Archive for the ‘Cardiovascular Medicine’ Category

Angiotensin-Receptor Blockades (ARBs) Found to Raise Risk of Cancer

July 9, 2010

Dr. Daniel Simon M.D., Division Chief of Cardiovascular Medicine and Director of HM-Heart and Vascular Institute at UHCMC; Dr. James Fang M.D., Section Chief of Heart Failure and Medical Director of Heart Transplantation at UHCMC; IIke Sipahi M.D., Associate Director of Heart Failure & Transplantation at UHCMC at the Harrington-McLaughlin Heart & Vascular Institute of UHCMC researched the effects of Angiotensin-Receptor Blockers (ARBs) on the risk of cancer.

ARBs are a widely utilized drug class used for treatment of hypertension, heart failure, diabetic nephropathy, and recently, for cardiovascular risk reduction.

Randomized controlled trials of ARBs with a follow-up of at least 1 year, and enrolling at least 100 patients were included in this meta-analysis. Information on new cancer development (first diagnosis) was available for 61,590 patients from five trials. Cancer data on common types of solid organ cancers such as lung and prostate cancer were available for 68,402 patients from five trials, and data on cancer deaths were available for 93,515 patients from eight trials.

The meta-analysis showed that patients randomly assigned to receive ARBs had a significantly increased risk of new cancer occurrence compared with patients in control groups (7.2%vs 6.0%). Specifically, the risk of lung cancer was increased by 25%, which was also statistically significant.

“We have found the risk of new cancers was increased with these medications by 8-11 percent.  Most importantly, risk of lung cancer was increased by 25 percent,” said Dr. Sipahi. Although there was no statistically significant excess in cancer deaths (1.8% with ARBs vs 1.6% with control) the investigators pointed out that the average duration of follow-up of 4 years may be too short to capture cancer deaths.

“In medicine, physicians must balance the benefits and risks of all drug and device therapies.  We recommend that patients discuss the findings of this study with their physicians since ARBs are effective agents in the treatment of high blood pressure and heart failure,” said Dr. Simon.

They conclude that because of the limited data, it is not possible to draw conclusions about the exact risk of cancer associated with each individual ARB on the market, but they stated that their findings need further investigation.

In response to this publication from Case Western Reserve University, the European Medicines Agency (EMA) of the European Union announced that they started an investigation about the possible cancer risk of ARBs.

“This is the first time an association between ARBs and cancer development is suggested,” Dr. Sipahi continued. “While our findings are robust, they need to be replicated in other studies before they can be considered as definitive.”

The US Food and Drug Administration has not made any statement regarding this issue yet.

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The Prophetic Protein :: Who is at risk for heart attack?

June 25, 2010

Tense hours in the emergency room while tests confirm a heart attack may be rolled back to mere minutes, thanks to a telltale protein marker identified by Case Western Reserve University School of Medicine researchers. Better yet, a routine blood test for the nefarious protein could serve as an early warning to people at high risk :: Take steps now, and you may dodge the dangerous attack altogether.

When the proverbial elephant takes a seat on one’s chest, it is a decided hint: That person might be having a heart attack, or myocardial infarction (MI). Every 25 seconds, someone in the United States has one, according to the American Heart Association, but the oft-reported sensation of chest tightening or pain is just that-a clue. Even in the hospital, it can take eight to 12 hours for current tests to conclusively rule a heart attack in or out. Common alternative culprits in chest pain are intense heartburn or a gallstone attack.

Led by top physician-researcher Daniel I. Simon, MD, investigators at the School of Medicine, however, have discovered a marker of heart attack that promises to cuthours off the time for definitive MI diagnosis-to the tune of confirmation within 10 to 15 minutes of arriving at the emergency room. What’s more, a simple blood test for the novel myeloid-related protein-8/14 (MRP-8/14) marker could give long-used cholesterol screening a run for its money as a signal of MI in the making, years ahead of the cardiac attack.

“Though we gain great insight into patients’ potential risk for cardiovascular disease using conventional biomarkers, we are limited in identifying some people at risk,” says Douglas Vaughan, MD, professor of cardiology at Northwestern University’s Feinberg School of Medicine and chair of its Department of Medicine. “An additional marker measured in people’s blood could valuably refine our ability to take care of patients with coronary artery disease.”

To hone in on the up-and-coming predictive protein MRP- 8/14, researchers applied an unprecedented scientific approach that scoured entire human genomes for cardiac warning signs. “We were on the hunt. We wanted to know what genes turn on or off in heart attack patients,” explains Dr. Simon, the Herman K. Hellerstein Professor of Cardiovascular Research at the School of Medicine and director of University Hospitals Harrington-McLaughlin Heart & Vascular Institute. Dr. Simon and his team of researchers identified MRP-8/14 as their best-bet marker for heart attack for use in emergency settings and as a potential companion to routine cholesterol screening in the doctor’s office.

Dr. Simon’s account is a tale of finding a little molecule with big potential-a project born in a lab in New England that has grown on a campus in Cleveland.

Read the full story at Medicus.

Much-needed complement to cholesterol testing

June 25, 2010

For patients outside the highest and lowest traditional risk factor categories, based on factors like high cholesterol, smoking, diabetes, hypertension and family history of heart disease, MRP-8/14 could become a prominent diagnostic tool. “We are attempting to determine whether the use of MRP-8/14 should sway us toward more aggressive preventive therapies,” says Carl Orringer, MD, the HarringtonMcLaughlin Chair in Preventive Cardiovascular Medicine at the School of Medicine.

Currently, a “high-sensitivity C-reactive protein” (hs-CRP) assay is sometimes used in conjunction with cholesterol tests to assess heart disease risk. Like hs-CRP, MRP-8/14 represents a different biological process than cholesterol and is likely to serve as a complement to, not a substitute for, cholesterol screening. Of cholesterol testing’s shortcomings, Dr. Orringer says, “Relying on cholesterol alone is ignoring the inflammation that lights the fuse that sets off the explosion that is the heart ttack.”

Dr. Orringer, who developed an innovative heart attack risk assessment program that uses CT scans to see whether a person has hardening of the arteries, believes that MRP-8/14 may come to be incorporated to aid in risk estimation.

“A person’s heart attack risk is related to how much calcium is in the arteries—the more calcium, the greater the risk,” Dr. Orringer explains. “Those with calcium in their arteries indicating atherosclerosis might be really good candidates for MRP-8/14 evaluation to see who is at the highest risk.”

Director of Institute for Transformative Molecular Medicine, Inaugural Robert S. and Sylvia K. Reitman Family Foundation Distinguished Chair in Cardiovascular Innovation

June 25, 2010

Pamela B. Davis, M.D., Ph.D., dean of the Case Western Reserve University School of Medicine, announced the appointment of Jonathan S. Stamler, M.D., as the director of the Institute for Transformative Molecular Medicine and the first to hold the Robert S. and Sylvia K. Reitman Family Foundation Distinguished Chair in Cardiovascular Innovation at the Case Western Reserve University Cardiovascular Center and University Hospitals Harrington-McLaughlin Heart & Vascular Institute.

The newly established chair was made possible by a $1.5 million gift from the Reitman Family Foundation and was slated to be held by a preeminent physician scientist dedicated to advancing cardiovascular medicine through compassionate patient care, clinical research, and training of fellows and residents.

As director of the Institute for Transformative Molecular Medicine, primarily based in the Department of Medicine, Stamler will be charged with developing the Institute, with purview across Case Western Reserve University and University Hospitals. His efforts will catalyze scientific discoveries in molecular medicine, formulate new therapies that benefit humankind, and inspire the next generation of physician scientists.

His research specifically has led to elucidating the fundamental role of nitric oxide in control of complex physiological responses through S-nitrosylation, a protein modification that he discovered. His work has helped to transform the simple notion of cellular redox state into the concept of a dynamic and precisely regulated mechanism for control of protein function, analogous to phosphorylation, but operating through covalent modifications at cysteine thiols. The ramifications of his work extend to all major classes of proteins and accumulating evidence suggests that protein S-nitrosylation is aberrant in many diseases.

Stamler completed his undergraduate studies at Brandeis University, earned his medical degree from Mount Sinai School of Medicine, and completed his medical residency and fellowship training in both cardiology and pulmonary medicine at Harvard Medical School and the Brigham and Women’s Hospital. He joined the faculty of Harvard Medical School as Assistant Professor of Medicine in October 1993. In December of 1993, Stamler joined the faculty of Duke University, where he is currently the George Barth Geller Professor of Research in Cardiovascular Disease and Professor of Medicine and Biochemistry.

Renowned researcher to lead transformative institute

June 25, 2010

A new initiative in translational research at Case Western Reserve University Department of Medicine and University Hospitals promises to catalyze scientific discoveries, formulate new therapies and inspire the next generation of physician-scientists.

Leading the effort will be one of the school’s newest additions: Jonathan S. Stamler, MD, who will serve as founding director of the Institute for Transformative Molecular Medicine. Dr. Stamler is also the first to hold the Robert S. and Sylvia K. Reitman Family Foundation Distinguished Chair in Cardiovascular Innovation at the Case Cardiovascular Center and University Hospitals Harrington-McLaughlin Heart & Vascular Institute.

“This newly established chair in cardiovascular investigation and its relationship to the Institute for Transformative Molecular Medicine will accelerate our scientific research to its full potential and provide new cures and therapies for the patients we serve,” says Richard A. Walsh, MD, physician-in-chief at University Hospitals and the John H. Hord Professor and chair of the Department of Medicine at Case Western Reserve University.

Cardiologists discover cancer risks in group of blood pressure medications

June 24, 2010

University Hospitals Case Medical Center cardiologists have uncovered new research showing an increased risk of cancer with a group of blood pressure medications known as angiotensin-receptor blockers (ARBs).

This class of drugs is used by millions of patients not only for high blood pressure but also for heart failure, cardiovascular risk reduction and diabetic kidney disease.

University Hospitals Harrington-McLaughlin Heart & Vascular Institute’s Drs. Ilke Sipahi, Daniel I. Simon and James C. Fang recently completed a meta-analysis of over 60,000 patients randomly assigned to take either an ARB or a control medication. Their findings are published online today at The Lancet Oncology.

The researchers found that patients randomized to ARBs has “significantly increased risk of new cancer” compared to control patients.

“We have found the risk of new cancers was increased with these medications by 8-11 percent,” said Dr. Ilke Sipahi, associate director of heart failure and transplantation and assistant professor at Case Western Reserve University School of Medicine. “Most importantly, risk of lung cancer was increased by 25 percent.”

However, the research did not establish any link between ARBs and other types of cancer such breast cancer.

“This is the first time an association between ARBs and cancer development is suggested,” Dr. Sipahi continued. “While our findings are robust, they need to be replicated in other studies before they can be considered as definitive.”

Before this study, there were no major safety concerns with ARBs except for their use in pregnancy and in patients with chronic kidney or blockages of kidney arteries. Interestingly, previous animal studies with ARBs have been negative for cancer development.

“In medicine, physicians must balance the benefits and risks of all drug and device therapies,” said Dr. Daniel Simon, director of the Harrington-McLaughlin Heart & Vascular Institute at University Hospitals Case Medical Center and professor at Case Western Reserve University School of Medicine. “We recommend that patients discuss the findings of this study with their physicians since ARBs are effective agents in the treatment of high blood pressure and heart failure. Meta-analyses are a powerful tool to look at low frequency safety signals, but require confirmation with other approaches, such as large national health and managed care registries.”

Good Morning America visits new heart imaging device in Cleveland

May 27, 2010

Dr. Marco Costa found a second blocked artery in Mack Bailey’s heart — and demonstrated to a Good Morning America audience the first vascular-imaging technology based on optical coherence tomography (OCT) — at the same time Thursday.

Costa is an interventional cardiologist and director of the cardiovascular research institute at University Hospitals Case Medical Center in Cleveland, Ohio. Bailey is a 60-year-old Clevelander with had a heart attack and is being treated by Costa.

Both agreed to be filmed and interviewed by the NBC morning news show because University Hospitals is the first — and so far only — hospital to use the C7-XR Imaging System and accompanying C7 Dragonfly Imaging Catheter made by LightLab Imaging Inc. during patient heart procedures.

While using the technology to place a stent in one of Bailey’s heart arteries, Costa found a second blocked artery that had not shown up on images of Bailey’s heart. Costa ended up placing two stents, that day.

“If he had gone home this weekend without having this procedure today, he would have gone home with a very nice, well-placed stent in the vessel that did not cause the heart attack,” Costa said during the Good Morning America segment.

The LightLab system uses near-infrared light to produce high-resolution, real-time images that are better and faster than images produced by competing ultrasound technology. The system recently was approved for sale by the Food and Drug Administration. UH Case Medical Center was the core laboratory on the FDA approval study and analyzed the study’s results, according to the Case Western Reserve University School of Medicine blog.

Impotence plus heart disease ups death risk – Dr. Sahil Parikh discusses the study

May 27, 2010

Reuters Report ::

Men with heart disease who also have erectile dysfunction die sooner than men who do not seek treatment for impotence, researchers reported on Monday.

They found that men who had both conditions were twice as likely to die from any cause and twice as likely to have a heart attack than men with heart disease alone.

The researchers expressed concern that using drugs such as Pfizer’s Viagra or Eli Lilly’s Cialis to treat erectile dysfunction could mask the symptoms that point to widespread heart and artery disease and said men complaining of impotence should be checked by a cardiologist.

“Erectile dysfunction is something that regularly should be addressed in the medical history of patients; it might be a symptom of early atherosclerosis,” Dr. Michael Bohm of the University of Saarland in Germany, who led the study, said in a statement.

His team studied 1,519 men in 13 countries taking part in some larger studies of various heart disease treatments. As part of the study the men were also asked about erectile dysfunction.

More than half of them, 55 percent, did, Bohm’s team said in a report published in the journal Circulation and also presented at a meeting of the American College of Cardiology.

During the two years of the study, 11.3 percent of the patients who reported erectile dysfunction died, compared to 5.6 percent of those with mild or no impotence problems.

“It has long been known that erectile dysfunction is a marker for cardiovascular disease,” said Dr. Sahil Parikh at University Hospitals Case Medical Center in Cleveland, Ohio, who was not involved in the study.

The first impotence drug, Pfizer’s Viagra, known generically as sildenafil, was at first developed to lower blood pressure, he said.

“They realized it had this other effect, which patients quite enjoyed,” Parikh said in a telephone interview.

HAPPY SIDE-EFFECT

Viagra and rival drugs such as Eli Lilly’s Cialis and Bayer AG’s BAYG.DE Levitra all work by increasing blood flow.

“In order to have proper erectile function, you have to have adequate blood flow to the genitals. If you have atherosclerosis, whether in the arteries on the neck, which can cause stroke, or the arteries of the heart, which can cause heart attack … it is the same disease.”

But while the erectile dysfunction drugs help blood flow all over the body, they do not treat the underlying hardening and narrowing in the arteries that is causing the problem.

“If patients have erectile dysfunction, we have to be very aggressive about screening and treating them for heart disease,” Parikh said.

When Viagra came onto the market, many health experts welcomed it as a way to get men who might otherwise neglect their health to go to a doctor. But Bohm and Parikh both agreed that patients — and their doctors — need to look hard at the hearts of men with erectile dysfunction.

“Men with ED going to a general practitioner or a urologist need to be referred for a cardiology workup to determine existing cardiovascular disease and proper treatment,” Bohm said.

“The medication works and the patient doesn’t show up any more,” he added. “These men are being treated for the ED, but not the underlying cardiovascular disease.”

The drugs are wildly popular. Viagra alone had sales of nearly $2 billion in 2009.

CWRUmedicine’s Dr Marco Costa feature on ABC’s Good Morning America

May 20, 2010

Marco Costa, MD, PhD, Medical Director, Cath Lab, Director, Center for Research & Innovation, will be featured in an exclusive segment tomorrow on ABC’s Good Morning America between 7:30 and 8 am.

Dr. Costa was filmed in the Stereotaxis Lab in Lerner Tower conducting the United States’ first ever Optical Coherence Tomography (OCT) procedure using the newly FDA approved C7-XR Imaging System made by LightLab. A pair of Dr. Costa’s patients will be featured in the story highlighting the speed, accuracy and new imaging technology that provides doctors faster operating times and improved accuracy.

This breakthrough intravascular imaging technology allows the clinician to readily see and measure important vessel characteristics otherwise invisible or difficult to observe with older intracoronary imaging modalities. UH Case Medical Center served as the core lab in the study prior to its FDA approval and was responsible for analyzing the study results. To date, UH Case Medical Center is the only hospital in the country where this procedure is available for patients.