of at least 6 METs. Children with physical activity below the threshold values had increased arterial stiffness.

Examples of moderate-to-vigorous physical activity include games involving running, ball games, gymnastics and dance.

The study was published in Pediatric Exercise Science (doi: 10.1123/pes.2016-0168).

NICE recommendation for HeartFlow FFRCT in stable chest pain

The National Institute of Health and Care Excellence (NICE) has recommended that HeartFlow® (HeartFlow Inc) can be used to help determine the cause of stable chest pain.

It says the case for adopting the technology for estimating fractional flow reserve from coronary CT angiography (cCTA)  is supported by the evidence, and is non-invasive, safe, and has a high level of diagnostic accuracy.

NICE estimates that the technology may avoid the need for invasive coronary angiography and revascularisation, which at a saving of around £214 per patient, could lead to savings of £9.1 million by 2022 for NHS England.

The medical technologies guidance (MTG32) was published in February 2017  The guidance follows chest pain guidelines published by NICE in November 2016, recommending non-invasive cCTA as the initial diagnostic test for patients with stable chest pain.

Can the internet protect AF patients from stroke?

Every 18 minutes someone in the UK suffers from an atrial fibrillation (AF) related stroke, which equates to roughly 30,000 stroke victims a year. MyTherapy and Anticoagulation Europe have banded together in an effort to raise awareness and reduce the risk.

With the help of the Stroke Association and Thrombosis UK, amongst other organisations, they have prepared an Infographic labelled “Atrial Fibrillation in the UK”. This can be accessed at:

The site also provides advice on apps which patients may find useful, including the MyTherapy app (available for iOS and Android) for supporting patients in safely taking medications, be it warfarin or one of the non-vitamin K oral anticoagulants (NOACs). MyTherapy also reminds patients to take their medication on time and helps with monitoring measurements, such as heart rate and weight.