Lowered HRT Use May Have Cut Heart Attacks

(HealthDay News) -- The decline in the use of hormone replacement therapy (HRT) to treat menopause symptoms has been mirrored by a drop in the rate of Heart attacks among American women, a new study finds.

But there's been no decrease in the rate of strokes, researchers noted.

Hormone replacement therapy was widely used to treat menopause symptoms until 2002, when researchers published a study that said HRT increased the risk of heart attack. After that, the use of HRT among women ages 50-69 decreased from more than 30 percent to less than 15 percent, the researchers said.

In this new study, the researchers examined U.S. death records, hospital discharge data and national surveys of medication usage between 1990 and 2005 for women ages 40-79. The analysis revealed a decrease in heart attacks but no reduction in the number of hospitalizations or deaths from stroke.

"We were surprised that HRT had such divergent effects on stroke and acute myocardial infarction (heart attack) in the overall population," lead author Dr. Kanaka Shetty, of the RAND Corporation in Santa Monica, Calif., said in a news release.

The study appears in the May issue of the journal Medical Care.

The decrease in heart attacks among American women may be due to factors other than reduced use of HRT, suggested Dr. Nieca Goldberg, a cardiologist at Total Heart Care in New York City whose practice focuses primarily on women.

"The reduction in hormone therapy coincided with the American Heart Association's and National Heart, Lung, and Blood Institute's women and heart disease awareness campaigns," Goldberg said in a news release.

"The lower rate of heart attacks may be due to better screening for heart disease risk factors and better awareness of women's heart attack symptoms by physicians," Goldberg said. "It's premature to attribute the decline in heart attack rates to the decline in hormone therapy."

More information
The U.S. National Institutes of Health has more about HRT.

Heavy Traffic Can Be Heartbreaking

(HealthDay News) -- The decline in highway traffic that was brought on by last summer's spike in gas prices may be a boon to heart health.

That's because automobile emissions are among a long list of risk factors for heart disease and stroke.

"There's a very coherent and consistent body of data that links particulate air pollution with cardiovascular disease and premature death," said Dr. Ted Schettler, science director of the Science and Environmental Health Network, an environmental and public health advocacy group.

Among the latest evidence: a German study published recently in Circulation: Journal of the American Heart Association, which found that people who live near heavy traffic are more likely to develop atherosclerosis, or hardening of the arteries, which can boost the risk of heart disease.

Atherosclerosis is a progressive disease that begins with damage to the lining of the arteries. Over time, the arteries accumulate plaque, a combination of fat, cholesterol, calcium and other substances. This causes the arteries to become rigid and narrow, impeding the flow of oxygen-rich blood to the heart and other parts of the body. This can lead to a heart attack, stroke or even death, according to the U.S. National Heart, Lung, and Blood Institute.

In 2004, the American Heart Association issued its first official statement on air pollution and cardiovascular disease. In reviewing the scientific evidence, an expert panel concluded that short-term exposure to elevated particulate matter, which includes motor vehicle emissions, "significantly contributes to increased acute cardiovascular mortality, particularly in certain at-risk subsets of the population."

The panel further noted that prolonged exposure to elevated levels of air pollution reduced overall life expectancy "on the order of a few years."

To assess the impact of long-term residential traffic exposure on the heart, Dr. Barbara Hoffmann, head of the unit of environmental epidemiology at the University of Duisburg-Essen, and colleagues used "electron-beam computed tomography" to measure calcium build-up in the arteries.

Compared with people who lived more than 200 meters, or 642 feet, from major traffic, the risk of coronary artery calcification was 63 percent higher for people living within 50 meters (160 feet) of heavy traffic, and 34 percent higher for those who were between 51 meters and 100 meters (164 to 328 feet) away. The risk was 8 percent higher for those living 100 meters to 200 meters (328 to 642 feet) away.

Hoffmann compares the damage wrought by traffic fumes to the effects of aging. "Living within 100 meters of a major road compared to people living further away amounts to a similar difference in coronary calcification as six months of aging," she said.

Her team is currently examining all study participants again to determine whether those living close to heavy traffic have suffered a greater increase in coronary calcification during the past five years.

So what can individuals do, short of moving away from heavily traveled roads, to stave off cardiovascular disease?

The best thing is focus on modifiable factors, such as keeping blood pressure and diabetes in check, lowering cholesterol, increasing physical activity and quitting smoking, Hoffmann said.

Reducing air pollution is a larger challenge.

In big U.S. cities, state and local agencies are required to report the Air Quality Index -- a measure of how pristine or polluted the air is -- each day, says AirNow, a federal government Web site on air quality. Depending on the level of concern, people with heart or lung disease, older adults and children may be advised to remain indoors

"That's just a Band-Aid on a public health problem," Schettler said. "Do we want people who have early cardiovascular disease to have to avoid breathing air outside, or do we want to clean up the air?"

More information
For more on the heart-health effects of air pollution, visit the American Heart Association.

Panel: Heart patients should be screened for depression

DALLAS (AP) -- Heart patients should be regularly screened for signs of depression, the American Heart Association recommended Monday.

Depression is about three times more common in heart attack survivors and those hospitalized with heart problems than the general population, according to the recommendations published in the journal Circulation.

The authors said only about half of heart doctors say they treat depression in their patients -- and not all those diagnosed with depression are treated.

"I think we could reduce considerable suffering and improve outcomes," by screening, said Erika Froelicher, professor of nursing at the University of California, San Francisco. "I know we can do more."

While there's no direct evidence that heart patients who are screened fare better, depression can result in poorer outcomes and a poorer quality of life, the panel said. Depressed patients may skip their medications, not change their diet or exercise or take part in rehabilitation programs, they said.

Anyone from cardiologists to nurses to primary care doctors can and should be involved in determining whether a patient is depressed, said Froelicher, who was co-chair of the panel that wrote the recommendations. Continue Reading >>