Imaging Techniques Can Identify Plaques Likely to Cause Heart Attacks

NEW YORK –  Imaging techniques can help identify the types of vulnerable plaque that are most likely to cause adverse cardiac events before they occur, say researchers.

This finding comes from a clinical trial called Providing Regional Observations to Study Predictors of Events in the Coronary Tree (PROSPECT), which is the first prospective natural history study of atherosclerosis using multi-modality imaging to characterize the coronary tree.

A presentation on the study was made at the 21st annual Transcatheter Cardiovascular Therapeutics (TCT) scientific symposium, sponsored by the Cardiovascular Research Foundation (CRF).

“As a result of the PROSPECT trial, we are closer to being able to predict-and therefore prevent – sudden, unexpected adverse cardiac events,” said principal investigator Dr. Gregg W. Stone, immediate past chairman of CRF, professor of medicine at Columbia University Hospital and Director of Cardiovascular Research and Education at the Center for Interventional Vascular Therapy at NewYork-Presbyterian Hospital/Columbia University Medical Center.

During the multi-centre trial, 700 patients with acute coronary syndromes (ACS) were studied using three-vessel multimodality intra-coronary imaging-angiography, intravascular ultrasound (IVUS), and virtual histology.

The purpose was to quantify the clinical event rate due to atherosclerotic progression, and to identify those lesions that place patients at risk for unexpected adverse cardiovascular events-sudden death, cardiac arrest, heart attacks and unstable or progressive angina.

The study revealed that most untreated plaques that cause unexpected heart attacks are not mild lesions, as previously thought, but actually have a large plaque burden and a small lumen area. These are characteristics that were invisible to the coronary angiogram but easily identifiable by IVUS.

Only about half of new cardiac events due to non-culprit lesions exemplified the classic notion of vulnerable plaque (rapid lesion progression of non flow limiting lesions), while half were attributable to unrecognized and untreated severe disease with minimal change over time.

Perhaps most importantly, for the first time it was demonstrated that characterization of the underlying plaque composition (with virtual histology) was able to significantly improve the ability to predict future adverse events beyond other more standard imaging techniques.

“These results mean that using a combination of imaging modalities, including IVUS to identify lesions with a large plaque burden and/or small lumen area, and virtual histology to identify a large necrotic core without a visible cap (a thin cap fibroatheroma) identifies the lesions that are at especially high risk of causing future adverse cardiovascular events,” Dr. Stone said.

Introducing – CoQ10

Other Names: Coenzyme Q10, Co Q10, Ubiquinone, Vitamin Q

CoQ10 is a naturally-occuring compound found in every cell in the body. CoQ10’s alternate name, ubiquinone, comes from the word ubiquitous, which means “found everywhere.”

CoQ10 plays a key role in producing energy in the mitochondria, the part of a cell responsible for the production of energy in the form of ATP.

Why People Use CoQ10

  • Heart failure
  • Cardiomyopathy
  • Heart Attack Prevention and Recovery
  • High Blood Pressure
  • Diabetes
  • Gum Disease
  • Kidney Failure
  • Migraine
  • Counteract Prescription Drug Effects
  • Parkinson’s disease
  • Weight loss

What is the Evidence For CoQ10?

  • Heart failure
    People with heart failure have been found to have lower levels of CoQ10 in heart muscle cells. Double-blind research suggests that CoQ10 may reduce symptoms related to heart failure, such as shortness of breath, difficulty sleeping, and swelling. CoQ10 is thought to increase energy production in the heart muscle, increasing the strength of the pumping action. Recent human studies, however, haven’t supported this.

In one study, 641 people with congestive heart failure were randomized to receive either CoQ10 (2 mg per kg body weight) or a placebo plus standard treatment. People who took the CoQ10 had a significant reduction in symptom severity and fewer hospitalizations.

In another study, 32 patients with end-stage heart failure awaiting heart transplantation received either 60 mg of CoQ10 or a placebo for 3 months. Patients who took the CoQ10 experienced a significant improvement in functional status, clinical symptoms, and quality of life, however there were no changes in echocardiogram (heart ultrasound) or in objective markers.

A study randomized 55 patients with congestive heart failure to receive either 200 mg per day of CoQ10 or a placebo in addition to standard treatment. Although serum levels of CoQ10 increased in patients receiving CoQ10, CoQ10 didn’t affect ejection fraction, peak oxygen consumption, or exercise duration.

A longer-term study investigated the use of 100 mg of CoQ10 or a placebo in addition to standard treatment in 79 patients with stable chronic congestive heart failure. The results indicated that CoQ10 only slightly improved maximal exercise capacity and quality of life compared with the placebo.

  • Cardiomyopathy

Several small trials have found CoQ10 may be helpful for certain types of cardiomyopathy.

  • Parkinson’s disease

Lower levels of CoQ10 have also been observed in people with Parkinson’s disease. Preliminary research has found that increasing CoQ10 may increase levels of the neurotransmitter dopamine, which is thought to be lowered in people with Parkinson’s disease. It has also been suggested that CoQ10 might protect brain cells from damage by free radicals.

A small, randomized controlled trial examined the use of 360 mg CoQ10 or a placebo in 28 treated and stable Parkinson’s disease patients. After 4 weeks, CoQ10 provided a mild but significant significant mild improvement in early Parkinson‘s symptoms and significantly improved performance in visual function.

A larger 16 month trial funded by the National Institutes of Health explored the use of CoQ10 (300, 600 or 1200 mg/day) or a placebo in 80 patients with early stage Parkinson’s disease. The results suggested that CoQ10, especially at the 1200 mg per day dose, had a significant reduction in disability compared to those who took a placebo.

  • CoQ10 and Statin Drugs

Some research suggests that statin drugs, or HMG-CoA reductase inhibitors, a class of drugs used to lower cholesterol, may interfere with the body’s production of CoQ10. However, research on the use of CoQ10 supplements in people taking statins is still inconclusive, and it is not routinely recommended in combination with statin therapy.

  • Diabetes
    In a 12-week randomized controlled trial, 74 people with type 2 diabetes were randomized to receive either 100 mg CoQ10 twice daily, 200 mg per day of fenofibrate (a lipid regulating drug), both or neither for 12 weeks. CoQ10 supplementation significantly improved blood pressure and glycemic control. However, two studies found that CoQ10 supplementation failed to find any effect on glycemic control.
  • Gum disease
    A small study looked at the topical application of CoQ10 to the periodontal pocket. Ten male periodontitis patients with 30 periodontal pockets were selected. During the first 3 weeks, the patients applied topical CoQ10. There was significant improvement in symptoms.

Dosage

A typical CoQ10 dosage is 30 to 90 mg per day, taken in divided doses, but the recommended amount can be as high as 200 mg per day.

CoQ10 is fat-soluble, so it is better absorbed when taken with a meal that contains oil or fat.

The clinical effect is not immediate and may take up to eight weeks.

Safety

Consult your doctor before trying CoQ10, especially if you have heart disease, kidney failure, or cancer.

Side effects of CoQ10 may include diarrhea and rash.

CoQ10 is used in combination with standard treatment, not to replace it.

CoQ10 may lower blood sugar levels, so people with diabetes should not use CoQ10 unless under a doctor’s supervision. CoQ10 may also lower blood pressure.

The safety of Co q10 in pregnant or nursing women or children has not been established.

PLEASE SEE THE POST ON “POLICOSANOL” FOR LOWERING CHOLESTEROL

 

Resynchronization Cuts Down Risk of Heart Failures

CHICAGO A therapy called cardiac ‘resynchronization’ reduced risk of heart failures by 41 percent, says an international study.

“This shows, for the first time, that the onset of heart failure symptoms and hospitalization for heart failure can be delayed with pacing therapy,” said David Wilber, director of the Cardiovascular Institute at Loyola University (Chicago) Stritch School of Medicine.

Cardiac resynchronization therapy (CRT) is an innovative new therapy that can relieve congestive heart failure (CHF) symptoms, by improving the coordination of its contractions.

It is done with the help of electrical impulses delivered by a device implanted in the upper chest, that help synchronize contractions of the left ventricle, the heart’s main pumping chamber.

The study included 1,820 patients from 110 centers in the US, Canada and Europe. All patients in the trial had been diagnosed with early stage, mild heart failure (Class 1 and Class 2 on the New York Heart Association classification system), according to a Loyola release.

For instance, Loyola heart failure patient Rosemary Jakubowski of Elmwood Park said before she received cardiac resynchronization, she had experienced significant fatigue. “I always had that dragging feeling,” she said.

Since receiving resynchronization, Jakubowski has been taking kickboxing and swim aerobics classes, without fatigue. “I’m 100 percent better — complete satisfaction,” she said. “It’s like I’m a new person.”

The Food and Drug Administration has approved cardiac resynchronization for patients with Class 3 (moderate) and Class 4 (severe) heart failure. Such patients experience marked limitations in physical activity or are unable to do any physical activity at all without discomfort.

“With this study, we have shown that certain patients with early-stage, mild heart failure also can benefit from cardiac resynchronization,” Wilber said.

These findings were published in the New England Journal of Medicine.

New Microchip-Based Device Can Put an End to Painful Biopsies

TORONTO – Canadian experts at the University of Toronto have come up with a microchip technology that they believe can prove helpful in diagnosing cancer and infectious disease in just half an hour.

Just as big in size as a BlackBerry, the novel device is expected to revolutionize the diagnosis and treatment of a wide range of cancers and other ailments.

The researchers say that it is aimed at eliminating the need for painful biopsies by detecting the presence and severity of cancer via a urine sample.

They hope that their device will also eliminate equally painful wait times that patients undergoing cancer diagnoses routinely endure, as test results computed by it can be completed in just 30 minutes.

“Today, it takes a room filled with computers to evaluate a clinically relevant sample of cancer biomarkers and the results aren’t quickly available,” the Globe and Mail quoted Shana Kelley, the U of T professor who was a lead investigator on the project, as saying.

“Our team was able to measure biomolecules on an electronic chip the size of your fingertip and analyze the sample within half an hour,” Kelley added.

The device, though in the engineering phase, has been tested on prostate cancer and head and neck cancer models.

The university team believe that it may potentially be used to diagnose and assess other cancers, besides detecting infectious diseases like HIV, MRSA and H1N1 flu.

“The system…is a revolutionary technology that could allow us to track biomarkers that might have significant relevance to cancer, with a combination of speed, sensitivity, and accuracy not available with any current technology. This type of approach could have a profound impact on the future management for our cancer patients,” says Dr. Fei-Fei Liu, a radiation oncologist at Princess Margaret Hospital and Head of the Applied Molecular Oncology Division at the Ontario Cancer Institute.

A research paper describing the novel device has been published in the journal Nature Nanotechnology.