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.
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?
* THIS STUDY analyzed the medical records of 1,187 adults with type 2 diabetes but without heart disease who used ACE inhibitors and compared them with 4,989 similar diabetics who did not take the drug. Participants averaged 60 years of age. After about five years, 9 percent of those who took ACE inhibitors had died, compared with 17 percent of those who did not take them.
* WHO MAY BE AFFECTED BY THESE FINDINGS? Adult diabetics, who are two to four times more likely to have heart disease or a stroke than people without the disease.
* CAVEATS Researchers did not have information on preexisting cardiovascular risk factors -- including hypertension, cholesterol levels and smoking -- that could have affected participants. The study was not randomized or controlled.
* BOTTOM LINE Diabetics may want to ask their doctor about ACE inhibitors.
* FIND THIS STUDY June issue of Diabetes Care; abstract available online at care.diabetesjournals.org.
* LEARN MORE ABOUT diabetes at diabetes.niddk.nih.gov and at www.diabetes.org.
Survival rates seem unaffected by timing of post-op radiation.
* THE QUESTION Having radiation treatments after prostate cancer surgery has been shown to reduce the chances of the cancer's recurring. Some doctors administer the radiation right after surgery, while others prefer to wait, giving radiation only if the cancer returns. Is one approach more successful than the other?
* THIS STUDY compared the results of 69 men given radiation an average of three months after a radical prostatectomy with those of 88 men who had radiation treatments once their cancer recurred, an average of 40 months after surgery. Both groups received about the same dose of radiation. About five years later, survival rates, considering death from any cause, varied only slightly: 87 percent for the immediate radiation group and 81 percent for the delayed group.
* WHO MAY BE AFFECTED BY THESE FINDINGS? Men with prostate cancer. An estimated one of every six men will be diagnosed with this disease at some point.
* CAVEATS The study was not randomized; rather, one group was selected from a medical center that had a policy of immediate radiation and the other came from a facility that followed a delayed-radiation policy.
* BOTTOM LINE Men with prostate cancer should continue to have their PSA levels checked after surgery and talk with their doctors about radiation.
* FIND THIS STUDY June issue of the International Journal of Radiation Oncology, Biology and Physics; abstract available online www.sciencedirect.com/science/journal/03603016.
* LEARN MORE ABOUT prostate cancer at www.cancer.gov and at www.cancer.org.
-- Linda Searing