Published on Monday, July 6, 2009 in THE PHILADELPHIA INQUIRER.
Likely benefits to prescribing statins to curb heart disease
Cholesterol-lowering statin drugs, the standard of care for people with heart disease, may also benefit many patients who are merely at risk of developing the disease, researchers report in a review of 10 previous studies involving 70,000 people worldwide.
Prescribing statins as a preventive measure to patients with risk factors such as diabetes and high blood pressure was associated with a 30 percent drop in major heart disease and a 12 percent drop in deaths over an average of four years, researchers said on bmj.com, an online British medical journal.
Statins are powerful drugs, and the researchers - several of whom reported support in the past from manufacturers - stopped short of recommending their use for all people at risk of developing heart disease.
While men over 65 who have other risk factors and older women with diabetes and other risk factors appear to be most in danger of developing heart disease, they write, "the correct identification of such people remains a challenge," as does prediction of an individual's risk. - Heather J. Chin
Study of falls suggests need to teach safer use of walkers
More than 47,000 older Americans a year - 129 a day - seek treatment at hospitals after falls involving walkers or canes, according to a six-year review of ER records that suggests more time should be spent teaching people how to use walking aids.
Falls are the leading cause of injuries in people over 65. Less than 3 percent involve walking aids, but the researchers, from the U.S. Centers for Disease Control and Prevention, said they were the frailest and most vulnerable population. And while twice as many older people use canes than use walkers, the researchers found seven times as many injuries associated with walkers.
Fractures were the most common type of injury. Men injured their head and neck most frequently, while women hit their hip or pelvis. Women, who are more likely to use walkers, made up 77 percent of all falls examined.
The goal now, the authors write in the Journal of the American Geriatrics Society, is to identify potential risk factors that lead to falls, to design better walking aids, and to provide education on safe usage. Information about falls and how to prevent them: http://go.philly.com/health. - Heather J. Chin
The number of patients hospitalized in the U.S. for heart failure and heart-related diseases almost tripled from 1979 through 2004 according to a recent study.
The Journal of the American College of Cardiology reported this month that hospitalizations rose from 1.27 million to 3.86 million in this time span, and the trend likely will continue.
The U.S. Centers for Disease Control and Prevention (CDC) conducted the study, which evaluated data from the National Heart Discharge Survey. More than 80 percent of those admitted to hospitals with any mention of heart failure were age 65 or older and most had Medicare or Medicaid.
In the study, Dr. Jing Fang, lead author and an epidemiologist with the CDC, said an aging American population largely accounts for the increases, because older patients more commonly suffer from heart failure and weakening of the heart.
Dr. Fang wrote, "the improvement in technology for treatment of patients with other heart diseases, such as [heart attacks], ... [helps] people with diseases of the heart live longer."
Hospitalizations due to actual heart failure account for up to 35 percent of heart-related hospital stays. The remaining cases had respiratory diseases and conditions such as pneumonia, diabetes and kidney failure.
Dr. Fang added, although better control of these conditions could reduce hospital visits for heart failure, once the condition becomes serious enough to warrant a visit, it cannot be cured.
These people keep coming back to the hospital, and "the best medicine [we] can do is to keep the heart functioning enough for the patient to have a good quality of life," he said.
No effective treatments for severe heart failure exist, said Dr. Javed Butler, director of heart failure research at Emory University, since "when you [talk] about medications that have been proven, they are all for chronic, stable outpatients. ... We don't have any proven medications for treatment at the hospital."
The report did not address cost of the increased hospitalizations over the given period, but the American Heart Association estimates it costs around $20 billion annually.
Considering the high cost, a major effort to develop in-hospital treatments for severe heart failure is needed, Dr. Butler said. "It is a least-studied, most costly problem. We need to get a better grasp on what we should be doing."
Heather J. Chin can be reached at hchin@thebulletin.us