Heart Beat August 2019 Issue

In The News: August 2019

First Drugs for Amyloid Cardiomyopathy Approved

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On May 3, 2019, the U.S. Food & Drug Administration (FDA) approved two medications for the treatment of transthyretin amyloid (ATTR) cardiomyopathy. Tafamidis meglumine (Vyndaqel) and tafamidis (Vyndamax) are the first drugs approved for treating this disease, in which amyloid protein accumulates in the heart muscle, causing heart failure. ATTR cardiomyopathy may be inherited or acquired.

In studies leading to FDA approval, tafamidis significantly reduced hospitalizations and deaths without increasing adverse events. The 30-month mortality rate in patients treated with tafamidis was 29.5 percent, compared with 42.9 percent in those treated with placebo.

Blood Pressure Reading Varies, Depending on Where It Is Taken

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What's your systolic blood pressure? The answer may depend on whether the reading is taken in your upper arm or wrist. Researchers have found the variation to be as large as 20 mmHg in 14 percent of the people tested. On average, a reading taken in the radial artery at the wrist was 5.5 mmHg higher than that taken in the brachial artery on the bicep. This could have implications for who is given anti-hypertension drugs, the authors said online March 25, 2019, in Hypertension.

Guidelines for measuring and treating blood pressure are based on use of a standard blood pressure cuff placed on the upper arm. But home-based devices for measuring blood pressure at the wrist have proliferated. The researchers measured blood pressure in both locations on 180 people and found only 43 percent had a wrist reading within 5mmHg of the standard bicep reading. On average, the radial artery blood pressure was12.9mmHg higher.

If you measure your blood pressure at home, you would be wise to take the device you use to your next doctor's appointment. That way, its findings can be compared with those your doctor takes with a blood pressure cuff.

Antibiotic Use by Older Women Linked to Heart Disease and Stroke

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Women who take antibiotics for more than two months are at increased risk for cardiovascular disease (CVD), defined as coronary artery disease or stroke, a study suggests. The increased risk was seen among women ages 60 and older who were taking the drugs primarily to treat a respiratory or urinary tract infection or for dental reasons.

This finding was based on 36,429 participants in the ongoing Nurses' Health Study. Participants were initially free of CVD but reported long-term antibiotic use when surveyed in 2004. Over time, 1,056 developed CVD. The researchers divided this cohort into age at the time of antibiotic use as 20 to 39 years; 40 to 59 years; and 60 years and older. Duration of antibiotic therapy was categorized as none; less than 15 days; 15 days to less than two months; and two months or more.

When adjusted for diet, lifestyle, weight, disease status, other medications and reason for antibiotics, no connection was seen between antibiotic use and CVD in younger women, nor short-term antibiotic use and CVD at any age. However, older women who used antibiotics for more than two months had a greater risk of developing heart attack or stroke, and use in middle age trended in this direction.

The study, published ahead of print April 24, 2019, in the European Heart Journal, was not designed to explain these findings. However, the authors theorized that antibiotics may increase the risk of sudden cardiac death or promote inflammation, or that long-term antibiotic use accelerates atherosclerosis.

A physician not connected to the study suggested that antibiotic use by senior adults may simply indicate those who are in poorer health. By design, the study cannot prove antibiotic use caused CVD, nor does it suggest that older women should avoid antibiotics. It does, however, underscore the need to use antibiotics appropriately and only when necessary to treat a bacterial infection.

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