The D2d Study (USA)

The goal of the Vitamin D and type 2 diabetes (D2d) study is to determine whether vitamin D supplementation is safe and effective in delaying the onset of type 2 diabetes in people at risk for the disease and to gain a better understanding of how vitamin D affects glucose metabolism. There are over 79 million Americans who are at increased risk for developing type 2 diabetes. Lifestyle changes, such as healthy eating, exercise and weight loss, can decrease the chances of developing diabetes. However, many people still develop diabetes despite efforts at changing their lifestyle. Therefore, there is a continued need for the identification of modifiable risk factors and interventions that are safe, inexpensive and easy to implement to prevent type 2 diabetes and decrease disease burden. Based on recently published studies, vitamin D has emerged as a potential determinant of type 2 diabetes risk. However, according to reports by the Institute of Medicine and the Endocrine Society, the evidence to support vitamin D supplementation for prevention of diabetes is inconclusive and there is a need for definite studies in this area, such as the D2d study. The D2d study is a large multi-center clinical trial conducted in twenty cities around the United States. The D2d study will enroll approximately 2,400 participants who are at risk of developing type 2 diabetes. Participants are randomly assigned to receive either vitamin D or placebo and be followed for up to 4 years for development of diabetes. The D2d study is expected to define the role of vitamin D supplementation in modifying diabetes risk in people at risk for the disease

Making the business case for cardiac rehab programs

You know the saying: an ounce of prevention is worth a pound of cure. When it comes to cardiac rehabilitation, a study presented recently at the Canadian Cardiovascular Congress has the numbers to prove it. "We found that cardiac rehabilitation programs have a financial 'return on investment' of about seven per cent," says author Dr. Dennis Humen, a professor of medicine at Western University. "Not only is cardiac rehab the pillar of preventing a second cardiac event; it also makes good business sense." The study also revealed that, for patients, the "return on investment" for participating in these programs also makes good heart sense: cardiac rehab leads to a 31 per cent reduction in hospital readmission and a 26 per cent drop in cardiovascular mortality. "There are more than 60,000 hospitalizations for heart attacks in Canada each year and another 160,000 due to coronary heart disease," says Dr. Humen. "This opens a huge window of potential: if we could provide intensive cardiac rehab services to just 60,000 individuals, there could be a reduction in healthcare costs for this group of about $8.5 million per year." If CR reduces cardiac events, mortality and hospital readmission rates, why isn't it funded more broadly? Governments often cite high costs as a barrier to funding comprehensive CR, which combines regular exercise with intensive education around lifestyle changes. Yet the Western University study shows that on a financial basis the investment is more than offset by the ensuing cost savings

'Hungry gene' discovery may help solve the obesity problem

Scientists have discovered a "hungry gene" which they believe could cause obesity. A study has identified a possible genetic root to the insatiable appetite and slow metabolism in some people. Looking at 2,101 patients who were severely obese, they found those with mutations of a gene called KSR2 were hungrier and burned fewer calories than people with a normal copy of the gene. Dr Sadaf Farooqi, of Cambridge University, said: "Changes in diet and levels of physical activity underlie the recent increase in obesity. However, some people gain weight more easily than others. This variation between people is largely influenced by genetic factors. "The discovery of a new obesity gene, KSR2, demonstrates that genes can contribute to obesity by reducing the metabolic rate - how well the body burns calories." Dr Farooqi said the discovery could provide clues as to how obesity develops and help develop new drugs to treat the condition as well as type-2 diabetes, which is linked with it. The study was published in the journal Cell

Text messages are saving Swedes from cardiac arrest

Sweden has found a faster way to treat people experiencing cardiac emergencies through a text message and a few thousand volunteers. A program called SMSlivräddare - or SMSLifesaver - solicits people who have been trained in cardiopulmonary resuscitation (CPR). When a Stockholm resident dials 112 for emergency services, a text message is sent to all volunteers within 500 meters of the person in need. The volunteer then arrives at the location within the crucial first minutes to perform lifesaving CPR. The odds for surviving cardiac arrest drop 10% for every minute it takes first responders to arrive. "The traditional emergency services, especially the ambulance - they have problems in the Stockholm area," said Dr. Mårten Rosenqvist, a professor of cardiology and spokesman for the group. "First there are not so many, second there is heavy traffic in Stockholm, and third, they are usually occupied by doing other things: transporting patients to the emergency room, or transporting patients between hospitals." With ambulance resources stretched thin, the average response time is some eight minutes, allowing SMSlivräddare volunteers to reach victims before ambulances in 54% of cases

CARG Newsletter - November 2013

The CARG Newsletter - November 2013 is now available online

Flu shot halves risk of heart attack or stroke in people with history of heart attack

The flu vaccine may not only ward off serious complications from influenza, it may also reduce the risk of heart attack or stroke by more than 50 per cent among those who have had a heart attack, according to new research led by Dr. Jacob Udell, a cardiologist at Women's College Hospital and clinician-scientist at the University of Toronto. What's more, the vaccine's heart protective effects may be even greater among those who receive a more potent vaccine. "Our study provides solid evidence that the flu shot helps prevent heart disease in vulnerable patients - with the best protection in the highest risk patients," Dr. Udell said. "These findings are extraordinary given the potential for this vaccine to serve as yearly preventative therapy for patients with heart disease, the leading cause of death among men and women in North America." Published recently in the Journal of the American Medical Association, the study reviewed six clinical trials on heart health in people who received the flu vaccine. The studies included more than 6,700 patients with a history of heart disease

Heart failure operation first in UK

Surgeons at King's College Hospital have used a pioneering procedure which can improve the function of failing hearts. The operation, a form of "cardiac sewing", is the first of its kind in the UK and involves removing scar tissue whilst the heart is still beating, reducing the size of the heart so that it can pump more efficiently. Patients with heart failure struggle to pump blood around the body, which can leave them breathless during make mild exercise and day-to-day tasks. Sevket Gocer, 58, was the first patient to be treated in the UK. His heart function is said to have "improved significantly" after the operation. Mr Olaf Wendler, a professor of cardiac surgery at King's College Hospital, commented: "In the technique we have now used for the first time in the UK, one does not need to stop the heart, one does not even necessarily need to place the patient on a heart-lung machine. "It's a less traumatic and less invasive type of procedure." The procedure is also being trialled by other hospitals across Europe

Some blood pressure medications may reduce Alzheimer's risk

Certain blood pressure medications may reduce the risk of dementia due to Alzheimer's disease, U.S. researchers say. Dr. Sevil Yasar, an assistant professor at the Johns Hopkins University School of Medicine in Baltimore, found about 3,000 people age 75 and older with normal cognition who used diuretics, angiotensin-1 receptor blockers and angiotensin-converting enzyme inhibitors showed a reduced risk of Alzheimer's disease dementia by at least 50 percent. "Our study was able to replicate previous findings, however, we were also able to show that the beneficial effect of these blood pressure medications are maybe in addition to blood pressure control, and could help clinicians in selecting an anti-hypertensive medication based not only on blood pressure control, but also on additional benefits." In addition, diuretics were associated with 50 percent reduced risk in those in the group with mild cognitive impairment. Beta blockers and calcium channel blockers did not show a link to reduced risk, the scientists said. "Identifying new pharmacological treatments to prevent or delay the onset of AD dementia is critical given the dearth of effective interventions to date," Yasar said

Making exercise a prescription for diabetes (Canada)

Most Canadians would agree that physical activity and exercise plays an important role in preventing or managing the devastating effects of chronic diseases, including diabetes. But what we say and what we do can be very different. In fact, the majority of Canadians do not meet the physical activity guideline recommendations established by the Canadian Society for Exercise Physiology and the Canadian Diabetes Association. A unique team of health care and exercise professionals representing medicine, physiotherapy, dietetics, kinesiology, and psychology, comprising the Exercise is Medicine® Canada National Task Force, is aiming to change this reality by bringing physical activity and exercise into mainstream patient care. Dr. Jan Hux, Chief Scientific Advisor for the Canadian Diabetes Association, says the Canadian Diabetes Association's 2013 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada (Guidelines) recommends all individuals with diabetes participate in at least 150 minutes of moderate to vigorous intensity aerobic exercise each week, and encourages resistance training three times a week. "Providing diabetes care providers with practical and effective strategies for incorporating physical activity into a management plan is extremely valuable for people living with diabetes," she says

Saskatoon Council on Aging - "Help us make our web site better"

Virginia Dakiniewich, Advancement Officer Saskatoon Council on Aging Inc. writes: The Saskatoon Council on Aging is looking for seniors to participate in our web site project. All levels of experience are welcome. We are hoping to get advice from seniors themselves on how we could make our web site easier to use and to find information they need. For more information or to register, please visit us online at http://www.scoa.ca/getinvolved or call tel:306-652-2255"

New class of drug targets heart disease (Alberta)

Researchers at the University of Alberta have developed a synthetic peptide that could be the first in a new class of drugs to treat heart disease, high blood pressure and diabetes. Researchers at the U of A found that a deficiency in the peptide apelin is associated with heart failure, pulmonary hypertension and diabetes. They also developed a synthetic version that targets pathways in the heart and promotes blood vessel growth. Lead author Gavin Oudit, an associate professor in the Faculty of Medicine & Dentistry, said the synthetic form of apelin is far more stable and potent than the naturally occurring peptide, making drug therapies possible. "It's a new group of drugs that we hope can be used for a wide variety of disorders, all of which have a huge economic burden on the health-care system," said Oudit, a cardiologist and clinician-scientist at the Mazankowski Alberta Heart Institute. Oudit's research group studied apelin deficiency in the hearts of mice and humans through the Human Explanted Heart Program, or HELP. The HELP program allows for the study of specimens obtained from patients undergoing a heart transplant

Ottawa scientist discovers possible early treatment for heart disease

Research by an Ottawa scientist and his team could lead to groundbreaking new treatment for certain forms of heart disease, care that could affect as much as 15 per cent of the population. Dr. Lynn Megeney, a specialist in regenerative medicine at the Ottawa Hospital Research Institute and an associate professor at the University of Ottawa, has discovered that certain proteins involved in normal cell death also play a significant role in abnormal thickening of the heart muscle. In a paper recently published in the online edition of Proceedings of the National Academy of Sciences, he says that by blocking these specific proteins in the heart, such damage can be prevented, and even reversed. The thickening, known as cardiac hypertrophy, can be a beneficial response to exercise or pregnancy. But it is often the unwelcome result of such stresses as high blood pressure, diabetes, heart failure and genetic conditions, and can cause the heart to grow to twice its size and eventually cease functioning properly, leaving transplant as the only viable treatment. It is, says Megeney, perhaps the most significant and least talked about long-term ramification of unregulated high blood pressure. "We often think of kidney problems and stroke, but nobody really discusses cardiac hypertrophy."

Study finds that participation in cardiac rehab programs can result in huge gains for recovery in stroke patients

Stroke patients who participate in a cardiac rehabilitation program for six months make rapid gains in how far and fast they can walk, the use of weakened limbs and their ability to sit and stand, according to a study presented today at the Canadian Stroke Congress. On average, participants saw a 21-per-cent improvement in the strength and range of motion of weakened limbs; a 19-per-cent improvement in walking speed; and a 16-per-cent improvement in the distance they could walk. "There should be a seamless referral of patients with mild to moderate effects of stroke to the network of established outpatient cardiac rehab programs in Canada," says lead researcher Dr. Susan Marzolini of Toronto Rehabilitation Institute/University Health Network. "Early referral is also important. In our study, those who started the cardiac rehab program earlier had the strongest results." Cardiac rehabilitation incorporates exercise training (aerobic and resistance/strength training), nutrition counseling, risk factor counseling and management (lipids, blood pressure, diabetes, weight management, smoking cessation and psychosocial management,) delivered by an interprofessional health care team. All of the 120 patients who participated in the study saw improved recovery

Europe to launch tiny, wireless pacemaker

The European Union has recently approved the use of a tiny and wireless pacemaker. This pacemaker does not require invasive surgery to be implanted because it is small enough to be intravenously inserted directly in the heart. Even though the design is relatively new, experts find this type of technology to be a very "exciting development." The new pacemaker was created by a start up company named Nanostim from the United States. It is smaller than the conventional pacemaker by 10 percent and is charged by a built in battery. The tiny pacemaker is implanted using a catheter that is inserted into the femoral vein by the groin. The built-in battery, which is much smaller than an AAA battery, can last between nine and 13 years. The procedure to get the device fitted takes only around half an hour. Since the procedure does not require surgery, patients will not have a scar. Even though this device has yet to receive full approval from the U.S. Food and Drug Administration (FDA), experts believe that it could change how conventional pacemakers are used

Survey claims staff cuts hitting cardiac care (Ireland)

Research by two leading groups in cardiac care claims that staff cuts are creating serious problems for patients and the battle against heart disease. The Irish Association of Cardiac Rehabilitation and the Irish Heart Foundation surveyed the 36 hospitals providing cardiac rehab. The results say that staffing cuts meant that none of these hospitals had all the expertise required to provide the life-saving services. More than 1,800 patients - including many with life threatening conditions - are on a waiting list of up to six months for cardiac rehab. The research showed that over half were missing at least four of the ten team members needed to deliver proper cardiac rehab services. "This survey exposes the impact of sustained cutbacks in cardiac rehabilitation and how these now threaten its long-term viability," said IACR President, Dr Charles McCreery. "Cardiac rehab is vital to thousands of patients coping with the physical and psychological impacts of heart attacks and heart surgery. But it is being treated almost like an optional service and that needs to change," he added. A full team includes a medical director, rehab coordinator, occupational therapist, physiotherapist, nursing, social worker, psychologist, pharmacist, dietitian plus administrative support. The survey says that 27 cardiac rehab units have no access to psychology and 29 have no medical social worker