Cath Lab Digest - February 2008 - (Page 68)

68 CLINICAL AND INDUSTRY NEWS FEBRUARY 2008 Heart and Stroke Death Rates cont. death rate and a 34% decline in the age-adjusted stroke death rate when the 2008 data are released in a few years (in comparison with the 1999 data). The population size in 2008 will also be larger, so it is projected that the estimated lives saved in 2008 will be approximately 240,000. Multiple factors appear to have led to the reduction in deaths. Ongoing scientific research has led to improvements in medications and in technology. The development of evidence-based practice guidelines has helped healthcare providers know what is effective both for the treatment and prevention of heart attacks and strokes. Some of the advances are complex and others are quite simple, though important. Among those practice measures making a difference is better control of blood pressure and cholesterol levels, both with lifestyle change and with medications. In addition, a variety of strategies to reduce smoking in this country have made a difference, including tobacco excise taxes, clean indoor air legislation and smoking cessation efforts. But not everyone is receiving the proven medicines and treatments that save lives. Coronary heart disease age-adjusted death rates for women have dropped 26.9% since 1999. But age-adjusted stroke death rates among women are down by only 23.7%, lower than the overall ageadjusted stroke death rate reduction and the ageadjusted stoke death rate reduction for men, which is 25.8%. The age-adjusted death rate for blacks is down 23.8% for coronary heart disease (compared to 25.6% for whites) and 20.3% for stroke (compared to 25% for whites.) These disparities in the outcomes for women and minority populations are echoed in the statistics for those living in certain parts of the country, such as the Stroke Belt in the South, and for those with lower income levels. “These disparities are unacceptable,” Jones said. “We are actively seeking ways to better address these issues so that we can ensure that every person has the appropriate care they need to live a healthier, longer life.” He said this will require reaching the American Heart Association goals for reducing the major modifiable risk factors for heart disease and stroke. Those include hypertension, high blood cholesterol, obesity, diabetes, physical inactivity and tobacco use. Because of progress in research, each of these risk factors can be controlled to goal levels for nearly everyone with either lifestyle changes alone or lifestyle combined with medications. However, the data show that while there is progress on some of these risk factors, others are not being reduced nearly enough. The number of people with uncontrolled hypertension has fallen by 16% since the American Heart Association set its 25% 2010 strategic goals. The number of people with elevated blood cholesterol is down 19.2% and tobacco use is down 15.4%. Perhaps most alarming, the rate of physical inactivity has only declined by 2.5% and the prevalence rates for obesity and type II diabetes are actually increasing, and are appearing at earlier ages than ever before. “We’re working on this, but much more needs to be done,” Jones pointed out. “If we don’t make a concerted effort to reduce these risks, we will lose the momentum we celebrate today. We will see our children developing heart disease earlier, experiencing early deaths or needing major medical care sooner. The financial and, more importantly, the emotional toll is too great.” “We are pleased with the progress this new data shows, but we know we can do much more,” Jones said. “We need to continue to push for more research and new medical advances, along with improved adherence to our practice guidelines. Most importantly, we must make it a priority to institute lifestyle and behavior changes, and the patienthealthcare provider partnership that can control risk factors and reduce the risk of developing cardiovascular disease in the first place.” The 2005 mortality report can be accessed at www.cdc.gov/nchs/data/nvsr/nvsr56/nvsr56_10.pdf. ■ Anti-Platelet Therapy for Pint-Sized Patients T iny babies sometimes have big heart problems, but when that happens, doctors are often left scratching their heads over how much medication to give them. “That’s because 75 percent of the drugs we use in children have never been tested in kids, so often, we’re working with a best-guess situation,” says Dr. Jennifer Li, a pediatric cardiologist at Duke University Medical Center. Li and colleagues from 22 research centers around the world are hoping to change that. They’ve just completed the first-ever study examining use of clopidogrel (Plavix) in children under age two. “We were astonished at how little of the drug they needed to reap the same benefits as adults,” says Li. “It was only about a fifth of the amount that we were expecting.” The study, known as the PICOLO Trial, appears in the January 29 issue of the journal Circulation. Studies show clopidogrel can reduce the risk of heart attack, stroke, or death in adults who are “Just because a kid is one-eighth the size of an adult doesn’t mean you give them oneeighth the amount of medicine,” says Li, who is chief of cardiovascular research in the division of pediatric cardiology. high risk for cardiovascular problems. But children with heart disease can benefit from clopidogrel, too, says Li. It’s just not been clear what the optimal dose should be. “Just because a kid is one-eighth the size of an adult doesn’t mean you give them one-eighth the amount of medicine,” says Li, who is chief of cardiovascular research in the division of pediatric cardiology. “Kids are not just small adults. Their bodies are changing faster; they metabolize drugs differently; they are just biologically different.” Li recruited 92 participants for the study. All had heart disease that put them at high risk of developing life-threatening blood clots. Most had been diagnosed with hypoplastic left heart syndrome, a disorder involving a poorly performing, small ventricle that left them weak and blue in color. Others had problems with floppy or imperfect valves and one had Kawasaki disease, a condition that causes inflammation in coronary arteries. Many of the children were facing multiple surgeries to correct the defects and three-quarters of them had already had shunts implanted in their hearts to keep their blood flowing properly. The patients were randomized into one of two groups: Some got clopidogrel, others, a placebo. Those in the treatment group were given one of four doses of clopidogrel, ranging from .01 to .20 milligrams per kilogram of weight over a period of one to four weeks. Li notes that adults, with an average weight of 75 kilograms, are typically given 75 milligrams of clopidogrel per day to inhibit clot formation. When extrapolated, would predict an optimal dose of about one milligram per day for children under age two. But the study showed that the optimal dose for infants and toddlers up to 24 months was actually only .2 milligrams per day — about a fifth of that amount. “It just goes to show you that you can’t simply extrapolate from what you do in adults and apply it to children,” says Li. Li says using even optimal dosing with clopidogrel in children may involve some side effects. While there were no reports of serious bleeding, one patient did develop lower platelet counts, a condition investigators say may have been related to treatment. Bristol-Myers Squibb and sanofiaventis, the makers of Plavix, sponsored the study. ■ http://www.cdc.gov/nchs/data/nvsr/nvsr56/nvsr56_10.pdf

Table of Contents Feed for the Digital Edition of Cath Lab Digest - February 2008

Cath Lab Digest - February 2008 Bay Regional Medical Center ENDEAVOR IV: A Zotarolimus-Eluting Stent Versus a Paclitaxel-Eluting Stent in a Randomized Clinical Trial A 3D CT Vessel “Roadmap” Over Live Fluoroscopy for Chronic Total Occlusions Contents Clinical Editor’s Corner An Evaluation of Cath Lab Turnaround Time Commentary: An Evaluation of Cath Lab Turnaround Time Excerpts from Chapter 19. STEMI Interventions – Future Perspectives The Potential Clinical Utility of Intravascular Ultrasound Guidance in Patients Undergoing Percutaneous Coronary Intervention With Drug-Eluting Stents The Ten-Minute Interview with…Debbie Charlton, RN The Society of Invasive Cardiovascular Professionals (SICP) at Transcatheter Cardiovascular Therapeutics (TCT) 2007 The Cath Lab is a Business: Do You Have the Knowledge to Stay Afloat? Incidence and Predictors of Vascular Complications after Invasive Coronary Procedures: A Prospective Analysis Ask the Clinical Instructor: A Q&A Column for those New to the Cath Lab Volunteer Survey SICP* Section Meetings Calendar What Do You Think? CEU Education Center Clinical & Industry News Classifieds Advertisers Index

Cath Lab Digest - February 2008

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