Docs Shoulder Some Liability for Athlete Exams
Physicians who evaluate the health of college athletes should be able to competently distinguish the athletic heart from structural heart disease related to genetic defects, wrote Timothy E. Paterick, MD, JD, from Aurora Cardiovascular Services in Aurora, Colo., and colleagues in the American Journal of Medicine.
Since physicians shoulder some risk of liability, they should stay informed of available guidelines including American Heart Association (AHA) screening recommendations and the American College of Cardiology's disqualification recommendations, they stated.
Screening athletes with ECG is not recommended by the AHA because it can result in false-positive studies, as well as false negatives. Echocardiography also is not recommended for routine screening of athletes. However, either one of these techniques should be used upon follow-up of suspicious historical or physical exams.
Those with hypertrophic cardiomyopathy should be excluded from most competitive sports, as this condition is responsible for about 30% of all cases of sudden cardiac death in athletes. Those with other cardiomyopathies and with arrhythmogenic right ventricular dysplasia also should be excluded from most competitive sports.
X-ray Grading System IDs Defective Leads
Identifying problematic Riata defibrillator leads with fluoroscopy might be easier with the use of a simple visual classification system, reported Sunthosh V. Parvathaneni, MD, from Vanderbilt University Medical Center in Nashville, and colleagues.
Researchers devised a 4-point scale to grade the degree of insulation failure in the recalled St. Jude Medical leads:
Type 0 = normal fluoroscopic structure
Type 1 = abnormal cable spacing not extending beyond the usual lead envelope
Type 2 = gross extrusion of ≤1 cm in length
Type 3 = lead with gross cable extrusion >1 cm in total length
They found that their visual system correlated well with damage found on extracted leads, according to the study published online in HeartRhythm. In addition, the amount of visible conductor externalization increased with longer duration of implantation.
Three-Pronged Attack to Reduce CV Disease
The "default" options in lifestyle choices have led to an increased risk of cardiovascular disease, which should be challenged regionally, nationally, and internationally, according to a position paper from the European Society of Cardiology.
Many people oppose government's involvement in "nudging" people toward healthier choices, but corporations already nudge them in the wrong direction, wrote Torben Jorgensen, MD, and colleagues in the European Journal of Preventive Cardiology.
They added that the government is responsible for population health, as demonstrated by clean air and water legislation.
But on a national and regional level, they suggested that taxing unhealthy foods reduces their consumption, thereby reducing cardiovascular deaths. Conversely, subsidizing fruits and vegetables keeps these healthy foods affordable, thereby increasing their consumption.
Regarding smoking, they noted that for each 10% increase in retail price, the rate of smoking is reduced by 4%, a trend that is similar for alcohol. Locally, access to tobacco products by adolescents should be restricted by tactics such as age-verification and banning tobacco-containing vending machines.
Physical activity can be increased by making the environment more user-friendly for walking and biking, they said. Local governments can decrease the price of public transportation, increase parking rates, and support physically active modes of transportation.
Genes Best Imaging for Identifying CAD
A gene expression score comprised of age, sex, and expression levels of 23 genes was better able to predict obstructive coronary artery disease (CAD), particularly in women, than myocardial perfusion imaging (MPI), researchers wrote online in the American Heart Journal.
Only 45% of men and 22% of women with an abnormal MPI test had obstructive CAD. However, each 10-point increase in the gene expression score was associated with a two-fold increase in the odds of obstructive CAD, according to Alexandra Lansky, MD, from Yale University School of Medicine in New Haven, Conn., and colleagues.
While the odds ratio for the genetic test to be an independent predictor of disease in men was 1.99, for women it jumped to 3.45. This is important as in women, "neither typical nor atypical symptoms were associated with significant increases in any of the measures of CAD."
The blood-based gene test, which is for nondiabetics, is the only such gender-specific diagnostic test available, researchers said. Patients were part of the PREDICT (Personalized Risk Evaluation and Diagnosis in the Coronary Tree) trial.
Exercise Your Blues Away
A 4-month aerobic exercise program was as good as medication for reducing depressive symptoms in patients with coronary heart disease, reported James A. Blumenthal, PhD, from Duke University in Durham, N.C., and colleagues.
Of the 101 randomized patients in the UPBEAT (Understanding the Prognostic Benefits of Exercise and Antidepressant Therapy) trial, those in the exercise group had a decrease of 7.5 points in their depression scores, compared with 6.1 for those taking sertraline (Zoloft) and 4.5 in the placebo group, according to the study published online in the Journal of the American College of Cardiology.
Compared with sertraline, those who exercised had lower levels of the inflammatory marker interleukin-6. In addition, 40% of the exercisers were remitted at the conclusion of the trial compared with 10% of those on the antidepressant and none of the patients on placebo.
Source:
medpagetoday.com
