Cardio Round-Up: The Role of Intensive Cardiac Rehab in Resistant Hypertension; and More

The Role of Intensive Cardiac Rehabilitation in Resistant Hypertension: An Uncharted Territory

A structured 4-month diet and cardiac rehabilitation program in addition to medications lead to a significant reduction in blood pressure (BP) in patients with resistant hypertension, according to the TRIUMPH trial recently published in Circulation. “Resistant hypertension represents a big problem,” comments Dr. Oscar Cingolani, director of the Hypertension Center at the Johns Hopkins Hospital. “There are several studies showing that the degree of compliance with antihypertensive medications is inversely correlated with the number of drugs taken. On the other hand, lowering as little as 3-5 mm Hg in systolic BP can lower cardiovascular risks significantly. The TRIUMPH study showed us that a dedicated lifestyle intervention in resistant hypertension can result in BP drop equivalent to what we often see by adding one to two extra medications (provided patients take them).

Another Study Suggests Too Much Fish Oil Could Trigger A-Fib

A new study confirms that fish oil supplements may raise the risk of a common heart-rhythm disorder — particularly when doses top 1 gram per day. The analysis — published recently in the journal Circulation — involved over 81,000 patients in total. During the study period, 3.6% developed a-fib.

Overall, Albert and her team found, trial participants given omega-3 were more likely to develop a-fib over an average of five years, versus those given a placebo.

CAD Risk Up With Radiation Treatment for Left-Sided Breast Cancer

Young women treated with radiation therapy (RT) for left-sided breast cancer have an increased risk for coronary artery disease (CAD) compared with those treated for right-sided breast cancer, according to a study published in the Sept. 1 issue of JACC: CardioOncology.

Lauren E. Carlson, M.P.H., from the Memorial Sloan Kettering Cancer Center in New York City, and colleagues reported CAD risk among 1,583 women aged younger than 55 years when diagnosed with breast cancer between 1985 and 2008. The risk for radiation-associated CAD was assessed by comparing women treated with left- versus right-sided RT. Overall, 972 women were eligible for analyses and were followed for a median of 14 years.

The researchers found that the 27.5-year cumulative incidences of CAD were 10.5 and 5.8 percent for women receiving left- versus right-sided RT, respectively. In the multivariable Cox model, the corresponding hazard ratio for CAD was 2.5 for left- versus right-sided RT. No statistically significant effect modification was seen by any factor evaluated.

Rivaroxaban Shows Promise For Pediatric Fontan Procedure Patients at Risk for Blood Clots

The Jansen Pharmaceutical Companies of Johnson & Johnson recently announced new data from the Phase III UNIVERSE study which demonstrated treatment with rivaroxaban in an oral suspension formulation, compared to treatment with aspirin, was associated with blood clots in pediatric patients who have undergone the Fontan procedure.

The Fontan procedure is performed in children with congenital heart disease who have a single functioning ventricle to redirect blood flow to the lungs to be reoxygenated. Children who undergo the Fontan procedure often face significant morbidity and mortality stemming from thrombotic events, especially during the critical 3- to 12-month period following the procedure. While it is common for physicians to prescribe aspirin, there are limited data regarding aspirin resistance or the optimal dose for thromboprophylaxis in children.

“For years, health care providers have had limited options to help reduce potentially fatal thrombotic events that often occur in young children following the Fontan procedure,” said Brian W. McCrindle, M.D., MPH, Pediatric Cardiologist at the Hospital for Sick Children in Toronto via a press release.  “We now not only have data suggesting that rivaroxaban has a similar positive effect and safety as aspirin, but we also have identified an age-appropriate formulation with precise weight-based dosing to help manage our young patients during a critical time.”