Heart Disease UK

From Richard N. Fogoros, M.D
The results of two large clinical trials using drug-coated stents were presented at the Transcatheter Cardiovascular Therapeutics 2002 scientific sessions on Washington D.C. Both confirmed and extended results from earlier trials using drug-coated stents. That is, with drug-coated stents the risk of restenosis (the largest remaining problem with the use of stents in coronary arteries) appears to be dramatically reduced.
The first of the two trials, the SIRIUS trial, examined the use of the sirolimus-coated stent, from Cordis and Johnson & Johnson. Previous trials with the sirolimus-coated stent suggested a remarkable reduction in restenosis compared to using "bare" metal stents.
However, the earlier trials were largely limited to patients whose coronary artery blockages were considered nearly ideal for the use of stents. In the SIRIUS trial, in contrast, patients were intentionally enrolled whose blockages were considered high-risk. Despite this higher risk population of patients, the SIRIUS trial showed a pronounced reduction in the rate of restenosis among patients receiving the sirolimus-coated stents. Patients receiving the drug-coated stent had a 91% reduction in restenosis within the stent itself. The main endpoint of the study, however, was not restenosis but "target vessel failure" defined as cardiac death, heart attack, or the need for revascularization within 9 months of stent placement. The drug-coated stents reduced target vessel failure from 21% to 8.6%.
In the second trial, TAXUS II, results with a paclitaxel-coated stent from Boston Scientific were presented. Overall results were comparable to those achieved with the sirolimus-coated stents. (In TAXUX II, most patients did not have high-risk coronary artery blockages. Ongoing trials with the paclitaxel-coated stents are enrolling high-risk patients.)
In summary, at least two types of drug-coated stents continue to yield remarkable decreases in the rate of restenosis when compared to standard, bare-metal stents. It is increasingly likely that, once these stents are approved by the FDA for use in the United States, they will revolutionize the treatment of coronary artery disease.
While cardiologists are extremely anxious to get their hands on this remarkable technology, the cost of these new stents will stress the budgets of many hospitals and create new stress for insurers.

Thanks to the dreadful nature of many diagnostic tests, we are often fearful of undergoing such invasive procedures. Who can be blamed for letting “colonoscopy” slip to the bottom of the to-do list?
Fortunately, scientists have been devising a whole new generation of tests that don’t make you sick just thinking about them.
As simple as a finger prick for blood or the click of a camera, these painless procedures can help catch diseases before they begin to wreak havoc. Here are three tests, available now, plus a preview of some others just around the corner.

Coronary heart disease is the number one killer in this country. Every four minutes is slays another victim. Geoffrey Lunt, 31, had no inkling that he could be next when he walked into the Wellington Hospital in North London. An investment banker, Lunt had slightly raised blood pressure and was fully aware that his father had died of a heart attack. A treadmill test (the baseline test to identify heart disease) had put him in the clear. However, based on his family background, Lunt’s GP referred him for a new electron beam computed tomography (EBCT) scan - the Lamborghini of scanners. Installed this year at the Wellington’s Cardiac Imaging & Research Centre the EBCT has already benefited 1,000 patients, with the capacity to scan 5,000 a year.
EBCT is like a regular CT scan, but much faster, explains consultant cardiologist Dr. Avijit Lahiri . “In both tests, the patient lies on a table surround by an X-ray tube. With EBCT, electron beams move from side to side, creating 40 to 50 cross-sectional images of the heart. You just hold your breath a couple of times and it’s over.”
Conventional CT scanners have shutter speeds of about three-quar¬ters of a second, during which the heart contracts and relaxes, so if you take a picture, it will be blurred. But with the EBCT’s 100-millisecond scan times, motion is minimised. The cameras work so fast they capture still pictures right round the heart.
The resulting images indicate how much calcium has formed in the coronary arteries. Calcium forms on the build-up of cholesterol on artery walls and eventually causes hardening of the arteries. The higher the calcium score , the greater the likelihood of coronary attack.
Lunts results were shocking. Doctors classify a calcium score above 400 as severe; Lunt’s was 1,180. One of his coronary arteries was almost totally blocked. Angiogram confirmed the findings. “He was heading straight for a heart attack,” says Lahiri.
Lunt was put on medication to lower his cholesterol and blood pressure. He also underwent angioplasty – a metal coil was inserted into the artery to brace it open. As Lunt says, “without this test I wouldn’t be here today.”
Some 500 hospital patients are being offered EBCT on the NHS as part of a study, but most people must go privately – the main health insurance companies cover the £400 cost. Contact the Welling¬ton’s Cardiac Imaging and Research Centre at info@heart0scan.co.uk

Reprinted with permission from
Reader’s Digest, December 2002

Vital Imaging (Europe) Press Release

Sheffield United manager, Neil Warnock, has used revolutionary new heart scanning technology from Vital Imaging (Europe) for a health check to help deal with the stress of top-level football management. Last season Warnock was involved in the Division One play-offs and is now faced with increasing pressure in football to be successful.
The scanning technology (Electron Beam Tomography) used by Warnock is the safest, fastest and most accurate way to find out if someone is at risk of heart disease . Using 3D images, it shows up levels of calcification (often called furring) inside arteries and veins. The scan showed that Warnock has traces of calcification which he can reduce with simple changes in diet and lifestyle.
Warnock said, "After losing the play-offs last season, the pressure is always on managers to turn in a good performance. But my health is one thing I don’t need to worry about. It’s a huge relief to have spotted the signs of risk early on and, with some simple changes to lifestyle and diet, know that I can avoid illness in the future."
Warnock had the scan and consultation with leading cardiologists, Dr Lahiri and Dr Lipkin, at one of Vital Imaging’s clinics in London. The services offered by Vital Imaging, which are available to anyone, can detect disease up to 10 years earlier than traditional methods. The first many people realise they have a cardiac problem is a heart attack and 50% of these are fatal.

Avijit Lahiri, Eric Lim & Vijay D. Anand
The numbers are ominous: From 191 million diabetics worldwide in 1990, the number of diabetics will shoot up to 376 by 2025, say the World Health Organization projections. The incident will be most sharply felt in the developing world with an estimated with 90 million in India and 120 million in China falling pray to it.
Diabetes is a disease with associated with abnormal glucose metabolism. The reason it has attracted such attention is that diabetes is closely associated with the development of cardiovascular diseases such as heart attack, stock hypertension, kidney failure, peripheral vascular diseases (including gangrene) and blindness.
Through the precise reasons are not clear, diabetes damages the lining of blood vessels (including the coronary arteries, which supply the heart with fresh blood) and alters the body’s handling of cholesterol and fat. The end- result is greatly accelerated development of heart disease and other related conditions are responsible for a very significant number of the life- impairing and life- threatening diseases in modern times.
The problem associated with detection of cardiovascular disease in patients with diabetes is linked to the fact that the disease is often ‘silent’. By the time the patient presents the heart disease to the doctor, the condition is usually advanced. In 35 per cent will suffer a heart attack when it is too late to prevent irreversible damage to the heart. It is surprising but well-documented finding that only about 30 per cent of patients will present to the doctor chest pain or other symptoms that can alert a doctor to the presence of cardiovascular disease. Even in this group, diabetic patients have a much poorer outlook than their non-diabetic counterparts.
Surgical treatment for coronary artery disease (coronary artery by-pass surgery) and angioplasty (opening up of narrowed arteries of the heart) are less often successful, repeat procedures are often necessary and the chance of failure of medical (tablet) treatments is high. For these reasons, Drs Brown and Goldstein (both) holders of Nobel Prizes for their work on cholesterol metabolism said, “if one waits for the one symptoms of heart disease, often the first symptom is sudden death, therefore, strategies for early detection of coronary disease are required”.
Highly prevalent worldwide, with World Health Organization projecting a stunning escalation by 2025, with much of the burden of disease failing on developing rather than developed nations, Diabetes is especially menacing for India as more than 70 per cent of the patients with diabetes are likely to die of a cardiovascular cause (mainly heart attack or stroke) eventually. The mortality from this condition in the developing countries will soon be at par with and probably exceed that due to infection (aids, tuberculosis and so on) or cancer.

Avijit Lahiri, Eric Lim & Vijay D. Anand
Health economics, therefore, has to aim its big guns at prevention of diabetes, particularly in the young. The cascade of diabetes as associated with diabetes, starting from high blood pressure (hypertension) to the development of coronary artery disease, unstable angina (acute coronary syndrome), acute myocardial infarction (heart attack) and ultimate development of heart failure (failure of the pump action of the heart) impose a very significant economic burden in developed countries .This includes, not only the cost of treatment – which is life- long – but also the reduced productivity and loss of working time. In the US alone, the direct and indirect economic costs attributable to diabetes exceed $100 billion.
Potentially, the most effective strategies are to limit the causes of diabetes: over-eating and lack of physical inactivity and consequent obesity. However, in those who already have it, a key challenge is early detection of the complications associated with diabetes in order to improve patient outcomes. Also, an exhaustive search for early cardiovascular disease must be the target. The problem is that the usual methods, which doctors currently use to identity ‘silent’ cardiovascular disease – for example, asking about smoking, checking blood pressure and measuring blood cholesterol – are surprisingly imprecise.