Category: Blood Pressure

Statins after Heart Transplantation

Heart Transplantation

Statins may help keep heart-transplant patients alive longer, say researchers from Munich-Bogenhausen, University Hospital Munich-Grosshadern, and University Hospital Leipzig. According to an eight-year prospective, randomized, unmasked study of 72 patients, 89% of those who were given simvastatin (Zocor medication, Merck) four days after transplantation survived, in contrast to 60% of patients who didn’t start a statin regimen until four years later. All patients had been given a strict low-cholesterol diet after surgery. Thirty-five patients were receiving daily statin treatment, and 37 were receiving dietary therapy alone.

The average ages of patients were 49 in the simvastatin group and 47 in the control group. The average donor age was 30 for the simvastatin transplant recipients and 34 for the control-arm recipients.

After four years, the benefits of sim-vastatin were so much better that all of the patients were offered the drug. The long-term effects might be explained, in part, the researchers say, by the drug’s efficacy in lowering cholesterol levels and thereby reducing the incidence of transplant vasculopathy, a major complication of heart transplantation characterized by thickening of the coronary artery. Early simvastatin treatment halved the incidence of vessel thickening; by eight years after the surgery, transplant vasculopathy occurred in only 24% of the patients taking statins but developed in 55% of the patients being treated with diet alone. There was no difference in organ function between the two groups.

Four patients in the diet-alone (control) group died as a result of transplant vasculopathy, whereas only one transplant patient died in the group receiving simvastatin. No severe adverse effects from the therapy were documented up to the end of the eight-year observation period.

The researchers suggested that sim-vastatin might be successful in reducing not only cholesterol levels but also the growth of smooth muscle cells, which contribute to vessel thickening.

Soy Protein and Warfarin

If patients who are taking the anticoagulant generic warfarin suddenly have a lower International Normalized Ratio (INR), health care providers are advised to determine whether they are also consuming soy protein. A pharmacist at Fallon Clinic, in Webster, Massachusetts, described a patient who was stable with warfarin therapy until he started drinking soy milk daily as part of his treatment for hypertriglyceri-demia. Within five days, his INR values began dropping, from 2.5 to 2.3. The patient drank approximately 480 ml of soy milk daily for three weeks while taking his prescribed medications as directed. After four weeks, his INR was 1.6. A …

DRUG NEWS Thrombocytopenia after Losartan

DRUG NEWS

An 82-year-old woman had been having nosebleeds and had been bruising easily for two weeks. The only culprit seemed to be the generic losartan she had been taking for cough—for two weeks.

There was no bleeding from any other site. The patient had no history of similar symptoms and had been taking her other medications for years. She had no infection, had not undergone chemotherapy or radiation, and had no malignancies. There was no family history of bleeding.

Although the patient was hemo-dynamically stable, alert, and oriented upon physical examination, petechiae were present over her body and palate. Laboratory tests revealed a low platelet count. The patient’s CD4/CD8 ratio was normal, without any evidence of a lym-phoproliferative disorder.

Because the patient’s physicians believed that she had immune thrombo-cytopenia as a result of losartan intake, they stopped the therapy. After she was given immune globulin and oral prednisone, her platelet count improved within one week. The prednisone dose was tapered, and the patient’s platelet count has remained normal on follow-up.

According to the authors, immune thrombocytopenia associated with losartan had never been reported.

Return of Hypertension after Blood Pressure Treatment

Who is more likely to keep blood pressure at normal levels after antihyperten-sive drug therapy is discontinued? Researchers in Australia monitored 503 patients aged 65 to 84, from 169 general practices, to find out. Their answer: After 12 months, it is the younger patients (ages 65 to 74) with a lower “on-treatment” systolic blood pressure measurement, a single-agent treatment, and a greater waist-to-hip ratio.

The predictors were most powerful in the first 70 days after treatment was stopped. The researchers note that anti-hypertensive therapy is often started in response to a transient situation, such as excessive alcohol consumption, intake of other drugs, fluctuations in weight, or an exaggerated, fearful “white coat” response during a physical examination. Each factor that predicts successful maintenance of normal blood pressure is based on the reason that the drug is taken in the first place, the researchers point out. seroquel 200 mg

Only 37% of the participants in the study had normal blood pressure one year after the drug was withdrawn, but the key may be when and how long follow-up is maintained, the researchers say. Although hypertension in most patients returned within the first 100 days, the rate was constant after that point. A reasonable regimen, the researchers advise, would be to schedule weekly visits for two weeks after the drug is withdrawn, then every two weeks for two months, then monthly for six months, and six monthly visits thereafter.

Fast-Tracking Patients with Atrial Fibrillation Safely

An accelerated approach to managing patients with atrial fibrillation may lead to safe and shorter hospital stays at lower cost. In a pilot study by researchers from Evanston (IL) Northwestern Healthcare and the University of Michigan, 18 patients with newly diagnosed or new-onset uncomplicated atrial fibrillation were managed either with traditional care (routine hospital admission with strategy guided by transesophageal echocardiography) or with admission to an emergency department-based clinical pathway with low-molecular-weight heparin (dalteparin [Fragmin®, Pharmacia and Upjohn]) and early cardioversion to sinus rhythm. In the clinical pathway group, dalteparin was continued in low-risk patients who underwent cardioversion until therapeutic generic warfarin levels were achieved.

All nine patients in the traditional group were admitted to the hospital, with a mean length of stay of two days (range, one to eight days). By contrast, all patients in the clinical pathway group were in the hospital for less than one day. Median time to chemical or electrical cardioversion and normal sinus rhythm were significantly shorter in the pathway group. Median costs were $1,112 in the traditional group and $984 (40% of the cost going for dal-teparin) in the pathway group.

No atrial fibrillation-related complications occurred throughout the hospital stay or after a mean follow-up of 27 days. No patients had a stroke or experienced thromboembolic events, bleeding, or complications from cardioversion procedures, and no patients died. One patient in the pathway group was lost to follow-up, and one in each group had atrial fibrillation at the time of clinic follow-up.

The clinical pathway still allowed time for evaluation of cardiac enzymes and for conversion to sinus rhythm. The frequency of medical evaluations was similar in both patient groups. Cardioversions were more frequent in the pathway group because of the accelerated time frame; some patients might have undergone spontaneous conversion if given more time. The researchers add, however, that faster conversion to sinus rhythm might have additional benefits, such as the enhanced probability of maintaining sinus rhythm after cardioversion.

Rosuvastatin for Lowering Cholesterol

The Food and Drug Administration (FDA) has approved rosuvastatin ( Drug Crestor ®, AstraZeneca) to lower serum cholesterol levels. Lowering cholesterol is a key to reducing the risk of heart disease. Rosuvastatin is in the class of drugs called HMG-coenzyme A reductase inhibitors, also known as statins. These drugs partially block the synthesis of cholesterol in the liver. This process leads to increased removal of cholesterol from the blood.

When Are Statins Risky

Statins, which are often prescribed to reduce high cholesterol levels, have proved safe, effective, and well tolerated; however, interactions with other drugs may be putting some patients at higher risk for myopathy (muscle disease). Myopathy is traditionally defined as a creatine kinase level greater than 10 times the upper limits of normal. Symptoms include generalized myalgia, fatigue, and weakness. Elevated creatine kinase levels are biochemical markers of the muscle damage.