UltraSight Receives CE Mark for Novel Cardiac AI Technology

 UltraSight, an Israeli-based digital health pioneer transforming cardiac imaging through the power of artificial intelligence, announced it has obtained a CE Mark for its AI guidance software for cardiac ultrasound. Today’s milestone comes just ahead of the European Society of Cardiology (ESC) Congress in Barcelona and aligns with its call for action to achieve heart health in Europe by 2025. UltraSight’s technology allows medical professionals, regardless of their sonography experience, to successfully capture diagnostic quality ultrasound images of the heart. 

The technology can be used at the point of care, paving the way for more widespread detection of cardiovascular diseases (CVD) and improved access to optimized cardiac care across the continent. The novel AI software pairs with point of care ultrasound devices that are currently on the market and provides the operator with real-time instructions on how to capture high quality diagnostic images. The underlying AI neural network predicts the position of the ultrasound probe relative to the heart, based on the ultrasound video stream only, and guides the user on how to maneuver the probe to ensure that the acquired images are of diagnostic quality. “UltraSight was founded with the intention to apply the power of machine learning in imaging and put the ability to scan patients into the hands of physicians everywhere,” said Davidi Vortman, CEO of UltraSight. “By empowering more medical professionals to accurately scan patients, we will have faster and greater detection of CVD across the continent. This is not only a momentous occasion for UltraSight as a company, but it brings us one step closer to helping the millions of people in Europe who suffer from CVD.” 

According to the ESC1 , there are 113 million people living with CVD in Europe today. Europe has the highest CVD mortality rate in the world, with approximately four million people succumbing to this disease each year. CVD is the leading cause of death for Europeans. UltraSight obtained CE Mark after results from a clinical study held at the Sheba Medical Center, Israel, validated its technology and confirmed that the software is effective at instructing novice medical professionals to acquire diagnostic-quality cardiac images. The study found that UltraSight AI guidance allowed medical professionals who did not have prior sonography experience to obtain diagnostic quality cardiac images in 100 percent of patients. The study was conducted using the Philips Lumify ultrasound device. “Many medical residents have entered the healthcare field since the pandemic; however, being able to provide them with the necessary hands-on training and supervision has become challenging for many European emergency departments looking to adopt point of care ultrasound,” said Prof. Salvatore Di Somma, MD, PhD, Director of Emergency Medicine and Chairman of the Postgraduate School of Emergency Medicine at the Department of Medical-Surgery Sciences and Translational Medicine University of Sapienza in Rome, Italy.

 “Supporting new ultrasound users with AI guidance, such as UltraSight’s AI guidance software, would increase efficiencies and expedite the learning curve while also reducing the time for obtaining good echocardiographic imaging in the Emergency Room, opening resources for experienced staff to respond to other acute needs.” “Point of care ultrasound can be a very useful tool for Intensive Care Unit physicians. Some key hemodynamic measurements, such as Left Ventricular Outflow Tract Velocity Time Integral (LVOT VTI), provide invaluable help to guide fluid therapy. However, some physicians are still reluctant to use it because they consider this measurement a competence reserved for advanced ultrasound operators,” said Professor Bernard Cholley, ICU Department Head at the Hôpital Européen Georges Pompidou, Paris, France. 

“When introduced to UltraSight’s AI guidance software, we were very compelled by the prospect of AI supporting more healthcare providers, including novice ultrasound users, to acquire a cardiac ultrasound view by which the LVOT VTI can be measured accurately for a reliable measurement and optimized patient care.” The UltraSight AI Guidance software is indicated for use in two-dimensional transthoracic echocardiography (2D-TTE) for adult patients. It is intended to assist medical professionals in performing cardiac ultrasound scans. UltraSight AI Guidance software is an accessory to compatible general-purpose diagnostic ultrasound systems and is intended to be used by medical professionals who have received UltraSight’s training as described in the user manual. The UltraSight software is expected to become available in Europe in 2023.  

You survived a heart attack. Now what about the depression?

: Heart attack patients with prolonged depression or anxiety are at a higher risk of death. That’s the finding of research published today in the European Journal of Preventive Cardiology, a journal of the European Society of Cardiology (ESC).

“Temporary mood swings, if they are not too frequent or dramatic, are a normal part of life,” said study author Dr Erik Olsson, of Uppsala University, Sweden. “Feeling a little depressed after a heart attack might even be a good thing if it makes you withdraw a bit and get some rest. Emotional states help us regulate our behaviours.”

“On the other hand, chronic emotional distress makes it harder to adopt the lifestyle changes that improve prognosis after a heart attack,” he continued. “These include quitting smoking, being physically active, eating healthily, reducing stress, and taking prescribed medications.”

Previous research has shown that emotional distress, such as depression and anxiety, affects prognosis after a heart attack. This was the first study to examine prognosis according to the duration of distress. The study included 57,602 patients from the national SWEDEHEART registers who survived at least one year after a first heart attack. Emotional distress (including depression and anxiety) was measured at 2 and 12 months after the heart attack. Patients were then followed-up for a median of 4.3 years.

The study shows that persistent emotional distress over 1 year impacts on prognosis, whereas short-term distress does not. Compared to those with no emotional distress, patients who felt depressed or anxious at both time points were 46% and 54% more likely to die from cardiovascular and non-cardiovascular causes, respectively, during follow-up. Patients who felt distressed only at 2 months were not at increased risk.

More than 20% of patients fell into the category of persistent emotional distress. Previous research shows that this state is mainly linked with sociodemographic, rather than clinical, factors.² For example being younger, female, born abroad, and unemployed (versus employed or retired).

“It appears that the Matthew effect³ also applies to cardiac rehabilitation, whereby those who have continue to benefit whereas those without do not,” said Dr Olsson. “Better resources in life including education and cognitive ability enable us to handle difficult patches, while a good job with a good salary gives us more control over our circumstances. This is not the case for people with a tougher life – we know for example that immigrants who have fled from difficult situations are less likely to get the right treatment.”
 
Most cardiac rehabilitation clinics offer some kind of counselling and Dr Olsson said this could be a good opportunity for people with continual feelings of anxiety or depression to get help.

Some 15% of participants felt anxious or depressed at 2 months but then recovered. “These are likely to be people with a higher socioeconomic status who have good coping mechanisms,” said Dr Olsson.

To recover from the initial emotional reaction to a heart attack, he said: “Try to keep doing your usual activities, at least the positive ones. Some patients begin to avoid exercise and sex because they are afraid of triggering another event, but most things that feel risky are not. If you’re in a low mood you may expect less enjoyment from socialising, but then find it is more pleasurable than you predicted. If you haven’t been depressed or anxious before, at least not very often, don’t worry about it. It is likely a normal reaction to a life-threatening event which is also partly biological.”

Dr Olsson noted that 10% of patients in the study felt distressed only at 12 months, and they were 46% more likely to die from non-cardiovascular causes during follow-up. “This distress is unlikely to be related to the heart attack,” he said. “These patients resemble those with persistent distress in terms of education, marital status, and employment, and may be another fragile group.”

You’re having a heart attack. Why not ask for help?

A perceived inability to act on symptoms could signify a life-threatening situation, according to research published today in the European Journal of Cardiovascular Nursing, a journal of the European Society of Cardiology (ESC) 

Most deaths from heart attack occur in the first few hours after the start of symptoms.  Quick treatment is crucial to restore blood flow to blocked arteries and save lives. The time it takes for patients to interpret and respond to symptoms is the main reason for delays in getting to a hospital and the care they need.

The study enrolled 326 patients undergoing acute treatment for a first or second heart attack. Participants completed the validated questionnaire “Patients’ appraisal, emotions and action tendencies preceding care-seeking in acute myocardial infarction” (PA-AMI).

Patients in the study waited a median of three hours before seeking medical help. Some delayed for more than 24 hours. So what went through their minds during that period? This study, for the first time, identified two general reactions.

A perceived inability to act had a significant impact on patients who waited more than 12 hours. These patients said: “I lost all power to act when my symptoms began”; “I did not know what to do when I got my symptoms”; “my symptoms paralysed me”; and “I felt I had lost control of myself when I got my symptoms”.

“This immobilisation during ongoing heart attack symptoms has not been shown or studied before,” said study author Dr Carolin Nymark, of Karolinska University Hospital, Stockholm, Sweden. “At the moment we don’t know why some patients react in this way. It is possibly linked to fear or anxiety. This should be a novel element in educating people about what to do when they have heart attack symptoms.”

Inaccurate symptom appraisal also affected those who delayed for more than twelve hours. These patients said it took a long time to understand their symptoms; they thought the symptoms would pass; they thought the symptoms were not serious enough to seek medical care; and they thought it would be difficult to seek medical care.

Conversely, patients who accurately identified their heart attack symptoms and sought medical help quickly had a wish to seek care, knew the symptoms were serious and where they should go to get help, and did not try to divert their thoughts away from the symptoms.

“Our previous research has shown that some patients believe their symptoms aren’t serious enough to call an ambulance,” said Dr Nymark. “Others think the intensive care unit is closed in the middle of the night, perhaps because they do not think clearly during the event.”

Warning signs of a heart attack include moderate to severe discomfort such as pain in the chest, throat, neck, back, stomach or shoulders that lasts for more than 15 minutes. It often comes with nausea, cold sweat, weakness, shortness of breath, or fear. “Another red flag is feeling you have no power to act on your symptoms,” said Dr Nymark. “This may indicate a real health threat and the need to call an ambulance.”

Dr Nymark said this new signal could be discussed in outpatient appointments for those with cardiovascular risk factors and in cardiac rehabilitation programmes for heart attack survivors. The study questionnaire could be used to identify patients who previously experienced an inability to act or poor symptom appraisal.

“Our findings are worrying because even a small reduction in delay would save heart muscle and lives,” said Dr Nymark. “Reducing patient delays appears to be a complex task and we need to find innovative ways to inform and educate patients and the public.”

Dr Nymark concluded: “If you have symptoms that may be caused by a heart attack, don’t ignore them. Call for help immediately. It is better to be wrong about the symptoms than dead.”

 

Stressed at work and trouble sleeping? It’s more serious than you think.

Sophia Antipolis, 28 April 2019:   Work stress and impaired sleep are linked to a threefold higher risk of cardiovascular death in employees with hypertension. That’s the finding of research published today in the European Journal of Preventive Cardiology, a journal of the European Society of Cardiology (ESC).1 Study author Professor Karl-Heinz Ladwig, of the German Research Centre for Environmental Health and the Medical Faculty, Technical University of Munich, said: “Sleep should be a time for recreation, unwinding, and restoring energy levels. If you have stress at work, sleep helps you recover. Unfortunately poor sleep and job stress often go hand in hand, and when combined with hypertension the effect is even more toxic.” One-third of the working population has hypertension (high blood pressure). Previous research has shown that psychosocial factors have a stronger detrimental effect on individuals with pre-existing cardiovascular risks than on healthy people. This was the first study to examine the combined effects of work stress and impaired sleep on death from cardiovascular disease in hypertensive workers. The study included 1,959 hypertensive workers aged 25–65, without cardiovascular disease or diabetes. Compared to those with no work stress and good sleep, people with both risk factors had a three times greater likelihood of death from cardiovascular disease. People with work stress alone had a 1.6-fold higher risk while those with only poor sleep had a 1.8-times higher risk. During an average follow-up of nearly 18 years, the absolute risk of cardiovascular death in hypertensive staff increased in a stepwise fashion with each additional condition. Employees with both work stress and impaired sleep had an absolute risk of 7.13 per 1,000 person-years compared to 3.05 per 1,000-person years in those with no stress and healthy sleep. Absolute risks for only work stress or only poor sleep were 4.99 and 5.95 per 1,000 person-years, respectively. In the study, work stress was defined as jobs with high demand and low control – for example when an employer wants results but denies authority to make decisions. “If you have high demands but also high control, in other words you can make decisions, this may even be positive for health,” said Professor Ladwig. “But being entrapped in a pressured situation that you have no power to change is harmful.”   Impaired sleep was defined as difficulties falling asleep and/or maintaining sleep. “Maintaining sleep is the most common problem in people with stressful jobs,” said Professor Ladwig. “They wake up at 4 o’clock in the morning to go to the toilet and come back to bed ruminating about how to deal with work issues.” “These are insidious problems,” noted Professor Ladwig. “The risk is not having one tough day and no sleep. It is suffering from a stressful job and poor sleep over many years, which fade energy resources and may lead to an early grave.” "The findings are a red flag for doctors to ask patients with high blood pressure about sleep and job strain", said Professor Ladwig. “Each condition is a risk factor on its own and there is cross-talk among them, meaning each one increases risk of the other. Physical activity, eating healthily and relaxation strategies are important, as well as blood pressure lowering medication if appropriate.” Employers should provide stress management and sleep treatment in the workplace, he added, especially for staff with chronic conditions like hypertension. Components of group stress management sessions: Start with 5 to 10 minutes of relaxation. Education about healthy lifestyle. Help with smoking cessation, physical exercise, weight loss. Techniques to cope with stress and anxiety at home and work. How to monitor progress with stress management. Improving social relationships and social support. Sleep treatment can include: Stimulus control therapy: training to associate the bed/bedroom with sleep and set a consistent sleep-wake schedule. Relaxation training: progressive muscle relaxation, and reducing intrusive thoughts at bedtime that interfere with sleep. Sleep restriction therapy: curtailing the period in bed to the time spent asleep, thereby inducing mild sleep deprivation, then lengthening sleep time. Paradoxical intention therapy: remaining passively awake and avoiding any effort (i.e. intention) to fall asleep, thereby eliminating anxiety.

Heart attack patients taken directly to heart centres have better long-term survival

Heart attack patients taken directly to heart centres for lifesaving treatment have better long-term survival than those transferred from another hospital, reports a large observational study presented today at Acute Cardiovascular Care 2019¹ a European Society of Cardiology (ESC) congress. Directly admitted patients were older, suggesting that heart attacks in young adults, and particularly women, go unrecognised by paramedics and patients.

Study author Dr Krishnaraj Rathod, of Barts Health NHS Trust, London, UK, said: “The age of first heart attacks is getting younger, one of the reasons is because of lifestyle habits. The average age in our cohort is no longer 60, but around 40 years and we even see patients in their 30s. Directly admitted patients were sicker but they were also older, indicating that paramedics may think heart attack is unlikely in younger adults. My message to them is ‘in cases of doubt, repeat the 12 lead ECG and consider speaking to the heart attack centre’.”

People in their 30s and 40s should not ignore heart attack symptoms, particularly womens   he said. “Younger patients likely wait longer to call for help because if they have chest pain, heart attack is not the first thing they think of. If you are in any doubt, phone an ambulance.”

The study from the London Heart Attack Group included 25,315 patients with ST-elevation myocardial infarction (STEMI), a serious type of heart attack where a major artery supplying blood to the heart is blocked. Rapid opening of the artery with a stent using primary percutaneous coronary intervention (PCI) improves survival and guidelines² advise taking STEMI patients directly to a primary PCI centre.

The study compared characteristics, time to primary PCI, and long-term outcomes of STEMI patients taken directly to a primary PCI hospital versus those transferred from another hospital. Patients with STEMI were treated with primary PCI between 2005 and 2015 at the eight primary PCI centres in London. Patient details were recorded at the time of the procedure in the British Cardiovascular Intervention Society dataset. Data on all-cause mortality were obtained from the Office for National Statistics.

A total of 17,580 (69%) patients were admitted directly to primary PCI centres and 7,735 (31%) were transferred from other hospitals. The time between call for help and first hospital admission was similar between the two groups. However, the median time from call for help to opening the blocked artery with primary PCI was 52 minutes longer in transferred patients compared to those admitted directly.

After a median follow-up of three years, patients admitted directly to a primary PCI centre were significantly less likely to have died than those transferred from another hospital (17.4% versus 18.7%). After adjusting for factors that could influence the risk of death including age, previous heart attack and diabetes, direct admission to a primary PCI hospital was associated with a 20% lower risk of all-cause death.

Dr Rathod said: “Our findings indicate that the superior survival in patients admitted directly to a primary PCI hospital was because there was a shorter gap between calling for help and receiving treatment.”

“All patients with STEMI should be admitted directly to a primary PCI centre within 90 minutes of diagnosis by electrocardiogram (ECG), which is done by ambulance teams,” he said. “Yet in our study nearly one-third were taken to another hospital first, indicating that a STEMI diagnosis was not made until patients reached that hospital, and they then had to be transferred. However, it must be noted that the rates of transfer directly to a primary PCI centre were better in the later years suggesting better identification of appropriate patients by healthcare staff.”

Women call ambulance for husbands with heart attack symptoms but not themselves

 Women call an ambulance for husbands, fathers and brothers with heart attack symptoms but not for themselves. “It’s time for women take care of themselves too” is the main message of two studies from the Polish Registry of Acute Coronary Syndromes (PL-ACS) presented today at Acute Cardiovascular Care 2019 a European Society of Cardiology (ESC) congress.

The findings come ahead of International Women’s Day on 8 March. This year’s campaign theme – #BalanceforBetter – is a call-to-action for driving gender balance across the world. Ischaemic heart disease is the leading cause of death in women and men yet today’s research shows disparities in management.

Professor Mariusz Gąsior, principal investigator of the registry, said: “Very often women run the house, send children to school, and prepare for family celebrations. We hear over and over again that these responsibilities delay women from calling an ambulance if they experience symptoms of a heart attack.”

Dr Marek Gierlotka, registry coordinator, added: “In addition to running the household, women make sure that male relatives receive urgent medical help when needed. It is time for women to take care of themselves too.”

A total of 7,582 patients with ST-elevation myocardial infarction (STEMI) were included in the analyses. STEMI is a serious type of heart attack where a major artery supplying blood to the heart is blocked. Faster restoration of blood flow translates into more salvaged heart muscle and less dead tissue, less subsequent heart failure, and a lower risk of death. Guidelines⁴ therefore recommend opening the artery with a stent within 90 minutes of diagnosis in the ambulance by electrocardiogram (ECG).

Overall, 45% of patients were treated within the recommended timeframe – these patients were less often women. After adjusting for factors that could influence the relationship, male sex remained an independent predictor of treatment within the recommended timeframe.

Patients within and outside the advised treatment window had similar rates of in-hospital mortality, but those treated promptly were less likely to have a left ventricle ejection fraction below 40% – meaning their heart was better able to pump blood and they had a lower chance of developing heart failure.

ECG results were transmitted from the ambulance to a heart attack centre in about 40% of patients. In women, the likelihood of ECG transfer rose with increasing age – from 34% in women aged 54 years and under to 45% in those aged 75 and above. In men, the rate of transfer was around 40% regardless of age.

Professor Gąsior said: “One of the reasons women are less likely than men to be treated within the recommended time period is because they take longer to call an ambulance when they have symptoms – this is especially true for younger women. In addition, ECG results for younger women are less often sent to the heart attack centre, which is recommended to speed up treatment.”

Dr Gierlotka said: “More efforts are needed to improve the logistics of pre-hospital heart attack care in young women. Greater awareness should be promoted among medical staff and the general public that women, even young women, also have heart attacks. Women are more likely to have atypical signs and symptoms, which may contribute to a delay in calling for medical assistance.”

Pain in the chest and left arm are the best known symptoms of heart attack. Women often have back, shoulder, or stomach pain. Call an ambulance if you have pain in the chest, throat, neck, back, stomach or shoulders that lasts for more than 15 minutes

Bittium Faros™ ECG-measuring devices’ arrhythmia detection algorithms received medical device approval in Europe

Bittium Faros ECG-measuring devices’ built-in algorithms for detection of arrhythmias have received medical device approval in Europe. The algorithms can be used to automatically identify sequences from the heart measurement data that include atrial fibrillation, tachycardia, bradycardia, and pauses in the operation of the heart. Early detection of atrial fibrillation can be used to predict the risk of stroke and to prevent its emergence with timely treatment initiation. These new medical device approved algorithms for detection of arrhythmias are available now with Faros ECG-measuring devices.

The new functions allow focusing only on the interesting events even in measurements that last for several days or weeks. In remote monitoring applications Faros devices’ arrhythmia detection algorithms help health care providers to react faster to changes in patients’ state of health. Faros technology is also used in Holtering as well as in group monitoring in cardiac rehabilitation.

Faros product family

Faros is a versatile ECG device that is used for early detection of cardiac abnormalities in everyday life. Faros is ultra-small and lightweight, which enables precise long-term full disclosure ECG measurements for long-term Holtering, cardiac event monitoring, mobile cardiac telemetry and assessing autonomic nervous system functioning.

The Faros outpatient monitoring solutions include several software options for cardiac monitoring. The built-in arrhythmia detection algorithms of the Faros device are used for event recording and mobile event monitoring that enable earlier repatriation of patients and even better ability to react to potentially emerging arrhythmias faster. The new, innovative and sophisticated Holter analysis software increases the accuracy and speeds up the analyzing work significantly.

Faros Cardiac Rehab is a solution for cardiac rehabilitation real-time monitoring for up to 16 patients simultaneously. The system offers safety and efficiency for cardiac rehabilitation by showing each patient’s heart rate, ECG and changes in ST-segment. Utilization of the latest wireless technology allows complete freedom to choose different exercises in various training environments.

More information on the offering: https://www.bittium.com/products__services/medical/faros

Vitamin D pill a day may improve exercise performance and lower risk of heart disease

Taking vitamin D supplements can improve exercise performance and lower the risk of heart disease, according to the findings of a preliminary study presented today at the Society for Endocrinology annual conference in Edinburgh.

Vitamin D, which is both a vitamin and a hormone, helps control levels of calcium and phosphate in the blood and is essential for the formation of bones and teeth. Sources of Vitamin D include oily fish and eggs, but it can be difficult to get enough through diet alone. Most people generate vitamin D by exposing their skin to ultraviolet B rays in sunlight.

Previous studies suggest that vitamin D can block the action of enzyme 11-βHSD1, which is needed to make the “stress hormone” cortisol.  High levels of cortisol may raise blood pressure by restricting arteries, narrowing blood vessels and stimulating the kidneys to retain water. As Vitamin D may reduce circulating levels of cortisol, it could theoretically improve exercise performance and lower cardiovascular risk factors.

In this study, researchers from Queen Margaret University in Edinburgh gave 13 healthy adults matched by age and weight 50μg of vitamin D per day or a placebo over a period of two weeks.

Adults supplementing with vitamin D had lower blood pressure compared to those given a placebo, as well as having lower levels of the stress hormone cortisol in their urine. A fitness test found that the group taking vitamin D could cycle 6.5km in 20 minutes, compared to just 5km at the start of the experiment. Despite cycling 30% further in the same time, the group taking vitamin D supplements also showed lower signs of physical exertion.

Around ten million people in England may have low vitamin D levels. On average, one in ten adults has low levels of vitamin D in summer, compared to two in five in winter. Because people with darker skin are less efficient at using sunlight to make vitamin D, up to three out of four adults with dark skin are deficient in winter.

“Our pilot study suggests that taking vitamin D supplements can improve fitness levels and lower cardiovascular risk factors such as blood pressure”, said Dr Raquel Revuelta Iniesta, co-author of the study. “Our next step is to perform a larger clinical trial for a longer period of time in both healthy individuals and large groups of athletes such as cyclists or long-distance runners”.

"Vitamin D deficiency is a silent syndrome linked to insulin resistance, diabetes, rheumatoid arthritis, and a higher risk for certain cancers", said lead author of the study Dr Emad Al-Dujaili. “Our study adds to the body of evidence showing the importance of tackling this widespread problem”.

British women are three times more likely to die of heart disease than breast cancer

More than 30,000 women die from coronary heart disease in the UK every year with over 700,000 women living with the consequences of heart disease and stroke, according to research published by The British Heart Foundation ahead of World Heart Day on 29^th September.

World Heart Day is organised by the World Heart Federation and aims to raise awareness of heart disease through education, advocacy and research. The aim of World Heart Day is to create healthy heart environments and encourage individuals to make healthy heart choices wherever they live, work and play.

This year, World Heart Day will be focusing on women’s heart health, as despite the shocking statistics above, The British Heart Foundation claim that women often wait longer then men before calling 999 after experiencing symptoms of a heart attack. Often, this is due to women being less likely to recognise the symptoms of a heart attack or being reluctant to cause a fuss. As Dr Cliff Bucknall, Consultant Cardiologist at London Bridge Hospital, notes,

“Many women believe that heart disease is a condition that only affects men. This is simply not true and as a result, women are less likely to be aware of the associated risks, particularly, around heart disease and contraception.”

Dr Bucknall states that for most women taking oral contraception, there is a very low risk of experiencing a heart attack. However, this does rise with age as the risk of having a heart attack rises significantly following the menopause. Dr Bucknall comments: 

“There are different types of hormonal contraception which can have different effects on the formation of blood clots and potential heart attacks. Consequently, it is extremely important to discuss with your healthcare provider the birth control options that carry the least risk for you.”

Also, Dr Bucknall dispels the myth that Hormone Replacement Therapy (HRT) medication protects women against heart disease. He states,

“HRT will help to relieve menopausal hot flushes and night sweats but don’t expect it to help your heart. Recent research now suggests that HRT isn’t heart protective and, as with all drug treatments there are potential side effects.”

For women who are worried about their heart health, Dr Bucknall shares the following advice:

“There are a number of simple self-help actions that women can take to reduce their risk of heart disease. These include, giving up smoking, maintaining a healthy weight and undertaking more physical activity.”

Living alone associated with higher risk of mortality, cardiovascular death

Living alone was associated with an increased risk of death and cardiovascular death in an international study of stable outpatients at risk of or with arterial vascular disease (such as coronary disease or peripheral vascular disease), according to a report published Online First by Archives of Internal Medicine, a JAMA Network publication. Social isolation may be associated with poor health consequences, and the risk associated with living alone is relevant because about 1 in 7 American adults lives alone. Epidemiological evidence suggests that social isolation may alter neurohormonal-mediated emotional stress, influence health behavior and effect access to health care, which may result in association with or acquisition of, cardiovascular risk, according to the study background.

Jacob A. Udell, M.D., M.P.H., of Brigham and Women's Hospital, Harvard Medical School, Boston, and colleagues examined whether living alone was associated with increased mortality and cardiovascular (CV) risk in the global REduction of Atherothrombosis for Continued Health (REACH) Registry. Among 44,573 REACH participants, 8,594 (19 percent) lived alone.

Living alone was associated with higher four-year mortality (14.1 percent vs. 11.1 percent) and cardiovascular death (8.6 percent vs. 6.8 percent), according to the study results.

Based on age, living alone was associated with an increased risk of death among those patients 45 to 65 years old compared with those living with others (7.7 percent vs. 5.7 percent) , and among those participants 66 to 80 years old (13.2 percent vs. 12.3 percent). However, among patients older than 80 years, living alone was not associated with an increased risk of mortality compared with those living with others (24.6 percent vs. 28.4 percent), the results indicate.

"In conclusion, living alone was independently associated with an increased risk of mortality and CV death in an international cohort of stable middle-aged outpatients with or at risk of atherothrombosis," the authors conclude. "Younger individuals who live alone may have a less favorable course than all but the most elderly individuals following development of CV disease, and this observation warrants confirmation in further studies."

Source: JAMA and Archives Journals

Calcium supplements linked to significantly increased heart attack risk

Calcium supplements might increase the risk of having a heart attack, and should be "taken with caution," concludes research published in the online issue of the journal Heart. Furthermore, boosting overall calcium intake from dietary sources confers no significant advantage in terms of staving off heart disease and stroke, the findings indicate.

Previous research has linked higher calcium intake with a lowered risk of high blood pressure, obesity, and type 2 diabetes, all of which are risk factors for heart disease and stroke.

And calcium supplements are commonly recommended to elderly people and women who have gone through the menopause to prevent bone thinning.

The authors base their findings on almost 24,000 participants of one of the German arms of the European Prospective Investigation into Cancer and Nutrition (EPIC) study in Heidelberg.

All the participants were aged between 35 and 64 when they joined the study in 1994-8.

Normal diet for the preceding 12 months was assessed using food frequency questionnaires and they were quizzed about whether they regularly took vitamin or mineral supplements.

Their health was tracked for an average of 11 years, during which time 354 heart attacks, 260 strokes, and 267 associated deaths occurred.

After taking account of factors likely to influence the results, those whose diets included a moderate amount (820 mg daily) of calcium from all sources, including supplements, had a 31% lower risk of having a heart attack than those in the bottom 25% of calcium intake.

But those with an intake of more than 1100 mg daily did not have a significantly lower risk. There was no evidence that any level of calcium intake either protected against or increased the risk of stroke, which backs up the findings of other research, say the authors.

But when the analysis looked at vitamin/mineral supplements, it found that those who took calcium supplements regularly were 86% more likely to have a heart attack than those who didn't use any supplements.

And this risk increased further among those who used only calcium supplements. They were more than twice as likely to have a heart attack as those who didn't take any supplements.

The authors conclude: "This study suggests that increasing calcium intake from diet might not confer significant cardiovascular benefits, while calcium supplements, which might raise [heart attack] risk, should be taken with caution."

In an accompanying editorial, Professors Ian Reid and Mark Bolland from the Faculty of Medical and Health Science at the University of Auckland in New Zealand, say that the safety of calcium supplements "is now coming under increasing scrutiny."

They point to previous research, showing a link between these supplements and kidney stones, and gut and abdominal symptoms, and note that while trial evidence suggests that calcium supplements cut levels of cardiovascular risk factors, this doesn't actually translate into fewer heart attacks and strokes.

They also suggest that many women taking calcium supplements to ward off brittle bones are already healthier than those who don't, and that the overall protective effect is modest -- in the order of just 10%.

The evidence that dietary calcium is helpful while calcium supplements are not can be explained by the fact that dietary calcium is taken in small amounts, spread throughout the day, so is absorbed slowly, they say.

Supplements, on the other hand, cause calcium levels in the blood to soar above the normal range, and it is this flooding effect which might ultimately be harmful, they suggest.

"Calcium supplements have been widely embraced by doctors and the public, on the grounds that they are a natural and therefore safe way of preventing osteoporotic fractures," they write.

"It is now becoming clear that taking this micronutrient in one or two daily [doses] is not natural, in that it does not reproduce the same metabolic effects as calcium in food," they say.

Given that it is neither safe nor effective, boosting calcium intake from supplements should be discouraged, they contend.

And they conclude: "We should return to seeing calcium as an important component of a balanced diet, and not as a low cost panacea to the universal problem of postmenopausal bone loss."

**Source: BMJ-British Medical Journal

Scientists turn patients' skin cells into heart muscle cells to repair their damaged hearts

For the first time scientists have succeeded in taking skin cells from heart failure patients and reprogramming them to transform into healthy, new heart muscle cells that are capable of integrating with existing heart tissue. The research, which is published online May 22 in the European Heart Journal, opens up the prospect of treating heart failure patients with their own, human-induced pluripotent stem cells (hiPSCs) to repair their damaged hearts. As the reprogrammed cells would be derived from the patients themselves, this could avoid the problem of the patients' immune systems rejecting the cells as "foreign." However, the researchers warn that there are a number of obstacles to overcome before it would be possible to use hiPSCs in humans in this way, and it could take at least five to ten years before clinical trials could start.

Recent advances in stem cell biology and tissue engineering have enabled researchers to consider ways of restoring and repairing damaged heart muscle with new cells, but a major problem has been the lack of good sources of human heart muscle cells and the problem of rejection by the immune system. Recent studies have shown that it is possible to derive hiPSCs from young and healthy people and that these are capable of transforming into heart cells. However, it has not been shown that hiPSCs could be obtained from elderly and diseased patients. In addition, until now researchers have not been able to show that heart cells created from hiPSCs could integrate with existing heart tissue.

Professor Lior Gepstein, Professor of Medicine (Cardiology) and Physiology at the Sohnis Research Laboratory for Cardiac Electrophysiology and Regenerative Medicine, Technion-Israel Institute of Technology and Rambam Medical Center in Haifa, Israel, who led the research, said: "What is new and exciting about our research is that we have shown that it's possible to take skin cells from an elderly patient with advanced heart failure and end up with his own beating cells in a laboratory dish that are healthy and young -- the equivalent to the stage of his heart cells when he was just born."

Ms Limor Zwi-Dantsis, who is a PhD student in the Sohnis Research Laboratory, Prof Gepstein and their colleagues took skin cells from two male heart failure patients (aged 51 and 61) and reprogrammed them by delivering three genes or "transcription factors" (Sox2, Klf4 and Oct4), followed by a small molecule called valproic acid, to the cell nucleus. Crucially, this reprogramming cocktail did not include a transcription factor called c-Myc, which has been used for creating stem cells but which is a known cancer-causing gene.

"One of the obstacles to using hiPSCs clinically in humans is the potential for the cells to develop out of control and become tumours," explained Prof Gepstein. "This potential risk may stem from several reasons, including the oncogenic factor c-Myc, and the random integration into the cell's DNA of the virus that is used to carry the transcription factors -- a process known as insertional oncogenesis."

The researchers also used an alternative strategy that involved a virus that delivered reprogramming information to the cell nucleus but which was capable of being removed afterwards so as to avoid insertional oncogenesis.

The resulting hiPSCs were able to differentiate to become heart muscle cells (cardiomyocytes) just as effectively as hiPSCs that had been developed from healthy, young volunteers who acted as controls for this study. Then the researchers were able to make the cardiomyocytes develop into heart muscle tissue, which they cultured together with pre-existing cardiac tissue. Within 24-48 hours the tissues were beating together. "The tissue was behaving like a tiny microscopic cardiac tissue composed of approximately 1000 cells in each beating area," said Prof Gepstein.

Finally, the new tissue was transplanted into healthy rat hearts and the researchers found that the grafted tissue started to establish connections with the cells in the host tissue.

"In this study we have shown for the first time that it's possible to establish hiPSCs from heart failure patients -- who represent the target patient population for future cell therapy strategies using these cells -- and coax them to differentiate into heart muscle cells that can integrate with host cardiac tissue," said Prof Gepstein.

"We hope that hiPSCs derived cardiomyocytes will not be rejected following transplantation into the same patients from which they were derived. Whether this will be the case or not is the focus of active investigation. One of the obstacles in dealing with this issue is that, at this stage, we can only transplant human cells into animal models and so we have to treat the animals with immunosuppressive drugs so the cells won't be rejected."

Much research has to be conducted before these results could be translated into treatment for heart failure patients in the clinic. "There are several obstacles to clinical translation," said Prof Gepstein. "These include: scaling up to derive a clinically relevant number of cells; developing transplantation strategies that will increase cell graft survival, maturation, integration and regenerative potential; developing safe procedures to eliminate the risks for causing cancer or problems with the heart's normal rhythm; further tests in animals; and large industry funding since it is likely to be a very expensive endeavour. I assume it will take at least five to ten years to clinical trials if one can overcome these problems."

Prof Gepstein and his colleagues will be carrying out further research into some of these areas, including evaluating using hiPSCs in cell therapy and tissue engineering strategies for repairing damaged hearts in various animal models, investigating inherited cardiac disorders, and drug development and testing.

**Source: European Society of Cardiology (ESC)

Long-term exposure to air pollution increases risk of hospitalization for lung, heart disease

Older adults may be at increased risk of being hospitalized for lung and heart disease, stroke, and diabetes following long-term exposure to fine-particle air pollution, according to a new study by researchers at Harvard School of Public Health (HSPH). It is the first study to look at the link between long-term effects of exposure to fine particles in the air and rates of hospital admissions. The study was published online April 17, 2012 in PLoS ONE.
Prior studies have reported an association between hospitalization and short-term air particle exposure (i.e. exposure to air particles on day of hospital admission or several days before). However, these short-term studies left unclear how many extra admissions occurred in the long run, and only included people who live near air pollution monitors, typically located in cities. No studies of long-term exposure to fine air particles (over the course of a year or two years) and rates of hospitalizations had been done.
"Our study found that long-term rates of admissions for pneumonia, heart attacks, strokes, and diabetes are higher in locations with higher long-term average particle concentrations," said lead author Itai Kloog, a research fellow in the Department of Environmental Health at HSPH.
Kloog and his colleagues, including senior author Joel Schwartz, professor of environmental epidemiology at HSPH and director of the Harvard Center for Risk Analysis, used novel prediction models, based on satellite observations, emissions, traffic, and weather data to predict levels of fine air particles in the air all over New England, which allowed the researchers to include rural and suburban areas. The researchers compared their findings with hospital admission records on all Medicare patients, ages 65 and older, admitted to 3,000 hospitals throughout New England from 2000-2006.
The researchers estimated zip code concentrations of fine air particles known as PM2.5 -- air matter with a diameter of 2.5 microns or less and more narrow than the width of a human hair. These particles, such as soot from vehicles, and other particles from power plants, wood burning, and certain industrial processes, are a significanthealth riskwhen they lodgein the lungs, causing inflammation there and in the rest of the body, and contributing to lung and heart disease.
The results showed an association between long-term exposure to fine air particles for all hospital admissions examined. For example, for every 10-µg/m³ increase in long-term PM2.5 exposure, the researchers found a 4.22% increase in respiratory admissions, a 3.12% increase in cardiovascular disease admissions, a 3.49% increase in stroke admissions, and a 6.33% increase in diabetes admissions.
"Particulate air pollution is one of the largest avoidable causes of death and illness in the United States, and unlike diet and exercise, does not require behavioral change. Off-the-shelf technology can be retrofitted onto sources of pollution at modest cost, with a large health benefit. This study shows that in addition to avoiding deaths, such measures will reduce chronic disease and medical care costs," said Schwartz.

**Source: Harvard School of Public Health

Stem Cells from Pelvic Bone May Preserve Heart Function

 Stem cells from the pelvic bone may help hearts beat stronger. Doctors and other clinicians at the Orlando Health Heart Institute are researching the use of stem cells from pelvic bone marrow to restore tissue and improve heart function after muscle damage from heart attacks.

"The thought is the body may use itself to heal itself," said Vijaykumar S. Kasi, MD, PhD, an interventional cardiologist, director, Cardiovascular Research, and principal investigator for the clinical trial at ORMC. "Because stem cells are immature cells they have the potential to develop into new blood vessels and preserve cardiac muscle cells. By infusing certain stem cells into the area of the heart muscle that has been damaged from a heart attack, tissue can be preserved and heart function restored."
The PreSERVE-AMI Study, sponsored by Amorcyte, LLC, a NeoStem, Inc. company (NYSE Amex: NBS), is for patients who have received a stent to open the blocked artery after a specific heart attack history (in part a ST-Segment Elevation Myocardial Infarction, or STEMI, a critical type of heart attack caused by a prolonged period of blocked blood supply, affecting a large area of the heart muscle and causing changes in the blood levels of key chemical markers). The study evaluates the effectiveness and safety of infusing stem cells collected from a patient's bone marrow into the artery in the heart that may have caused the heart attack. About 160 patients will participate in this national study at approximately 34 sites.
The infusion procedure begins with a catheter inserted through an incision in the groin. An X-ray camera is used to guide doctors in positioning the catheter in the heart artery where the stent was placed. A balloon is inflated within the stent and the infusion takes place in the area impacted by the heart attack. Because the study is randomized, double blinded and placebo controlled, patients are infused with either AMR-001, a cell therapy product composed of stem cells taken from one's own bone marrow, or a placebo (inactive substance).
Prior to the infusion, patients are screened using various assessments including an electrocardiogram, a cardiac MRI (magnetic resonance image) and a cardiac nuclear test. After the necessary screenings, patients have a mini-bone marrow procedure where the stem cells are "harvested" (removed) from the bone marrow in their pelvic bone, using a special needle. The stem cells are processed at Progenitor Cell Therapy, another NeoStem, Inc. company, in preparation for infusion. Patients who are randomized to placebo will have their bone marrow frozen and stored and available to them for clinical use, should they require bone marrow for any reason.
"We are excited to participate in innovative clinical trials as part of our continued efforts to play a vital role in future solutions to improve patient outcomes," said Dr. Kasi. "Heart disease remains the No.1 killer of men and women in our country." Effective treatment options are part of the medical journey to more heart healthy communities locally and globally.
"Severe heart failure, often the end result of large or multiple heart attacks, is a major health care challenge, impacting more than five million people in the United States and costing more than $35 billion annually," said Dr. Kasi. "Stem cell therapy is part of the movement from treatment to cure and has the potential to overcome limitations and expenses of heart transplants and offers hope for patients who are desperately praying for another chance at life."

**Published in "SCIENCE DAILY"

Heart failure's effects in cells can be reversed with a rest

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Structural changes in heart muscle cells after heart failure can be reversed by allowing the heart to rest, according to research at Imperial College London. Findings from a study in rats recently published in the European Journal of Heart Failure show that the condition's effects on heart muscle cells are not permanent, as has generally been thought. The discovery could open the door to new treatment strategies. Heart failure means that the heart muscle is too weak or stiff to pump blood as effectively as it needs to, and it is commonly the result of a heart attack. Around 750,000 people in Britain are living with heart failure. Severe heart failure carries a risk of death within one year which is worse than most cancers, and new heart failure treatments are badly needed.
Patients with advanced heart failure are sometimes fitted with a left ventricle assist device (LVAD). The LVAD is a small pump that boosts the function of the heart and reduces strain on the left ventricle, the biggest chamber of the heart, which pumps blood around the body's main circulation.
In 2006, researchers at Imperial led by Professor Magdi Yacoub showed that resting the heart using an LVAD fitted for a limited time can help the heart muscle to recover. The new study is a major step in understanding the mechanisms for this improvement at the level of heart muscle cells.
The Imperial researchers studied the changes that occur in heart muscle cells during heart failure in rats, and whether "unloading" the heart can reverse these changes.
"If you injure a muscle in your leg, you rest it and this allows it to recover," said Dr Cesare Terracciano, from the National Heart and Lung Institute (NHLI) at Imperial, who supervised the study. "The heart can't afford to rest -- it has to keep beating continuously. LVADs reduce the load on the heart while maintaining the supply of blood to the body, and this seems to help the heart recover. We wanted to see what unloading does to heart muscle cells, to see how this works."
To study the effect of unloading, they transplanted a failing heart from one rat into another rat alongside that rat's healthy heart, so that it received blood but did not have to pump. After the heart was able to rest, several changes in the structure of heart muscle cells that impair how well they can contract were reversed.
"This is the first demonstration that this important form of remodelling of heart muscle cells induced by heart failure is reversible," said Michael Ibrahim, also from the NHLI at Imperial, who conducted the research for his PhD funded by the British Heart Foundation. "If we can discover the molecular mechanisms for these changes, it might be possible to induce recovery without a serious procedure like having an LVAD implanted."
The most profound cellular effects observed in this study concerned structures called t-tubules. These allow electrical signals to travel deep into the muscle cells so that all of the fibres contract simultaneously. T-tubules are densely packed and regular in healthy heart cells, enabling efficient muscle contraction, but they become sparse and irregular after heart failure. Unloading the heart led to the t-tubules returning to normal.

**Source: Imperial College London

Diabetes drug can prevent heart disease

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The widely used diabetes medicine metformin can have protective effects on the heart, reveals a new study conducted at the Sahlgrenska Academy, at the University of Gothenburg, Sweden. Researchers at the University of Gothenburg's Sahlgrenska Academy have shown in a preliminary study in rats that one of the most common diabetes drugs, metformin, also has a protective effect on the heart.
The study, carried out in collaboration with a research group from Naples and published in the journal Diabetes, reveals that metformin helps increase pumping capacity, improve energy balance, reduce the accumulation of fat, and limit the loss of heart cells through programmed cell death.
Long term effect
The results were compared with animals treated with another diabetes drug, which proved to have no positive effects on the heart.
“The animals in our study were treated with metformin for a whole year, so the effect seems to persist,” says Jörgen Isgaard, the researcher at the Sahlgrenska Academy who led the Swedish research group involved in the study.
New study on patients
Diabetes drugs have proved to have a number of serious side-effects for people with heart disease. Rosiglitazone, for example, was recently withdrawn due to its cardiac side-effects. Metformin too can occasionally have side-effects, primarily in patients with kidney failure.
“Our results nevertheless strengthen the indication for metformin as a diabetes medicine, and we hope that they are now followed up with studies on actual patients,” says Isgaard.
The article Metformin Prevents the Development of Chronic Heart Failure in the SHHF Rat Model was published in Diabetes on 22 February.

**Source: University of Gothenburg

Diabetes Drug Can Prevent Heart Disease, New Study Suggests

Researchers at the University of Gothenburg's Sahlgrenska Academy have shown in a preliminary study in rats that one of the most common diabetes drugs, metformin, also has a protective effect on the heart.
The study, carried out in collaboration with a research group from Naples and published in the journal Diabetes, reveals that metformin helps increase pumping capacity, improve energy balance, reduce the accumulation of fat, and limit the loss of heart cells through programmed cell death.
Long term effect
The results were compared with animals treated with another diabetes drug, which proved to have no positive effects on the heart.
“The animals in our study were treated with metformin for a whole year, so the effect seems to persist,” says Jörgen Isgaard, the researcher at the Sahlgrenska Academy who led the Swedish research group involved in the study.
New study on patients
Diabetes drugs have proved to have a number of serious side-effects for people with heart disease. Rosiglitazone, for example, was recently withdrawn due to its cardiac side-effects. Metformin too can occasionally have side-effects, primarily in patients with kidney failure.
“Our results nevertheless strengthen the indication for metformin as a diabetes medicine, and we hope that they are now followed up with studies on actual patients,” says Isgaard.
The article Metformin Prevents the Development of Chronic Heart Failure in the SHHF Rat Model was published in Diabetes on 22 February.

**Published in "SCIENCE DAILY"

Study links male Y chromosome variants with the risk of coronary heart disease

Scientists in the UK have shown that genetic variations in the Y chromosome affect a male’s risk of coronary heart disease. It is well known that males have a higher incidence of coronary heart disease than females due, in part, to the Y chromosome they inherit from their fathers. To investigate the role of the Y chromosome further, a team from the University of Leicester carried out research to determine whether genetic variations in the Y-chromosome affect risk for males.
Not all Y chromosomes are the same. There are variants within the male gender called “Y-haplogroups”, which are usually associated with specific geographic regions and tend to indicate the origin of the ancestral line. Professor Nilesh Samani explains the background to the project that was funded by the British Heart Foundation, “We set out to determine if men with differing types of Y chromosome were at differing risk of heart disease. We tested nearly 3,000 British males, and found that those carrying the I-haplogroup variant had a 55 percent higher risk of coronary heart disease.”
Of the 3,000 men tested, 1,295 were the cohort group of those with coronary heart disease and the rest were the control group. The Y-haplogroup was identified in all men, and the results showed that those in the I-haplogroup had an approximately 55 percent higher risk of coronary heart disease compared to the others. The association of the I-haplogroup with coronary heart disease was independent of, and not explained by, traditional heart risk factors such as cholesterol, high blood pressure and smoking.
Commonly found in central, eastern and northern Europe, the I-haplogroup is carried by about 13 percent of British men. Its origin is thought to be of the Gravettian culture, which arrived in Europe from the Middle East about 25,000 years ago. Since the I-haplogroup is not so prevalent in southern parts of Europe, an interesting speculation is whether it contributes to the higher levels of coronary heart disease in the north compared to the south – however, this requires further research and testing.
What is clear from this study though, is that men carrying the I-haplogroup are more likely to suffer from coronary heart disease than men with other Y-haplogroups.