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Diversity
creates challenge in heart disease management
News conference: 7:30–8:15 a.m., EST, Wednesday,
March 20
(ATLANTA)—Heart disease can strike without regard to
gender, race, or age. Still, such characteristics can strongly
influence not only symptoms but also treatment and outcomes,
as demonstrated by studies being presented at the American
College of Cardiology 51st Annual Scientific Session in Atlanta,
March 17–20, 2002.
Stenting
is the best approach to treating heart attack in women, a
subanalysis of the Controlled Abciximab and Device Investigation
to Lower Late Angioplasty Complications, or CADILLAC, trial
has shown (Alexandra J. Lansky, #824FO-2). Nearly 600 women
participated in the study, and just over half received stents.
Researchers found that stenting reduced by half the risk of
experiencing major cardiac problems during the subsequent
six months. Nonetheless, women were still at significantly
higher risk than men, at least partly because they were older
and had more health problems before having a heart attack.
(Original presentation on March 18, 2:15–2:30 p.m.)
When
coronary artery disease is difficult to manage with medication
alone, elderly women are just as likely to benefit from bypass
surgery as elderly men but often rate their quality of life
lower, both before and after surgery. Those were two of the
findings of the Prospective Randomized Trial of Invasive Versus
Medical Therapy in the Elderly (TIME) (Gabriela M. Kuster,
#847-6). Researchers at University Hospital in Basel, Switzerland,
also found that during follow-up, elderly women were significantly
more likely than men to die or have a heart attack. (Original
presentation on March 19, 9:45–10 a.m.)
Coronary
artery calcification is far more severe among patients who
have a first heart attack at a young age when compared to
their healthy peers, according to research from the University
of Erlangen in Germany (Karsten Pohle, #805-4). In a study
of more than 100 people who suffered a heart attack at an
average age of 40, investigators found that the calcium score
was above the 50th percentile for age in nine out of ten,
compared to fewer than half of healthy volunteers, and above
the 90th percentile for age in nearly two out of three, compared
to about one in twenty healthy volunteers. The researchers
noted, however, that the artery responsible for the heart
attack was not always the one hardened with calcification.
(Original presentation on March 18, 10–10:15 a.m.)
Several
studies have shown that patients who belong to a racial minority
are less likely than whites to have invasive coronary procedures,
such as angiography, angioplasty, and stenting. Now, a new
analysis suggests that their risk may be higher when they
are treated invasively, at least when experiencing unstable
angina or a type of heart attack known as non–ST segment
elevation myocardial infarction (Marc S. Sabatine, #840-1).
Nearly 500 “nonwhite” patients were enrolled in
the Treat angina with Aggrastat and determine Cost of Therapy
with an Invasive or Conservative Strategy, or TACTICS-TIMI
18, trial. In reviewing their medical records, researchers
from Brigham and Women’s Hospital in Boston found that
those who were treated invasively were significantly more
likely than their white counterparts to die, have a heart
attack, or need to be hospitalized again. Minority patients
treated with medication faced no increased risk in comparison
to white patients. (Original presentation on March 19, 8:30–8:45
a.m.)
Moderator:
Dr. C. Noel Bairey Merz, Cedars-Sinai Medical Center, Los
Angeles
The
American College of Cardiology, a 28,000-member nonprofit
professional medical society and teaching institution, is
dedicated to fostering optimal cardiovascular care and disease
prevention through professional education, promotion of research,
leadership in development of standards and guidelines, and
the formulation of health care policy.
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