Department of Medicine

Case Western Reserve University School of Medicine & UH Case Medical Center

Sugary Drinks Might Raise Hypertension Risk

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BusinessWeek

Drinking sugar-sweetened sodas and fruit drinks appears to be associated with a greater risk for high blood pressure among adults, a new study suggests.

Dr. Sahil Parikh, Professor in the Division of Cardiovascular Medicine, and cardiologist at the Harrington Heart & Vascular Institute at University Hospitals Case Medical Center in Cleveland, said the findings “fall along the lines of the kind of common sense your mother would offer.”

“We have long known that sugary drinks are bad for you, because they are a lot of empty calories,” he said. “But what makes this study important is that it suggests that beyond just making you fatter these drinks also prompt hypertension, which can increase the incidence of heart attack and stroke.”

“Now we will need to have future studies to understand how this works,” Parikh added, “because even though this data shows a pretty clear association between sugary drinks and high blood pressure, it doesn’t definitively suggest a mechanistic link.”

“Having said that, as a cardiologist my concern is how do we minimize our risk factors for cardiovascular events,” he continued. “And we know the way to do that is to avoid tobacco use and avoid obesity. So to the extent that one can control calorie intake, there really isn’t a downside to eliminating sugar drinks. They’re empty calories of limited value. So why not do that?”

In response to the latest findings, the American Beverage Association issued a statement Monday saying that while high blood pressure is “a serious health concern,” the current study “does not and cannot establish that drinking sugar-sweetened beverages in any way causes hypertension.”

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New England Journal of Medicine editorial :: James Fang, MD

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A substudy of a randomized comparison of medical therapy with or without bypass surgery for ischemic heart disease in patients with LV systolic dysfunction found that overall, substantial viable myocardium evident at baseline imaging studies had no independent bearing on all-cause mortality over five years; and such viability didn’t influence the relative effectiveness of the two treatment strategies, either for all-cause mortality or the secondary end points of CV mortality and CV hospitalization.

The findings, from the Surgical Treatment for Ischemic Heart Failure trial, based on a selected cohort of about half the total trial population, don’t necessarily mean myocardial viability doesn’t have functional implications, observe the substudy authors…

After pointing out the abundant and longstanding but primarily observational support for revascularization guided by viability testing, Dr James C Fang, University Hospitals and Case Medical Center, Cleveland, OH writes in an accompanying editorial that it was “perhaps surprising” that viability didn’t predict a survival benefit from revascularization. The findings, however, “should be interpreted cautiously,” given the substudy’s limitations; for example, patients were selected for viability testing individually at the physicians’ discretion. “However, the substudy’s findings do raise reasonable questions about the most appropriate method to assess myocardial viability,” Fang writes. “The analysis is a strong reminder that in this era of cost-effectiveness, the role of expensive technologies should be accountable to a rigorous study of incremental benefit.”

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1st deployment of transcather aortic valve inplantation – TAVI

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The Division of Cardiovascular Medicine successfully deployed the first transcatheter aortic valve implantation [TAVI].

University Hospitals Case Medical Center is one of only forty sites in the U.S. and the only one in Northeast Ohio – to participate in this clinical trial.

TAVI is a state of the art, minimally invasive technique that benefits high-risk elderly patients who develop aortic stenosis.

Dr. Barbara Williams: Women’s Heart Health

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Director of the Women’s Cardiovascular Center at University Hospitals Dr. Barbara Williams discusses heart health and prevention.

Jim Fang, MD, discusses Dick Cheney & Heart Transplant case

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Former VP Dick Cheney has announced that he is getting by with a heart pump, which makes it awkward for him to walk … and he touched on the possibility of getting a heart transplant. Dr. James Fang shows Shepard Smith just what that pump looks like that’s keeping his heart in shape.

Physicians speak out on implications of dabigatran approval

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Cardiology Today | December 1 2010

Expert, Albert Waldo, MD, weigh pros and cons of the first new oral anticoagulant in more than 50 years.

The market for stroke prevention in patients with nonvalvular atrial fibrillation may soon be heading in a new direction with the recent FDA approval of dabigatran etexilate.

This approval came 1 year after data published in The New England Journal of Medicine from the Randomized Evaluation of Long-term Anticoagulation Therapy (RE-LY) trial reported a reduction in risk for stroke and systemic embolism in patients given dabigatran (Pradaxa, Boehringer Ingelheim) compared with the current standard of care, warfarin (Coumadin, Bristol-Myers Squibb). The 150-mg dose of the newly approved drug was released to pharmacies nationwide on Nov. 3, with the release of the 75-mg dose following shortly afterward.

An economic factor that must be considered, according to Albert L. Waldo, MD, Walter H. Prichard Professor of Cardiology at Case Western Reserve University/University Hospitals Case Medical Center, Cleveland, and Editorial Board member for Cardiology Today’s Arrhythmia Disorders section, is the expected long-term benefits with dabigatran.

“If this drug is significantly better than warfarin, you would hope that there would be fewer complications than from warfarin. So it would be more economical in the long run by keeping people out of hospitals,” Waldo told Cardiology Today. “However, on an individual basis, there is concern about the expense of the pill. So I think it is going to have to filter through our health care system on how drugs get supported by the different insurance plans and see how costly it is going to be for the patient. The hope is that because the drug is better and safer, there will be a lot of cost savings in the long run associated with fewer strokes and less bleeding than in patients taking warfarin.”

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Telmisartan improved outcome in patients with hemodialysis, chronic HF

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Cardiology Today | November 18 2010

All-cause and CV mortality, as well as HF-associated hospital stays, were significantly lower in patients with hemodialysis and chronic HF who were treated with telmisartan, new data suggested.

“To the best of our knowledge, our results are the first to provide evidence that the addition of an [angiotensin II type 1 receptor blocker], namely telmisartan, to regimens, including various combination of ACE inhibitor, digitalis, and beta-blockers, is feasible and beneficial in end-stage renal disease patients with chronic HF receiving dialysis treatment,” the researchers wrote.

The 3-year, randomized, double blind, placebo-controlled, multicenter trial was performed in 30 Italian clinics featuring hemodialysis patients with chronic HF (NYHA Class II to III; left ventricular ejection fraction ≤40%). Besides ACE inhibitor therapy, patients were randomly assigned telmisartan (Micardis, Boehringer Ingelheim; n=165; target dose, 80 mg) or placebo (n=167).

During a mean follow-up of 35.5 ± 8.5 months, researchers reported a significant reduction for all three primary endpoints in patients taking telmisartan vs. placebo: all-cause mortality (35.1% vs. 54.4%; P<.001), CV death (30.3% vs. 43.7%; P<.001) and hospital admission for chronic HF (33.9% vs. 55.1%; P<.0001).

Additionally, Cox proportional hazards analysis revealed telmisartan to be an independent determinant of all-cause mortality (HR=0.51; 95% CI, 0.32-0.82), CV mortality (HR=0.42; 95% CI, 0.38-0.61) and hospital stay for chronic HF decompensation (HR=0.38; 95% CI, 0.19-0.51).

Such beneficial effects of telmisartan as seen in the trial, the researchers noted, “were evident within 6 months from the beginning of the treatment and persisted for the entire treatment period. … Although further larger trials in hemodialyzed patients with [chronic] HF are desirable, our experience could offer clinicians an opportunity to make additional improvements in the poor prognosis of end-stage renal disease patients with chronic HF.”

“Although the power calculations in the present study showed 90% power, this was to detect a 50% hazard reduction in death, not a commonly seen magnitude of benefit with most agents in any clinical trial setting,” Ilke Sipahi, MD, and James C. Fang, MD, of the Harrington Heart & Vascular Institute, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, wrote in an accompanying editorial. “Given this aggressive target of event-reduction benefit and a modest total number of patients (which is comparable to a ‘pilot’ trial), it is not clear whether this trial provides enough power to be definitive.”

Despite this, the findings are important and should lead to further investigation. However, “For now, clinicians should carefully evaluate the choice of agents in the treatment of HF when it complicates dialysis and make sure that drugs that antagonize both the [renin-angiotensin system] and adrenergic axes are considered,” Sipahi and Fang said.

Paper :: Cice G. J Am Coll Cardiol. 2010;56:1701-1708

Richard Walsh, MD, Chair
discusses 2010 achievements

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UH System Achievement Award for Time-is-Muscle CWRUmedicine's Cardiovascular Medicine Committee door-to-balloon time initiative

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This is a multi-disciplinary team effort from EMS/Transfer Center, ED, cath lab, CICU, and Quality Center.

Median D2B reduced from 94 to 37 min with 100 per cent of pts receiving AHA/ACC recommended D2B less than 90 min.

Key Department of Medicine MDs included Madan Mohan, Rich Jospehson, Tom Lassar, Shyam Bhakta, Tom Carrigan, Marco Costa, and Dan Simon.

Learn more about Cardiovascular Medicine at CWRUmedicine

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