Cardiology congress raises key issues

Cardiology experts recently raised some serious areas of concern at ESC congress 2011 – including the fact that maternal heart disease has become a leading cause of maternal death during pregnancy, in Europe. The risk of cardiovascular disease in pregnant women is growing, due to increasing age at first pregnancy and higher rates of diabetes, hypertension, and obesity – while improvements in the treatment of congenital heart disease also mean that more women are reaching reproductive age. In view of this growing problem, the society announced the publication of new guidelines, at the congress, highlighting the need for improvements in screening for heart disease, appropriate risk assessment and counselling for pregnant women. The guidance states that: • Pregnant patients with cardiovascular disease should be managed by interdisciplinary teams. • High-risk patients should be treated in specialist centres. • Diagnostic procedures and interventions should be performed by specialists with significant expertise in the individual techniques and experience in treating pregnant patients. The event further highlighted concerns that patients with cardiovascular disease are ‘not receiving adequate treatment’. New evidence shows that there is a widespread failure to administer inexpensive, proven drugs that could help prevent cardiovascular disease. The underuse of such drugs was described as a ‘global tragedy’, by Dr Salim Yusuf from McMaster University, Canada, who presented results from the Prospective Urban Rural Epidemiological (PURE) study. The study (published in The Lancet) found that, in low-income countries, 80.2% of patients with previous cardiovascular disease received no preventive medication at all. Even in high-income countries 11.2% did not receive treatment.

Lifestyle factors

 Lifestyle risk factors were also discussed at the event – in one session, a number of speakers examined the impact of laughter, music and reducing work-related stress in enhancing cardiovascular health. Michael Miller and colleagues from the University of Maryland, US, for example, studied the impact of positive emotions on vascular reactivity. Using ultrasound, they measured the diameter of the brachial artery in 20 non-smoking healthy men and women who on one day watched clips of comedy films, while on another day watched the stressful opening sequence of ‘Saving Private Ryan’. The results showed that blood flow was enhanced by 22% in those watching the humorous film, but decreased by 35% in those watching the stressful film. “The magnitude of the effects we saw were similar to the effects of exercise or taking a statin,” said Michael Miller. He identified a need for further study of the long-term effects of laughter on cardiovascular health. Hans-Joachim Trappe, an organist and cardiologist from the University of Bochum, Herne, Germany, also explored how listening to classical music has the potential to decrease blood pressure and heart rate. Trappe suggested that classical music offers the ideal therapy for patients with hypertension and increased heart rates, revealing plans for a prospective study: ‘Bach or beta blockers?’, in which patients with hypertension are randomised to one or the other and their blood pressure monitored. Music studies are being undertaken in 36 pigs and 60 healthy human volunteers to see if there are differences in blood pressure, respiration rate and cortisol levels when exposed to Bach, heavy metal music and controlled episodes of silence. “From this study we hope to understand more about why music produces its beneficial effects on blood pressure,” said Trappe. “If our hypothesis is correct, we should see the same effects in animals and humans.” He reported that some subjects listening to heavy metal have shown episodes of atrial fibrillation.