5 New Findings About Heart Disease

March 16, 2015

Research presented at the American College of Cardiology’s Annual Scientific Session and other developments make the news.

Patients with symptoms of heart disease have similar outcomes in terms of death and major cardiac conditions regardless of whether they undergo a functional stress test or a computed tomographic scan, according to research presented at the American College of Cardiology’s 64th Annual Scientific Session in San Diego.

This and other developments about cardiovascular disease (CVD) are making the news.

The findings are highlighted on the pages that follow:

Heart CT Scans Show Benefits Over Functional Tests

• A computed tomographic scan may be better at ruling out the need for subsequent tests and procedures in patients who are free of heart disease.

• The PROMISE trial is the first-ever randomized controlled trial to compare clinical outcomes in patients receiving functional stress testing or computed tomographic angiography to check for signs of CVD.

• The trial also provides the first data to inform clinical guidelines on the use of these tests, the authors said.

• The study included 10,003 patients who visited 193 health centers in the United States and Canada. Participants had no prior diagnosis of coronary artery disease but had new symptoms that made physicians suspect they might have heart disease.

• Nearly all had at least 1 CV risk factor, such as high blood pressure, diabetes, or a history of smoking.

• The study showed no differences between patients receiving a heart CT scan and those receiving functional heart tests in terms of the study’s primary end point, a composite rate of death, heart attack, major procedural complications, or hospitalization for chest pain.

• The authors said that the results are important because current clinical guidelines leave the selection of tests for patients reporting symptoms such as chest pain or shortness of breath largely up to physician and patient preference.

Docs Want to Learn More About Diet and CVD Prevention

Most physicians are aware of the importance of lifestyle factors in preventing CVD and think that diet is as important as statin therapy and exercise, according to a survey from NYU Langone Medical Center.

• A majority of doctors would welcome additional training in diet and nutrition so that they can effectively inform patients on the subject.

• The 28-question online survey, completed by 236 cardiologists and internal medicine physicians and trainees, was designed to identify gaps in nutritional knowledge and to evaluate physician attitudes and practices concerning diet in the prevention of CVD.

• Most of the survey respondents (78%) were open to additional training and thought it would result in better patient care.

• Just over half of the physicians said they currently spend 3 minutes or less educating patients about diet and lifestyle.

Women, Men React Differently to Heart Disease

The latest gender-specific research on heart disease continues to show differences between women and men:

• In a qualitative study of 30 female heart attack survivors, women inaccurately assessed their personal risks of heart disease, reported poor preventive health behaviors, and delayed seeking medical care.

• In an analysis of nearly 86,000 veterans, including more than 3000 women who had initial cardiac catheterizations, women veterans were younger than men, more likely to be obese and depressed and have post-traumatic stress disorder, and less likely to have blockages in their arteries.

• In a study of more than 17,000 patients with a new diagnosis of atrial fibrillation, women were at higher risk for stroke than men.

• In a review of heart failure prevalence and therapies, researchers noted that women and men are equally likely to have heart failure, but women are more likely to die. Women are less likely to be referred for advanced therapies, including heart transplant and left ventricular assist device, and if referred, women receive them at a later stage than men.

This research was published online in the March 2015 issue of Circulation: Cardiovascular Quality and Outcomes.

Sauna Use May Reduce Risk of Heart Deaths

The risks of fatal cardiovascular events and all-cause mortality may be reduced in men who use saunas frequently, according to a prospective cohort study of more than 2300 middle-aged men (age 42 to 60 years) in Finland.

• After a median follow-up of nearly 21 years, compared with men who reported 1 sauna bathing session per week, the risk of sudden cardiac death was 22% lower for 2 or 3 sauna bathing sessions per week and 63% lower for 4 to 7 sauna sessions per week.

• The risk of fatal coronary heart disease events was 23% lower for 2 or 3 bathing sessions per week and 48% lower for 4 to 7 sauna sessions per week compared with once a week.

• CV death also was 27% lower for men who took saunas 2 or 3 times a week and 50% lower for men who were in the sauna 4 to 7 times a week compared with men who used the sauna once per week.

• For all-cause mortality, sauna bathing 2 or 3 times per week was associated with a 24% lower risk and 4 to 7 times per week with a 40% reduction in risk compared with only 1 sauna session per week.

• Further studies are needed to establish the potential mechanism that links sauna bathing and CV health. The reasons could include the time spent in a hot room, relaxation time, a leisurely lifestyle that allows for more relaxation time, and the camaraderie of a sauna.

The researchers published their results online in the February 23, 2015 JAMA Internal Medicine.  

Homeless with Mental Illness at Higher Risk for Serious CVD

The chance of having a myocardial infarction, a fatal or nonfatal stroke, or sudden cardiac death over 30 years is 24.5% in a homeless person with mental illness, more than twice the risk in someone the same age and sex with no risk factors for the disease.

• The risk is significantly greater among men than women and is higher among those with a substance abuse problem.

• Canadian researchers assessed the CVD risk factors in 352 homeless persons with mental illness. In calculating the 30-year risk of CVD, the researchers examined associations with need for mental health services, diagnosis of psychotic disorder, sex, ethnicity, access to a family physician, and diagnosis of substance dependence.

• Many of the factors that might be associated with the 30-year CV risk among homeless adults with mental illness were not significant, such as not having a family doctor or having a diagnosis of psychosis or having a higher need for mental health services.

• Smoking represents a key modifiable CVD risk factor and is known to be a common behavior among both homeless persons and those with mental illness, the researchers noted.

The researchers published their results in the February 23, 2015 BMC Public Health.

Take-home Messages:

• Patients with symptoms of heart disease have similar outcomes in terms of death and major cardiac conditions regardless of whether they undergo a functional stress test or a computed tomographic scan.

• Most physicians are aware of the importance of lifestyle factors in preventing CVD and think that diet is as important as statin therapy and exercise.

• There are numerous differences between men and women in heart disease risks.

• Regular sauna bathing may reduce the risk of sudden cardiac death and fatal CVD.

• The 30-year risk of serious CVD is particularly high in homeless men.