Should Coke Talk About Heart Health?

By TARA PARKER-POPE

Frazer Harrison/Getty Images for Heart Truth Heidi Klum

Soft drink makers increasingly are being blamed for contributing to the nation’s obesity epidemic. Now a consumer advocacy group is questioning whether Coca-Cola should be allowed to sponsor a national heart health campaign.

The Center for Science in the Public Interest has issued a letter to the National Heart, Lung and Blood Institute asking the agency to end its partnership with Coca-Cola in a program that raises awareness of heart disease among women. Diet Coke is the most prominent sponsor of The Heart Truth campaign, which includes heart graphics on Diet Coke cans and appearances by model Heidi Klum as the “Diet Coke heart health ambassador.”

In a statement, the center’s executive director, Michael Jacobson, compared Coke’s corporate sponsorship to allowing a cigarette maker to fund a government anti-smoking campaign. The fact that the campaign is sponsored by Diet Coke, rather than a sugar-laden soda brand, is irrelevant, he said.

“Coca-Cola promotes heart disease by marketing drinks that contribute to obesity,” Mr. Jacobson wrote. “Coke has long sought to affiliate with or co-opt health groups and associate its brand with athletes and models. I fervently hope that N.H.L.B.I. officials understand that letting Coke bask in their agency’s good reputation does American hearts far more harm than good.”

Coca-Cola defended its participation in The Heart Truth program, saying in a statement:

We’ve used our communications and marketing expertise to reach millions of people with this important heart health message. We’ve made free heart health screenings available to thousands of people across the country. As a result of The Heart Truth campaign, awareness that heart disease is the No. 1 cause of death among women has risen to nearly 70 percent compared to 34 percent in 2000 when the campaign was first introduced. And since Diet Coke has been involved, awareness of The Heart Truth and our support of it has nearly doubled. We are extraordinarily proud of the work we’ve done in partnership with N.H.L.B.I. and Heidi Klum to have a positive impact on the lives of our consumers.

Mr. Jacobson also questioned why other food marketers, such as snack food company Snyder’s of Hanover and Sara Lee Corp. are co-sponsors of the campaign.

What do you think? Should Diet Coke continue as a sponsor of the nation’s heart health awareness campaign? Join the discussion below.

CRP is risk factor for heart disease

CRP (C-reactive protein) is a protein made by the liver which is known to be a ‘marker’ for a state of inflammation in the body. In recent years, there has been growing interest in the role CRP might play in heart disease. For instance, CRP is present in the atherosclerotic plaque that is the hallmark of heart disease. Raised CRP may indicate a state of inflammation in the coronary arteries that may set the scene for heart disease. So should doctors be measuring CRP as a risk factor, as they do cholesterol and blood pressure?

A report from the Emerging Risk Factors Collaboration, led by doctors at the University of Cambridge, UK, suggests that we should, indeed, take CRP seriously as a risk factor in heart disease. In this meta analysis, they looked at CRP and other risk factors in 54 long-term prospective studies covering over 160,000 people. CRP was found to be associated with various known heart disease risk factors, like high cholesterol, and with other inflammatory markers. Higher CRP was linked to increased risk of heart disease, stroke, death from these conditions, and overall mortality.

These findings do not, however, prove that CRP actually causes heart disease or stroke, although other studies have suggested it may play a part in blood clotting or rupture of plaque in the arteries, triggering heart attack and stroke. It has also been argued that measuring CRP might help to pinpoint patients at high risk of heart disease more accurately. Some studies have shown, for example, that patients with high CRP may have more to gain from treatment with cholesterol-lowering statins. Further studies are now needed to clarify the role of CRP in heart disease and stroke. Drugs that target CRP are currently in development; it will be interesting to see if these will be a new approach to the prevention and treatment of heart disease and stroke.

Source:

The Emerging Risk Factors Collaboration C-reactive protein concentration and risk of coronary heart disease, stroke, and mortality: an individual participant meta-analysis The Lancet January 9 2010;375:132-140

PrimeCuts: This Week in the Journals

Rachel Bond, MD

Faculty peer reviewed

August 12, 2003. Rosuvastatin aka Crestor becomes FDA approved in combination with diet and exercise to increase HDL cholesterol (HDL-C), reduce total cholesterol (TC), LDL cholesterol (LDL-C), apolipoprotein B, non-HDL cholesterol and triglycerides in patients with known hyperlipidemia and mixed dyslipidemia. [1] Additionally, guidelines propose the use of statins in patients with hyperlipidemia and diabetes and/or established vascular disease.[2] These effects have been shown to slow down the progression of atherosclerosis and ultimately reduce the risk of cardiovascular disease (CVD) such as myocardial infarction (MI), stroke and/or death from CVD.

All of this sounded great; however, recent research has shown that nearly half of all MI’s and strokes occur amongst apparently healthy men and women with levels of LDL-C that are below currently recommended thresholds for treatment with statins.[3] What are we to do now? Fast-forward to six year, five months and twenty seven days later…

February 8, 2010. The FDA approves a new indication, making Rosuvastatin the first and only statin to receive the additional indication for primary prevention of CVD in healthy adult patients with normal LDL-C levels, an increased risk for CVD based on age, elevated high-sensitivity C-reactive protein (hsCRP) levels and the presence of one additional CVD risk factor,[4] such as hypertension, low HDL-C, smoking or family history of premature heart disease.

As reported by Reuter’s in The NY Times Business Section “this clears the way for the drug to be used by millions of people who are not typically prescribed the drug now…likely increasing sales of the drug .”[5] This statement leads one to think: does this new approval help in the advancement of preventive medical research for the betterment of our patient population or is this just another way for pharmaceutical companies to make a whopping profit? Hmmm, maybe it’s a little bit of both.

After all, this novel approval stems from a clinical trial presented for the first time in 2008 at the American Heart Association’s Annual Scientific Sessions in New Orleans, sponsored by the actual makers of Crestor, AstraZeneca Pharmaceutical Company. The trial is referred to as the Justification for the Use of statins in Prevention: an Intervention Trial Evaluating Rosuvastatin (JUPITER). In JUPITER, which is a randomly controlled, double-blinded, placebo-controlled, multi-center trial, the use of Crestor was examined in approximately 18,000 older patients who did not have elevated LDL cholesterol levels but illustrated other risk factors for heart disease, such as an elevated hsCRP (3). All patients examined in the trial were men and women of at least 50 and 60 years of age respectively. All lacked clinical evidence of heart disease and high LDL cholesterol levels (inclusion criteria of LDL<130>

HsCRP is a protein/inflammatory marker found in the blood stream. Inflammation has been shown to play a major role in the initiation and progression of cardiovascular disease at the cellular level. In studies involving large numbers of patients, CRP levels have been shown to correlate with levels of cardiac risk. In fact, CRP seems to be at least as predictive, if not more predictive, of cardiac risk when compared to cholesterol levels. The Physicians Health Study,[6] a clinical trial involving 18,000 apparently healthy men, was the first large scale study to show that elevated levels of CRP were associated with a threefold increase in the risk of MI. In accordance, the Harvard Women’s Health Study [7] showed that the CRP test was more accurate than cholesterol levels in predicting coronary problems and was the strongest predictor of risk. As such, women in the group with the highest CRP levels were more than four times as likely to have died from coronary disease, suffered a nonfatal MI or stroke or to have required a cardiac procedure.

In the current study, Ridker et al. selected a treatment population according to their hsCRP level, based on the logic explained above and that statins have been shown to reduce levels of both hsCRP and LDL-C. [8,9] The investigators proposed that the main benefit of Crestor in individuals with normal levels of LDL, but elevated levels of hsCRP would be a reduced risk of non-fatal MI, non-fatal stroke and arterial revascularization (iii). In fact, patients in the study who were randomly assigned to take Crestor at a dose of 20 mg daily experienced a 44% reduction in the trial primary end point of all vascular events (P<0.00001), p="0.0002)," p="0.002)," p="0.02)">

The percentage of patients who suffered MI, stroke, revascularization, hospitalization for unstable angina or died from cardiovascular causes was 1.6% in the Rosuvastatin arm and 2.8% in the placebo arm (iii), an absolute risk reduction of 1.2%. The proportion of participants with hard cardiac events in JUPITER was reduced from 1.8% (157 of 8901 subjects) in the placebo group to 0.9% (83 of the 8901 subjects) in the Rosuvastatin group; thus, 120 participants were treated for 1.9 years (actual duration of the study) to prevent one event.[10]

Side effects associated with Crestor in the JUPITER trial were generally similar to those previously associated with the statin class of medication and comparable in the Rosuvastatin and placebo group, with myalgia being one of the most frequently experienced adverse reactions. Of note, in the study, patients taking Crestor had higher rates of physician-reported diabetes than those taking placebo, including a higher increase in glycosylated hemoglobin (5.9% and 5.8%, respectively; P=0.001); however, it is important to note that an analysis of individuals in the JUPITER trial who had impaired fasting glucose at baseline did show a 34% reduction in major cardiovascular events with the use of Crestor. Once again, showing it to be of some clinical benefit.

Despite the positive findings, the question still prevails: patient beneficial, pharmaceutical moneymaker or a little of both? After all, there are many limiting factors that should be taken in to account in this trial. For one, scientists are still unsure whether the positive results of the trial are due to further reduction in LDL-C, hsCRP or both, since Crestor has been clinically shown to reduce both. As evaluated in the trial at twelve months there was a 50% lower median LDL-C and 37% lower median hsCRP in the Rosuvastatin group when compared to placebo (iii). This question cannot be answered in this study; however, it suggests that future studies should look specifically at the role of other anti-inflammatory medications as vascular therapeutic agents. Importantly, the absolute risk difference, a more clinically important factor, was found to be less impressive than the relative difference. Unfortunately, this point was overlooked in the discussion section of the trial. The study may also be limited due to its inability to adequately assess the potential risks of prolonged Crestor therapy in this population. The study was designed to last approximately four-years, but was stopped after only 1.9-years by an independent data monitoring board due to “meeting” predefined efficacy goals for the patients treated with Rosuvastatin. This short follow-up period raises concern of possible longer-term effects that could not be evaluated due to the shorter duration. In addition, lack of comparison of patients with low hsCRP levels (less than 2 mg/L) is a huge study limitation as there is not a pre-defined level goal. Further, since CRP is a nonspecific protein, elevated by a number of acute inflammatory conditions, it may not be reasonable to use it as a surrogate in the decision to initiate treatment with an expensive medication with associated adverse effects. Rosuvastatin, which roughly costs $3.45 per day, is much more expensive than that of generic statins (x). With this new FDA approval it should only be a matter of time before other pharmaceutical companies promote future studies comparing similar uses of other statins.

Based on these limitations, the FDA placed restrictions on their approval of Crestor for this indication. They state that physicians should take into account the clinical context of asymptomatic individuals who have evidence of clinical risk factors. As such, the FDA maintains Crestor should only be used as a preventative measure in individuals who have no clinical evidence of heart disease, but are at increased risk due to combined effect of older age (Men≥50, Women≥60), high hsCRP levels (≥2mg/L) and patient’s who illustrate one additional risk factor such as hypertension, low HDL-C, smoking or family history of premature heart disease. This makes the approval more conservative than may have been desired by the pharmaceutical company.

Regardless, debate will continue and AstraZeneca will continue to promote this medical breakthrough that has already increased its revenue. Crestor was AstraZeneca’s third-best selling product with estimated sales of $3.6 billion early last year. Since the publication of the JUPITER study in 2008, Crestor has increasingly been taking share away from competitors, including Pfizer’s Lipitor [11] which is expected to go generic in 2011. In fact, in the last quarter, revenue rose 29% to $4.5 billion, and now the FDA has cleared the way for an estimated six million more people in the US to buy the drug. Clearly, a true money maker.

In spite of the controversy, the study did succeed in its attempt to solve one piece of a vexing problem: not everyone who suffers a cardiovascular event has high cholesterol, and it’s next to impossible to predict who’s most likely to suffer from one imminently, even among people with some risks. Maybe hsCRP is the answer. Now with the new findings, a new question to ponder: to check hsCRP levels or not? I can only say physician discretion is advised.

Dr. Bond is a first year resident in internal medicine at NYU Medical Center.

Peer reviewed by Michael Poles MD, NYU Division of Gastroenterology

Mixing Medication and Herbs May Threaten Heart Health

Tuesday February 16, 2010

A number of popular herbal remedies may pose a threat to people taking heart disease medications, warns a new report. The report focuses on several commonly used herbal supplements (including St. John's wort, ginkgo biloba, and garlic), highlighting their potentially harmful interactions with cardiovascular drugs.

The report's authors caution that certain herbs can reduce the effectiveness or augment the potency of drugs used to treat heart disease, which may in turn lead to serious health problems. Ginkgo biloba and garlic, for instance, have been found to raise the risk of bleeding in people taking warfarin, while St. John's wort may contribute to the recurrence of high blood pressure or increases in cholesterol in people taking cardiac drugs.

In order to protect against dangerous herb-drug interactions, the report's authors urge supplement consumers to fully disclose their use of herbal remedies to their healthcare providers.

Silver nanoparticles may one day be key to devices that keep hearts beating strong and steady

By University at Buffalo, [RxPG] BUFFALO, N.Y. -- Diamonds and gold may make some hearts flutter on Valentine's Day, but in a University at Buffalo laboratory, silver nanoparticles are being designed to do just the opposite.

The nanoparticles are part of a new family of materials being created in the laboratory of SUNY Distinguished Professor and Greatbatch Professor of Advanced Power Sources Esther Takeuchi, PhD, who developed the lithium/silver vanadium oxide battery. The battery was a major factor in bringing implantable cardiac defibrillators (ICDs) into production in the late 1980s. ICDs shock the heart into a normal rhythm when it goes into fibrillation.

Twenty years later, with more than 300,000 of these units being implanted every year, the majority of them are powered by the battery system developed and improved by Takeuchi and her team. For that work she has earned more than 140 patents, believed to be more than any other woman in the United States. Last fall, she was one of four recipients honored in a White House ceremony with the National Medal of Technology and Innovation.

ICD batteries, in general, now last five to seven years. But she and her husband and co-investigator, SUNY Distinguished Teaching Professor of Chemistry Kenneth Takeuchi, PhD, and Amy Marschilok, PhD, UB research assistant professor of chemistry, are exploring even-better battery systems, by fine-tuning bimetallic materials at the atomic level.

Their research investigating feasibility for ICD use is funded by the National Institutes of Health, while their investigation of new, bimetallic systems is funded by the U.S. Department of Energy.

So far, their results show that they can make their materials 15,000 times more conductive upon initial battery use due to in-situ (that is, in the original material) generation of metallic silver nanoparticles. Their new approach to material design will allow development of higher-power, longer-life batteries than was previously possible.

These and other improvements are boosting interest in battery materials and the revolutionary devices that they may make possible.

We may be heading toward a time when we can make batteries so tiny that they -- and the devices they power -- can simply be injected into the body, Takeuchi says. Right now, her team is exploring how to boost the stability of the new materials they are designing for ICDs. The materials will be tested over weeks and months in laboratory ovens that mimic body temperature of 37 degrees Celsius.

What's really exciting about this concept is that we are tuning the material at the atomic level, says Takeuchi. So the change in its conductivity and performance is inherent to the material. We didn't add supplements to achieve that, we did it by changing the active material directly.

She explains that new and improved batteries for biomedical applications could, in a practical way, revolutionize treatments for some of the most persistent diseases by making feasible devices that would be implanted in the brain to treat stroke and mental illness, in the spine to treat chronic pain or in the vagal nerve system to treat migraines, Alzheimer's disease, anxiety, even obesity.

And even though batteries are an historic technology, they are far from mature, Takeuchi notes. This spring, she is teaching the energy storage course in UB's School of Engineering and Applied Sciences and the class is filled to capacity. I've never seen interest in batteries as high as it is now, she says.

N-Terminal Pro–B-Type Natriuretic Peptide-Guided Treatment for Chronic Heart Failure

Results From the BATTLESCARRED (NT-proBNP–Assisted Treatment To Lessen Serial Cardiac Readmissions and Death) Trial

John G. Lainchbury, MD, Richard W. Troughton, MD, PhD, Kim M. Strangman, RN, Christopher M. Frampton, PhD, Anna Pilbrow, PhD, Timothy G. Yandle, PhD, Amjad K. Hamid, MBChB, M. Gary Nicholls, MD and A. Mark Richards, MD, PhD^_*

Department of Medicine, Christchurch Cardioendocrine Research Group, University of Otago, Christchurch, New Zealand

Manuscript received November 26, 2008; revised manuscript received February 19, 2009, accepted February 24, 2009.

^_* Reprint requests and correspondence: Dr. A. Mark Richards, The Christchurch Cardioendocrine Research Group, Department of Medicine, University of Otago, P.O. Box 4345, Christchurch 8140, New Zealand (Email: mark.richards@cdhb.govt.nz).

Objectives: The purpose of this study was to compare the effects of N-terminal pro–B-type natriuretic peptide (NT-proBNP)-guided therapy with those of intensive clinical management and with usual care (UC) on clinical outcomes in chronic symptomatic heart failure.

Background: Initial trial results suggest titration of therapy guided by serial plasma B-type natriuretic peptide levels improves outcomes in patients with chronic heart failure, but the concept has not received widespread acceptance. Accordingly, we conducted a longer-term study comparing the effects of NT-proBNP–guided therapy with those of intensive clinical management and with UC of patients with heart failure.

Methods: Three hundred sixty-four patients admitted to a single hospital with heart failure were randomly allocated 1:1:1 (stratified by age) to therapy guided by NT-proBNP levels or by intensive clinical management, or according to UC. Treatment strategies were applied for 2 years with follow-up to 3 years.

Results: One-year mortality was less in both the hormone- (9.1%) and clinically-guided (9.1%) groups compared with UC (18.9%; p = 0.03). Three-year mortality was selectively reduced in patients 75 years of age receiving hormone-guided treatment (15.5%) compared with their peers receiving either clinically managed treatment (30.9%; p = 0.048) or UC (31.3%; p = 0.021).

Conclusions: Intensive management of chronic heart failure improves 1-year mortality compared with UC. Compared with clinically guided treatment and UC, hormone-guided treatment selectively improves longer-term mortality in patients 75 years of age. (NT-proBNP–Assisted Treatment To Lessen Serial Cardiac Readmissions and Death [BATTLESCARRED]; Australian New Zealand Clinical Trials Registry 12605000735651)

Key Words: NT-proBNP • chronic heart failure • survival

Abbreviations and Acronyms

ACEI = angiotensin-converting enzyme inhibitor

ARB = angiotensin receptor blocker

BB = beta-adrenergic blocker

BNP = B-type natriuretic peptide

CG = clinically guided

CHF = chronic heart failure

LVEF = left ventricular ejection fraction

NT-proBNP = N-terminal pro–B-type natriuretic peptide

NYHA = New York Heart Association

UC = usual care

Exclusive: Third of PCTs fail to start vascular checks

More than a third of England's PCTs have yet to carry out any health checks, nine months after the DoH said they would begin.

Even among trusts that have started NHS Health Checks, half have screened less than 5% of those patients eligible for assessment.

Just five PCTs of the 106 surveyed have assessed the 20% of patients that the Primary Care Cardiovascular Society (PCCS) estimates will be necessary if trusts are to offer screening to all eligible people by 2012/3 as planned.

So far 360,719 checks have been performed by the 106 PCTs surveyed, equivalent to around 508,000 checks across England. This is about half the one million checks that the DoH committed to delivering by April 2010.

11 trusts said that they would not begin conducting any vascular checks until the 2010/11 financial year. Two PCTs said that they may not even start a screening programme, because its launch would be dependent on funding being approved.

Daiichi Sankyo's Benicar receives FDA approval for hypertension treatment in children and adolescents aged 6-16

11. February 2010 08:45

Daiichi Sankyo, Inc. announced today that the U.S. Food and Drug Administration (FDA) has approved the hypertension treatment Benicar® (olmesartan medoxomil) for use in children and adolescents 6 to 16 years of age. Benicar was originally approved in 2002 for the treatment of hypertension in adults.

Approximately 5 percent – or 3.6 million – American children suffer from high blood pressure, with the majority unaware they have the condition. Studies have also found that the average blood pressure of American children is on the rise, in parallel with the increase of children's weight. In fact, an analysis of nearly 40 years of national surveys of high blood pressure trends in children and adolescents showed that the prevalence of elevated blood pressure among this group has been growing since the late 1980's.

"As hypertension is on the rise also in a younger population, Daiichi Sankyo believes it is important to help doctors meet the challenge of treating these pediatric patients by providing a treatment option to help people effectively manage their hypertension," said Reinilde Heyrman, MD, Vice President Clinical Development – Operations, Daiichi Sankyo Pharma Development.

Pediatric hypertension is closely linked to childhood obesity, as obese children are at approximately a three-fold higher risk for hypertension than non-obese children. Additionally hypertension during childhood has been shown to be an independent risk factor for hypertension in adulthood, and to be associated with early markers of cardiovascular disease, making it important to treat this condition in children and adolescents.

The approval of this expanded indication was based on a phase III study examining the antihypertensive effects of Benicar in pediatric patients. The study found Benicar to be safe and efficacious in children ages 6-16 with hypertension, resulting in blood pressure reductions that were statistically different in comparison to placebo. Benicar was generally well tolerated in pediatric patients, and the adverse event profile was similar to that for adults.

Benicar is an angiotensin II receptor blocker (ARB), which blocks the action of a substance in the body called angiotensin II that increases blood pressure. It is indicated for the treatment of hypertension in adults as well as pediatric patients 6-16 years of age, alone or with other antihypertensive agents.

SOURCE Daiichi Sankyo, Inc.

FDA Approves World's Most Powerful Cardiac Resynchronization Therapy Defibrillator

Sorin Group (Milan, Italy) has announced U.S. FDA approval and first implant of its next-generation of cardiac resynchronization therapy defibrillator (CRT-D), Paradym CRT Model 8750. According to the company, this is the world's most powerful AICD, with a 37 Joule punch:

Paradym™ offers consistent charge times throughout the life of the device (10s at Beginning Of Life, 13s at Elective Replacement Indicator - ERI), improved longevity, and a 6-month ERI to End of Service (EOS) period, twice as long as any other ICD.

Paradym™ CRT is designed to allow more flexibility in the management of cardiac resynchronization and antitachyarrhythmia therapy in heart failure patients. BTO (Brady-Tachy Overlap) is designed to unlock pacing and detection to ensure delivery of resynchronization therapy at high pacing rates during exercise without any compromise on the management of slow ventricular tachycardias (VTs). BTO gives freedom of programming for physicians.

Paradym™ CRT, at 34cc and 11mm thin, also features the PARAD®+ detection algorithm whose superior specificity in discriminating ventricular arrhythmias has been clinically proven. Studies have demonstrated that the absolute risk of experiencing an inappropriate shock has been observed to be only 5%, the lowest percentage recorded thus far.

MS Study Links Narrow Veins to Disease

More than half of the multiple sclerosis patients in a closely watched study had narrowing of some neck veins leading from the brain, researchers said.

On the other hand, so did 22.4% of healthy controls in the first large study to test a new theory about the disease: that it's caused by such abnormally narrow veins, a condition dubbed "chronic cerebrospinal venous insufficiency."

Nevertheless, Robert Zivadinov, MD, PhD, of the University of Buffalo, said in a university news release that he is "cautiously optimistic and excited" about the results, which were originally scheduled to be presented at the annual meeting of the American Academy of Neurology in April.

"The data encourage us to continue on the same course," he said in the statement. "They show that narrowing of the extracranial veins, at the very least, is an important association in multiple sclerosis."

Zivadinov was traveling and not immediately available for further comment.

The study drew intense interest when it began enrolling patients last year, because the theory that abnormal veins play a role in multiple sclerosis -- as yet unproved -- is the first major shift in thinking about the disease in decades. (See Radical MS Theory Stirs Interest)

But experts cautioned that the press release doesn't contain enough details to allow scientists to judge the validity of the results, which in any case are partial and preliminary.

"From the press release, it's very difficult to analyze this in any way," said John Richert, MD, executive vice president for research and clinical programs at the National Multiple Sclerosis Society.

"It makes you want to see more," he told MedPage Today.

The release, which has not been subject to the usual scientific peer review, contained data on 441 volunteers, including 280 with multiple sclerosis, most of them adults.

However, that's a small fraction of the more than 1,700 volunteers, including 1,000 adults and 50 children with the disease, who are expected to be enrolled.

It also was limited to data on ultrasound scans of the volunteers. The results of magnetic resonance imaging, to test other aspects of the theory, were not given.

Blocked veins in the volunteers were studied according to five criteria, other experts noted, but what they were wasn't reported, so that it was impossible to tell if they differed from earlier studies.

The release also said the researchers saw a correlation between venous insufficiency and the progression of the disease, "but even that statement is difficult to interpret exactly," Richert said.

The Buffalo study is a follow-up to research conducted by Paolo Zamboni, MD, of the University of Ferrara in Italy, which showed chronic cerebrospinal venous insufficiency to be strongly associated with multiple sclerosis.

Zamboni also conducted a small surgical intervention trial that appeared to show a benefit to patients from opening up the veins.

Not all experts were skeptical of the reports.

The Buffalo report was a surprise mainly because its results were "less impressive" than Zamboni's findings, according to Salvatore Sclafani, MD, of SUNY Downstate College of Medicine in Brooklyn.

Sclafani said in an e-mail that the first results showed about 65% of patients had abnormal veins, but recent research puts the figure at about 90%.

"I have now studied many patients with MS and all have had abnormalities of the veins," said Sclafani, who has recently begun studying the issue.

The Buffalo results vary slightly, depending on how some "borderline" volunteers are counted, the release said.

If the 10.2% of volunteers whose results were classed as borderline were included in the normal category, the incidence of venous insufficiency was 56.4% in the multiple sclerosis patients and 22.4% in the controls.

On the other hand, if the borderline results were excluded, the proportion of affected patients rose to 62.5%, compared with 25.9% percent of healthy controls.

But the finding that a proportion of healthy controls had venous insufficiency needs further investigation, Zivadinov said in the release.

This article was developed in collaboration with ABC News

Compound shows promise against intractable heart failure

Published: Thursday, February 11, 2010 - 17:16 in Health & Medicine

A chemical compound found normally in the blood has shown promise in treating and preventing an intractable form of heart failure in a mouse model of the disease, report researchers at the University of Illinois at Chicago College of Medicine. The study is published in the February issue of Circulation.

More than five and half million Americans have heart failure, according to the American Heart Association, and 670,000 new cases are diagnosed each year.

In heart failure the heart is unable to pump effectively and cannot meet the body's need for blood and oxygen. It is really two diseases, each with about half of all patients, says Dr. Samuel Dudley, professor of medicine and physiology at UIC and chair of the section of cardiology. Systolic heart failure occurs when the heart can no longer contract effectively. In diastolic heart failure, the heart is unable to relax after contraction.

"Although we have a number of treatments for systolic heart failure, there are no approved treatments at all for diastolic heart failure, a deadly disease with a 60 percent mortality rate five years after diagnosis," said Dudley.

Hypertension is the cause in the overwhelming majority of diastolic heart failure cases.

"We know from previous studies that nitric oxide (NO) is necessary for blood vessel relaxation," said Dudley, "and that hypertension can lead to a decrease of NO in blood vessels."

Dudley and his colleagues knew that -- in blood vessels -- the problem was depletion of a chemical called tetrahydrobiopterin, or BH4, which is needed for the tissues to make NO.

"We decided to try thinking of the heart as a huge blood vessel that might also be unable to make the NO it needed due to long-term hypertension, and see if adding BH4 could make a difference," said Dudley.

They found that by giving mice BH4 they were not only able to prevent diastolic heart failure from developing, but to restore function to the heart after the fact.

"We are very excited about the possibilities of developing therapies for human heart failure based on BH4," said Dudley. BH4 has already been shown to be safe in FDA trials, in a formulation currently used to treat phenylketonuria, a genetic condition.
Source: University of Illinois at Chicago

RECORD Confirms Climb in HF Risk With Rosiglitazone

February 11, 2010 (Sophia Antipolis, France) — A secondary analysis of a high-profile randomized trial concluded that the risk of heart-failure events in diabetics goes up when rosiglitazone (Avandia, GlaxoSmithKline) is added to standard glucose-lowering monotherapy, either metformin or a sulfonylurea [1].

It's well recognized that the insulin-sensitizing thiazolidinediones (TZDs), primarily rosiglitazone and pioglitazone (Actos, Takeda Pharmaceuticals), promote water retention, and there are abundant data suggesting they can induce new or aggravate existing heart failure.

So a twofold increase in risk of heart-failure death or hospitalization observed in the Rosiglitazone Evaluated for Cardiac Outcomes and Regulation of Glycemia in Diabetes (RECORD) trial comes as not a surprise but as further support for treatment guidelines that already recommend against using rosiglitazone in diabetics with heart failure, according to Dr Michel Komajda (Université Pierre et Marie Curie, Paris, France) and colleagues in a study published online January 29, 2010 in the European Heart Journal.

On the other hand, the results can also be seen as validating cautions against rosiglitazone as add-on therapy even in diabetics without heart failure. A 2007 interim analysis of the trial also pointed to a doubling of heart-failure risk associated with the TZD.

RECORD randomized 4474 type 2 diabetics to receive either rosiglitazone (on top of either metformin or sulfonylurea) or a metformin/sulfonylurea combination.

The rate of CV hospitalization or death from cardiovascular causes, the primary end point, reached 14.5% in both groups over an average of 5.5 years [2], as previously reported by heartwire . There were no significant differences in individual rates of CV death, MI, or stroke.

The nonsignificant 14% increased risk of MI in the TZD group was noteworthy to some observers, given published evidence that rosiglitazone might increase MI risk [3], also as covered by heartwire .

The RECORD authors have pointed out that their trial wasn't powered to show significant differences in the rate of MI on its own.

In their current analysis, by intention-to-treat, the hazard ratio (HR) for fatal or nonfatal heart-failure events in the rosiglitazone group compared with controls was 2.10 (95% CI 1.35–3.27; p=0.001). The estimated excess heart-failure event rate was 2.6 per 1000 person-years. There was no rosiglitazone-related significant increase in risk of cardiovascular mortality or hospitalization or of CV death, the group reported.

Significant independent baseline predictors of heart-failure events included age, increased body-mass index, urinary-albumin-to-creatinine ratio, rosiglitazone treatment (p<0.001 p="0.002),">

Funding to pay the open-access publication charges for the paper was provided by GlaxoSmithKline. Two coauthors are employees of and hold stock in the company. All other coauthors "receive funding for research, educational, and/or advisory activities from pharmaceutical companies including GlaxoSmithKline, the manufacturers of rosiglitazone, and in some cases from the manufacturers of sulfonylurea and metformin preparations and other competing products."

References

Health Blog Primer: What’s a Stent?

Bill Clinton was admitted to the hospital for chest pain today and had two stents placed in one of the arteries around his heart.

Here’s what that means:

A stent is a wire mesh tube that’s used to prop open an artery. That’s a stent in the picture.

Stents are often used for patients with unstable angina — sudden chest pain that can be a prelude to a heart attack.

In a typical procedure, doctors start by making a small incision in the patient’s groin, then threading a catheter through the incision and into a clogged artery. Then they perform a procedure called angioplasty, using a tiny balloon to clear away plaque that’s clogging up the artery. Then the doctors run the stent through the catheter and into section of the artery that was just de-gunked.

The stent reduces the risk that the artery will re-close. Some stents are coated with a drug, to further reduce that risk.

There’s been a lot of discussion over the past few years about whether stents are overused, particularly for patients with chronic chest pain. For more on that subject see this front-page story from this morning’s WSJ.

Image via Bloomberg News

Silver nanoparticles may one day be key to devices that keep hearts beating strong and steady

Published: Wednesday, February 10, 2010 - 15:21 in Physics & Chemistry

Diamonds and gold may make some hearts flutter on Valentine's Day, but in a University at Buffalo laboratory, silver nanoparticles are being designed to do just the opposite. The nanoparticles are part of a new family of materials being created in the laboratory of SUNY Distinguished Professor and Greatbatch Professor of Advanced Power Sources Esther Takeuchi, PhD, who developed the lithium/silver vanadium oxide battery. The battery was a major factor in bringing implantable cardiac defibrillators (ICDs) into production in the late 1980s. ICDs shock the heart into a normal rhythm when it goes into fibrillation.

Twenty years later, with more than 300,000 of these units being implanted every year, the majority of them are powered by the battery system developed and improved by Takeuchi and her team. For that work she has earned more than 140 patents, believed to be more than any other woman in the United States. Last fall, she was one of four recipients honored in a White House ceremony with the National Medal of Technology and Innovation.

ICD batteries, in general, now last five to seven years. But she and her husband and co-investigator, SUNY Distinguished Teaching Professor of Chemistry Kenneth Takeuchi, PhD, and Amy Marschilok, PhD, UB research assistant professor of chemistry, are exploring even-better battery systems, by fine-tuning bimetallic materials at the atomic level.

Their research investigating feasibility for ICD use is funded by the National Institutes of Health, while their investigation of new, bimetallic systems is funded by the U.S. Department of Energy.

So far, their results show that they can make their materials 15,000 times more conductive upon initial battery use due to in-situ (that is, in the original material) generation of metallic silver nanoparticles. Their new approach to material design will allow development of higher-power, longer-life batteries than was previously possible.

These and other improvements are boosting interest in battery materials and the revolutionary devices that they may make possible.

"We may be heading toward a time when we can make batteries so tiny that they -- and the devices they power -- can simply be injected into the body," Takeuchi says. Right now, her team is exploring how to boost the stability of the new materials they are designing for ICDs. The materials will be tested over weeks and months in laboratory ovens that mimic body temperature of 37 degrees Celsius.

"What's really exciting about this concept is that we are tuning the material at the atomic level," says Takeuchi. "So the change in its conductivity and performance is inherent to the material. We didn't add supplements to achieve that, we did it by changing the active material directly."

She explains that new and improved batteries for biomedical applications could, in a practical way, revolutionize treatments for some of the most persistent diseases by making feasible devices that would be implanted in the brain to treat stroke and mental illness, in the spine to treat chronic pain or in the vagal nerve system to treat migraines, Alzheimer's disease, anxiety, even obesity.

And even though batteries are an historic technology, they are far from mature, Takeuchi notes. This spring, she is teaching the energy storage course in UB's School of Engineering and Applied Sciences and the class is filled to capacity. "I've never seen interest in batteries as high as it is now," she says.
Source: University at Buffalo

Novel Biomarker-Guided Strategy Hastens Optimal Dosing in Highest-Risk HF Patients

February 10, 2010 (Vienna, Austria) — A novel method for using natriuretic-peptide testing to optimize postdischarge therapy after acute heart-failure decompensation can cut the number of later days spent in the hospital and improve other clinical outcomes, according to researchers [1].

Their randomized study suggests that the biomarker assays can help both by singling out higher-risk patients for intensified care and then by providing targets for adjustments to their medical therapy--potentially speeding up the uptitration of beta blockers compared with contemporary nurse-led outpatient therapy.

Although other trials have explored natriuretic-peptide–guided outpatient therapy for heart failure, with mixed results (as covered by heartwire ), the biomarkers were used primarily for guidance of med dosing, not necessarily for individualizing the overall management strategy.

"Our concept was different," Dr Rudolf Berger (Medical University of Vienna, Austria), lead author of the 12-center study published in the February 16, 2010 Journal of the American College of Cardiology, told heartwire . The group's strategy uses predischarge N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels to identify patients at highest risk of subsequent decompensation (NT-proBNP >2200 pg/mL) and so most likely to benefit from intensified management led by a heart-failure physician.

qNatriuretic-peptide–guided management in combination with a heart-failure clinic might increase the cost-effectiveness of heart-failure clinics per se.

That kind of frequent attention from a specialist at a heart-failure clinic can facilitate beta-blocker uptitration and lead to rapid dose optimization for diuretics and other drugs in response to rising or falling NT-proBNP levels, according to Berger.

"Doing it this way, we can uptitrate the beta blocker as quickly as possible," when otherwise--because of the short-term dampening effect beta blockers have on ventricular function--it would have to be done slowly and cautiously.

The group's method, Berger noted, contrasts with the current state of the art in many countries: management of all discharged patients by multidisciplinary teams led by heart-failure nurses, often in the home, with more limited physician involvement.

The key difference, he said, is that in most countries, even experienced heart-failure nurses do not generally take the lead in more advanced aspects of medication management, such as decisions regarding beta-blocker uptitration. They manage the delivery of medical therapy, instruct patients on the proper use of diuretics, and teach how to measure weight daily, Berger observed, but typically wouldn't adjust prescriptions in response to biomarker test results.

"It depends on the country and what heart-failure nurses are allowed to do," Berger said. But NT-proBNP–guided heart-failure therapy is most likely to be helpful when it is handled directly by heart-failure physicians and, as the current study suggests, when it is applied to patients most at risk of decompensation.

In the current study, 278 patients hospitalized with acute decompensated heart failure were randomized predischarge to one of three outpatient-care groups:

• "Usual care," handled by the patient's primary-care physician, generally without access to heart-failure physicians or nurses.
• HF-nurse–led "multidisciplinary care" that included multiple home visits, two prescheduled clinic visits, and on-demand physician consultations.
• Natriuretic-peptide–guided care, consisting of multidisciplinary care, plus--only for the subgroup of patients with NT-proBNP >2200 pg/mL at discharge--visits to an HF physician at least every two weeks for optimization of medical therapy based on NT-proBNP readings and standard clinical and laboratory parameters; patients with discharge NT-proBNP levels below the 2200 pg/mL threshold, as well as those starting out with higher levels but who achieved lower levels with intensified care, went on to receive nurse-led multidisciplinary care only.

"This approach ensured rapid uptitration of therapy guided by NT-proBNP in patients at highest risk for cardiac decompensation," according to Berger et al.

Consequently, they write, "such treatment, when compared with nurse-led multidisciplinary management alone, was associated with a higher proportion of antineurohormonal triple therapy, more frequent adjustments of diuretics, a more pronounced decrease in NT-proBNP levels, and an improved outcome." Both the physician-led and nurse-led strategies produced better results than management solely by a primary-care physician.

Natriuretic-Peptide–Guided Heart-Failure Therapy, Outcomes 12 Months After Randomization

End point	Usual care, n=90	Multidisciplinary care, n=96	NT-proBNP-guided care, n=92
HF-hospitalization days (d)	1588	1254a	488b,c
HF hospitalization (%)	61	40d	28
Death (%)	39	22a	22a
Death or HF hospitalization (%)	65	50a	37b,c

a. p<0.05>

b. p<0.05>

c. p<0.001>

d. p<0.01>

Berger said that natriuretic-peptide–guided management "in combination with a heart-failure clinic might increase the cost-effectiveness of heart-failure clinics per se, because the biomarker can be used to identify the highest-risk patients with the greatest need for specialized care." At the same time, he added, it can identify the lower-risk patients who are less of a challenge to treat and don't require intensive management.

The study was supported by AstraZeneca, Novartis, Roche Diagnostics, Roche Medical, Merck, Medtronic, and Guidant.

References

The Broken Heart Syndrome

Studies have shown that sudden emotional stress can trigger a severe, but reversible heart muscle weakness that mimics a heart attack. This condition known as
Takotsubo Cardiomyopathy is sometimes called The Broken Heart Syndrome.

First described in Japan 15 years ago, Broken Heart Syndrome occurs because emotional trauma floods the body with stress hormones, over-stimulating the nervous system and stunning the heart muscle.

Unlike a heart attack, Broken Heart Syndrome is reversible if diagnosed early. Patients are hospitalized and can recover within days - with no permanent damage to their hearts. Once medical issues are stabilized, seeking a trained mental health specialist will help cure the emotional trauma.

Derrick, D. (2009). The"Broken Heart Syndrome": Understanding Takotsubo Cardiomyopathy Critical Care Nurse, 29 (1), 49-57 DOI:

IQ among strongest predictors of CVD -- second only to cigarette smoking in large population study

While lower intelligence scores - as reflected by low results on written or oral tests of IQ - have been associated with a raised risk of cardiovascular disease, no study has so far compared the relative strength of this association with other established risk factors such as obesity, smoking and high blood pressure. Now, a large study funded by Britain's Medical Research Council, which set out to gauge the relative importance of IQ alongside other risk factors, has found that lower intelligence scores were associated with higher rates of cardiovascular disease and total mortality at a greater level of magnitude than found with any other risk factor except smoking.(1) The findings, published in the February issue of the European Journal of Cardiovascular Prevention and Rehabilitation, are derived from the West of Scotland Twenty-07 Study, a population study designed to investigate the influence of social factors on health. The present analysis was based on data collected in 1987 in a cohort of 1145 men and women aged around 55 and followed up for 20 years. Data were collected for height, weight, blood pressure, smoking habits, physical activity, education and occupation; cognitive ability (IQ) was assessed using a standard test of general intelligence.

When the data were applied to a statistical model to quantify the associations of nine risk factors with cardiovascular mortality, results showed that the most important was cigarette smoking, followed by low IQ. Similar results were apparent when the health outcome was total mortality.

The relative strengths of the association were measured by an "index of inequality", which summarised the relative risk of a health outcome (cardiovascular death) in the most disadvantaged (high risk) people relative to the most advantaged (low risk). This relative index of inequality for the top five risk factors was found to be 5.58 for cigarette smoking, 3.76 for IQ, 3.20 for low income, 2.61 for high systolic blood pressure, and 2.06 for low physical activity.

The investigators note "a number of plausible mechanisms" whereby lower IQ scores could elevate cardiovascular disease risk, notably the application of intelligence to healthy behaviour (such as smoking or exercise) and its correlates (obesity, blood pressure). A further possibility, they add, "is that IQ denotes 'a record' of environmental insults" (eg, illness, sub-optimal nutrition) accumulated throughout life.

Commenting on the public health implications of the findings, the study's principal investigator Dr David Batty said that the individual skills reflected in a person's IQ may be important in the management of personal cardiovascular risk.(2)

"From a public health perspective, there is the possibility that IQ can be increased, with some mixed results from trials of early learning and school readiness programmes," said Dr Batty. "It may also be worthwhile for health promotion campaigns to be planned with consideration of individual cognition levels."

He also noted that IQ may well be one important factor behind the place of social class as a fundamental determinant of inequalities in health. So far, said Dr Batty, explanations for such socio-economic gradients in health have traditionally focused on access to resources (such as education and income), physical exposures at home and at work (such as housing conditions and toxins), and health related behaviours (such as smoking and diet). But studies show that such factors do not fully explain class-based differentials in health. A low IQ, he explained, as suggested in this study, may be a further independent explanation.
Source: European Society of Cardiology

New Guidance for In-Hospital Torsades De Pointes

February 9, 2010 (Dallas, Texas and Washington, DC) — Many common, useful drugs have the side effect of electrocardiographic QT-interval prolongation, which substantially increases the risk of sudden death from torsades de pointes, a polymorphic VT. A given QT-prolonging drug may more likely cause torsades in hospitalized patients than in the general population, as hospitalized patients "are often elderly people with underlying heart disease who may also have renal or hepatic dysfunction, electrolyte abnormalities, or bradycardia and to whom drugs may be administered rapidly via the intravenous route," observes a new scientific statement from the American Heart Association and American College of Cardiology [1]. Those features, including advanced age, have confirmed or suspected associations with development of the malignant arrhythmia, the document states.

The document, also endorsed by the American Association of Critical-Care Nurses, describes the state of the art of how to identify the arrhythmia and its precursors on the ECG, drugs and patient features that promote it, strategies for prevention and monitoring, and acute management of both QT prolongation and the manifest arrhythmia. Dr Barbara J Drew (University of California, San Francisco) chaired its writing group.

The benefits of using QT-prolonging agents must be weighed against the risk in patients with increased susceptibility to torsades, it states. The susceptibility can include certain genetic mutations that, when such drugs are given, can promote the arrhythmia.

In such cases, continuous monitoring of the corrected QT (QTc) interval is recommended; "prompt action" is needed if the QTc exceeds 500 ms compared with an ECG obtained before drug administration; the QTc must be measured by the same method and/or device each time.

Responses can include drug withdrawal, correction of electrolyte abnormalities, temporary pacing, and "the ready availability of an external defibrillator."

Other ECG features can signal impending torsades, including distortions of the TU wave, visible T-wave alternans, new ventricular ectopic beats, and "couplets and nonsustained polymorphic ventricular tachycardia initiated in the beat after a pause."

Drugs that promote QTc prolongation and torsades, to different degrees, include the antiarrhythmics quinidine, disopyramide, procainamide, sotalol, dofetilide, and ibutilide as well as methadone, thioridazine, and haloperidol, according to the statement.

Still, it notes, "where benefit clearly outweighs risk, QT prolongation should not limit necessary therapy."

The report states that "the American Heart Association and the American College of Cardiology Foundation make every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel" and lists disclosures for individual members of the writing group.

References

Study finds racial gaps continue in heart disease awareness

Racial gaps exist in women's heart-health awareness, women's knowledge of heart attack warning signs requires attention and nearly half of women report they would not call 9-1-1 if they were having heart attack symptoms, according to new research published in Circulation: Cardiovascular Quality and Outcomes, a journal of the American Heart Association.

Results of the study, commissioned by the American Heart Association, revealed that although 60 percent of white women were aware of heart disease as the leading cause of death for women, less than half of African-American (43 percent), Hispanic (44 percent) and Asian (34 percent) women identified heart disease as the leading cause.

In addition, most women lacked knowledge of evidence-based therapies for preventing cardiovascular disease, and half of women ages 25-34 were unaware of heart disease as women's No. 1 killer, demonstrating the need for prevention education to avert death and disability from heart disease.

"The American Heart Association just announced its 2020 strategic goal: by 2020, to improve the cardiovascular health of all Americans by 20 percent while reducing deaths from cardiovascular diseases and stroke by 20 percent," said Lori Mosca, M.D., Ph.D, M.P.H., lead author of the paper and Director of Preventive Cardiology at New York-Presbyterian Hospital in New York City. "Our study shows that these goals will be virtually impossible to achieve without first creating awareness among multicultural and younger women, educating women about the warning signs of heart attack and underscoring the importance of calling 9-1-1 immediately if they are experiencing heart attack symptoms."

The study surveyed women to measure their current awareness of CVD risk and barriers to prevention and, from previous surveys, evaluated awareness trends since 1997.

For the 2009 survey, 2,300 women age 25 or older were interviewed (1,142 by phone; 1,158 online). Telephone data was used to understand changes since 1997.

In 2009, online respondents received additional survey questions about caregiving, preventive actions and barriers to healthy behaviors, to set a baseline for future data.

Of women surveyed by telephone, 54 percent understood that CVD is the leading cause of death among women, compared with 30 percent in 1997. Additional survey findings:

• Since 1997, the gap between minority and white women's awareness of CVD as the leading cause of death has narrowed, with awareness roughly doubling among white and Hispanic women and tripling among black women.
• Knowledge of heart attack warning signs in 2009 has not improved appreciably since 1997, with only 56 percent of women citing chest pain and neck, shoulder and arm pain; 29 percent, shortness of breath; 17 percent, chest tightness; 15 percent, nausea; and 7 percent, fatigue.
• Only 53 percent of all women said they would call 9-1-1 if they thought they were having heart attack symptoms.
• Most respondents listed non evidence-based therapies to prevent cardiovascular disease, including the use of multivitamins (69 percent), antioxidants (70 percent), and special vitamins (58 percent); 29 percent cited aromatherapy as a preventive strategy.
• Of online respondents, the most commonly cited barrier to taking preventive action was family/caretaking responsibility, at 51 percent; confusing media reports was the next most common barrier at 42 percent.
• Community actions that online respondents thought would be most helpful in encouraging healthier lifestyles included access to healthy foods (91 percent) and public recreation facilities (80 percent), and listing of nutritional information in restaurants (79 percent).

The study highlights the need to sustain awareness and educational campaigns for women that incorporate evidence-based prevention messages, Mosca said.

"It's particularly important that national campaigns cut through the mixed messages women receive and deliver the facts about how they can prevent heart disease," said Mosca, also a spokesperson for Go Red For Women. "Despite recent research showing no benefit of antioxidant vitamins in women, the majority of women surveyed cited them as a way to prevent heart disease."

The authors note that the latest survey, which used a cross-sectional sample with an oversampling of racial and ethnic minorities, may represent a "best-case" scenario, because respondents were fairly well-educated.

The triennial tracking study was funded by the American Heart Association through a grant from Macy's Go Red For Women Multicultural Fund. Macy's is a national sponsor of Go Red For Women. The survey was conducted by Harris Interactive.

Co-authors are Heidi Mochari-Greenberger, M.P.H., R.D.; Rowena J. Dolor, M.D., M.H.S.; L. Kristin Newby, M.D., M.H.S.; and Karen J. Robb, M.B.A. Author disclosures are on the manuscript.

Statements and conclusions of study authors published in American Heart Association scientific journals are solely those of the study authors and do not necessarily reflect the association's policy or position. The association makes no representation or guarantee as to their accuracy or reliability. The association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific association programs and events. The association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and device corporations are available at www.americanheart.org/corporatefunding.

Editor's Note: Go Red For Women is the American Heart Association's solution to save women's lives. It is a premier source of information and education, connecting millions of women of all ages and giving them tangible resources to turn personal choices into life-saving actions. For more information please visit GoRedForWomen.org or call 1-888-MY-HEART (1-888-694-3278). Go Red For Women is nationally sponsored by Macy's and Merck & Co., Inc.

Link:

http://www.americanheart.org