Heart Beat March 2019 Issue

In The News: March 2019

New Document May Help Smokers Quit

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Cigarette smoking is a major risk factor for cardiovascular disease (CVD) and death from CVD. In fact, nearly one-third of U.S. deaths attributed to cigarette smoking are due to CVD. Although most smokers attempt to quit multiple times before they are able to call it quits, many do not stop smoking until they have developed smoking-related complications. Quitting smoking reduces subsequent CV events and mortality, regardless of duration or intensity of smoking, comorbidities or age. Patients benefit even when they quit smoking after they have developed CVD. This provides a strong rationale for quitting-if only the best way to accomplish this were known. Physicians have had little guidance to use in counseling patients on the most effective strategies to stop smoking. The American College of Cardiology addressed this need with an Expert Consensus Decision Pathway on TobaccoCessation Treatment (Journal of the American College of Cardiology, Dec. 25, 2018). It summarizes recommendations for a comprehensive approach to treating tobacco dependence with a chronic disease management strategy, monitoring tobacco use over time and making repeated efforts to encourage and assist smokers to quit using tobacco. The document gives physicians the information they need to answer smokers' questions about therapies for overcoming nicotine withdrawal, while bolstering self-control over smoking. It also discusses barriers to implementing and sustaining smoking cessation treatment that should be recognized and addressed to help smokers overcome their addiction to tobacco.

Explaining Revascularization Risks in Heart Patients with Cancer

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Angioplasty and stenting (percutaneous coronary intervention, or PCI) is generally a safe revascularization procedure. But patients who have, or have had, cancer are at increased risk for complications. An article published ahead of print on Nov. 30, 2018, in the European Heart Journal spells out these complications and their associated cancers. The authors used data from the Nationwide Inpatient Sample to examine the association between four forms of cancer-lung, breast, colon and prostate-and in-hospital mortality and complications in more than 6.5 million PCI procedures performed in the U.S. from 2004 to 2014. They found that patients with active lung cancer had the poorest outcomes from PCI and the highest risk of in-hospital complications and mortality. Current colon cancer patients had an increased risk of complications in general and bleeding in particular. Patients with active prostate cancer were also at increased risk of bleeding. Metastatic cancer increased these risks four- or fivefold. At the other end of the spectrum, patients with active breast cancer had no increased risk over patients who did not have cancer, perhaps because they tended to be younger and healthier overall. These findings will help physicians ensure that cancer patients needing revascularization are appropriately treated, carefully watched for complications and not denied PCI inappropriately.

Men Continue Taking Testosterone Despite Known Heart Dangers

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Supplemental testosterone use by men with age-related testosterone deficiency may increase the risk of heart attack and stroke without improving symptoms. Despite these dangers, a study published online Dec. 28, 2018, in JAMA Internal Medicine found that men with coronary artery disease (CAD) continue to use testosterone "off label"-that is, in an unapproved fashion. A group of researchers examined Medicare data on millions of U.S. men ages 50 and older (average age 71.2) from 2007 to 2016 and compared testosterone prescriptions written for on-label and off-label use. They found these prescriptions reached a high in 2013 when written for 3.2 percent of men who received a CAD diagnosis that year and 2.4 percent of those who did not have CAD. Regional variations ranged from 0.5 percent to 7.0 percent. Despite elevated cardiovascular risk without proven benefit, testosterone prescriptions cost Medicare $108 million in 2017, a figure that rose to $402 million in2016.

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