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Heart Smart: Cardiology News Tips

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Affairs of the Heart

Feb. 14 is not a day to take your heart lightly - especially
if you are alone, according to Duke cardiologists. Being
divorced or separated doubles your risk of coronary disease,
says Dr. Marty Sullivan. Marital support can become a major
preventive tool to ward off or fight illness, he says. He notes
that half of all U.S. deaths result from heart disease -- and
half of all marriages end in divorce. While the association
between the two may not be one-to-one, it is important,
Sullivan says.

Dr. Redford Williams agrees. He has conducted years of
research on the toll that stress takes on the body, and has
found that heart patients who had no one to talk to were three
times as likely to die than patients who had a support system.
"The mere fact that someone was married - whether or not it was
a good marriage - or that someone had a good friend, was
protective."

But being buddies with your children may not do the trick.
Yet another Duke study found that the level of stress hormones
in working mothers rises each morning and stays high until
bedtime, putting them at higher risk than other working women
for health problems such as heart attacks. The good news is
that stress levels don't rise higher depending on the number of
children at home; the bad news is that it just takes one child
to make those hormones zoom skyward - nor does it matter if a
woman has a husband or not. Researcher Linda Luecken believes
the stress is due to the strain of responsibility and meeting
demands at home, rather than stress in the office. Some may
want to know -- will being married to your job save your
heart?

The Mantra Study

Everyone's chanting about complementary medicine right now,
and Duke researchers are trying to analyze whether touch and
relaxation therapy really does make a difference in restoring
health to patients. They are studying hundreds of heart
patients who undergo a cardiac catheterization at either Duke
Hospital or the Durham Veterans Administration Medical Center
to see if any of four different techniques result in better
outcomes.

Because cath patients are awake for their procedure, in
which a thin tube is inserted into the heart through a vein,
they are prone to anxiety, says Duke cardiologist Dr. Mitch
Krucoff. The patients are either receiving traditional care or
one of the four following therapies: stress management
education and meditation training; touch relaxation therapy;
training in imagery and visualization; or, the most unusual of
the treatments, intercessory prayer, in which someone prays for
the patient from afar.

Ironically, the researchers will use a special high-tech
monitoring device to study how well the patients react to what
they call "noetic" interventions - therapy whose influence is
intellectually, intuitively, or spiritually perceived in the
absence of any classically concrete or visible components. The
machines will measure blood pressure, heart rate, cardiac
rhythm, oxygen saturation, pain, anxiety, and other variables
before, during, and after a patient's cath, Krucoff says.

While some major hospitals like Duke use complementary
medicine already, scientific validation will help move these
techniques into the mainstream, says Susan Crater, a nurse
practitioner who is co-leading the project. Adds Krucoff, "We
are looking for something, besides drugs and devices, that
constitutes a healing space."

Question: When Can Heart Disease Be Like an Ulcer?

One answer: When a bacteria could be the root of the
problem. Just as the bacteria Helicobacter pylori -- and not
stress or spicy foods -- was shown to be a cause of peptic
ulcers, many researchers believe that another common bug may be
implicated in some cases of coronary artery disease.

The potential culprit is Chlamydia pneumoniae, a cousin of
the sexually-transmitted disease strain, and it can be
successfully treated by antibiotics.

"Several pathology and epidemiological studies have shown an
association between these bacteria and coronary artery
disease," says Dr. Murray Abramson, infectious disease
specialist at Duke. "And a recent small study published in the
Lancet showed that a similar antibiotic had a beneficial
effect. It seems logical then, to see if treating these
patients with antibiotics would have any effect on their
disease."

So was born a clinical trial that has just enrolled more
than 3,000 heart attack patients. The study, being conducted by
Duke, Duke-trained physicians around the country, and a
manufacturer of the antibiotic, will follow these patients for
more than two years to see if the antibiotic treatment has any
positive effect on future cardiac events or death. Duke
cardiologist Christopher O'Connor and Abramson head Duke's
portion of the trial

"At this point we don't know chlamydia's exact role in
coronary artery disease or why there is an association. And we
also don't know why the antibiotic is so effective against it,"
Abramson says. "For me, finding a link between an infectious
agent and something that previously hadn't been considered
infectious is very exciting. Time will tell the rest of this
very interesting story."

Angiogenesis As Treatment: A Cautionary Tale

Angiogenesis may be viewed as the Holy Grail in cardiology,
but it is not without its risks, according to Duke cardiologist
Dr. Brian Annex.

Researchers are eager to understand how angiogenesis, the
growth of new blood vessels, could help nourish blood-starved,
moribund heart tissues. And they want to know if stopping it
will starve nutrient flow to growing tumors.

Annex recently studied portions of human coronary arteries
removed because of atherosclerosis and he saw that new vessel
growth was occurring in half of the patients with unstable
angina, but only in 10 percent of those patients with stable
angina. Unstable angina often leads to death.

According to Annex, this is the first time that new vessel
growth in atherosclerosis has been linked to actual clinical
symptoms.

"There is incredible enthusiasm in the medical community
about finding out how to make new blood vessels grow," Annex
says. "But while there is great deal of potential here, we need
to keep our eyes open and be constantly aware that angiogenesis
is a part of atherosclerosis.

"In the current environment of pushing angiogenesis as a
possible treatment for coronary artery disease, this study may
be a cautionary tale," he says.

Heart Therapy: His and Hers

If a woman has heart disease, should she be treated the same
as a man?

Duke researchers believe they have the beginning of an
answer. An analysis of gender differences in 164 individual
clinical trials including more than 46,000 women and 160,000
men shows that women respond as well as men to medical
treatment of heart disease.

According to Duke cardiologist Dr. Kristen Newby, the result
dispels a growing concern that a woman's heart may not respond
to drug treatment the same as a man's. It also means that
physicians, who traditionally have not recognized heart
diseases as quickly in women as in men, need to see women as
candidates for the same types of therapies as men.

To Norwood or To Transplant?

Pediatric surgeons have long been able to restructure tiny
hearts, saving many of the 30,000 children born each year with
congenital malformations. But there is one tragic exception - a
devastating disorder known as hypoplastic left heart syndrome
(HLHS).

In these children, either the vessels around the heart's
main pump, the left ventricle, or the left ventricle itself, is
withered or non-existent. Within days of birth, it becomes
obvious that the child's body is not receiving enough
oxygen-rich blood.

This had been a death sentence correctable by only a heart
transplant, but now a second option exists and Duke is one of
the few centers that offers both. The new approach, called the
Norwood procedure, is essentially a re-plumbing job,
accomplished by three separate surgeries over 18 months.

"We essentially turn the right ventricle, which is
responsible for pumping blood to the lungs to pick up oxygen,
into a left ventricle," says Dr. James Jaggers, pediatric heart
surgeon at Duke. Now physicians are trying to understand which
procedure works best. While transplantation offers the benefits
of a brand-new heart that will grow as the child grows,
recipients must take immunosuppressive drugs for the rest of
their lives. The severe shortage of donor organs, especially
those from children, make this an option for only a handful of
children. So, while the jury is still out on which approach is
the best, children with HLHS who don't get a transplant no
longer face an automatic death sentence.

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