Bypass boosts survival in heart failure, 10-yr study says

Testosterone therapy may lower heart attack risk in older men

CHICAGO, April 4, (Agencies): Heart failure patients with clogged arteries have a better chance of surviving 10 years if they get bypass surgery plus medicine rather than just drugs alone, according to an international study.

Earlier results from the same research raised questions about the benefits of bypass versus medicine alone, but researchers say the long-term evidence clearly favors the surgery.

The lead author of the study, Duke University cardiologist Dr Eric Velazquez, said the results “are so definitive and so robust” that they would likely to lead to stronger recommendations favoring bypass surgery for these patients.

Nearly 6 million Americans and 23 million people worldwide have heart failure, and many of them also have artery disease similar to those studied. In recent years, bypass surgery has increasingly been recommended for such patients, along with medicines to ease heart failure symptoms.

Concerns were raised when results after nearly five years of research showed about equal number of deaths in bypass patients and in those who got only medicine, despite fewer heart-related deaths in the bypass group. Those findings were published in 2011.

The 10-year results were published online Sunday in the New England Journal of Medicine and presented at an American College of Cardiology meeting in Chicago.

The study involved 1,200 heart failure patients in 22 countries, including the United States. Most were men around age 60 when the study began. All were taking heart medicines, and about half were assigned to also get bypass surgery.

More than half the patients in each group lived beyond the study’s first phase. The 10-year results are a look back at all patients studied.

A total of 359 bypass patients died from any cause, or about 59 percent, compared with 398 medicine-only patients who died, or 66 percent.

Deaths from heart disease-related causes totaled 247 in the bypass group, or 41 percent, versus 297 medicine-only patients, or 49 percent.

A journal editorial published with the study says the latest results “solidly support” strengthening treatment guidelines to say that bypass surgery is “probably beneficial” for these patients.

The long-term results “are very encouraging” and confirm what many doctors believed about potential benefits of bypass for these patients, said Dr Ted Feldman, a cardiologist at NorthShore University HealthSystem in Evanston, Illinois. Feldman was not involved in the study.

The National Heart, Lung and Blood Institute paid for the study.

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Older men with clogged arteries who took testosterone therapy seemed to have a lower risk of heart attacks than men who did not take the hormone, a study suggested Sunday.

Testosterone is currently considered risky to the heart, and the US Food and Drug Administration mandated last year that manufacturers of all approved testosterone products add labels to describe these dangers, which include heart attack and stroke.

The methods of the study were observational — one of the weakest kinds of scientific research — but its authors said the results should lead to more rigorous trials on the hormone therapy in the future.

The study by Intermountain Medical Center Heart Institute in Salt Lake City included 755 men, aged 58 to 78, with severe coronary artery disease and low testosterone.

Those who did not take testosterone as part of their follow up were 80 percent more likely to suffer a heart attack, stroke, or death from a cardiovascular event in the next three years.

After a year, 64 patients who were not taking testosterone supplements suffered major adverse cardiovascular events, compared to 21 taking testosterone.

After three years, 125 patients not on testosterone therapy patients suffered major adverse cardiovascular events, compared to 60 patients receiving the hormone.

The findings were presented at the American College of Cardiology conference in Chicago.

“Although this study indicates that hypo-androgenic men with coronary artery disease might actually be protected by testosterone replacement, this is an observational study that doesn’t provide enough evidence to justify changing treatment recommendations,” said cardiologist Brent Muhlestein, co-director of cardiovascular research at the Intermountain Medical Center Heart Institute.

“It does, however, substantiate the need for a randomized clinical trial that can confirm or refute the results of this study.”

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Genetic mutations that can be blamed for unusually high cholesterol are far rarer than previously thought, existing in only about two percent of the population, researchers said Sunday.

Previous studies have suggested that as many as 25 percent of people with very high cholesterol — defined as low-density lipoprotein (LDL) cholesterol levels of 190 mg/dl or higher — could blame their condition on their genes.

LDL is widely known as “bad choles- terol” because it leads to buildup of harmful plaque in the arteries.

“Many clinicians assume that patients with LDL above 190 have a familial hypercholesterolemia mutation as the major driver,” said Amit Khera, a cardiology fellow at Massachusetts General Hospital and lead author of the findings presented at the American College of Cardiology conference in Chicago.

“But there are a lot of other causes that can lead to this very high LDL, such as poor diet, lack of exercise and a variety of common genetic variants that each have a small impact on cholesterol but can add up to a big impact when they occur together.”

To perform the study, researchers compiled the largest gene sequencing analysis to date based on people with very high cholesterol, including more than 26,000 people.

There are three different known mutations that can lead to a diagnosis of familial hypercholesterolemia.

Only two percent of individuals had mutations in any of the three known familial hypercholesterolemia genes.