QUICK STUDY : A weekly digest of new research on major health topics

CARDIOMYOPATHY

Implanted heart devices may reduce the risk of heart failure.

• THE QUESTION The most common type of heart muscle disease, or cardiomyopathy, occurs when the organ becomes enlarged, or dilated. The weakened muscle can prevent the heart from pumping blood efficiently and can cause it to stop altogether. Would implanting a pacemaker and possibly a defibrillator, which can deliver an electrical shock to keep the heart beating, help prevent heart failure?

• THIS STUDY randomly assigned 1,520 people diagnosed with advanced heart failure caused by cardiomyopathy to be treated one of three ways: by taking proven drugs such as ACE inhibitors, beta blockers and spironolactone; by taking these drugs and also having a pacemaker implanted; or by taking the drugs and implanting a pacemaker-defibrillator combination. Compared with the group that took only the drug regimen, hospitalization for or death from heart failure occurred 34 percent less among people who took the drugs in tandem with a pacemaker and 40 percent less among those with the pacemaker-defibrillator combination.

• WHO MAY BE AFFECTED BY THESE FINDINGS? People with heart muscle disease, especially those with dilated cardiomyopathy. It occurs most often in middle-aged people, men more than women.

• CAVEATS Participants knew which type treatment they were receiving. When the devices used in the study became available commercially, 26 percent of the participants in the drugs-only group withdrew to have one of the devices implanted. The study was funded by Guidant, which designs and produces cardiovascular devices, including pacemakers and defibrillators; several authors of the study were consultants to or employees of the company. One author was an employee of Pfizer, the drug manufacturer.

• BOTTOM LINE People with cardiomyopathy may want to ask their doctor whether a pacemaker or a defibrillator, or both, might benefit them.

• FIND THIS STUDY May 20 issue of the New England Journal of Medicine; abstract available online at www.nejm.org.

• LEARN MORE ABOUT cardiomyopathy at www.americanheart.org and at www.tmc.edu/thi.

diabetes

A blood pressure drug may help reduce heart disease risks.

• THE QUESTION Besides monitoring their insulin levels, diabetics need to watch for other problems associated with diabetes, including cardiovascular disease. Blood pressure drugs such as ACE inhibitors block the action of a chemical that constricts blood vessels and thus controls blood pressure. Does taking this drug affect the risk of death from heart disease among diabetics?