Heart Beat January 2019 Issue

Heart Beat: January 2019

Breast Calcifications May Be a Sign of Coronary Artery Disease

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Small calcium deposits in breast arteries are not associated with breast cancer, but they may be a marker of coronary artery disease (CAD) long before other symptoms appear. Researchers evaluated 2,100 asymptomatic women ages 40 and older using mammography and computed tomography angiography imaging of the coronary arteries, among other tests. As they explained in the Aug. 15, 2018, issue of JACC: Cardiovascular Imaging, 9.5 percent (199) of the women were found to have breast artery calcifications, 11.2 percent (235) had coronary artery calcifications and 15.6 percent (328) had plaque deposits in their coronary arteries. When their 10-year risk of cardiovascular disease was calculated, the presence and severity of calcifications in the breast arteries was significantly associated with the presence and extent of coronary calcifications and plaques. The reason for this association is not yet understood, but it suggests that women whose mammograms show breast calcifications should consult their doctor and take measures to lower any risk factors for CAD they might have.

Effect of Sleep on Stroke Risk Varies with Race and Gender

Regularly sleeping fewer than six hours a night is known to increase the risk of heart disease and stroke, as well as dying from one of these events. Now, it appears this finding may be race- and gender-specific. A large study published in the Oct. 3, 2018, issue of Neurology found that middle-aged and older black adults-specifically men-who were short sleepers had a reduced risk of stroke. Conversely, white men who slept nine or more hours a night had a significantly increased risk of stroke. Why sleep duration might have a stronger or weaker impact on adults of a specific race or gender would require a closer look at what other risk factors might be involved. What these findings do not imply, physicians warn, is that black men can be protected from stroke by sleeping six hours or less a night. However, these findings do imply that white men who sleep nine hours or longer every night should be evaluated and any stroke risk factors they have brought under control.

Evidence Strongest for Statins' Power to Prevent Cardiovascular Events

Cardiovascular physicians call statins a miracle drug for their ability to reduce heart attacks and strokes. Various studies have also attributed other beneficial effects to statins-278 different effects, to be exact. A review of outcomes for these non-cardiovascular diseases reported in the Oct. 8, 2018, Annals of Internal Medicine found most studies lacked the evidence necessary to make their conclusions valid or credible. The researchers analyzed 112 meta-analyses of observational studies and 144 meta-analyses of randomized, controlled clinical trials. Among the observational studies, the association between statins and decreased mortality in patients with cancer, as well as lower likelihood of death in patients with chronic obstructive pulmonary disease, were considered plausible. Other associations were merely "suggestive" or "weak." Among randomized clinical trials, they found a credible association between statin use and lower risk of death from any cause in patients with chronic kidney disease.

Using Carpal Tunnel Syndrome to Diagnose Cardiac Amyloidosis Early

In amyloidosis, abnormal proteins are deposited in tissues anywhere in the body. Over time, these deposits cause a host of problems, depending on their location. When amyloid invades the heart, the muscle becomes thick and stiff. Resulting problems include heart failure, blood clots and electrical abnormalities. In biopsies of joint fluid taken from patients undergoing wrist surgery to relieve the symptoms of carpal tunnel syndrome, Cleveland Clinic researchers found 10 of the 98 patients were positive for amyloid. In two of the 10, the heart muscle was involved, although the patients had no symptoms of heart disease. As the authors explained in the October 2018 issue of the Journal of the American College of Cardiology, patients with cardiac amyloidosis often develop carpal tunnel syndrome years before heart disease. Testing the joint fluid at the time of hand surgery may allow cardiac amyloidosis to be diagnosed and treated early.

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