Heart disease is the leading cause of death for both men and women, reports the Centers for Disease Control and Prevention. About 610,000 people die of heart disease in the United States every year – that’s one in every four deaths.
Coronary artery disease (CAD) is the most common type of heart disease in the United States, killing more than 370,000 people annually. For some people, the first sign of CAD is a heart attack.
CAD is caused by plaque buildup in the walls of the arteries that supply blood to the heart. Plaque is made up of deposits of cholesterol and other substances in the artery. Too much plaque buildup and narrowed artery walls can make it harder for blood to flow through the body. When the heart muscle doesn’t get enough blood, the result can be chest pain or discomfort, called angina.
Over time, CAD can weaken the heart muscle. This may lead to heart failure, a serious condition where the heart can’t pump blood the way that it should. An irregular heartbeat, or arrhythmia, also can develop.
High blood pressure, high cholesterol and smoking are key risk factors for heart disease. About half of Americans (47 percent) have at least one of these three risk factors. Several other medical conditions and lifestyle choices can also put people at a higher risk for heart disease, including:
- Diabetes
- Overweight and obesity
- Poor diet
- Physical inactivity
- Excessive alcohol use
For more information, visit the CDC website at https://www.cdc.gov/heartdisease/facts.htm
Vitamin B7 may interfere with lab tests
The U.S. Food and Drug Administration issued a “Safety Communication” in November, alerting the public that taking biotin – also known as vitamin B7 – can interfere with certain lab tests, including tests for markers of cardiac health, such as troponin.
Biotin in blood or other samples taken from patients who are ingesting high levels of biotin in dietary supplements can cause clinically significant incorrect lab test results. The FDA has seen an increase in the number of reported adverse events, including one death, related to biotin interference with lab tests.
Biotin in patient samples can cause falsely high or falsely low results, depending on the test. Incorrect test results may lead to inappropriate patient management or misdiagnosis. For example, a falsely low result for troponin, a clinically important biomarker to aid in the diagnosis of heart attacks, may lead to a missed diagnosis and potentially serious clinical implications. The FDA has received a report that one patient taking high levels of biotin died following falsely low troponin test results when a troponin test known to have biotin interference was used.
The FDA is aware of people taking high levels of biotin that would interfere with lab tests. Many dietary supplements promoted for hair, skin, and nail benefits contain biotin levels up to 650 times the recommended daily intake of biotin. Physicians may also be recommending high levels of biotin for patients with certain conditions such as multiple sclerosis (MS).
Patients and physicians may be unaware of biotin interference in laboratory assays. Even physicians who are aware of this interference are likely unaware as to whether, and how much biotin, patients are taking. Since patients are unaware of biotin interference, they may not report taking biotin supplements to their physicians, and may even be unaware they are taking biotin (e.g., when taking products generally labeled for their benefits to hair and nails).
To view the FDA Safety Communication, go to https://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/ucm586505.htm
Cardiac troponin is the biomarker of choice
A recent article in JAMA Internal Medicine evaluated recent literature as well as a report by the American College of Cardiology and the European Society of Cardiology, all of which demonstrate that cardiac troponin is the biomarker of choice, reports COLA, the lab accreditation organization.
“The research shows that cardiac troponin alone is adequate in the evaluation of patients with suspected heart muscle damage because of its nearly absolute myocardial tissue specificity and high clinical sensitivity in the detection of myocardial injury,” says John Daly, M.D., chief medical officer for COLA. “The reports conclude that CK-MB [Creatine Kinase-MB] provides no additional diagnostic or clinical value in diagnosing heart attacks and can safely be eliminated in the evaluation of a patient for a diagnosis of myocardial infarction.”
In fact, adds Daly, CK-MB performed with cardiac troponin can even cause clinical confusion when the results are contradictory. Because many laboratories offer a default order set that includes both cardiac troponin and CK-MB, it is recommended that order sets be eliminated.
Health screenings are up
By reducing out-of-pocket costs for preventive treatment, the Affordable Care Act appears to have encouraged more people to have health screenings related to their cardiovascular health a UCLA study found. Comparing figures from 2006 through 2013, researchers found that more people were screened for diabetes, high cholesterol, cigarette use and high blood pressure – all risk factors for heart disease – after the ACA was implemented than before.
The research, published in the peer-reviewed American Journal of Managed Care, found that from 2006 to the fourth quarter of 2013, the percentage of doctor visits during which diabetes screening was performed increased to 7.6 percent from 3.9 percent; during which people talked to their doctors about smoking, to 74.5 percent from 64.4 percent; and during which screening for high blood pressure, or hypertension, was performed to 76.4 percent from 73.2 percent.
But the research also revealed a disparity between men and women in one key area. Although more men who are at risk for heart attacks and stroke take daily doses of baby aspirin, the number of women taking baby aspirin each day is unchanged since before the ACA became law. Baby aspirin is commonly prescribed to people at risk for heart attack and stroke.
“There has been a lot of concern about women receiving poorer quality cardiovascular care, and our study reinforces this concern,” said Dr. Joseph Ladapo, the study’s lead author and an associate professor of medicine in the division of general internal medicine and health services research at the David Geffen School of Medicine at UCLA.
Data for the study was drawn from the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey data from 2006 to 2013.
Four legs good
Regular screenings, a proper diet and plenty of exercise all have their place in helping prevent heart disease. Dog ownership is another.
In a population-based study with 12 years of follow-up, researchers in Sweden showed that dog ownership is associated with a lower risk of cardiovascular disease in single households and with a reduced risk of cardiovascular and all-cause death in the general population. The results of the study were published in the journal Nature.
“One mechanism by which dog ownership could reduce CVD risk and mortality is by alleviating psychosocial stress factors, such as social isolation, depression and loneliness – all reportedly lower in dog owners, the researchers write. “These factors have been linked to increased risk of coronary heart disease, cardiovascular death and all-cause mortality.
“Dog ownership has also been associated with elevated parasympathetic and diminished sympathetic nervous system activity, lower reactivity to stress, and faster recovery of blood pressure following stressful activity. Apart from the social support, it has consistently been shown that dog owners achieve more physical activity and spend more time engaged in outdoor activities4.”
Of course, more study is needed to establish a direct causal relationship between dog ownership and better cardiovascular health, the researchers say. “Although careful attention was paid to adjusting for potential confounders in a set of sensitivity analyses, it is still possible that personal characteristics that we did not have information about affect the choice of not only acquiring a dog, but also the breed and the risk of CVD.”
CPR training will demand feedback devices
The American Heart Association will require the use of an instrumented directive feedback device in all courses that teach adult CPR skills, effective Jan. 31, 2019. The devices provide real-time, audiovisual and corrective evaluation and instruction on chest compression rate, depth, chest recoil and proper hand placement during CPR training.
The Association reports that studies reveal that this technology, which can be integrated into or serve as an accessory to a manikin, helps students master CPR skills and reduces the time between training and demonstration of competence in a training environment. This new requirement impacts the AHA’s Basic Life Support (BLS), Advanced Cardiovascular Life Support (ACLS), ACLS for Experienced Providers and Heartsaver® adult CPR training coursestaught in the United States and internationally.
When CPR is taught and performed according to the American Heart Association’s CPR and ECC Guidelines, chest compressions are delivered at a rate of 100 to 120 compressions per minute and a depth of at least 2 inches. To comply with the new course requirement, feedback devices must, at a minimum, measure and provide real-time audio and/or visual feedback on compression rate and depth, allowing students to self-correct or validate their skill performance immediately during training.
On ZOLL’s AED Plus® and the AED Pro®, rescuers hear – and see – “Push Harder” or “Good Compressions,” as well as encouragement to “Start CPR” if needed, according to the company. On the R Series® and the X Series®, Real CPR Help provides numeric displays of both rate and depth, as well as verbal feedback, if desired, to “Push Harder” or “Good Compressions.”
Each year, more than 350,000 cardiac arrests occur outside the hospital and over 200,000 occur in a hospital setting, according to the American Heart Association. Only 46 percent of people who suffer an out-of-hospital cardiac arrest receive bystander CPR before professional help arrives. CPR, if performed immediately and correctly, can double or triple a victim’s chance of survival.