The Cleveland Clinic Heart Advisor

Volume 11
Number 7
July 2008

Many of the charts & tables found on this site are PDFs.

July 2008

Clogged Carotid Arteries Benefit From Statins, Stents, and/or Surgery
When the carotid arteries—the blood vessels on either side of the neck that supply blood to the brain—become narrowed and clogged by plaque buildup along the arterial wall, the risk of ischemic stroke increases. If diagnosed early enough, however, clogged carotid arteries can be treated effectively with a variety of methods; which method depends on the severity of the blockage and the overall health of the patient. Two recent studies are giving doctors and patients greater confidence as they weigh their options in treating carotid artery disease. Led by doctors at Cleveland Clinic, the Stenting and Angioplasty with Protection in Patients at High Risk for Endarterectomy (SAPPHIRE) trial found that placing small, wire-mesh stents in clogged neck arteries was just as effective—and in some cases safer—than a traditional carotid endarterectomy, in which the surgeon makes an incision in the neck and opens up the affected artery to scrape out the lesions. The results were published in the April 10 issue of the New England Journal of Medicine.

CT Heart Scan Shows Promise In Predicting Heart Disease
To identify which healthy-looking people are headed toward serious heart disease, most physicians classify patients using standard risk factors. These include high blood pressure, smoking, low HDL ("good") cholesterol, family history of heart disease, diabetes, obesity, and age. But cardiac experts have been searching for more precise diagnostic tools. One potential risk-assessment tool is an imaging study called a coronary calcium computed tomography (CT) scan, which has been around since the late 1980s. "It was initially promoted as an assessment tool for anyone, but without data [to prove its effectiveness]," says Milind Desai, MD, a staff cardiologist at Cleveland Clinic and assistant professor of medicine at Cleveland Clinic Lerner College of Medicine. "Data have emerged in the last few years showing that it has a role for predicting risk for heart disease in rightly selected individuals."

ARBs vs. ACE Inhibitors: Which Is Better for Hypertension?
According to the Centers for Disease Control and Prevention, more than half of Americans age 65 and older have high blood pressure. Angiotensin-converting enzyme (ACE) inhibitors, such as lisinopril (Prinivil, Zestril) or ramipril (Altace), are commonly used to treat it—but some estimates suggest that up to 25 percent of patients can’t tolerate them. Could an angiotensin II receptor blocker (ARB) such as telmisartan (Micardis) be a useful alternative? A qualified "yes" is the message from the ONTARGET study, which followed 25,620 patients over the age of 55, with heart disease or diabetes (a risk factor for heart disease), for 55 months. The results, published in the March 31 online edition of the New England Journal of Medicine, suggest that telmisartan is just as effective as ramipril.

New CRT Technology Boosts Care For heart Failure Patients
No one looks forward to having an electronic device implanted in their chest to keep their heart beating normally, but advances in cardiac resynchronization therapy (CRT) are improving the quality of life and medical care of heart failure patients around the world. CRT involves the use of either a pacemaker or an implantable cardioverter defibrillator (ICD). The devices electronically "remind" the opposite walls of the heart to contract at the same time and prevent the rhythm of the heart from beating too quickly or slowly, or in an uncoordinated manner, says Cleveland Clinic cardiologist Bruce Wilkoff, MD. "The CRT will pace the heart to keep it from going too slow and pace or shock the heart if it goes too fast," he says, adding that CRT is only for people with life-threatening arrhythmias who are also on medication.

Resistant Hypertension Often Can Be Managed
By definition, resistant hypertension is high blood pressure that remains above a patient’s target number despite the use of at least three medications, which may include diuretics, beta blockers, angiotensin II receptor blockers (ARBs), calcium channel blockers, angiotensin-converting enzyme (ACE) inhibitors, or some combination thereof. For most adults, that blood pressure target number is below 140/90; for those with diabetes, it’s below 130/80. Among the drugs that patients with resistant hypertension should take are thiazide-type diuretics—which help lower blood pressure by reducing water volume in the body—unless there is a specific medical reason why the patient can’t take them, says Cleveland Clinic cardiologist Michael Faulx, MD.