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Cardiovascular Illnesses in the News

Geriatric Times

January/February 2003

Vol. IV

Issue 1

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Chronic Use of OTC Pain Medication Linked to Hypertension in Women

According to a study published in JAMA, acetaminophen, ibuprofen and aspirin are the three most-consumed medications in the United States, and women are the most common users (2000; 287[3]:337-344). Each of these drugs works by altering prostaglandin production, leading researchers to suspect that they may also be capable of elevating blood pressure. Investigators in the department of medicine at Boston Medical Center have confirmed this association through a large prospective cohort study of women ages 44 to 69 years, published in the November 2002 issue of Hypertension.

The study questioned 51,630 women who had no history of hypertension or chronic renal insufficiency about their use of nonnarcotic analgesics, then followed them biennially for eight years to assess incidence of physician-reported diagnosis of hypertension. Over a span of 381,078 person-years, researchers identified 10,579 incident cases of hypertension. They found that women who used aspirin or acetaminophen at least one day per month or nonsteroidal anti-inflammatory drugs (NSAIDs) five or more days per month were at a significantly higher risk for development of hypertension than women who used no medication. Increased frequency of analgesic use correlated with increased incident hypertension for each analgesic type (p<0.001). Women who used analgesics the most--at least 22 days a month--had an odds ratio of 1.21 for aspirin (95% CI, 1.13 to 1.30), 1.20 for acetaminophen (1.08 to 1.33) and 1.35 for NSAIDs (1.25 to 1.46) compared with women who did not use analgesics.

These results agreed with a previous report on a younger cohort of women (Arch Intern Med 2002;162[19]:2204-2208). The authors suggested that, given the large population at risk, health care professionals should consider the possible hypertensive effects of aspirin, acetaminophen and NSAIDs when counseling their patients about the use of nonnarcotic analgesics--JH

Hostility and Exhaustion May Heighten Risk for Heart Disease

Recent studies have concluded that hostility and vital exhaustion may be greater risk factors for heart disease than previously known factors such as cigarette smoking and alcohol consumption.

Researchers from Brown University Medical School, Boston University School of Public Health, the University of Memphis and Harvard Medical School examined the impact of hostility on coronary heart disease (CHD) using prospective data from the Normative Aging Study (Health Psychology 2002;21[6]:588-593). The study involved 774 healthy white men between the ages of 21 and 80 years old who were required to participate in regular examinations every three years (age 52 or older) or five years (younger than age 52). The total Cook-Medley Hostility Scale score, anthropometric data, serum lipids, fasting insulin concentrations, blood pressure, cigarette smoking, alcohol consumption and total dietary calories were used to predict incidence of CHD. Multivariate analysis indicated that only the hostility scores positively predicted, and high-density lipoprotein (HDL) cholesterol level negatively predicted, incidence of CHD.

How your patient feels mentally may play a part in how they feel physically. Doctors know that preceding a heart attack, many patients experience severe fatigue, increased irritability and general feelings of hopelessness. A recent study conducted in the Netherlands (Psychosomatic Medicine 2002;64:787-792) found that a mental state known as vital exhaustion more than doubles the risk of a first heart attack. Van Diest and colleagues compared blood samples from two groups of 30 participants. One group was classified as vitally exhausted after completing a 23-item questionnaire called the Maastricht interview for vital exhaustion. The participants who tested negative for vital exhaustion served as the control group.

The participants with vital exhaustion tended to have higher blood levels of a protein called fibrinogen, which causes blood to clot. Previous studies have found that high fibrinogen levels increase heart attack risk.

Researchers concluded, "These [blood] changes provide a potential mechanism by which vital exhaustion is related to heart attack"--AR

Tooth Decay Related to Heart Arrhythmia in the Very Old

At the Gerontological Society of America 2002 Annual Meeting in Boston, Poul Holm-Pedersen of the University of Copenhagen in Denmark presented the results of a study of 129 healthy dental patients over 80 years of age living in Stockholm, Sweden. The study found that octogenarians with a type of tooth decay known as root caries are more likely to develop heart arrhythmia.

The investigators performed a cardiovascular exam and studied the medical and dental history of each participant. Holm-Pedersen reported that 71% of those with root caries also had irregular heart rhythm, compared with 56% whose roots were cavity-free. After adjusting the figures for variables such as age, gender, ability to function and smoking habits, the participants with root caries had more than twice the risk of arrhythmia than those without tooth decay.

Root caries are decayed or filled root surfaces that appear as the gum line recedes. The authors of the study warn that root caries may be a "marker that something is going on in the body."

The link between poor oral health and poor general health is not clear. The researchers concluded that although "root caries may be a marker of beginning physical decline in the oldest old … the biological pathway is not obvious. The results point to the need for further studies on these relationships."

Surprisingly, no correlation between gum disease and arrhythmia was found. While this seems to contradict recent research suggesting that gum disease increases the risk of heart attack, Holm-Pedersen offered a possible explanation by pointing to the age of the study participants. He noted that gum disease and heart disease occur mostly in younger and middle-aged people, and those who suffer from both may not reach their 80th birthday--JK

Lipoprotein Particles May Help Identify Heart Attack Risk

Given that heart disease is the No. 1 killer of Americans, it is vitally important to be able to predict heart attacks in high-risk patients. A new study from the Centers for Disease Control and Prevention, Tufts University, Boston University, and LipoScience Inc. found that an innovative method for directly measuring the exact number of "bad" lipoprotein particles (low-density lipoprotein [LDL]) and "good" lipoprotein particles (HDL) can give as good, if not better, an indication of the risk for a second heart attack as conventional methods of measuring cholesterol.

James D. Otvos, Ph.D., and colleagues presented the results of their findings at the American Heart Association's Scientific Sessions 2002 meeting. They studied blood samples from 336 men with cardiovascular disease during a five-year follow-up period, compared to 695 age-matched controls. Using nuclear magnetic resonance spectroscopy, the researchers directly measured the number of LDL and HDL particles, both before and after initiation of gemfibrozil (Lopid) treatment. They discovered that many of the patients had LDL particles that were smaller than normal in size, placing those patients at a higher risk for a subsequent heart attack. The findings also explained that gemfibrozil works by raising HDL levels and increasing the size of individual LDL particles so that they are less likely to block arteries.

Otvos, in a statement to the press, elaborated: "Direct measurement of the number of LDL and HDL lipoprotein particles … allowed us to identify patients who were up to five times more likely to suffer a potentially fatal second cardiovascular event. Many of the patients had perfectly normal levels of LDL cholesterol, yet were found to have excessive numbers of LDL particles that created substantial risk. By identifying which patients have this unseen risk, it is possible to treat them very successfully"--TB

Antihypertension Trial Results Favor Older, Cheaper Drugs

Thiazide diuretics, which have been used to treat hypertension cheaply and effectively for more than 40 years, can still hold their own against cutting edge--and more costly--treatments such as angiotensin-converting enzyme (ACE) inhibitors and calcium channel blockers, according to the results of a large, randomized, controlled, double-blind trial published in the Dec. 18, 2002, issue of JAMA.

The Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) compared the effects of the traditional diuretic chlorthalidone with amlodipine (Norvasc) or lisinopril (Prinivil, Zestril) treatment on lowering the incidence of cardiovascular events and disease. Investigators followed 33,357 patients for a mean of 4.9 years.

Rates of myocardial infarction as well as all-cause mortality did not differ between groups. Furthermore, five-year systolic blood pressures were significantly lower in patients treated with chlorthalidone than with amlodipine (0.8 mm Hg, p<0.03) or lisinopril (2 mm Hg, p<0.001).

The implications of these findings cannot be understated, as $15.5 billion annually is spent on drug costs alone to treat the 50 million people in the United States who have hypertension. According to the study authors, "Thiazide-type diuretics are superior in preventing one or more major forms of [cardiovascular disease] and are less expensive." Had diuretic use not declined in favor of newer treatments and remained at the 1982 level, the authors concluded, $3.1 billion in health care costs could have been saved--JH