Cardiovascular

ROCHESTER, Minn. — August 27, 2012.  People who are of normal weight but have fat concentrated in their bellies have a higher death risk than those who are obese, according to Mayo Clinic research presented today at the European Society of Cardiology Congress in Munich. Those studied who had a normal body mass index but central obesity — a high waist-to-hip ratio — had the highest cardiovascular death risk and the highest death risk from all causes, the analysis found. "We knew from previous research that central obesity is bad, but what is new in this research is that the distribution of the fat is very important even in people with a normal weight," says senior author Francisco Lopez-Jimenez, M.D., a cardiologist at Mayo Clinic in Rochester. "This group has the highest death rate, even higher than those who are considered obese based on body mass index. From a public health perspective, this is a significant finding." The study included 12,785 people 18 and older from the Third National Health and Nutrition Examination Survey, a representative sample of the U.S. population. The survey recorded body measurements such as height, weight, waist circumference and hip circumference, as well as socioeconomic status, comorbidities, and physiological and laboratory measurements. Baseline data were matched to the National Death Index to assess deaths at follow-up. Those studied were divided by body mass index into three categories (normal: 18.5–24.9 kg/m2; overweight: 25.0–29.9 kg/m2; and obese: >30 kg/m2) and two categories of waist-to-hip ratio (normal: The mean age was 44; 47.4 percent were men. The median follow-up period was 14.3 years. There were 2,562 deaths, of which 1,138 were cardiovascular related. The risk of cardiovascular death was 2.75 times higher, and the risk of death from all causes was 2.08 times higher, in people of normal weight with central obesity, compared with those with a normal body mass index and waist-to-hip ratio. "The high risk of death may be related to a higher visceral fat accumulation in this group, which is associated with insulin resistance and other risk factors, the limited amount of fat located on the hips and legs, which is fat with presumed protective effects, and to the relatively limited amount of muscle mass," says Karine Sahakyan, M.D., Ph.D., a cardiovascular research fellow at Mayo Clinic in Rochester.

People who are of normal weight but have fat concentrated in their bellies have a higher death risk than those who are obese. The Mayo Clinic ...

In the U.S., hundreds of thousands of X-rays are performed each year to detect and treat common cardiovascular conditions. But there's growing concern about the potential risks of ...

ROCHESTER, Minn. — August 16, 2012.  Each year, hundreds of thousands of X-rays are performed across the country to help detect and treat common cardiovascular conditions such as coronary artery disease, valve disease and other heart problems. However, concern is growing within the medical community about the potential risks of radiation exposure from this imaging technology. Now, researchers at Mayo Clinic have been able to dramatically cut the amount of radiation that patients and medical personnel are exposed to during invasive cardiovascular procedures. The solution: targeted modifications to the use of standard X-ray equipment, coupled with intensive radiation safety training. The efforts are detailed in a paper published online Aug. 20 in the Journal of the American College of Cardiology: Cardiovascular Interventions. MULTIMEDIA ALERT: Video of Dr. Ken Fetterly is available for journalists to download on the Mayo Clinic News Network "Through our efforts, we were able to quickly cut the overall radiation exposure to patients by nearly half using simple but effective methods," said Charanjit Rihal, M.D., chair of Mayo's Division of Cardiovascular Diseases. "We think this program could serve as a useful model for other cath labs in the U.S." Cardiologists rely on X-ray images to identify heart problems and provide real-time guidance for procedures such as implanting stents to open narrowed arteries and aortic valve replacement. However, radiation from X-rays can be harmful. It can injure the skin if not administered judiciously, and can also damage DNA, which can increase the risk of certain cancers. The amount of radiation used in a procedure should not exceed the minimum necessary, Dr. Rihal says. Recognizing this, Mayo instituted a broad-based program that has raised awareness about radiation safety and changed the way standard X-ray systems are used in the cath lab. For example, medical staff now set the radiation output of their systems to a very low setting, minimizing the radiation dose to their patients. They only increase the radiation dose if higher-quality images are needed, such as temporarily during a critical portion of a procedure. As a result, they can obtain useful images while lowering radiation exposure. In addition, practice-wide radiation safety is now included when training fellows and junior faculty. The cath lab teams also are informed of the radiation dose delivered to patients during each procedure. Radiation exposure is routinely reported in the patient's medical record. "The reductions in the radiation dose administered to patients occurred practice-wide and across diverse procedures," says Kenneth Fetterly, Ph.D., Division of Cardiovascular Diseases. Dr. Fetterly says the initiative is part of Mayo's ongoing commitment to patient safety. The changes implemented by Mayo go well beyond standard procedures used in hospitals across the country. Buy-in across the practice is needed for such programs to succeed, Dr. Fetterly says. Success also requires physicians to shift their expectations from attaining the highest image quality to focusing on lower radiation exposure and accepting adequate image quality.

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ROCHESTER, Minn. — June 26, 2012.  In the realm of deadly and disabling diseases, conditions such as cancer and Alzheimer's seem to attract the most media attention. But there are others that take a similarly high toll, and rheumatoid arthritis is one of them, Mayo Clinic researchers say. It is a common cause of disability: 1 of every 5 rheumatoid arthritis patients is unable to work two years after diagnosis, and within five years, that rises to one-third. Life expectancy drops by up to five years, they write in the July issue of Mayo Clinic Proceedings in an article taking stock of current diagnosis and treatment approaches. Rheumatoid arthritis patients also have a 50 percent higher risk of heart attack and twice the danger of heart failure, Mayo researchers say. Much progress has been made in recognizing the importance of early diagnosis and prompt and aggressive treatment, but gaps in understanding of the disease remain, say the authors, Mayo Clinic rheumatologists John Davis III, M.D., and Eric Matteson, M.D. "There are many drug therapies available now for management of rheumatoid arthritis, but the challenge for patients and their physicians is to decide on the best approach for initial management and then subsequent treatment modification based on the response," Dr. Davis says. "In our article, we reveal our approach including algorithms for managing the disease that we believe will enhance the probability that patients will achieve remission, improved physical function, and optimal quality of life." In rheumatoid arthritis, the immune system assaults tissue, causing swollen and tender joints and sometimes involving other organs. The top goal of treatment is to achieve remission, controlling the underlying inflammation, easing pain, improving quality of life and preserving patients' independence and ability to work and enjoy other pursuits. Long-term goals include preventing joint destruction and other complications such as heart disease and osteoporosis. Dr. Davis and Dr. Matteson offer several tips and observations: "It is very important to have rheumatoid arthritis properly diagnosed, and treatment started early on. Getting the disease under control leads to better outcomes for the patient, ability to continue working and taking care of one's self, less need for joint replacement surgery, and reduced risk of heart disease," Dr. Matteson says. More than medication is needed to best manage rheumatoid arthritis. Educating patients about how to protect their joints and the importance of rest and offering them orthotics, splints and other helpful devices can substantially reduce pain and improve their ability to function. Cognitive behavioral therapy can make patients feel less helpless. Exercise programs that include aerobic exercise and strength training help achieve a leaner body; even modest weight loss can significantly reduce the burden on joints. No treatment approach or guidelines can ever take into account every possibility; when a patient describes joint tenderness, fatigue and disease activity worse than the physician thinks they are, the physician should investigate the causes of symptoms. Non-inflammatory causes of pain such as osteoarthritis or regional musculoskeletal pain syndromes may be to blame. Unanswered questions in rheumatoid arthritis include the relative benefits and harms of emphasizing initial treatment with prednisone; the effects of treatment on the risk of developing cardiovascular disease and other potentially deadly complications; and how to better predict how well treatments will work for specific patients and what the side effects will be.

ROCHESTER, Minn. — June 14, 2012.  Symptoms of gastric discomfort — indigestion, heartburn and stomach cramps — usually diminish in just a few hours. But for some people, digestive distress persists and becomes a constant concern. An eight-page Special Report in the June issue of Mayo Clinic Health Letter focuses on digestive health problems, which often can be successfully treated or managed. Highlights include: Many causes, many treatments: The Special Report covers treatments for digestive problems including ulcers, celiac disease, pancreatitis, Crohn's disease, diverticular disease, gallstones and liver disease. Seeking medical care sooner, rather than later, can help manage or even cure these conditions. Early action also may prevent a serious condition from becoming life threatening. Aging alone isn't the problem: People often blame aging for digestive problems. With aging, changes do occur. For example, the stomach loses elasticity and doesn't hold as much food. But, in general, changes due to aging have a mild impact on digestion. Heartburn (or heart attack?): Emergency care is recommended when heartburn seems different or worse than usual, especially if it occurs during physical activity or is accompanied by shortness of breath, sweating, dizziness, nausea or pain radiating into the shoulder and arm. The heart and esophagus are in close proximity and share similar nerve connections. They both can cause chest pain, ranging from mild to severe. And distinguishing heartburn from heart attack is not always easy. Don't blame spicy food: Most ulcers develop because of a bacterial infection or as a side effect of medications, not because of last night's dinner. The most common ulcer symptom is gnawing pain in the upper abdomen between the navel and breastbone. Treatment usually involves antibiotics and medications to reduce the level of acid in the stomach and give it a chance to heal. Being 'regular' doesn't mean every day: Constipation — one of the most common complaints among older adults — is generally defined as having fewer than three bowel movements a week with stools that are hard and painful. In contrast, easy bowel movements, even if they occur just every other day, would be considered normal. Constipation may be caused by dehydration, overuse of laxatives, medication side effects, a pattern of delaying bowel movements or underlying medication conditions. Exercise and adequate fiber in the diet can help. A physician can recommend other treatments such as fiber supplements or a brief course of laxatives.

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Heart disease can become a deadly complication for rheumatoid arthritis patients, but it has often been difficult for physicians to spot early. A Mayo Clinic study ...

ROCHESTER, Minn. — May 23, 2012.   Mayo Clinic today announced Heartland Health, based in St. Joseph, MO., is joining the Mayo Clinic Care Network. The ...