Heart health can be a real squeeze
Promising pills have fizzled after further study
Undiagnosed hypertension, failed drugs
Research presented this week at a major medical meeting underscores the importance of preventing heart disease— but also illustrates how difficult that is to put into practice.
Several studies of drugs and supplements that doctors hoped would improve heart health, for example, proved disappointing.
Although a pill called dalcetrapib was found to improve HDL, or “good” cholesterol, it didn’t actually reduce heart attacks in people with pre-existing heart disease, according to a study presented at the American Heart Association’s Scientific Sessions in Los Angeles.
And taking fish oil, which has long been touted as good for the heart, didn’t prevent a form of irregular heartbeat after cardiac surgery, a study showed.
All of these pills had seemed promising in early, less rigorous trials. But as with so many drugs and supplements, larger, more carefully designed tests failed to uphold those benefits, says Christopher Cannon, a professor at HarvardMedical School.
Yet even when there are proven prevention strategies available, new studies found that doctors and patients may not follow them.
Nearly one in five hospitalized smokers, for example, continue to smoke during a hospital stay, according to a study published in Archives of
Internal Medicine that is unrelated to the heart meeting. Though patients in the study weren’t allowed to smoke inside the hospital, they found places outside to light up.
Another study found that doctors often miss crucial opportunities to intervene early and prevent major heart problems before they turn deadly. An analysis of nearly 14,000 medical records found that many doctors fail to diagnose patients with high blood pressure, even though patients’ blood pressure readings are recorded in their charts.
Doctors were 28% less likely to diagnose high blood pressure in college-age adults compared with patients over 60, especially if they smoked or spoke English as a second language, according to a study presented at the meeting by Heather Johnson, an assistant professor at the University of Wisconsin School of Medicine and Public Health in Madison.
Doctors failed to diagnose 54% of patients over age 60 with high blood pressure and 67% of those who were ages 18 to 24, even after multiple visits and four years of follow-up, the study says.
Johnson says it’s possible that doctors are discussing high blood pressure readings with patients but not recording it as a diagnosis. She also says they may be falling victim to stereotypes, ignoring high blood pressure in young people assuming it’s a disease of the elderly.
The study reinforces other research showing that doctors may be blinded by preconceptions about
“We’re missing a chance for prevention and missing the point at which we can change heart disease.”
Suzanne Steinbaum, Lenox Hill Hospital Doctors failed to diagnose 54% of patients over age 60 with high blood pressure and 67% of those ages 18-24.
heart disease, says Suzanne Steinbaum, director of women and heart disease at Lenox HillHospital in New York. Physicians often ignore symptoms of heart disease in women as well, she says. “We’re missing a chance for prevention and missing the point at which we can change heart disease,” Steinbaum says. “If we don’t treat hypertension in 18- to 24-year-olds, then guess what’s going to happen 20 years from now? They’re going to be in heart failure.”
So which prevention strategies do work? The latest research once again points to exercise.
People who get even a small amount of leisure-time physical activity live longer, according to a study from the National Cancer Institute released Tuesday and also unrelated to the heart meeting.
Americans who get the recommended 21⁄ hours a week of “moderate
2 intensity” exercise live 3.4 years longer than those who don’t exercise, according to the study, published online in PloS Medicine. Even those who get only half the amount of recommended exercise still add 1.8 years to their lives.
A study presented at the heart meeting Monday also shows that people who avoid health pitfalls live not just longer but better. People with good heart health at age 45 — without hypertension, high cholesterol, diabetes or tobacco use — enjoyed an additional 14 years of healthy life, free of ailments such as heart attacks, stroke or chronic heart failure, compared with people with two of the risk factors, according to a study published in the Journal of the American Medical Association.