News & Trends

Cardiology Review® Online, April 2012, Volume 28, Issue 2

Heart Failure Associated With Fractures and Osteoporosis

Findings from a Canadian study published in the April 2012 Journal of Clinical Endocrinology and Metabolism suggest that heart failure is associated with a 30% increase in the risk of major fractures. The population-based cohort study was conducted in over 45,500 adults aged 50 years and over in Manitoba, who underwent initial bone mineral

density (BMD) testing from 1998 through 2009. Of these patients, 1841 had recent-onset heart failure. Data were collected on patients’ osteoporosis risk factors, comorbidities, medications, and BMD. Even after adjustments were made for osteoporosis risk factors, comorbidities, medications, and total hip BMD, the association


The study’s lead author, Sumit Majumdar, MD, of the University of Alberta in Edmonton, Ontario, said that the study demonstrated that heart failure and thinning of bones go “hand in hand,” and that understanding the mechanism between heart failure and osteoporosis might lead to new treatments for both conditions. Dr Majumdar noted that osteoporosis screenings should include examining chest x-rays of patients with heart failure.

Majumdar SR, Exekowitz JA, Lix LM, Leslie WD. Heart failure is a clinically and densitometrically independent risk factor for osteoporotic fractures: population-based cohort study of 45,509 subjects [published online ahead of print January 18, 2012]. J Clin Endocrinol Metab.

AHA Issues a Call to Action on PAD in Women

The rate of death and health care costs associated with peripheral artery disease (PAD) is comparable to or higher than that of coronary heart disease and stroke. Four to 5 million US women have PAD, but few are aware of it and fewer still are treated for PAD, according to a new scientific statement issued by the American Heart Association (AHA). The statement calls for improvements in diagnosis and treatment of PAD as well as an increase in enrollment of women in clinical trials of PAD.

Women suffer the consequences of PAD at rates at least as high as those observed in men, but gender-specific data on PAD are lacking, the report states. Clinical research to evaluate gender-based differences that might underlie the delayed postmenopausal presentation of PAD in women has not been conducted. It remains unknown whether gender-based distinctions in clinical presentations exist, and whether sensitivity and specificity of PAD diagnostic tests are affected by gender.

Lead author Alan T. Hirsch, MD, of the University of Minnesota Medical School, said the report seeks to change the way women think about PAD, similar to how the AHA’s Go Red for Women campaign helped make US women aware that heart disease was their greatest killer. Outreach efforts are also needed to educate primary care providers on how to better identify women at high risk for PAD.

The scientific statement is a collaboration between the AHA and the Vascular Disease Foundation to summarize the evidence on PAD in women; describe the associated cardiovascular risk of ischemic events and symptoms and clinical presentations; highlight the efficacy of current treatments; and discuss the challenges

caused by the low levels of PAD awareness among women.

Hirsch AT, Allison MA, Gomes AS, et al. A call to action: women and peripheral artery disease. A scientific statement from the American Heart Association. Circulation. 2012:125:1449-1472.

Test of Circulating Endothelial Cells May Predict Plaque Ruptures

Researchers at the Scripps Translational Science Institute are studying a potential test to identify which patients with chest pain are about to have an acute myocardial infarction (MI). The project at Scripps was started by Dr Eric Topol and is now being conducted by Dr Paddy Barrett, who is working on applying the findings to a point-of-care test for acute MI.

The test measures circulating endothelial cells (CECs) in an ST-segment elevation MI (STEMI) population, and could potentially be performed on all patients presenting to the emergency department with chest pain. The assay will be performed on a peripheral whole-blood sample before coronary angiography to avoid the false elevation in CECs that can be caused by coronary catheters.

The study compared samples of CECs from 50 patients with STEMI and 44 patients who were healthy. Using the Veridex CellSearch rare-cell-isolation platform, the researchers were able to show that CEC counts were significantly elevated in the MI patients versus controls. In addition, researchers showed that at a morphological level, CEC cells from MI patients are grossly different from those in the healthy control group and display different morphological characteristics.

Dr Barrett expects to have a commercially available point-ofcare blood test based on CEC in approximately 2 years. The group is planning to create a rapid, 20- to 30-minute test. The Scripps group’s findings were published online March 21, 2012, in Science Translational Medicine and are available at

Damani S, Bacconi A, Libiger O, et al. Characterization of circulating endothelial cells in acute myocardial infarction. Sci Transl Med. 2012;4(126):126ra33. doi:10.1126.scitranslmed.3003451.