Antibiotic linked with rare but deadly heart risk

An antibiotic widely used for bronchitis and other common infections seems to increase chances for sudden deadly heart problems, a rare but surprising risk found in a 14-year study.

Zithromax, or azithromycin, is more expensive than other antibiotics, but it's popular because it often can be taken for fewer days. But the results suggest doctors should prescribe other options for people already prone to heart problems, the researchers and other experts said.

Vanderbilt University researchers analyzed health records and data on millions of prescriptions for several antibiotics given to about 540,000 Tennessee Medicaid patients from 1992 to 2006. There were 29 heart-related deaths among those who took Zithromax during five days of treatment. Their risk of death while taking the drug was more than double that of patients on another antibiotic, amoxicillin, or those who took none.

To compare risks, the researchers calculated that the number of deaths per 1 million courses of antibiotics would be about 85 among Zithromax patients versus 32 among amoxicillin patients and 30 among those on no antibiotics. The highest risks were in Zithromax patients with existing heart problems.

Patients in each group started out with comparable risks for heart trouble, the researchers said.

The results suggest there would be 47 extra heart-related deaths per 1 million courses of treatment with Zithromax, compared with amoxicillin. A usual treatment course for Zithromax is about five days, versus about 10 days for amoxicillin and other antibiotics. Zithromax is at least twice as expensive as generic amoxicillin; online prescription drug sellers charge a few dollars per pill for Zithromax.

"People need to recognize that the overall risk is low," said Dr. Harlan Krumholz, a Yale University health outcomes specialist who was not involved in the study. More research is needed to confirm the findings, but still, he said patients with heart disease "should probably be steered away" from Zithromax for now.

The study appears in Thursday's New England Journal of Medicine. The National Heart, Lung and Blood Institute helped pay for the research.

Zithromax, marketed by Pfizer Inc., has been available in the United States for two decades. It's often used to treat bronchitis, sinus infections and pneumonia. Wayne Ray, a Vanderbilt professor of medicine, decided to study the drug's risks because of evidence linking it with potential heart rhythm problems. Also, antibiotics in the same class as Zithromax have been linked with sudden cardiac death.

Zithromax is among top-selling antibiotics. U.S. sales last year totaled $464 million, according to IMS Health, a health care information and services company.

Pfizer issued a statement saying it would thoroughly review the study. "Patient safety is of the utmost importance to Pfizer and we continuously monitor the safety and efficacy of our products to ensure that the benefits and risks are accurately described," the company said.

Patients studied were age 50 on average and not hospitalized. Most had common ailments, including sinus infections and bronchitis. Those on Zithromax were about as healthy as those on other antibiotics, making it unlikely that an underlying condition might explain the increased death risk.

Medicaid patients generally have more disability and lower incomes than other patients, so whether the same results would be found in the general population is uncertain, Ray said.

Dr. Bruce Psaty, a professor of medicine at the University of Washington, said doctors and patients need to know about the potential risks. He said the results also raise concerns about long-term use of Zithromax, which other research suggests could benefit people with severe lung disease. Additional research is needed to determine if that kind of use could be dangerous, he said.

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AP Medical Writer Lindsey tanner can be reached at http://www.twitter.com/LindseyTanner

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Eye Changes May Predict Heart Disease in Blacks With Diabetes

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Ultramarathon runner Micah True died from heart disease: autopsy

Reuters – 3 hrs ago SANTA FE, New Mexico (Reuters) - Ultramarathon runner Micah True died from heart disease while on a run last March in the rugged wilderness of southwestern New Mexico, an autopsy report revealed Tuesday.

True, 58, was found to have idiopathic cardiomyopathy, heart disease with an unknown cause, the state's Office of the Medical Investigator found.

The coroner found numerous abrasions on True's extremities but no sign of internal injuries, though the left side of his heart was found to be enlarged. Chemical tests revealed the presence of caffeine and mild dehydration. The report said True's manner of death was "natural."

True, a legend among dedicated marathoners, was found dead on March 31 after leaving days earlier on a 12-mile run. His body was found on the banks of a small stream with just his legs covered by water, the report said.

The area where the marathoner was running was so extreme, search crews at the time had to have a fixed-wing airplane hover above searchers to communicate with the search and rescue office, said Steve Riley, the superintendent for Gila Cliff Dwellings National Monument.

Friends followed footprints and found True 2 miles off the trail, near a stream. Because of the challenging terrain his body had to be carried a mile by hand before being attached to a mule for the final mile to the trail head, Riley said.

Nicknamed "Caballo Blanco," or White Horse, True became a celebrity after he was featured in the best-selling book "Born to Run" by Christopher McDougall.

True served as race director for the Copper Canyon Ultra Marathon, a roughly 50-mile race that drew a dedicated group of runners to northern Mexico.

(Reporting by Zelie Pollon; Editing by Mary Wisniewski and Lisa Shumaker)

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Study Finds Direct Link Between Obesity, Heart Disease

HealthDay – 3 hrs ago WEDNESDAY, May 2 (HealthDay News) -- A large new study is the first to show a direct link between a high body-mass index and the risk of developing heart disease, British and Danish researchers say.

Body-mass index (BMI) is a measurement based on height and weight. People with a BMI of 18.5 to 24.9 are normal weight while those with a BMI of 30 or more are obese. Those in between are deemed overweight.

For the study, the researchers analyzed data from more than 75,000 people in Copenhagen and found that those with a high BMI had a 26 percent increased risk of developing heart disease. Further analysis using genetic and other data showed that a BMI increase of 4 points increases the risk of heart disease by no less than 52 percent.

"By doing epidemiological studies combined with genetic analysis, we have been able to show in a group of nearly 76,000 persons that a high BMI is enough in itself to damage the heart," Borge Nordestgaard, chief physician at Copenhagen University Hospital, said in a university news release.

"Observational studies have also suggested a relationship between heart disease and obesity, but that is not enough to prove a direct correlation. Obese people can share characteristics or lifestyle traits that have an influence on both the heart and weight. Or there can be a reverse causality, that is, it is the diseased heart that causes obesity and not the other way round," said Nordestgaard, who is also a clinical professor in the health and medical sciences faculty at the university.

The study was published May 1 in the journal PLoS Medicine.

Study co-author Dr. Nicholas Timpson, a lecturer in genetic epidemiology at the University of Bristol in England, noted in the news release: "In light of rising obesity levels, these findings are fundamental to improving public health. Our research shows that shifting to a lifestyle that promotes a lower BMI -- even if it does nothing else -- will reduce the odds of developing the disease."

More information

The U.S. National Institute of Diabetes and Digestive and Kidney Diseases has more about the health risks of being overweight.

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Aspirin as Effective as Warfarin for Heart Failure: Study

HealthDay – 3 hrs ago WEDNESDAY, May 2 (HealthDay News) -- Aspirin is just as effective as the blood-thinner warfarin in preventing stroke and death in heart failure patients with a normal heart rhythm, a landmark study indicates.

Although the two treatments are equally effective, researchers from Columbia University in New York City said their findings could prompt more doctors and patients to choose aspirin because it is much cheaper.

The 10-year study was the largest comparison of aspirin and warfarin (Coumadin) in the treatment of heart failure patients. In conducting the comparison, researchers followed more than 2,300 patients in 11 countries on three continents. Study participants were assigned randomly either to aspirin or warfarin, and neither the patient nor their doctor knew which medication each patient was taking.

The investigators found that the combined risk of death, stroke and cerebral hemorrhage during the study period was 7.47 percent for patients taking warfarin and 7.93 percent for patients taking aspirin -- a difference that is statistically insignificant.

Although patients taking warfarin had a nearly 50 percent lower risk for stroke than those taking aspirin, their risk for major bleeding was twice as high. As a result, the researchers argued that the benefits do not outweigh the risks. They noted, however, that taking warfarin for four years or more may be more effective at preventing stroke and death.

"With at least 6 million Americans -- and many more around the world -- suffering from heart failure, the results of the ... study will have a large public health impact," Dr. Walter Koroshetz, deputy director of the U.S. National Institute of Neurological Disorders and Stroke, said in a Columbia University news release. "Patients and their physicians now have critical information to help select the optimum treatment approach. The key decision will be whether to accept the increased risk of stroke with aspirin or the increased risk of primarily gastrointestinal hemorrhage

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Less Invasive Heart Valve Replacement Works for Elderly: Study

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Aspirin works as well as blood thinner in heart patients

"Aspirin works as well as the blood thinner warfarin, or Coumadin, in most patients with heart failure when it comes to preventing death, stroke or brain hemorrhage, said a major international study on Wednesday. (AFP Photo/Tim Boyle)" title

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Heart Test Spots Sudden Death Risk in Young Athletes

HealthDay – 16 hrs ago FRIDAY, April 27 (HealthDay News) -- Electrocardiograph (EKG) screening of young athletes can help identify those at risk for sudden cardiac death, according to a new study.

Researchers screened nearly more than 1,300 young athletes and conducted EKGs on 586 of them based on medical history, family history, a physical exam or prior EKG. Six athletes were found to have a heart disorder known to cause sudden cardiac death.

The study looked at how sensitive and specific the EKGs were as tests. Sensitivity refers to how confidently a doctor can rule out a problem and that it isn't a "false negative." Specificity refers to how sure a doctor can be that a positive test result is accurate.

For medical history alone, the sensitivity and specificity to detect heart disorders linked to sudden cardiac death were 33 percent and 69 percent. For physical exam, the figures were 16 percent and 91 percent. For EKG, sensitivity was 100 percent and specificity was 95 percent.

Half of disorders known to cause sudden cardiac death were detected by EKG alone, said Dr. Jessie Fudge, who is completing a fellowship in primary care sports medicine at the University of Washington in Seattle.

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New Techniques May Improve Infant Heart Surgery

HealthDay – 4 hrs ago WEDNESDAY, April 25 (HealthDay News) -- Two new monitoring techniques may provide early warnings about possible brain damage in children as they undergo surgery for heart defects, researchers report.

Autoregulation monitoring is a noninvasive technique that can determine when blood flow to the brain may be low. The other method, a blood test, uses a small sample of blood to detect brain-tissue injury during surgery.

Doctors previously had no way to detect brain injuries as they occurred during heart surgery.

Details of the research are to be presented Wednesday during an American Heart Association press briefing.

Brain injury occurs in 30 percent to 70 percent of infants and children who have surgery to repair congenital heart defects, which are heart abnormalities present at birth. For each 1,000 live births in the United States, about eight babies will have some type of heart defect, according to a heart association news release.

This was a pilot study to evaluate the feasibility of new ways to monitor for brain damage while children have surgery to repair heart defects. The researchers plan to conduct another study to assess the effectiveness of these brain monitoring techniques 18 months after surgery.

Researchers' data and conclusions should be considered preliminary until published in a peer-reviewed medical journal.

More information

The March of Dimes has more about congenital heart defects.

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China study finds mine workers at higher risk of cancer, heart disease

Reuters – 40 mins ago HONG KONG (Reuters) - Chinese workers who are exposed to silica dust in mines, and pottery and gemstone factories suffer not only from respiratory illnesses, but are at higher risk of contracting heart and infectious diseases and cancer, researchers in China have found.

Silica is a compound found in sand and rock. When rocks are drilled or broken, fine silica dust particles are produced that lodge deep in the lungs and can lead to scarring, severe respiratory problems and death.

Researchers monitoring the health of 74,040 mine and pottery workers over an average of 33 years found that they suffered a far higher risk of contracting a range of diseases compared with people who were not exposed.

"In addition to a higher risk of respiratory disease, we see a heightened risk of cardiovascular disease in exposed workers. This is a new discovery," said Professor Weihong Chen at the School of Public Health, Huazhong University of Science and Technology in Wuhan, Hubei province.

"Before we were mostly concerned about respiratory diseases ... as to whether it raises the risk of cancer, we can give a definite answer: We see a heightened risk of lung cancer in workers exposed to silica."

Compared with people operating in cleaner environments, workers exposed to silica were nearly seven times more likely to contract infectious diseases, nearly five times more susceptible to respiratory tuberculosis and nearly twice as vulnerable to cardiovascular disease, Chen and colleagues said in a paper published this week in the Public Library of Science journal PLoS Medicine.

Exposed workers who have spent at least a year in either metal mines or pottery factories were found to be nearly twice as susceptible to cancers of the nose and throat.

More than 23 million workers in China and more than 10 million in India are exposed to silica dust. This occupational health hazard is also present in the developed world, with 1.7 million people in the United States and 3 million in Europe similarly exposed.

According to the World Health Organisation, more than 24,000 workers in China die each year from silicosis - a disease caused by silica penetrating deep into the lungs, causing inflammation and scarring. Many victims die relatively young, in their mid-40s, according to social workers.

Medical research has also estimated that one in two former gold miners has silicosis in South Africa, where gold mines employed as many as 500,000 people in the 1980s.

Chen said she hoped the study would help lead to work place interventions.

"We recommend that worksites control levels of such pollutants; it's a public health problem. Through changes in the work environment, we can reduce the risk of disease and (early) death," she said. "Factories can use stronger ventilators, and more effective masks for workers will reduce silica exposure."

The full paper is available at: http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001206

(Editing by Chris Lewis)

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Optimism Might Cut Your Risk for Heart Attack

HealthDay – 30 mins ago WEDNESDAY, April 18 (HealthDay News) -- Being upbeat is good for your heart, a new study suggests.

Many previous studies have shown that negative mental states -- such as depression, anger, anxiety and hostility -- can harm the heart.

This Harvard School of Public Health review of more than 200 studies found that positive feelings appear to reduce the risk of cardiovascular disease and events such as heart attack and stroke.

"The absence of the negative is not the same thing as the presence of the positive," lead author Julia Boehm, a research fellow in the department of society, human development, and health, said in a university news release. "We found that factors such as optimism, life satisfaction and happiness are associated with reduced risk of

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No Proof That Gum Disease Causes Heart Disease, Experts Say

HealthDay – 30 mins ago WEDNESDAY, April 18 (HealthDay News) -- A new scientific statement issued by the American Heart Association says no convincing evidence exists linking untreated gum disease to heart disease or stroke. Nor is there strong evidence that treating gum disease can reduce your risk of heart disease or stroke, the report says.

For more than 100 years, it was said that gum, or periodontal, disease could lead to cardiovascular disease, a major cause of death in the United States, but an extensive analysis found no proof of that connection.

"It's a statement that current science does not support a direct association or a causative association," said Dr. Peter Lockhart, a professor, dentist and co-chair of oral medicine at the Carolinas Medical Center, in Charlotte, N.C.

The report has been in the works for more than three years, Lockhart said. "It was a matter of finding out, what is the state of the science?"

The statement, released April 18, is published in the journal Circulation.

The American Dental Association's Council on Scientific Affairs agrees with the statement. The World Heart Federation, a nongovernmental organization that fights heart disease globally, also endorses it.

Many U.S. adults suffer from some form of gum disease, which can range from mild swelling and redness to periodontitis, when the gums pull away from the teeth and develop pockets that get infected.

The writing group -- co-chaired by cardiologist Dr. Ann Bolger of the University of California, San Francisco -- combed the medical literature on cardiovascular and gum disease from 1950 until mid-July 2011. They found more than 500 studies, and looked in-depth at the most scientific ones.

Gum disease, heart disease and stroke all produce inflammation in the body. The conditions share some risk factors, such as cigarette smoking, age and diabetes, which is why they often develop in the same people.

However, the writing group did not feel the evidence is strong enough to say gum disease causes heart disease or stroke.

"So far, there is no conclusive evidence

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Researchers Repair Damage Caused by Heart Attacks in Mice

HealthDay – 29 mins ago WEDNESDAY, April 18 (HealthDay News) -- Scientists report they were able to repair mouse hearts that were damaged by heart attacks.

Researchers from the Gladstone Institutes successfully converted scar tissue in the mice into beating heart muscle. Their findings, they said, might eventually lead to a similar treatment for people who've had heart attacks.

"The damage from a heart attack is typically permanent because heart-muscle cells -- deprived of oxygen during the attack -- die and scar tissue forms," Dr. Deepak Srivastava, who directs cardiovascular and stem cell research at Gladstone, a nonprofit biomedical research institution, said in a Gladstone news release. "But our experiments in mice are a proof of concept that we can reprogram non-beating cells directly into fully functional, beating heart cells -- offering an innovative and less invasive way to restore heart function after a heart attack."

In conducting the study, the researchers delivered three genes, known as GMT, involved in embryonic heart development directly into the damaged areas of the mouse hearts. They found the non-beating scar tissue was transformed into beating heart muscle within one month. The heart function of the mice improved even more after three months, the study added.

"These findings could have a significant impact on heart-failure patients -- whose damaged hearts make it difficult for them to engage in normal activities like walking up a flight of stairs," Li Qian, a postdoctoral scholar, who is also a California Institute for Regenerative Medicine postdoctoral scholar and a Roddenberry Fellow, said in the news release. "This research may result in a much-needed alternative to heart transplants -- for which donors are extremely limited. And because we are reprogramming cells directly in the heart, we eliminate the need to surgically implant cells that were created in a petri dish."

The next step, the study authors noted, is to duplicate their research and test its safety in larger mammals, such as pigs. This will bring the scientists one step closer to testing this type of treatment in people.

"We hope that our research will lay the foundation for initiating cardiac repair soon after a heart attack -- perhaps even when the patient arrives in the emergency room," said Srivastava, who is also a professor at the University of California, San Francisco, with which Gladstone is affiliated.

The findings were published online April 18 in the journal Nature.

In the future, the scientists say they hope this type of direct reprogramming will be used to also treat spinal cord injury and illnesses such as Alzheimer's and Parkinson's disease.

While the findings of the new study are promising, scientists note that research involving animals often fails to produce similar results in humans.

More information

The U.S. National Heart, Lung, and Blood Institute provides more information on heart attacks.

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Happy? Positive outlook may be good for your heart

it seems to be good for your heart.

Scientists have long known that Type A personalities and people who are chronically angry, anxious or depressed have a higher risk of heart attacks.

Now a Harvard review of the flip side of that psychology concludes that being upbeat and optimistic just may help protect against heart disease.

Rather than focusing only on how to lessen heart risks, "it might also be useful to focus on how we might bolster the positive side of things," said lead researcher Julia Boehm of the Harvard School of Public Health.

Boehm reviewed dozens of studies examining a positive outlook

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Analysis: Heart device troubles cloud St Jude's outlook

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Turmeric extract may protect heart after surgery: study

Reuters – 9 hrs ago (Reuters) - Extracts from turmeric spice, known for their antioxidant and anti-inflammatory properties, may help ward off heart attacks in people who have had recent bypass surgery, according to a study from Thailand.

During bypass surgery the heart muscle can be damaged by prolonged lack of blood flow, increasing the patient's risk of heart attack. But the new findings, published in the peer-reviewed American Journal of Cardiology, suggest that curcumins - the yellow pigment in turmeric - may ease those risks when added to traditional drug treatment.

The conclusions are based on a relatively small group of subjects and needs to be confirmed in larger studies, said researchers led by Wanwarang Wongcharoen from Chiang Mai University. Turmeric extracts have long been used in traditional Chinese and Indian medicine.

Research has suggested inflammation plays an important role in the development of a range of diseases, including heart disease, and curcumins could have an effect on those pathways, said Bharat Aggarwal, who studies the use of curcumins in cancer therapy at the MD Anderson Cancer Center in Houston, Texas.

"It's very, very encouraging," said Aggarwal of the study, which he did not take part in.

The researchers studied 121 patients who had non-emergency bypass surgery at their hospital between 2009 and 2011.

Half of those patients were given one-gram curcumin capsules to take four times a day, starting three days before their surgery and continuing for five days afterwards. The other half took the same number of drug-free placebo capsules.

The researchers found that during their post-bypass hospital stays, 13 percent of patients who'd been taking curcumins had a heart attack, compared to 30 percent in the placebo group.

After accounting for any initial pre-surgery differences, Wongcharoen and his colleagues calculated that people on curcumins had a 65 percent lower chance of heart attack.

Researchers said it's likely that the antioxidant and anti-inflammatory properties of curcumins may have helped limit heart damage in the patients.

"Curcumin has for many years now been shown to reduce inflammation and to reduce oxygen toxicity or damage caused by free radicals in a number of experimental settings," said Jawahar Mehta, a cardiologist at the University of Arkansas for Medical Sciences in Little Rock, who didn't work on the study.

"But that doesn't mean that this is a substitute for medication," he said, noting that drugs like aspirin, statins and beta blockers have been proven to help heart patients and people in the current study were taking those as well.

One limitation was that the study was relatively small. Another is that while curcumins are thought to be safe, there could be side effects at very large doses.

"Taken in moderation or used in cooking, (curcumins) are quite useful. But I wouldn't go to a health food store and start taking four grams of curcumin a day, as was done in this study," Mehta said. SOURCE: http://bit.ly/HEnC5f

(Reporting from New York by Genevra Pittman at Reuters Health; editing by Elaine Lies and Jeremy Laurence)

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EKG Heart Test May Predict Risk in Older Adults

HealthDay – 4 hrs ago TUESDAY, April 10 (HealthDay News) -- Minor changes in the results of a commonly used heart test -- an electrocardiogram, or EKG -- translate into a 35 percent increased risk of heart events, such as heart attacks, hospitalizations for chest pain or the need for heart surgery, in people over 70, according to new research.

For people with major abnormalities in their EKG, the risk of having a heart event is even higher, compared to people with normal tests.

"We analyzed data from the Health, Aging and Body Composition Study. More than 3,000 patients had an electrocardiogram done at baseline, but we only included the people who didn't have a previous history of coronary heart disease or cardiovascular disease, so no heart attacks or strokes," said lead study author Dr. Reto Auer, a research fellow in the department of epidemiology and biostatistics at the University of California, San Francisco.

"We found that people who had minor or major changes in their electrocardiogram had a greater risk of heart events," Auer said. "And, when we adjusted the data for commonly known risk factors -- smoking, cholesterol, body mass and high blood pressure -- we still found an association between minor or major EKG changes and heart events."

Results of the study are published in the April 11 issue of the Journal of the American Medical Association.

An EKG is a painless and noninvasive test that records each heartbeat onto a piece of paper. To conduct the test, clinicians attach numerous wires to your chest and legs to capture each heartbeat.

The test is commonly included as part of a routine physical, though the widespread use of this test in people without any cardiac symptoms has recently come into question. While it may be noninvasive, it's not without risk. People who have abnormal test results are often referred to specialists and for more tests, which may be invasive. In addition, if the results of the EKG suggest an increased risk, someone might be placed on a new medication to reduce their risk.

"The American College of Cardiology currently recommends against routine screening in asymptomatic individuals unless there are risk factors," said Dr. David Friedman, chief of heart failure services at North Shore-LIJ Health System's Plainview Hospital, in Plainview, N.Y.

The U.S. Preventive Services Task Force and the American Heart Association also do not recommend routine EKG screening in people without symptoms or risk factors, according to an accompanying editorial in the same issue of the journal.

"Just because its use is widespread and it's cheap doesn't mean it should necessarily be given to everyone. While it might seem to make sense, where does it stop? Why just get an EKG? Why not an echocardiogram or a cardiac stress test, too? All of these tests have to be used rationally and cost-effectively. This is still a gray area," Friedman said.

The current study is a first step in assessing how electrocardiograms might effectively be used in an older population, the researchers suggested.

From the larger study, the investigators analyzed data on 2,192 people who had no history of heart disease or stroke, but had undergone an EKG at the start of the study.

All of the study volunteers were between the ages of 70 and 79. Fifty-five percent of study participants were women and 59 percent were white. The study included an average eight years of follow-up information.

The researchers found that people who had minor abnormalities in their EKG at the start of the study were 35 percent more likely to experience a heart event than those without any abnormalities. Those with major EKG abnormalities had a 51 percent greater risk of having a heart event.

Auer said even with this study's findings, it's too soon to recommend routine screening with EKG. "Prediction is not prevention," he said.

An additional issue that both doctors mentioned is that the EKG test is only as good as the person who's reading the test. Major abnormalities are generally easy to see, but minor ones aren't always as easy to interpret, Auer and Friedman said.

"I see minor abnormalities all the time, and variable changes in the same patient from year to year. There are some things we expect that are normal variants," Friedman said.

Until the experts sort out the best way to use EKG to help them predict someone's risk of a heart attack, Auer said that it's important to talk to your doctor about your heart disease risk factors, such as high blood pressure, high cholesterol and smoking. Making changes in these risk factors is already known to reduce the risk of heart disease. It isn't yet known if changing the results of your EKG will help lower your heart disease risk, he noted.

More information

Learn more about the electrocardiogram test from the U.S. National Heart, Lung, and Blood Institute.

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Common Blood Pressure Drug Safe for Heart Failure: Study

HealthDay – 4 mins 46 secs ago TUESDAY, April 10 (HealthDay News) -- Although research has suggested that the blood pressure drug losartan (Cozaar) may be tied to an increased risk of death in heart-failure patients compared to a similar medication, a new study finds that's not the case.

"Use of this and other similar drugs has been shown to reduce morbidity and mortality in patients with heart failure," said Dr. Gregg Fonarow, co-director of the Preventative Cardiology Program at the University of California, Los Angeles, and director of the Ahmanson-UCLA Cardiomyopathy Center, commenting on the study results.

An earlier observational study in patients with heart failure suggested that losartan was associated with higher risk of death compared to the drug candesartan (Atacand), he said.

"There were, however, a number of limitations to this prior study that could have biased these results, including differences in dosing and treating physicians," said Fonarow, who was not involved in the studies.

The new research, conducted in Denmark, finds no meaningful difference in survival among heart failure patients treated with losartan or candesartan, he said.

"This study also finds for both agents that the use of higher doses, as recommended in guidelines, is associated with better outcomes than the use of lower doses," Fonarow said.

The report was published in the April 11 issue of the Journal of the American Medical Association.

Heart failure, also called congestive heart failure, means the heart is unable to pump blood to the rest of the body the way it should.

For the study, Henrik Svanstrom, from the Statens Serum Institute in Copenhagen, and colleagues collected data on nearly 6,500 heart failure patients who had recently started taking losartan (4,397 patients) or candesartan (2,082 patients).

Both are a type of drug called angiotensin II receptor blockers (ARBs).

During follow-up, 2,378 participants died -- 330 taking candesartan and 1,212 patients taking losartan, the researchers found.

However, there was no significant increased risk of all-cause death or cardiovascular death associated with losartan compared to candesartan, the researchers said.

But dosage was important, the team said. The study found twice the risk of death with low-dose losartan compared to high-dose candesartan. Medium-dose losartan and low-dose candesartan also had a higher risk of death, but high-dose losartan had no increased death risk compared to high doses of candesartan.

"Our data provide a more detailed insight into the complexity of the association between losartan use and mortality risk in heart failure," the researchers concluded.

"These findings do not support the hypothesis of differential effects of specific ARBs in patients with heart failure," they added.

Dr. David Friedman, chief of heart failure services at North Shore-LIJ Health System's Plainview Hospital in Plainview, N.Y., said, "These medications are very helpful in heart failure patients."

Friedman noted that those in the losartan group were older and sicker, which may explain why more of them died.

These patients could only tolerate lower doses of losartan, and because they were sicker they were more likely to die than patients who could tolerate higher starting doses of candesartan, he said.

More information

For more on heart failure, visit the American Heart Association.

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Heart test could predict future attacks in elderly

"A volunteer works at an EKG station at a clinic in 2010. A test to measure the heart's electrical activity could help predict future heart attacks in otherwise healthy adults over 70, said a US study on Tuesday. (AFP Photo/Rod Lamkey Jr)" title

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Moderate Drinking Might Help Men Live Longer After Heart Attack

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