British Heart Foundation

Two New Drug Classes Tied to Better Survival in Type 2 Diabetes

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Patients with type 2 diabetes who did not achieve adequate glycemic control with metformin had improved survival during follow-up if they received add-on therapy with a sodium-glucose cotransporter 2 (SGLT-2) inhibitor or a glucagon-like peptide 1 (GLP-1) agonist rather than a dipeptidyl peptidase-4 (DPP-4) inhibitor or control (placebo or no treatment), in a network meta-analysis that indirectly compared these three drug classes.

Rates of heart failure and myocardial infarction (MI) were also lower in patients who received SGLT-2 inhibitors rather than controls.

But GLP-1 agonists were associated with a higher rate of (largely gastrointestinal) adverse events leading to withdrawal from the trials.

These findings, by Sean L Zheng, MB, from the National Heart and Lung Institute at Imperial College, London, UK, and colleagues were published April 17 in JAMA.

“Based on these findings, SGLT-2 inhibition and GLP-1 agonists may be preferred over DPP-4 inhibitors as add-on therapies to metformin,”

In fact, “of the three classes tested, SGLT-2 inhibition may be preferred over the incretin-based therapies based on their association with lower mortality and their favorable adverse event profile,” Zheng and colleagues indicate.

However, they caution that SGLT-2 inhibitors were also associated with increased risk of genital infections, and canagliflozin, but not empagliflozin, was linked with a significant increase in lower-limb amputations. So “our analyses do not rule out the possibility of a clinically meaningful safety signal for SGLT-2 inhibitors and amputation,” they warn.

On the other hand, DPP-4 inhibitors were linked with a greater risk of pancreatitis.

Thus, “careful treatment selection may be necessary to minimize these outcomes in at-risk patients,” Zheng and colleagues advise. Moreover, because the network meta-analysis was an observational study, it cannot determine cause and effect, and the findings would have to be confirmed in further research.

Increasingly Prescribed, But Which Drug Class Is Best?

“The three drug classes assessed here are being increasingly prescribed,” for type 2 diabetes, said Zheng in a statement by Imperial College, “yet until now there have been no clinical trials studying how these drugs compare to each other, and which type of drug could be the best option for patients.”

He and his coauthors searched for studies published up until October 2017 and identified 236 randomized clinical trials in 176,310 patients.

There were 65 trials of SGLT-2 inhibitors, 83 trials of DPP-4 inhibitors, and 65 trials of GLP-1 agonists that compared these agents with a control, and 23 studies that directly compared two drug classes.

Zheng and colleagues aimed to investigate the rate of all-cause mortality (the primary outcome) as well as cardiovascular mortality, heart failure, MI, stroke, adverse events, and hypoglycemia, with use of the three drug classes.

Almost half of the patients came from nine cardiovascular outcome trials: EMPA-REG OUTCOME and CANVAS with SGLT-2 inhibitors; ELIXA, LEADER, SUSTAIN-6, and EXSCEL with GLP-1 agonists; and SAVOR-TIMI 53, EXAMINE, and TECOS with DPP-4 inhibitors.

Overall, during follow-up, patients who received an SGLT-2 inhibitor had a 1% absolute lower rate of death and a 0.8% lower rate of cardiovascular death than patients who received control therapy.

Patients who received a GLP-1 agonist, which are subcutaneously injected, had a “more modest” 0.6% lower risk of death and a 0.5% lower risk of cardiovascular death during follow-up than patients who received control therapy.

However, rates of these two outcomes were similar in patients who received a DPP-4 inhibitor or control therapy.

Expressed another way, patients who received an SGLT-2 inhibitor or a GLP-1 agonist were less likely to die of all causes during follow-up than patients who received control therapy (hazard ratio [HR], 0.80 and 0.88, respectively).

Similarly, patients who received an SGLT-2 inhibitor or a GLP-1 agonist were less likely to die of cardiovascular causes during follow-up than patients who received a DPP-4 inhibitor (HR, 0.78 and 0.0.86, respectively).

The researchers acknowledge a limitation is that they assume there are class effects on mortality. But while, for example, all-cause mortality during follow-up was reduced with GLP-1 agonists liraglutide (in LEADER) and semaglutide (in SUSTAIN-6) it was not with lixisenatide (in ELIXA) or exenatide (in EXSCEL).

Also, the trials may have been too short to detect cardiovascular mortality in patients at low cardiovascular risk, and the meta-analysis did not examine how glycemic control affected mortality.

“Crowded Market” of Second-Line Diabetes Drugs

Separately, an analysis of US sales figures for 2017 shows that sales of GLP-1 agonists rose by 32% in 2017 compared with 2016. Sales of SGLT-2 inhibitors grew by 24% during that time, but sales of DPP-4 inhibitors were flat.

The SGLT-2 inhibitor sales were likely boosted on the one hand by a new US indication for empagliflozin (Jardiance, Lilly/Boehringer Ingelheim), that of improving cardiovascular survival, but were probably diminished by a black-box warning mandated by the Food and Drug Administration for amputations for canagliflozin (Invokana, Janssen).

Meanwhile, Zheng and colleagues say their analysis will help inform patient–physician discussions.

“Our hope is that in the crowded market that is diabetes medications, patients and their doctors have the necessary information to allow them to make informed decisions about long-term treatment strategies,” said Zheng.

The study was supported by a grant from the British Heart Foundation.

Younger women and women with STEMI ‘less likely’ to be prescribed evidence-based medicines

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Results from a study funded by the British Heart Foundation and published in Journal of the American Heart Association have hit the headlines claiming that women who suffer heart attacks are not being offered the same treatment as men. [1]

The report from the SWEDEHEART study analysed data from 48,118 patients, 35.4% of whom were women, and all who were diagnosed with acute myocardial infarction. The primary endpoint of this analysis was all-cause mortality, however researchers also looked at the likelihood of patients receiving the recommended evidence-based pharmacological drugs.

This study revealed that, on the surface women had a better adjusted prognosis than men after an acute MI. However, scratch beneath the surface and a different picture emerges.

Younger women (aged under 60 years) and women with ST-elevation Myocardial Infarction (STEMI) had a worse prognosis, and were less likely to be prescribed evidence-based treatment than their male counterparts. Furthermore, this discrepancy in gender did not decrease over two decades. [1]

Women in the study were more likely to have previously been diagnosed with hypertension or type II diabetes, and were also more likely to develop prehospital cardiogenic shock or in-hospital heart failure.

Sub-group analyses showed that the estimated risk for developing prehospital cardiogenic shock was higher for women compared to men (OR 1.67, 95% Cl 1.30 to 2.16, P<0.001), and the risk in women with STEMI was also higher compared to the risk in men (OR 1.31, 95%Cl 1.16 to 1.48). [1]

Other findings show that women with STEMI were less likely to undergo coronary angiography than men, and after adjustment of traditional CV risk factors women were less likely to receive evidence-based treatments including beta-blockers, ACE inhibitors, statins and P2Y12 inhibitors.

The reasons for this are unclear and certainly warrant further investigation. It is common for women to present at a later stage in the disease than men for a variety of reasons. For example, as Professor Angela Maas, Professor Women’s Cardiac Health, Cardiology Department, Radboud University Medical Center, Nijmegen, The Netherlands told Cardio Debate: “We often think hypertension is asymptomatic, but it can actually give a lot of symptoms, especially in women who are middle aged,” adding that: “It is easy to discriminate between stress-related elevated blood pressure and severe developmental hypertension. Just ask questions about pregnancy [e.g., the presence of gestational diabetes] or the family history.” [2]

However the study authors suggest the presence of ‘systemic undertreatment’ in women. [1] Professor Juan Tamargo, Professor of Pharmacology, Universidad Complutense, Madrid, Spain has previously addressed this issue with Cardio Debate, saying: “We need to clarify to people that there is a problem and that there are some ways to improve it.” [3]

“There is the feeling that male physicians usually consider that women need less strict treatments; we don’t give the same advice to women as we do to men. There are lots of things (regarding gender differences and gender treatment bias) that should be included in position papers and clinical guidelines [to avoid undertreatment in women].” [3]

Patients should be prescribed evidence-based medicines regardless of their gender, and this should be a given. Hopefully this study will steer the conversation in the right direction, and encourage the medical community to address this serious issue.

References

  1. Redfors B, Angeras O, Ramunddal T, et al. Trends in gender differences in cardiac care and outcome after acute myocardial infarction in Western Sweden: A report from the Swedish Web System for Enhancement of Evidence-Baed Care in Heart Disease Evaluated According to Recommended Therapies (SWEDEHEART). J Am Heart Assoc DOI: 10.1161/JAHA.115.001995
  2. https://www.cardio-debate.com/2017/11/12/hypertension-in-post-menopausal-women-is-a-major-health-issue-prof-angela-maas/
  3. https://www.cardio-debate.com/2017/10/15/gender-differences-in-cardiovascular-disease/

Is Omega-3 Pointless for Preventing Heart Disease?

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Meta-analysis showed no significant link to coronary disease, any major vascular events

Omega-3 fatty acids have gotten a heart-healthy reputation without good evidence that they actually prevent major cardiovascular disease events, according to a meta-analysis.

Across 10 large randomized trials lasting at least 1 year, taking the supplements was not associated with significantly reduced risk of:

  • Death from coronary heart disease: rate ratio 0.93 (99% CI 0.83-1.03)
  • Nonfatal myocardial infarction: RR 0.97 (99% CI 0.87-1.08)
  • Any coronary heart disease events: RR 0.96 (95% CI 0.90-1.01)
  • Major vascular events: RR 0.97 (95% CI 0.93-1.01)

Benefits also weren’t seen in subgroups with prior coronary heart disease, diabetes, elevated lipid levels, or statin use, Robert Clarke, MD, of the University of Oxford in England, and colleagues reported in JAMA Cardiology.

While the European Society of Cardiology has called a protective effect of omega-3s debatable at best, the American Heart Association has recommended use as “reasonable” for secondary prevention of coronary heart disease in patients with recent events and “might also be considered” in people with heart failure and reduced ejection fraction.

“However, the results of the present meta-analysis provide no support for the recommendations to use approximately 1 g/d of omega-3 FAs in individuals with a history of CHD for the prevention of fatal CHD, nonfatal MI, or any other vascular events,” Clarke’s group concluded. “The results of the ongoing trials are needed to assess if higher doses of omega-3 [fatty acids] (3-4 g/d) may have significant effects on risk of major vascular events.”

The study was supported by the British Heart Foundation, British Heart Foundation Centre for Research Excellence Oxford, and Medical Research Council Clinical Trial Service Unit.

Salt in medicines ‘a health risk’

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Effervescent tablet

Soluble painkillers used by millions of people in Britain could pose a health risk because they are high in salt, UK researchers are warning.

Some formulations taken at maximum dose tip users over the recommended daily sodium intake for an adult, with potentially dangerous consequences, the study authors say.

Their work in the BMJ looks at the outcomes for 1.2 million UK patients.

It found a link between effervescent tablets and heart attacks and stroke.

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Without clear labelling on these products, it is impossible to know how much additional sodium you would be eating”

Prof Gareth Beevers Blood Pressure UK

All medicines that contain at least 1mmol (or 23mg) of sodium – a component of salt – in each dose are required to declare on their labelling that the product contains sodium.

The accompanying patient information leaflet provides information on the quantity of sodium and includes a warning to patients on a low-sodium diet to take the amount of sodium in the medicine into account.

Compared with patients taking the same drugs without salt, those who regularly took effervescent or soluble medications increased their risk of having a heart attack, stroke or dying from a vascular cause by a fifth

They were also seven times more likely to develop high blood pressure or hypertension, which the researchers say is at the root of the problem.

Lead researcher Dr Jacob George, from Dundee University, said: “We know that high salt causes hypertension and that hypertension leads to stroke.”

The British Heart Foundation said it was important to remember that the research applied to people who were taking these medicines every day – it did not mean that occasional use could damage your heart health.

Hidden salt

Effervescent medicines contain a substance called bicarbonate, which helps them fizz and dissolve, and this is often combined with sodium.

The study looked at 24 different prescribed effervescent medicines, including common painkillers such as paracetamol and aspirin, as well as supplements.

But Dr George said many more people bought these types of treatment from chemists, without a prescription.

He said that people needed to be aware of the risks and drug manufacturers should look at cutting the salt content of their products.

In the study, sodium levels in tablets ranged from as low as 3mmol to as high as 18mmol – approximately a fifth of a teaspoon.

The recommended sodium intake for an adult in the UK is 104mmol per day.

A person who takes the maximum daily dose of eight tablets of soluble paracetamol, for example, would ingest 148.8mmol of sodium, which exceeds their daily salt allowance.

If you then took in to account the dietary salt a person was likely to get from the food that they ate, their overall salt intake could be dangerously high, said Dr George.

The Medicines and Healthcare products Regulatory Agency (MHRA) said it kept a close check on the safety of all licensed medicines.

“We will carefully review the findings of this new research,” said a spokeswoman.

“We recommend that people with questions about their salt intake should read the patient information leaflet and speak to their GP,” the MHRA said.

But Prof Gareth Beevers, of Blood Pressure UK, said many consumers would be unaware of the risks.

“It is extraordinary to think that sodium has been hiding in our medicines all this time.

“Without clear labelling on these products, it is impossible to know how much additional sodium you would be eating, so it is shocking to find you could be having more than your daily maximum from medicines alone.

“Eating too much sodium – in any form – puts up our blood pressure, which puts you at increased risk of strokes and heart attacks, the biggest killers in the world.”

Scan predicts heart attack risk

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A new way of scanning the heart can identify those who may be at high risk of a heart attack, early tests suggest.

It can identify dangerous plaques in the arteries which nourish the heart. If a fatty plaque ruptures, it can lead to a clot, blocking the flow of blood.

Scientists at the University of Edinburgh said an effective tool for predicting a heart attack would make a “massive difference” to patients.

Experts said it was an exciting start.

More than 100,000 people have a heart attack in the UK each year and disease of the arteries around the heart is the leading cause of death in the world.

Light up

The researchers used a radioactive tracer which can seek out active and dangerous plaques. This was combined with high resolution images of the heart and blood vessels.

The overall effect is a detailed picture of the heart with the danger zones clearly highlighted. The technology is already used to detect tumours in cancer patients.

The first tests of the technique for danger spots in the heart were on 40 patients who had recently had a heart attack.

The scan highlighted the plaque which caused the heart attack in 37 of the patients according to a study published in the Lancet medical journal.

It is the first time a scan has been able to identify danger zones but further tests are needed to see if detecting dangerous plaques before, rather than after, a heart attack has the potential to save lives.

“I suspect not all plaques detected will cause a heart attack, but it could be useful for identifying high risk patients who need aggressive therapy,” cardiologist Dr Marc Dweck told the BBC.

This could include drugs such as statins or aspirin, drastic lifestyle change or even inserting stents into the arteries to keep them open.

Scan
The scan shows a cross-section of the heart and the high risk plaque in orange

‘Massive difference’

The researchers will look at high risk patients, including those about to have surgery, to see if the scan can save lives.

Dr Dweck said if this scan or similar ones proved successful it would make a “massive difference”.

He said: “Heart attacks are the biggest killer in the Western world and there is no prior warning, the first time people know about heart disease is when they have a heart attack.

“If we can treat and stabilise the plaques then we might be able to prevent heart attacks and stop people dying.”

Prof Peter Weissberg, the medical director of the British Heart Foundation, said: “Being able to identify dangerous fatty plaques likely to cause a heart attack is something that conventional heart tests can’t do.

“This research suggests that PET-CT scanning may provide an answer – identifying ‘ticking time bomb’ patients at risk of a heart attack.

“We now need to confirm these findings, and then understand how best to use new tests like this in the clinic to benefit heart patients.”

Prof Andrew Morris, the chief scientist for health in Scotland, said: “These are exciting data – being able to prospectively identify patients at the highest risk of a heart attack and provide treatment to prevent this would be a significant step forward.”

Saturated fat heart disease ‘myth’

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The risk from saturated fat in foods such as butter, cakes and fatty meat is being overstated and demonised, according to a cardiologist.

Dr Aseem Malhotra said there was too much focus on the fat with other factors such as sugar often overlooked.

It is time to “bust the myth of the role of saturated fat in heart disease“, he writes in an opinion piece in the British Medical Journal.

But the British Heart Foundation said there was conflicting evidence.

It added reducing cholesterol through drugs or other means does lower heart risk.

Studies on the link between diet and disease have led to dietary advice and guidelines on how much saturated fat, particularly cholesterol, it is healthy to eat.

Millions of people in the UK have been prescribed statins to reduce cholesterol levels.

Dr Malhotra, a cardiology registrar at Croydon University Hospital, London, says the “mantra that saturated fat must be removed to reduce the risk of cardiovascular disease has dominated dietary advice and guidelines for almost four decades”.

Saturated fat

  • Saturated fat is the kind of fat found in butter and lard, pies, cakes and biscuits, fatty cuts of meat, sausages and bacon, and cheese and cream
  • Eating a diet that is high in saturated fat can raise the level of cholesterol in the blood, which increases the risk of heart disease, according to NHS Choices.
  • Most of us eat too much saturated fat – about 20% more than the recommended maximum amount.
  • The average man should eat no more than 30g of saturated fat a day.
  • The average woman should eat no more than 20g of saturated fat a day.

He says saturated fat has been “demonised” and any link with heart disease is not fully supported by scientific evidence.

The food industry has compensated for lowering saturated fat levels in food by replacing it with sugar, he says, which also contributes to heart disease.

Adopting a Mediterranean diet – olive oil, nuts, oily fish, plenty of fruit and vegetables and a moderate amount of red wine – after a heart attack is almost three times as powerful in reducing mortality as taking a statin, writes Dr Malhotra.

However, Prof Peter Weissberg, medical director at the British Heart Foundation, says studies on the link between diet and disease frequently produce conflicting results.

Unlike drug trials, it is difficult to carry out a controlled, randomised study, he says.

“However, people with highest cholesterol levels are at highest risk of a heart attack and it’s also clear that lowering cholesterol, by whatever means, lowers risk.”

Cholesterol levels can be influenced by many factors including diet, exercise and drugs, in particular statins, he adds.

“There is clear evidence that patients who have had a heart attack, or who are at high risk of having one, can benefit from taking a statin.

“But this needs to be combined with other essential measures, such as eating a balanced diet, not smoking and taking regular exercise.”

Statins are a group of medicines that can help lower rates of cholesterol in the blood.

Cholesterol can also be reduced by eating a healthy, balanced diet, maintaining a healthy weight and doing regular physical activity.

UK first in heart failure operation.

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Sevket Gocer,
Sevket Gocer, right, was the first patient in the UK

A pioneering operation to improve the function of failing hearts while they are still beating has taken place in the UK for the first time.

Patients with heart failure struggle to pump blood around the body and mild exercise can leave them breathless.

Surgeons used a form of “cardiac sewing” to remove scar tissue and reduce the size of the heart so it pumps more efficiently.

The operation took place at King’s College Hospital in London.

One common cause of heart failure is when the arteries which nourish the organ become blocked, leading to a heart attack. Heart muscle dies and is replaced by hard scar tissue which does not beat.

Over time, the scar tissue can stretch so chambers of the heart become larger, meaning the organ has more blood to force out with each heartbeat.

The overall effect is a weaker heart, less able to do its job, transforming simple day-to-day tasks like climbing stairs into extreme exertions.

In the operation, surgeons used a wire with anchors at both ends to pierce two sections of heart muscle. When the wire was tightened, the walls of the heart were “remodelled”.

Before and after surgery
Scar tissue, in grey, is “sewn out”

The scar tissue was effectively removed and the volume of one of the chambers of the heart was reduced by a quarter.

Sevket Gocer, 58 and from Bromley in south-east London, was the first patient to be treated in the UK. His heart function is said to have “improved significantly” after the operation.

A similar procedure used to be performed by opening up the chest and stopping the heart, but it was a very risky operation and fell out of medical practice.

Surgeons hope the less invasive operation, which can be performed while the heart is still pumping, will be a better option for patients.

Mr Olaf Wendler, a professor of cardiac surgery at King’s College Hospital, told the BBC: “In the technique we have now used for the first time in the UK, one does not need to stop the heart, one does not even necessarily need to place the patient on a heart-lung machine.

“It’s a less traumatic and less invasive type of procedure.”

He said the operation was being tested in a trial at hospitals across Europe and that the procedure could make a difference to patients’ lives.

He said: “[If successful] it’s bringing them on to an exercise level where they’re able to look after themselves properly including going to do the shopping and having a social life.”

Prof Jeremy Pearson, associate medical director at the British Heart Foundation, said: “The results of this trial will determine if this experimental procedure is safe.

“If the trial is successful, there will be further use of the technology as surgeons gain expertise in the technique. As more people are treated with this procedure, it will become fully clear whether it will have a real benefit for patients.”

Wireless pacemaker comes to Europe.

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A miniaturised, wireless pacemaker that can be inserted into the body without invasive surgery has been given approval for use in the European Union.

Developed by US start-up Nanostim, the device is designed to be implanted intravenously directly in the heart.

Nanostim pacemaker

It is less than 10% of the size of a conventional pacemaker and uses a built-in battery.

Experts said it was an “exciting development” but at a very early stage.

The pacemaker has yet to receive full US Food and Drug Administration (FDA) approval.

Conventional pacemakers require a patient to be cut open and a pocket created in the body to house the pacemaker and associated wires.

Such wires are regarded as the component of pacemakers most likely to fail. The pocket created for the pacemaker is also liable to infection.

By contrast the Nanostim pacemaker is delivered via a catheter inserted through the femoral vein near the groin.

It has a built-in battery, smaller than an AAA battery, that lasts between nine and 13 years. Eliminating the need for wires lowers the risk of infection or malfunction and means that patients are not restricted in the amount of activity they do, the firm behind the device claims.

The procedure to fit the pacemaker typically lasts around half an hour. The device is designed to be easily retrievable so that the battery can be replaced.

Because the device is delivered intravenously, it also means patients will have no scarring.

One doctor, involved in its trials, described it as “the future of pacemaking”.

“For the past 40 years the therapeutic promise of leadless pacing has been discussed, but until now, no-one has been able to overcome the technical challenges,” said Dr Johannes Sperzel of the Kerchhoff Klinik in Bad Nauheim, Germany.

“This revolutionary technology offers patients a safe, minimally-invasive option for pacemaker delivery that eliminates leads and surgical pockets,” he added.

Better understanding

But others were more cautious.

Prof Jeremy Pearson, associate medical director at the British Heart Foundation, said: “This is a potentially exciting development but it’s early days.

“Before this leadless pacemaker becomes widely available, we need a better understanding of how long it will last, as well as how easy it is to replace if necessary. As our knowledge of this new pacemaker widens, so too will the expertise needed to fit this potentially exciting device.”

The company behind the device has recently been bought by global medical device firm St Jude.

It has had several wire-based pacemakers recalled in recent years.

Other device makers are also planning to go wireless. The Wireless Cardiac Stimulation system has been developed by US start-up EBR Systems and UK-based tech firm Cambridge Consultants and uses a tiny wireless electrode no bigger than a grain of rice powered by an ultrasonic pulse generator, inserted lower down in the chest.

In 2011 the device was implanted in 100 patients in hospitals across Europe.

Cardiac pacemakers are used to treat slow heart rates. The devices monitor the heart and provide electrical stimulation when the heart beats too slowly.

The first pacemaker was fitted in 1958. Currently more than four million people around the world have some sort of cardiac rhythm device with an additional 700,000 people getting one each year.

Scientists come closer to ‘mending broken hearts’ by using gene therapy to … – The Independent

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Scientists have come a step closer to being able to repair the damage done by heart attacks, using a “cocktail of genes” to transform scar tissue into working heart muscles.

Novel techniques to “mend broken hearts” using gene therapy and stem cells represent a major new frontier in the treatment of heart disease.

In the latest breakthrough, achieved by researchers at the Gladstone Institute of Cardiovascular Disease in California, researchers were able to re-programme scar-forming cells into heart muscle cells, some of which were capable of transmitting the kind of electrical signals that make the heart beat, according to the latest issue of the Stem Cell Reports journal.

The same team demonstrated their technique last year in live mice, transforming scar-forming cells, called fibroblasts, into beating heart muscle cells, but this is the first time that human fibroblasts have been re-programmed in this way.

So far, the work with human fibroblasts has only been done in the lab, but it paves the way for new treatments for heart attack victims. Researchers said that the “cocktail of genes” used to regenerate cells could one day be replaced with “small drug-like molecules” that would offer safer and easier delivery.

“We’ve now laid a solid foundation for developing a way to reverse the damage [done by a heart attack] —something previously thought impossible — and changing the way that doctors may treat heart attacks in the future,” said Dr Deepak Srivastava, director of cardiovascular disease at the Gladstone Institutes. “…Our findings here serve as a proof of concept that human fibroblasts can be re-programmed successfully into beating heart cells.”

In 2012, Dr Srivastava and his team reported in the journal Nature that, by injecting three genes into the hearts of live mice that had been damaged by heart attack, fibroblasts could be turned into working heart cells.

The scientists attempted the same technique using human fibroblasts from foetal heart cells, embryonic stem cells and neonatal skin cells, injected with genes in petri dishes in the lab. An increased number of genes was required to transform the human cells, and the efficiency of the transformed cells was low, but the team were encouraged by the results.

“While almost all the cells in our study exhibited at least a partial transformation, about 20 per cent of them were capable of transmitting electrical signals – a key feature of beating hearts,” said Gladstone staff scientist Ji-dong Fu, the study’s lead author.

The number of people who survive heart attacks has increased considerably in recent decades. The British Heart Foundation (BHF) said earlier this year that 70 per cent of women and 68 per cent of men were now surviving. However, success in keeping people alive after a heart attack has led to a rise in the number of people suffering from the long-term after-effects, which include debilitating heart failure.

Heart failure occurs when the heart cannot function efficiently and can be caused by the damage done to the heart muscle during heart attack. More than 750,000 people in the UK suffer from heart failure.

Professor Jeremy Pearson, Associate Medical Director at the British Heart Foundation, said: “This research represents a small but significant step forward.  Last year these scientists had a real breakthrough when they turned fibroblasts – the cells that form scarred heart tissue – in the hearts of mice into beating heart cells, by injecting them with a ‘cocktail’ of different genes.

“Now, using a different combination of genes, they have managed to turn human fibroblasts into beating heart cells in a culture dish. This process is still a long way from the clinic, but advances like this bring us closer to the likelihood that we could one day use these techniques to mend human hearts.”

Source: Independent.uk

Children of obese mothers ‘have higher heart risk’.

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Children born to obese and overweight mothers are more likely to die early of heart disease, a study has found.

Scottish research showed a 35% higher risk of dying before the age of 55 in adults whose mothers were obese in pregnancy.

It is not known how much of the link is down to genetics, influences in the womb or later lifestyle.

But the authors say their findings, in the British Medical Journal, are of “major public health concern”.

One woman in five in the UK is obese at their antenatal booking appointment.

Continue reading the main story

“Start Quote

This study emphasises the need for everyone, but in particular pregnant women, to try to eat healthily and be active”

Doireann MaddockBritish Heart Foundation

Premature deaths

The analysis included 28,540 women whose weight was recorded at their first antenatal check-up and their 37,709 children now aged between 34 and 61.

One in five mothers was classed as overweight with a body mass index (BMI) between 25 and 29.9 and 4% were obese with a BMI above 30.

There were 6,551 premature deaths from any cause and heart disease was the leading contributor.

The risk of premature death was 35% higher among people born to obese mothers compared with those whose mothers had had normal weight in pregnancy. This was after adjusting the results for factors such as the mother’s age at delivery, social class and infant birthweight.

The results also revealed that children born to obese mothers went on to be at 42% increased risk of being treated in hospital for a heart attack, stroke or angina.

Appetite control

Study leader Prof Rebecca Reynolds, of the University of Edinburgh, said the results highlighted the importance of current advice to maintain a healthy weight, eat sensibly and keep active during pregnancy.

She added that more work was needed to unpick the reasons for the increased risk and to look at the impact of weight gain over pregnancy.

“It would be nice to know how much of this risk is modifiable.”

Previous research has shown a link between obesity in pregnancy and changes in appetite control and metabolism in children.

Prof Sir Stephen O’Rahilly, of the University of Cambridge, warned that obesity runs in families.

“Obese people are at higher risk of heart disease, so it is very likely that the people in this study whose mothers were obese were fatter than those whose mothers were lean.”

‘Eat healthily’

The researchers did not measure or account for this.

The Royal College of Midwives said it was important for women to start their pregnancy at a normal weight.

But Louise Silverton, RCM director for midwifery, said not all pregnancies are planned and midwives work hard to support women avoid excess weight gain and lose weight sensibly after birth.

Drastic dieting is not recommended.

Doireann Maddock, senior cardiac nurse at the British Heart Foundation, which part-funded the study, said: “This study emphasises the need for everyone, but in particular pregnant women, to try to eat healthily and be active.”

Source: BBC