Early menopause may raise the risk of cardiovascular issues

Researchers suggest that attaining menopause before the age of 40 is linked to several heart  conditions in women.

In the largest, single study to-date of diverse heart disease risks relative to age at menopause, researchers used the UK Biobank to examine data on more than 144,000 postmenopausal women ( average age of 60), including about 4,900 women who experienced menopause before age 40 after their ovaries were removed surgically.

During an average of 7 years of follow-up, researchers found that women who had experienced premature menopause were  significantly more likely to develop conventional heart disease risk facttors, such as high blood pressure, high levels of " bad" cholesterol and tyep 2 diabetes.

Even after accounting for conventional risk factors, women with premature menopause still had a significantly increased risk of coronary artery disease, heart failure, thickening and narrowing of the arotic valve, atrial fibrillation ( an abnormal heart rhythm) and blood clots forming in the legs or lungs.

The heart disease risks were higher for women who experienced menopause due to surgery compared to natural menopause. Some of this risk difference may be explained by differences in cardiovascular disease risk factors.

Whether or not a woman took hormones for menopausal symptoms did not change the cardiovascular risks.

Menopausal age prior to age 50 had a dose-dependent effect on cardiovascular disease risk, meaning risk continued to increase with younger menopausal ages and increased cardiovascular risks lasted for decades after menopause.

Our study reinforces the importance of menopause history in informing a woman's risk of future heart disease, said the lead author of the study.

Women should make sure their physician knows their menopause history, particularly of they experiences menopause before age 40. History of premature menopause should prompt physicians to refine the patient's estimated future risks for heart disease and to work toward lowering their heart disease risks, added the author.

He said early evaluations could lead to intervention and medication recommendations. 

Whether or not medications are warranted, eating a heart-healthy diet and exercising regularly may be especially important for women with a history of premature menopause, he said.

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Fluoroquinolones antibiotics associated with risk of heart problems

In a new study, researchers have established the link between one of the most commonly prescribed class of antibiotics and heart problems.

In a study, researchers found that current users of fluoroquinolone antibiotics, such as Ciprofloxacin or Cipro, face a 2.4 times greater risk of developing aortic and mitral regurgitation, where the blood back-flows into the heart compared to patients who take amoxicillin, a different type of antibiotic.
The greatest risk is within 30 days of use.

Some physicians favour fluoroquinolones over other antibiotics for their broad spectrum of antibacterial activity and high oral absorption, which is as effective as intravenous or IV, treatment.
You can send patients home with a once-a-day pill, said the lead author of the study.

The class of antibiotics is very convenient, but for the majority of cases, especially community-related infections, they're not really needed. The inappropriate prescribing may cause both antibiotic resistance as well as serious heart problems, added the author.

One of the key objectives of Therapeutic Evaluation Unit is to evaluate different drugs and health technologies to determine whether they enhance the  quality of care delivered by our programs or improve patient outcomes, said the researcher.

For the study, researchers analysed data from the U.S. Food and Drug Administration's adverse reporting system. They also analysed a massive private insurance health claims database in the U.S. that captures demographics, drug identification, dose prescribed and treatment duration.

Researchers identified 12,505 cases of valvular regurgitation with 125,020 case-control subjects in a random sample of more than 9 million patients.

They defined current fluoroquinolone exposure as an active prescription or 30 days prior to the adverse event, recent exposure as within days 31-60 , and past exposure as within 61-365 days prior to an incident. They compared fluoroquinolone use with amoxicillin and azithromycin.

The results showed that the risk of aortic and mitral regurgitation, blood back-flow into the heart, is highest with current use, followed by recent use. They saw no increased risk aortic and mitral regurgitation with past use.


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Mechanical heart valves safer than biological ones

Mechanical heart valves may be safer in certain cases than those made of animal tissue and should be used more as a replacement, especially in younger patients, according to a study.

Researchers  found that the best choice can hinge on whether the aortic or mitral valve is being replaced.

The study shows that for patients undergoing mitral valve replacement, a mechanical valve is actually beneficial until the age of 70.

On the other hand, for patients undergoing aortic valve replacement, the benefit of implanting mechanical valves ceased after the age of 55.

"This has potential to significantly impact the current national practice guidelines," said a professor.

Most patients who need open-heart surgery to remove a diseased heart valve face complicated conversations with their heart surgeons about whether to use a natural-tissue or mechanical valve as a replacement.

Mechanical valves can last a lifetime, but they come with increased risks of blood clotting and bleeding and a lifetime of having to take the blood-thinning medication warfarin.

Biological valves, which are most often made from pig or cow tissue, do not increase the risk of bleeding or clotting, but they wear out within about 10 to 15 years, making a second surgery likely.

The decision has been made difficult by the lack of sufficient scientific evidence to back up either choice, said senior author of the study .

For those younger than 50, a mechanical valve is currently recommended, and for those older than 70, a biologic tissue valve is recommended, author said.

However, the guidelines do not distinguish between whether the mitral or aortic valve is being replaced.

"If you think about this just in terms of age, the older you are, the less likely that you will outlive the durability of a biological valve," author said.

Surgeons have noted in recent years a trend towards younger patients choosing biological valves, primarily because they do not want to deal with a lifetime of taking blood thinners and with the accompanying dietary restrictions and routine blood testing necessitated by a mechanical valve.

Researchers examined rates of mortality, stroke, bleeding and reoperation in patients who underwent heart-valve surgery at 142 hospitals  between 1996 and 2013.

They examined the records of 9,942 patients who underwent aortic-valve replacement and 15,503 patients who underwent mitral-valve replacement during the study period.

Results showed a stark difference in health benefits depending on which valve was being replaced, the author said.

The long-term mortality benefit associated with a mechanical valve compared with a biological valve persisted until age 70 in patients undergoing mitral-valve replacement, the study found.

For those undergoing aortic-valve replacement, this benefit persisted only until age 55.

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New heart valve does not require open surgery

  Doctors in the US have implanted a newly approved aortic heart valve device in a patient that does not require open surgery.

The device, approved by the Food and Drug Administration (FDA), is called the Medtronic CoreValve System.

On March 28, Loyola University Medical Centre became the first Illinois hospital to implant the device in a patient who was not part of a clinical trial.

The new device is deployed with a catheter, which is inserted in an artery in the groin and guided up to the heart.

Once in place, the artificial valve takes over the function of a diseased valve. The system is much less invasive than traditional open-heart surgery.

Loyola physicians also have implanted the device in patients participating in clinical trials, including a landmark trial.

The study found that patients who received the device had significantly lower mortality than heart valve patients who underwent open-heart surgery.

"This is a major breakthrough," said Fred Leya, co-principal investigator at the Loyola site, along with Mamdouh Bakhos.

The study, published in the New England Journal of Medicine, included 795 seriously ill heart-valve patients who were randomly assigned to receive the new device or to undergo open-heart surgery.

After one year, the mortality rate was 19.1 per cent in the group that underwent open-heart surgery, but only 14.2 per cent in the group that received the new device.

After 30 days, quality-of-life scores improved 19 points for patients who received the new device, compared with 3.7 points for open-surgery patients.

At the one-year mark, quality-of-life scores increased 23.2 points in the device group and 21.9 points in the open-heart surgery group.

Quality of life is measured on a 100-point scale, in which 5 points is considered important and 20 points is considered a very large improvement.

Aortic stenosis occurs when the heart's aortic valve is narrowed, restricting blood flow from the heart to the body. The valve doesn't open properly, forcing the heart to work harder to pump blood.

Symptoms include fatigue, dizziness, chest pain/pressure, heart murmur, shortness of breath during activity, heart palpitations and fainting.

Aortic stenosis can lead to heart failure and death, researchers said.

The FDA approved the device in January 2014 to treat patients with severe aortic stenosis who are too ill or frail to have their aortic valves replaced through open-heart surgery.

Such patients have a nearly 50 per cent risk of death at the one-year mark unless they are treated.

 

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Study backs nonsurgical way to fix heart valves

A new study gives a big boost to fixing a bad aortic valve, the heart's main gate, without open-heart surgery. Survival rates were better one year later for people who had a new valve placed through a tube into an artery instead.

The results were reported Saturday at an American College of Cardiology conference in Washington and prompted some doctors to predict that in the near future, far fewer people will be having the traditional operation.

"It's going to be very hard to tell a patient that if they need an aortic valve, surgery is going to be their best option," said one of the conference leaders, Dr. Prediman K. Shah of Cedars Sinai Heart Institute in Los Angeles.

Several hundred thousand Americans have a bad aortic valve, which can stiffen and narrow with age, keeping blood from passing through as it should. Until a few years ago, the only solution was a major operation to open the chest, cut out the bad valve and sew in a new one.

That changed in 2011, when Edwards Lifesciences Inc. won federal approval for an expandable valve that could fit in a catheter into a leg artery, guided to the heart and placed inside the old valve. Studies showed survival was comparable to or a little better with it than with surgery, but strokes were more common after the catheter approach, making some leery of it.

Earlier this year, a rival device — Medtronic Inc.'s CoreValve — was approved for treating people at too high risk to have surgery. The new study tested it in nearly 800 people less sick — eligible for the operation but still with elevated risks.

One year after treatment, 19 percent of the surgery patients but only 14 percent of those given a CoreValve had died.

Stroke rates also seemed lower, though this was not one of the main results researchers were tracking. After one year, 13 percent of surgery patients and 9 percent of the others had had a stroke.

Two-year follow-up is not complete, but "we are certainly encouraged" that trends appear to be continuing, said one of the study's leaders, Dr. David Adams of at New York's Mount Sinai Hospital.

There were drawbacks to the CoreValve, though — twice as many patients needed pacemakers afterward. Other complications were a tradeoff — more vascular problems with the CoreValve but more problems with a fluttering heartbeat called atrial fibrillation among those who had surgery.

Still, several independent experts praised the results.

"It's a great leap forward" for fixing valves through blood vessels, said Dr. David Kandzari of Piedmont Heart Institute in Atlanta.

The study was paid for by Medtronic, and many study leaders consult for Medtronic, Edwards or other heart device makers. Results also were published online by the New England Journal of Medicine.

Doctors say both companies' artificial valves need more long-term study to see if they hold up as well as the ones implanted surgically, which typically last 20 years. Other firms also are testing catheter-placed valves.

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