Report from Annual American College of Cardiology Meeting

DOCTORS IDENTIFY NEW PREDICTOR OF CORONARY ARTERY DISEASE(Embargoed until Monday, March 8, 4 p.m. ET)

By more closely scrutinizing levels of creatinine, a breakdown product of muscle, doctors may be able to prevent future heart attacks in people who present at hospitals with chest pain, a Johns Hopkins study reveals.

For several years, doctors have known that individuals with high levels of creatinine, an indication of kidney failure, are at increased risk of developing coronary artery disease. A wide range of levels considered normal, however, exists.

To see if high-normal levels of creatinine could predispose a person to poor outcomes, Johns Hopkins doctors prospectively followed 459 patients with ongoing chest pain who were admitted to the hospital because of a suspected heart attack. They discovered that among patients with high-normal creatinine, 22 percent suffered a subsequent myocardial infarction, revascularization (surgery to restore blood supply) or death by 120 days, in comparison with 13 percent of patients with low-normal levels of the white crystalline compound.

"In evaluating patients with chest pain, if there is even a mild elevation of creatinine in the high-normal range, doctors should think twice about how they triage those patients," says Charles Henrikson, M.D., M.P.H., a cardiology fellow at Hopkins who will present the research March 8 during the American College of Cardiology's annual meeting. He points out that working up these individuals more aggressively could help better identify individuals at risk and save lives.

Dr. Henrikson's collaborators were David Bush, M.D.; Eric Howell, M.D.; and Nisha Chandra- Strobos, M.D.

A MOM, NOT DAD, WITH HEART DISEASE INCREASES CORONARY HEART DISEASE RISK IN OFFSPRING(Embargoed until Sunday, March 7, 2 p.m. ET)

For some time now, doctors have known that parental history of coronary heart disease plays a role in whether a person will develop the disease. Now, Johns Hopkins researchers have discovered that, in most cases, only the mother's history matters.

"If doctors identify patients with a maternal history of coronary heart disease, they should compulsively look for other risk factors, such as hypertension, elevated cholesterol and obesity, and aggressively manage them, " said Pamela Ouyang, M.D., an associate professor of medicine at Johns Hopkins. She will present the research March 7 during the American College of Cardiology's annual meeting.

Until now, only anecdotal evidence had suggested that maternal history plays a greater role in coronary heart disease. To nail down the issue, researchers interviewed patients who had been admitted to Hopkins with the disease to identify their siblings. They then enrolled these siblings in the study if they were less than 60 years old and not yet symptomatic. Siblings, average age 46, were then followed for roughly eight years.

The researchers found that if individuals had a mother with coronary heart disease, they were twice as likely to develop it themselves, compared to those with no maternal history. If the mother had the disease when she was 55 or younger, the individual was six times more likely to develop it. Surprisingly, the father's history had no effect unless he had the disease before the age of 45, and, in this case, the child's risk increased fivefold.

The researchers are uncertain why a mother's history is so important. "We are still trying to figure out why," said Ouyang. "It suggests some heritable change or possibly something involving the X chromosome. The next step is to look at some of the potential genetic components."

Other authors of the study include Lisa Yanek, M.P.H.; Daniele Fallin, Ph.D.; Taryn Moy, M.S.; Lewis Becker, M.D.; and Diane Becker, Sc.D., M.P.H.

EXERCISE PRESCRIPTIONS MAY SIGNIFICANTLY REDUCE CORONARY HEART DISEASE (Embargoed until Monday, March 8, 1 p.m. ET)

Doctors should dole out prescriptions for frequent, moderate-level physical activity to women at risk for developing atherosclerosis, thickening of the artery walls. A study by Johns Hopkins researchers shows that women who are at risk for this disease are far less likely to develop it if they walk briskly for 30 minutes or more, two to three times a week.

"At a time when health care is becoming dominated by expensive technologies and medicine, the provider community should not lose sight of the benefits of promoting exercise and healthy lifestyle patterns," said Khurram Nasir, M.D., M.P.H., a Hopkins research fellow who will present the research March 8 during the American College of Cardiology's annual meeting. "Providing simple exercise prescriptions to patients should be a routine part of any health maintenance program."

While exercise has been shown to be effective in reducing atherosclerosis in men, the impact of exercise on this disease in women has been unclear. Johns Hopkins researchers thus studied 1,801 asymptomatic women who had risk factors for atherosclerosis, including a family history, hypertension, diabetes, or obesity. Participants were classified as participating in no activity, or low or high levels of moderate physical activity, such as brisk walking, running or other recreational activity. Low levels were classified as less than 30 minutes, two to three time per week. High levels were defined as 30 minutes or more, two to three times per week. The researchers then measured levels of coronary artery calcification, a marker for the disease, and analyzed them with respect to exercise.

After controlling for other CHD risk factors, doctors found that women who were 65 or older had almost 50 percent less calcification if they fell into the high category, compared to those who fell into the low category or didn't exercise at all. Women 45 to 64 years of age who engaged in high levels of moderate activity had 33 percent less calcification than women of the same age who exercised less or not at all.

"This study provides further evidence on the cardiovascular benefits of adhering to an active lifestyle," said Nasir. "Unfortunately, few people follow this simple advice." He says doctors need to aggressively recommend frequent exercise to patients.

Other Johns Hopkins collaborators were Rinky Bhatia, M.D.; Milind Desai, M.D.; Joel Braunstein, M.D.; Wendy Post, M.D.; and Roger Blumenthal, M.D. Also participating were John Rumberger, M.D., Ph.D., Ohio State University, and Matthew Budoff, M.D., Saint John's Cardiovascular Research Center, Torrance, Calif.