Between 1994 and 2006, in-hospital death rates decreased among all patients, but decreased more strikingly in women than in men. The decreased risk of death was largest in women younger than 55 years (a 52.9 percent reduction) and lowest in men of the same age (33.3 percent). The absolute reduction in the risk of death among patients younger than 55 was three times larger in women (2.7 percent) than men (0.9 percent).
Vaccarino and her colleagues say a large part (93 percent) of this sharper decrease in mortality of younger women compared with men in recent years is due to the improved risk profile of women compared with men at the time of the heart attack hospitalization, perhaps the result of better recognition and management of coronary heart disease and its risk factors in women before the acute heart event.
Whatever the reason, the improvement indicates that we are headed in the right direction, says Vaccarino. Increased and ongoing awareness to the prevention of cardiovascular risk factorsâ€”by healthy diet, regular physical activity and avoidance of smoke and smokingâ€”is saving lives, she notes.
Just like diabetes and hypertension, depression is a prevalent medical condition that is highly treatable. However, if ignored, it appears to increase the risk for heart disease. Researchers at Emory are continuing studies related to the link between depression and heart disease as a result of a 2-year, $1.5 million grant from the National Institutes of Health (NIH) through the 2009 American Recovery and Reinvestment Act.
Vaccarino says although depression has been implicated as a risk factor for heart disease for many years, there is still question whether this is a causal association or whether there are other reasons why people who are depressed may be more likely to get heart disease. Clarification of these mechanisms will improve our understanding of the disease and ultimately point to more effective primary prevention strategies for the identification and treatment of high-risk individuals.
Vaccarino and her team will study twin males born between 1946 and 1956 from the Vietnam Era Twin Registry comparing one twin who has depression and one who does not. She says this is almost a natural experiment, allowing researchers to separate out genetics and influences from the environment or behavior.
Vaccarino will be looking at myocardial blood flow measured with PET, a common imaging technique of the heart. It can quantify exactly how much blood is going to the coronary arteries in the heart and carefully determine if depression is associated with decreased blood flow to the heart.
This grant builds on a previous project looking at the same population of twins and allows researchers to bring these twins back and compare two time points. Researchers measured myocardial blood flow with PET a few years ago and will now be able to monitor progression of heart disease over time
A new option for heart valve replacement is under study at Emory University Hospital. Cardiologists at the Emory Heart & Vascular Center are conducting groundbreaking research to study a non-surgical treatment option for patients with severe aortic stenosis, a narrowing of the aortic valve opening that affects tens of thousands of people each year. It is most common among elderly patients over 70 years of age, but can surface earlier in life in those with rheumatic heart disease or congenital abnormalities of the valve. Patients often develop symptoms of chest pain, shortness of breath, fainting spells and heart failure.
Peter Block, MD
Emory cardiologists, led by Peter Block, MD, FACC, professor of medicine, Emory School of Medicine, are performing percutaneous aortic valve replacement as part of a clinical trial, comparing this procedure with traditional, open-heart surgery or medical therapy in high-risk patients with aortic stenosis. It provides a new way for doctors to treat patients who are too ill or frail to endure the traditional surgical approach. So far, 115 people have participated in the phase II clinical trial.
In this new procedure, doctors create a small incision in the groin or chest wall and then feed a wire mesh valve through a catheter and place it where the new valve is needed. The standard therapy, which has been used to treat aortic stenosis for more than 30 years, is to remove the diseased valve through open-heart surgery.
Block says the results seen so far in this clinical trial show great promise for this procedure. He says this is especially important since tens of thousands of Americans are diagnosed with failing valves each year and that number is expected to increase substantially in the coming years as baby boomers pass the age of 70.
An aging U.S. population, an increase in the prevalence of obesity and improved cardiovascular therapies for acute problems are boosting the number of people living with the condition of heart failure.
Javed Butler, MD, MPH, director of heart failure research at Emory Healthcare and associate professor of medicine at Emory University School of Medicine, is looking for new ways to prevent and treat heart failure.
According to Butler, heart failure is any condition in which the heart is unable to pump enough blood for the metabolic needs of the body, but that does not mean that the heart is not cheap oakleys pumping or the heart has stopped working. Heart failure is not a disease but a syndrome, so thereâ€™s a whole family of different diseases that can precede this condition. These are known collectively as heart failure.
In the clinic, Butler treats patients already diagnosed with heart failure. His research focuses on prevention through life style changes as well as models pinpointing who is at risk for heart failure.
Butler and his colleagues recently created the Health ABC Heart Failure Model for predicting risk of new onset heart failure in the elderly. That model has now been strengthened by validating it via a library of patient data from an earlier cardiovascular study. The results suggest the Health ABC risk model can be used to identify high-risk individuals for whom interventions can be cost-effectively targeted to prevent heart failure.
To hear Butlerâ€™s own discussion about heart failure, access the podcast from Emoryâ€™s Sound Science series.