Cath Lab Digest

9. Effectiveness and safety of drug-eluting stents in Ontario This large Canadian study found that drug-eluting stents are effective in reducing the need for target-vessel coronary artery bypass in patients at the highest risk for re-narrowing of previously blocked arteries, without a significantly increased rate of death or heart attack. Source: New England Journal of Medicine, Oct. 7, 2007; N Engl J Med 2007; 14;357:1393–1402; www.nejm.org.
Funding: The Ontario Ministry of Health and Long-Term Care to the Program for Assessment of Technology in Health, the CCN of Ontario and the Institute for Clinical Evaluative Sciences supported this study in part.

10. Underdiagnosis of hypertension in children and adolescents This study of more than 14,000 children found that hypertension and prehypertension were often undiagnosed in the pediatric population. Patient age, height, obesity-related diagnoses, and magnitude and frequency of abnormal blood pressure readings all increased the odds of hypertension. Source: Journal of the American Medical Association, Aug 2007; JAMA 2007; 298(8):874–879; www.jama.org.
Funding: This research did not receive funding support.

Statements and conclusions of study authors are solely those of the study authors and do not necessarily reflect association policy or position. The American Heart Association makes no representation or warranty as to their accuracy or reliability.

Heart Attack Risk From Smoking Due to Genetics
Heart attacks among cigarette smokers may have less to do with tobacco than genetics. A common defect in a gene controlling cholesterol metabolism boosts smokers’ risk of an early heart attack, according to a study in Annals of Noninvasive Electrocardiology. The findings also show that smokers without the defect normally have heart attacks no sooner than their non-smoking peers.
Although the link between smoking and heart disease was established decades ago, the reasons for that link were unclear. More recent studies suggest smoking interferes with cholesterol metabolism, lowering smokers’ levels of high-density lipoprotein, the good cholesterol that protects against heart-attack risk. An estimated 55 to 60 percent of smokers face the added risk of a defective gene that also lowers levels of the protective high-density lipoprotein. Therefore, the combination of smoking plus a defective gene substantially accentuates the risk of heart attacks in these patients.
Researcher Ilan Goldenberg, MD, and colleagues were the first to evaluate both smoking history and the genetic trait in heart-attack patients. They found that smokers with the genetic defect had their first heart attack eight to nine years earlier than non-smokers. Smokers with a healthy version of the gene had their first heart attack only three years earlier than non-smokers, a difference the researchers considered non-significant.
“Since the frequency of this ‘bad’ gene in the general population is about 60 percent, many people who smoke have a high risk of experiencing a heart attack at a young age,” Goldenberg said. “This finding should increase awareness for smoking cessation.”