Cath Lab Digest

Cardiovascular Disease Death Rates Decline, but Risk Factors Still Exact Heavy Toll American Heart Association Statistical Update
Cardiovascular disease (CVD) death rates are declining, but CVD is still the No. 1 cause of death in the United States, and risk factor control remains a challenge for many, according to the most recent data from the American Heart Association’s Heart Disease and Stroke Statistics — 2008 Update. The Update is available in the Dec. 17 online issue of Circulation: Journal of the American Heart Association at http://www.americanheart.org/statistics.
The Update provides statistics about cardiovascular diseases, risk factors, treatments, quality of care and costs. The American Heart Association does not generate the data, but synthesizes it from many sources and provides it online without charge for government policymakers, physicians, researchers, educators and the public, making the Update a unique national — and even international — resource.
Cardiovascular diseases include heart disease, stroke, high blood pressure, heart failure and several other conditions including arrhythmias, atrial fibrillation, cardiomyopathy and peripheral arterial disease. CVD has been the leading cause of death in the United States every year since 1900 except during the 1918 flu epidemic. In 2004, the most recent year for which final statistics were available for this report, the age-adjusted CVD death rate per 100,000 persons was 288.0, compared to 307.7 in 2003. CVD (the No. 1 overall cause of death) was listed as the underlying cause of death in 869,724 deaths, compared to 911,163 deaths in 2003. Cancer was the second-leading cause of death, responsible for 553,888 lives lost. Stroke, when considered separately from other cardiovascular diseases, was the nation’s third-leading killer (150,074 deaths), followed by accidents (112,012). Coronary heart disease, even when considered separately from other cardiovascular diseases, was still by far the nation’s single leading cause of death (451,326).
“These statistics make it clear that cardiovascular disease remains, by far, our greatest public health challenge,” said Donald Lloyd-Jones, MD, ScM, chair of the association’s Statistics Committee, which, along with the association’s Stroke Statistics Subcomittee, is responsible for the Update.
While CVD deaths appear to be decreasing, the prevalence of many related risk factors is holding steady or increasing. Overweight, in both adults and children, has been rising for several decades. Sixty-six percent of adults are overweight while 31.4 percent are obese. Seventeen percent of children and adolescents ages 12–19 are overweight, along with 17.5 percent of children ages 6–11, and 14 percent of children ages 2–5.
“Although we have made some substantial strides in understanding the causes of cardiovascular disease, the data in this publication show that we have a long way to go to capture people’s attention and to implement the prevention and treatment programs we need,” said Lloyd-Jones, an associate professor in the Department of Preventive Medicine at Northwestern University’s Feinberg School of Medicine in Chicago.
Changing dietary habits appear to be fueling increased obesity, because many Americans are not consuming recommended levels of foods like fruits and vegetables. As cited in the Update, data from the Youth Risk Behavior Surveillance Study of the Centers for Disease Control and Prevention (CDC) shows that in 2005, among high school students, only 21.4 percent of males and 18.7 percent of females reported eating at least five daily servings of fruits and vegetables. A 2005 Behavioral Risk Factor Surveillance Study (CDC) shows that fewer than one in three U.S. adults consumes fruit two or more times per day, and only 27.2 percent eat vegetables three or more times per day.
Smoking, which raises the risk of coronary heart disease death two to three times, remains highly prevalent. More than 46 million U.S. adults are daily smokers, and about 4,000 people ages 12–17 begin smoking every day.
The 2008 Update includes enhanced content for diabetes, a major cardiovascular risk factor, and end-stage renal disease and chronic kidney disease, commonly associated with diabetes and high blood pressure. Based on 1984–2004 National Health and Nutrition Examination Studies, it is projected that diabetes prevalence will more than double from 2005 to 2050. About a third of the more than 15.1 million people with diabetes don’t know they have it, and another 59.7 million have prediabetes (a fasting blood glucose level between 100 and 125 milligrams per deciliter), which greatly increases the risk of diabetes. The Update cites a 2007 report in Circulation: Journal of the American Heart Association, which suggests that the increasing prevalence of diabetes is leading to an increasing prevalence of CVD morbidity and mortality. (At least 65 percent of people with diabetes die from some type of cardiovascular disease.)
Kidney disease is also on the rise. A projection by the U.S. Renal Data System says the number of people requiring treatment for kidney failure could increase 60 percent between 2001 and 2010.
The Update includes continued good news on improvements in the quality of care CVD patients receive at the nation’s hospitals. According to the ADHERE study, among 159,168 patients treated for heart failure at 285 U.S. hospitals in 2002–04, there were improvements in clinical outcomes and in the number of patients receiving counseling at discharge, smoking cessation counseling, prescription of beta blockers, and assessment of left ventricular function.
The American Heart Association also reports continued improvements in quality of care, through its Get With The Guidelinessm (GWTG) program, which works with participating hospitals to increase adherence to treatment guidelines for patients with coronary artery disease (CAD), stroke and heart failure:
• Using data from 58,847 patients who were admitted to 315 participating hospitals in 2006, the GWTG–CAD program reports the composite quality of care based on several performance measures was 89 percent, up from 86.3 percent in 2005. Performance measures include whether patients received aspirin, cholesterol-lowering drugs and other medications when they were discharged from the hospital and whether they were counseled to quit smoking.
• From 2006 data of 141,449 patients at 778 hospitals, the GWTG–Stroke program reports a composite quality of care score of 90 percent, up from 88 percent in 2005. Key performance measures for stroke include the administration of clot-busting therapy in eligible patients, proper anti-clotting medications during the hospital stay and, upon discharge, cholesterol-lowering therapy and counsel to quit smoking.
• GWTG–Heart Failure reports a composite quality of care score of 88 percent based on data from 35,576 patients in 231 hospitals in 2006, up from a 2005 composite score of 82.5. Performance measures include giving patients a complete set of discharge instructions, measuring left-ventricular function, counsel to quit smoking, and release from the hospital with proper medications.

While the quality of hospital care for patients with cardiovascular disease appears to be improving, the cost associated with cardiovascular disease will rise to a projected $448.5 billion in 2008, an increase of more than $16 billion over projections for 2007.

Vascular Solutions Launches Pronto® LP Extraction Catheter
Vascular Solutions, Inc. recently launched the Pronto^® LP (low profile) extraction catheter. The Pronto LP catheter is designed for soft thrombus aspiration from coronary and peripheral arteries as small as 1.5mm in diameter. The rapid exchange Pronto LP catheter is compatible with any 0.014” guidewire and is designed specifically for aspirating soft thrombus from smaller distal vessels. It combines a low crossing profile with a hydrophilic coating and a braid- and stylet-reinforced proximal shaft. The preloaded stylet provides kink-resistant delivery that can be removed rapidly to allow for full-lumen aspiration. Compatible with all 6F guide catheters (min I.D. 0.066”), the catheter is packaged with all components necessary for soft thrombus removal. The Pronto LP is currently available in the United States, along with additional Pronto catheters: the Pronto V3 catheter, the larger Pronto .035 catheter and the specialty Pronto-Short catheter.

U.S. Physician Wants All Non-heart Drugs Tested for Cardiovascular Risk
A U.S. physician-scientist insists that current regulatory policies should be strengthened to ensure acceptable cardiovascular safety of medicines primarily developed for non-cardiovascular medical problems. Dr. Jeffrey Borer, an authority in cardiovascular medicine and surgery at NewYork-Presbyterian Hospital/Weill Cornell Medical Center, recommends earlier testing of all drugs’ cardiovascular effects. He also stresses the importance of authorising regulatory bodies to mandate continuing evaluation of drug effects, even after approval for marketing.
“The importance of evaluating the cardiovascular safety of new drugs has been highlighted by recent examples of drugs — anti-arthritis drugs and others — that were withdrawn from the market when unacceptable cardiovascular risks were discovered after regulatory approval,” says Dr. Borer.
Even though a medicine has been developed to cure some other condition, he says, its possible effects on cardiac physiology/pharmacology should be tested in animal studies. Dr. Borer stresses that similar evaluations should begin in the earliest phases of drug testing in patients.
He says that the definitions of adverse cardiovascular events like heart attacks and strokes should be standardized for all observers before the drug is administered to any patient. Currently, the definition of adverse events is left up to each observer individually, limiting the strength of conclusions about cardiovascular safety.
Dr. Borer also suggests that regulatory bodies be given more teeth so that they can withdraw approval of medicines if mandated post-marketing studies have not been performed. He made these suggestions at the recent annual meeting of the European Society of Cardiology in Vienna. A report on his recommendations has been published in the European Heart Journal.