Posts Tagged ‘james fang’

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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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.”

Uninsured heart attack victims delay ER trip :: Watch Dr James Fang as he discusses this issue with NBC

April 14, 2010

Uninsured heart attack victims delay ER trip

A new study of heart attack patients finds those without insurance or patients with very limited coverage are more likely to delay going to the emergency room when they’re having heart attack symptoms.

That’s a huge mistake, according to Arnold’s cardiologist, Dr. James Fang of University Hospitals Case Medical Center  in Cleveland.

“If you can get to somebody within what they call the golden hour, very first hour that this is occurring the chances of their long-term survival is very close to patients who never had a heart attack,” Fang said.

Watch the video :: http://bit.ly/amhEtS

James Fang discusses LVADs for End-Stage Heart Failure with WebMD

April 11, 2010

More than 5 million Americans have heart failure, a progressive and often lethal condition that weakens the heart and saps its pumping power. The mainstays of treatment — including drug therapy, lifestyle modification, and surgery to implant pacemakers or defibrillators — can be quite effective at managing symptoms of mild to moderate heart failure.

But what about the estimated 150,000 Americans who suffer from chronic, severe heart failure?

Doctors traditionally have had little to offer these patients in the way of lifesaving treatment, short of a heart transplant. But with only about 2,100 donor hearts available each year, the demand for hearts inevitably outweighs the supply. And some patients are simply too old to qualify for a transplant. For them, what’s the alternative?

There’s now an option that could change the outlook for many with severe heart failure: implantable mechanical pumps called left ventricular-assist devices (LVADs or sometimes simply VADs.)

These devices were once just used as a “bridge” — a temporary stopgap to keep heart failure patients alive until they could get a heart transplant. But now, they have become so effective that doctors use them as a treatment in themselves. LVADs are now an alternative to heart transplants, permanently augmenting the action of a heart’s main pumping chamber.

In addition, the continuous-flow LVAD was associated with fewer infections and a significantly lower rate of failure.

“The continuous-flow LVAD has changed the landscape of advanced heart failure,” says James C. Fang, MD, chief medical officer of the Harrington-McLaughlin Heart and Vascular Institute at University Hospitals Case Medical Center in Cleveland and the author of an editorial on LVADs that accompanied the study in the New England Journal of Medicine.

“In addition to being more durable, the new device is a lot smaller – about the size of a D battery. It’s also quiet. You can barely hear it. With the old devices, you could hear them coming down the street.”

Find the full article on CWRUmedicine.org

Dr James Fang discusses the VAD Approach

March 24, 2010

An alternative one-on-one, patient-oriented approach to  heart disease and heart failure

According to James C. Fang, MD, Medical Director, Advanced Heart Failure & Transplant Center and Professor, Case Western Reserve University Department of Medicine, “The mission of the Advanced Heart Failure & Transplant Center is to provide the latest and most effective therapies to patients in Northeast Ohio and surrounding regions in a personalized one-on-one, patient-centered approach.”

With a high level of expertise in treating heart failure, performing heart transplants, and implanting VADs (also known as heart pumps), the Center offers another sophisticated site in Ohio for patients to consider for their heart and vascular health. One of the most important services provided by the physicians at the Center is their ability to review a patient’s current medical and device therapies and then to provide other treatment options to improve their prognosis and quality of life. “At University Hospitals Case Medical Center, we offer many options and a very personalized approach. We are proud of the fact that we offer very individualized care,” says Dr. Fang. “Many patients don’t recognize that they are suffering needlessly.”

The VAD Option
Patients seen at the Center have refractory congestive heart failure and continue to be short of breath despite medications, device therapy (such as biventricular pacemakers) and heart surgery. These patients find that even doing simple activities like taking a shower or sitting in a chair are difficult. In addition, they cannot stay out of the hospital for very long – they are often regularly admitted for shortness of breath and fluid buildup in the legs. Such patients may be candidates for heart transplantation or a VAD.

VADs are sophisticated, miniaturized pumps that help the heart to provide sufficient blood flow throughout the patient’s body. “VADs are the newest form of a mechanical heart,” says Dr. Fang. A healthy heart can normally pump about 5 L of blood per minute around the body at rest. If, for example, a patient’s heart can pump only 1 L of blood per minute, the VAD will pump an additional 4 L, for a total of 5 L of blood per minute. “The heart pump helps,” notes Dr. Fang, “without entirely taking over the function of the heart.”

Typically, heart pumps are used temporarily while a patient awaits a heart transplant. Current first generation VADs, such as the Thoratec Heartmate XVE, are also used as a “destination” therapy – a permanent solution for heart failure. These devices can function for 12 to 18 months before they must be replaced. It is anticipated that a new, second generation of heart pumps, now undergoing investigational study, will increase the duration of ventricular assistance to two to four years. Nationwide about 2,500 heart transplant operations are performed annually and the Advanced Heart Failure & Transplant Center’s heart surgeons have collectively performed hundreds of heart transplants.

Learn more about VADs at CWRUmedicine.org