European Heart Journal (2015) 36, 191–198 doi:10.1093/eurheartj/ehu464
The European Society of Cardiology and European Heart Journal at the Spanish Society of Cardiology Congress 2014
As with most National Societies, the Spanish Society of Cardiology (Sociedad Espan˜ola de Cardiologı´a) has been holding an annual meeting for many years. In Spain, the location of the congress changes every year. Last year (2014), El Congreso de las Enfermedades Cardiovasculares SEC 2014 took place in Santiago de Compostela from 30 October to 1 November 2014 under the leadership of its current president Jose´ Ramo´n Gonza´lez-Juanatey, MD, PhD, FESC. Lina Badimon from Barcelona, a well-known cardiovascular scientist trained at the Mayo Clinic in Rochester, MN (1990–1992) and Director of the Cardiology Research Laboratory at the Mount Sinai Hospital in New York (1983–1992) and at the Massachusetts General Hospital in Boston (1992–1995), and currently the Director of the Barcelona Cardiovascular Research Center, CSIC-ICCC at the Hospital Sta. Creu i S. Pau and Vice-President of the Spanish Society of Cardiology, was responsible for the programme. In addition to numerous cardiologists and researchers from Spain, many experts from other European countries and the USA, as well as representatives of the European Society of Cardiology and the American College of Cardiology, were part of the faculty. A total of 3300 participants attended the National Congress, of which 2300 were clinical cardiologists and scientists.
Speakers at Hot Topics Session (from left to right: Stewart Peacock, J.R. Gonzalez-Juanatey, Lina Badimon, Fausto Pinto, Pat O’Gara, and Keith Fox)
Franz-Josef Neumann at SEC 2014
Published on behalf of the European Society of Cardiology. All rights reserved. & The Author 2015. For permissions please email: [email protected].
Downloaded from http://eurheartj.oxfordjournals.org/ at Uniwersytet Warszawski Biblioteka Uniwersytecka on April 13, 2015
Spanish Society of Cardiology
Keith Fox, chairman of the program committee of the European Society of Cardiology’s annual congress in Barcelona, gave a brilliant review of the important presentations at this congress, while Fausto Pinto, the current president of the European Society of Cardiology, reviewed the current state of the art of cardiovascular imaging. Pat O’Gara, President of ACC, reviewed the most important presentations of the ACC meeting in Washington in 2014. Another prominent lecturer was Stewart Peacock from London. Furthermore, the incoming president of the American College of Cardiology, Dr Kim A. Williams, from Rush University in Chicago, discussed nuclear imaging in cardiac patients. The European Heart Journal was represented by its editor-in-chief Prof. Thomas F. Lu¨scher who together with Antoni Baye´s-Genis from Barcelona chaired a session on ‘Lo mejor del European Heart Journal y Revista Espan˜ola de Cardiologı´a’ (The Best of the European Heart Journal and Revista Espan˜ola de Cardiologı´a). The most important publications from the European Heart Journal and the official journal of the Spanish Society of Cardiology, as well as other important works, were reviewed by four expert cardiologists from Germany, Greece, and Spain. John Parissis from Athens, Greece, reviewed the most important papers in the field of heart failure, whilst Franz-Josef Neumann, Director of the University Heart Center, Freiburg-Bad Krozingen, Germany, discussed important publications in interventional cardiology.
192
CardioPulse
The arrhythmias were reviewed by Dr Ferna´ndez Lozano from Madrid, while Dr Javier Bermejo Thomas also from Madrid discussed important publications in cardiac imaging. The Revista Espan˜ola de Cardiologı´a has made a remarkable impact during the last years thanks to the late Dr Magda Heras Fortuny, who until her unfortunate and untimely death was editor-in-chief of the Spanish national journal. The Revista Espan˜ola de Cardiologı´a publishes all papers in English and Spanish, thereby
being attractive to cardiologists not only in Spain, but also in Central and South America. Next year’s congress of the Spanish Society of Cardiology will be held in Bilbao in the Basque country, again under the program leadership of Lina Badimon and its current president Jose´ Ramo´n Gonza´lez-Juanatey. Andros Tofield
A new position was created on the EHJ Editorial Board to facilitate the selection and management of clinical review articles and to reduce their time to publication On 1 November 2014, Freek W.A. Verheugt, MD, FESC, FACC, FAHA was appointed as Associate Editor of European Heart Journal for Clinical Review papers. He is Emeritus Professor of Cardiology at the Heart-Lung Centre of the University Medical Centre of Nijmegen and was Chairman of the Department of Cardiology, Onze Lieve Vrouwe Gasthuis (OLVG) in Amsterdam, Netherlands. He is an editorial adviser of Lancet, New England Journal of Medicine, and Circulation. Bringing with him his broad clinical, editorial, and scientific experience the journal will benefit from his skills in this field. Professor Verheugt was born and raised in Amsterdam, The Netherlands, and graduated from the Ignatius Gymnasium in 1967. He studied Medicine at the University of Leiden and Amsterdam, where he received his MD in 1974. He wrote a thesis on platelet and granulocyte antigens and antibodies and trained in cardiology at the Thoraxcenter of the Erasmus University in Rotterdam. With his special interest in platelets and coagulation in heart disease, he went to the USA, where he has been a Professor at the University of Colorado Health Sciences Center in Denver, Colorado.
In 1982 he returned to Amsterdam and became Professor of Cardiology at the Free University, then in 1997 he was appointed Chief of Cardiology at the Heart-Lung Centre of the University Medical Centre of Nijmegen. He has been President of the Netherlands Society of Cardiology during 1999– 2001. Prof. Verheugt has published over 500 papers in peer-reviewed international journals including New England Journal of Medicine, Lancet, Circulation, Journal of the American College of Cardiology, and European Heart Journal, of which he is an Editorial Board Member. He has over 23 000 citations and an H-index of 63. His main fields of scientific interest are pharmacological and interventional treatments of acute coronary syndromes and atrial fibrillation. The journal plans to expand the number of Clinical Reviews because they are popular, highly cited, and often downloaded. Prof. Verheugt’s experience will be valuable to facilitate the review process. Andros Tofield
The Belgian Society of Cardiology (BSC) Guy Van Camp, BCS president, discusses the Society’s position which is at the centre of the European Community in Brussels The BCS is a scientific organization and its main goal is the promotion in Belgium of: scientific activities educational activities initiatives aiming to increase the quality of care for patients suffering from cardiovascular diseases. Guy Van Camp
Belgian Society of Cardiology
The management of the BSC is organized by its board (http://www. bscardio.be).
Downloaded from http://eurheartj.oxfordjournals.org/ at Uniwersytet Warszawski Biblioteka Uniwersytecka on April 13, 2015
EHJ Associate Editor review articles: Professor Freek W.A. Verheugt
193
CardioPulse
† Belgian Working Group of Interventional Cardiology (http://www. bwgic.org), † Belgian Heart Rhythm Association (http://www.behra.eu/en), † Belgian Working Group on Non-Invasive Cardiac Imaging (https:// sites.google.com/site/bwgnici), † Belgian Working Group on Heart Failure and Cardiac Function (http://bwghf.be/), † Belgian Working Group on Cardiovascular Prevention and Rehabilitation, † Belgian Interdisciplinary Working Group on Acute Cardiology (http://www.biwac.be), † Belgian Working Group on Adult Congenital Heart Disease (http:// www.bwgachd.be), † Belgian Working Group on Cardiovascular Nursing and the Young Cardiologists Club (http://www.ycc.be), † These working groups are the cornerstones of the BSC, each organizing educational and scientific events. An overview of the working
groups and their activities can be found at the website of the BSC and on the individual websites: http://www.bscardio.be. The BSC is proud to have its own international journal for the society: Acta Cardiologica. All information about the journal and how to submit your scientific work can be found at the website: http://www .actacardiologica.be. The financial crisis in Europe requires that the BSC also has an important supplementary task. Close contacts with the government and reimbursement institutions in Belgium are becoming more and more important. The main goal is to guarantee the maintenance of a high-quality level of care for patients with cardiovascular diseases, following the ESC guidelines and recommendations. Linear restrictions in reimbursement of cardiovascular technical procedures on the one hand and the lack of a prospective strategy for reimbursement of new innovative techniques illustrates the difficulties the BSC has to face in this domain. Despite these economic constraints, the growing number of members of the BSC and of the participants during the scientific meetings organized by the BSC and its Working Groups illustrate the dynamic nature and enthusiasm of the cardiological community in Belgium. This is also reflected by the very active role of several BSC members within the ESC, in the past and now in the present. It is the ambition of the BSC to maintain this tradition of excellent collaboration with the ESC. The central place of Belgium within Europe and the recent opening of a ‘European Heart House’ within Brussels are stimulating factors promoting this close collaboration. Guy Van Camp Cardiovascular Center OLV Aalst, Belgium President of the BSC. [email protected]
Profile: Marc A. Pfeffer, MD PhD Marc Pfeffer is the Dzau Professor of Medicine at Harvard Medical School and Senior Physician in Cardiology at the Brigham and Women’s Hospital in Boston, Massachusetts. He is a globally recognized expert clinical investigator with interests in the pathophysiology of progressive cardiac dysfunction following myocardial infarction and in the design and conduct of clinical trials to improve therapeutic decision-making. Marc Pfeffer was born in Brooklyn, a borough of New York City. Although his parents were not wealthy, he was encouraged to pursue an education to strive for ‘an occupation where you wear a tie’. He did well at high school gaining acceptance to a tuition-free education at Brooklyn College. However, a chance encounter with the Director of Admissions from Rockford College, Illinois, and subsequent scholarship, offered an alternative. He took a leap of faith and left Brooklyn for the first time to travel to Rockford. He found the relaxed style of learning at this small liberal arts college to his liking and he thrived there. Importantly, he met his first wife, Janice Sikorski, a fellow biology major.
Janice and Marc Pfeffer In 1969, the Pfeffers graduated from Rockford College, were married, and moved to the University of Oklahoma, where Marc was awarded a scholarship in medical physiology. Janice accepted a position in the lab of Edward Frohlich, MD, the Director of Clinical and Experimental Hypertension. Pfeffer rotated through several laboratories at Oklahoma and chose to work in Frohlich’s lab alongside Janice. This marked the start of an auspicious professional collaboration and Pfeffer would become Frohlich’s first graduate student with his thesis on the changes in cardiac function with ageing in the spontaneously hypertensive rat. Janice became Frohlich’s second PhD
Downloaded from http://eurheartj.oxfordjournals.org/ at Uniwersytet Warszawski Biblioteka Uniwersytecka on April 13, 2015
The BSC works in close collaboration with the College of Cardiology, the official organization responsible for quality control within cardiology in Belgium and with the Belgian patient’s organization BCL-LCB (http://www.liguecardioliga.be). The number of cardiologists who are members of the BSC is continuously increasing and in January 2014, 498 cardiologists were members of the BSC. The scientific highlight is the annual meeting of the BSC which takes place during the last Thursday and Friday of January in the centre of Brussels. About 600 cardiologists and cardiologists in training participate in this scientific happening. National and international speakers each year guarantee important high-level scientific information. The daily activities are however organized by the different working groups:
194
and provided the rationale and justification for Pfeffer’s first major clinical outcomes study—Survival and Ventricular Enlargement (SAVE). In this international trial, he and his collaborators demonstrated that the use of an ACE inhibitor could prolong survival in patients experiencing an acute myocardial infarction. Since then, the randomized-controlled clinical trial has been Pfeffer’s major investigative tool. After SAVE, Pfeffer went from strength to strength. His output was as prolific as it was influential with key leadership roles in trials such as: CARE, CHARM, VALIANT, PEACE, ARISE, TREAT, ALTITUDE, RED-HF TOPCAT, and other well-known studies. Through these activities and others such as data safety monitoring committees, he has developed strong collaborations and friendships in the international cardiovascular community. In 2006, he was identified by Science Watch as having the most ‘Hot Papers’ in all of clinical medicine and he is currently one of the most highly cited medical scientists. He says the ‘proof of a good trial is that it generates sufficiently robust evidence to improve the practice of medicine’. When Janice Pfeffer died in 2000, Pfeffer lost his loving wife, foremost collaborator, and research inspiration, and the scientific community a leading light. Her friends and colleagues and notably mentors, Edward Frohlich and Eugene Braunwald, assisted Pfeffer in establishing a permanent endowment scholarship fund at Rockford College as a memorial to Janice’s distinguished career. Its aim is to foster women’s education in science—a cause which was close to Janice’s heart as she had to address financial issues to pursue her education. With a scholarship awarded each year, there have already been over six graduates pursuing their passion in science. The Pfeffers’ children, Katie, a nutritionist in the Boston area, and Michael, a second-year medical student in the Ochsner/Queensland University programme, also contribute to her legacy. Pfeffer has remarried and he enjoys saying that his wife, US Federal Magistrate Judge the Honourable Marianne Bowler, ‘conducts more trials than he does’. Pfeffer’s ability to collaborate and build teams and advance young investigative careers is a great asset for a clinical researcher and has been a source of pride. He believes he has had a CHARMed life with wonderful opportunities, had and still has, world-class mentors, and has been afforded the privilege of working with quality individuals sharing the common purpose of generating meaningful information to improve prognosis of patients with cardiovascular disease. He believes that this wonderful aspect of academic medicine remains open to young investigators who will also have many opportunities to share their academic journey with others.
Reference 1. Pfeffer MA, Lamas GA, Vaughan DE, Parisi AF, Braunwald E. Effect of captopril on progressive ventricular dilatation after anterior myocardial infarction. N Engl J Med 1988; 319:80 –86.
Downloaded from http://eurheartj.oxfordjournals.org/ at Uniwersytet Warszawski Biblioteka Uniwersytecka on April 13, 2015
student and her thesis was entitled, ‘Longitudinal Changes in Cardiac Function and Geometry during the Natural Development of Left Ventricular Hypertrophy in the Spontaneously Hypertensive Rat’. At that time there was very little work on haemodynamics in the rat or assessment of cardiac performance in animals with genetic hypertension and the Pfeffers were keen to explore this area. Under Frohlich’s influence Pfeffer went on to complete a medical degree to enable him to translate his lab work into developing therapies for cardiovascular diseases. By the mid-1970s and at a relatively young age, the couple had amassed a substantial body of work on hypertension, hypertrophy, and cardiac function which eventually brought them to the attention of Eugene Braunwald, MD. Pfeffer gave a presentation at a scientific meeting outlining work that appeared to contradict an aspect of Braunwald’s findings regarding cardiac function during the development of ventricular hypertrophy. He had no idea the eminent cardiologist was in the audience until Braunwald approached him and invited him to Boston to discuss these findings. Consequently, Braunwald offered Pfeffer, then a medical student, an internship at the then Peter Bent Brigham Hospital currently Brigham and Women’s Hospital. Pfeffer says he ‘moved to Boston to be under the mentorship of Braunwald, the person, rather than Harvard, the Institution’. This was an exciting time and place as Braunwald was actively generating the scientific evidence for the salvage of myocytes during an acute MI—the foundation of modern acute clinical MI care. Although the Pfeffers were in awe of Braunwald, they were determined to plough their own furrow exploring the long-term consequences of a myocardial infarction on ventricular size, shape, and function rather than acute infarct size limitation. He said: ‘We all knew that during an acute myocardial infarction there was a relationship between the loss of myocytes and the degree of diminished ventricular function. The long-term consequences of structure and the function of the ventricle following an infarction were less well established. One of their major discoveries was that there was a time dependent process of adverse left ventricular enlargement and shape distortion (remodelling) following myocardial infarction’. They then demonstrated in an experimental model that an angiotensin-converting enzyme inhibitor could attenuate this deleterious process. This concept of adverse ventricular remodelling and its modification is now a central tenet in the discovery of drugs purported to improve ventricular function. Pfeffer gives credit to Janice for the genesis of this now entrenched concept. The couple applied their understanding of adverse remodelling to rodents and used captopril to favourably modify the relation between infarct size and long-term LV performance. The discovery that captopril also prolonged survival in the rat model attracted funding for a small clinical randomized trial to determine whether an ACE inhibitor could reduce ventricular enlargement following a myocardial infarction in humans. This was Pfeffer’s first clinical trial, which showed both progressive enlargement in patients with acute MI as well as the favourable modification of this process with an ACE inhibitor. These findings published in the New England Journal of Medicine,1 did not go unnoticed,
CardioPulse
195
CardioPulse
National Institute for Health and Care Excellence Professor Martin R. Cowie MD FESC discusses the UK’s NICE (The National Institute for Health and Care Excellence) Institution which produces the NICE practice guidelines for clinical care
(1) Centre for Clinical Practice—develops clinical guidelines on the treatment and care of specific disease or conditions for people working in the NHS. (2) Centre for Public Health—develops guidance on the prevention of disease and promotion of good health for those working in the NHS, local authorities, the wider public and private, and voluntary sectors. (3) Centre for Health Technology Evaluation—develops guidance on the use of new and existing treatments and procedures, such as medicines, medical devices, diagnostic techniques, and surgical procedures. The Scientific Advice Programme sits here along with the research and development team and the Highly Specialised Technologies Programme. The Scientific Advice programme was established in 2009, and has advised 27 different manufactures on 94 different projects in 57 disease areas. (4) Communications directorate—responsible for raising awareness of NICE work among key audiences and external partners and for dissemination of NICE guidance, and press and public enquiries. (5) Health and Social Care Directorate—the most recent addition, producing guidance, and advice for the social care sector. (6) Evidence Resources Directorate—this manages digital evidence services called the ‘NICE Evidence Series’ with very helpful
search facilities for health and social care evidence, and clinical knowledge summaries on topics aimed at general practitioners. (7) NICE International—which supports other countries to use evidence-based decision-making in healthcare policy, with 13 projects taking place in the past year in countries such as China, Vietnam, and India. This is a not-for-profit fee-for-service activity. NICE works with patients, carer-givers, experts from the NHS, local authorities, and others in the public, private, voluntary, and community sectors, and the life science industries, to make independent decisions in a transparent way, based on the best available evidence. The topics that are examined are selected based on the burden of disease, the impact on resources, and whether there is inappropriate variation in practice across England. The guidance is then produced by independent advisory committees, set up by NICE. NICE currently employs approximately 560 people, with a total annual budget of around £70 million. The core teams that run the organization are relatively small, with nearly all of the work performed by advisory committees set up for specific purposes. The NICE website (www.nice.org.uk) contains all of the guidance issues by NICE, and NICE Pathways—flow charts of the key stages in the patient pathway and the evidence related to these steps. It receives more than 4 million page views each month. Smartphone users can download the NICE Guidance ‘App’, and other Apps such as the British National Formulary, which provides rapid and easy access to the latest prescribing information in the UK. This App has been downloaded more than 230 000 times since it was made available. @NICEcomms has 43 000 Twitter followers. Has NICE made a difference? Undoubtedly it helps to decrease variation in practice across England, and helps highlight where there are problems. It permits easy access to best practice guidelines for healthcare professionals, patients, and care-givers. However, implementation of NICE guidance is sometimes slower and more variable than expected because of local funding constraints and the way services are configured. Recently, NICE has set up the NICE Implementation Collaborative, a partnership between the NHS, the life sciences industry, healthcare professional bodies, key health organizations, and the public. Its aim is to identify and remove barriers to the successful implementation of NICE guidance. A recent example of its work relates to encouraging faster adoption of novel oral anticoagulation therapy for stroke prevention in atrial fibrillation.
Downloaded from http://eurheartj.oxfordjournals.org/ at Uniwersytet Warszawski Biblioteka Uniwersytecka on April 13, 2015
NICE was established in 1999 as a public body independent of the UK Government, with the remit to reduce the variation in the availability and quality of National Health Service (NHS) treatments and care in England. Since that time it has provided national guidance and advice, with the aim of promoting high-quality healthcare and public health. In 2013 its remit broadened to include issuing guidance and quality standards for social care. Its name has changed three times since it was set up, and now stands for the ‘National Institute for Health and Care Excellence’. In 2013–14 NICE published 20 new clinical guidelines, 31 technology appraisals, guidance on 34 interventional procedures, and 4 medical technologies, and advice on 8 public health topics. Guidance was also given on four diagnostic assessment topics along with the first piece of social care guidance on ‘Managing medicines in care homes’. Twenty-eight ‘Quality Standards’ were issued—concise sets of statements, with accompanying metrics, designed to drive and measure quality improvements within a particular area of care, such as heart failure. They are derived from the best available evidence, particularly NICE’s own guidance and, where this does not exist, from other evidence sources accredited by NICE. The work programme is organized around several ‘virtual’ centres, including:
196
CardioPulse
Cardiac health benefits of light drinking brought into question A reduction in alcohol consumption, even for light-to-moderate drinkers, could be linked to improved cardiovascular health, according to research published in The BMJ in 2014 1
The research, led by the London School of Hygiene & Tropical Medicine with University College London and University of Pennsylvania, looked at evidence from over 50 studies into the drinking habits and cardiovascular health of over 260 000 people. They found that individuals who carry a genetic variant which tends to lower their alcohol consumption have, on average, a more favourable cardiovascular profile. The authors say this suggests that a reduction in alcohol consumption, even for light-to-moderate drinkers, is beneficial for cardiovascular health. Specifically, the researchers found that these individuals had on average a 10% lower risk of having coronary heart disease, lower blood pressure, and a lower body mass index (BMI). In this study, the researchers used a gene to serve as an indicator of alcohol consumption. Individuals who carry a genetic variant of the ‘alcohol dehydrogenase 1B’ gene are known to breakdown alcohol at a different pace. This causes unpleasant symptoms including
nausea and facial flushing, and has been found to lead to lower levels of alcohol consumption in the long term. By using this genetic variant as an indicator of lower alcohol consumption, they were able to find associations between these individuals and improved cardiovascular health. The authors say that their study’s genetic approach parallels the principles of a randomized control trial and therefore makes it less prone to some of the limitations of previous observational studies. These limitations are partly due to bias from the effects of other good health behaviours associated with a lifestyle of low-to-moderate alcohol consumption. This may explain why a protective effect has been observed in past studies, but does not mean that alcohol itself is protective. The current study’s results strongly suggest that reduction of alcohol consumption is beneficial for cardiovascular health, and is closer to establishing causality than observational studies; however, further replication of similar genetic studies using large-scale prospective studies, such as the UK Biobank, will be needed. The study was an international collaboration that included 155 investigators from the UK, continental Europe, North America, and Australasia and was funded by the British Heart Foundation and the Medical Research Council. Andros Tofield, ESC Press Office
Reference References are available as supplementary material at European Heart Journal online.
Downloaded from http://eurheartj.oxfordjournals.org/ at Uniwersytet Warszawski Biblioteka Uniwersytecka on April 13, 2015
These latest findings challenge the results of previous observational studies which found that the consumption of light-to-moderate amounts of alcohol (12 –25 units per week) may have a protective effect on cardiovascular health.
197
CardioPulse
Wine and cardiovascular disease Wine only protects against cardiovascular disease in people who exercise according to the In Vino Veritas (IVV) study from the Czech Republic exercise. They were required to return the corks from the wine bottles to confirm that they had drank the wine rather than sold it. The researchers found that there was no difference between HDL cholesterol levels at the beginning of the study compared with 1 year in either the red or white wine groups. LDL cholesterol was lower in both groups at 1 year while total cholesterol was lower only in the red wine group. Professor Taborsky said: ‘A rise in HDL cholesterol is the main indication of a protective effect against CVD, therefore we can conclude that neither red nor white wine had any impact on the study participants as a whole’. He added: ‘The only positive and continuous result was in the subgroup of patients who exercised regularly at least twice a week, plus the wine consumption. In this group HDL cholesterol increased and LDL and total cholesterol decreased in the red and white wine groups. There may be some synergy between the low dose of alcohol in wine and exercise which is protective against CVD’. He continued: ‘In a future study we will compare the effects of red and white wine on markers of atherosclerosis in patients at high risk for CVD who take statins and do regular physical activity. We hope to find that moderate wine consumption is safe in these patients’. Professor Taborsky concluded: ‘Our current study shows that the combination of moderate wine drinking plus regular exercise improves markers of atherosclerosis, suggesting that this combination is protective against cardiovascular disease’. Andros Tofield, ESC Press Office
Reference 1. Taborsky M, Ostadal P, Petrek M. A pilot randomized trial comparing long-term effects of red and white wines on biomarkers of atherosclerosis (In Vino Veritas: IVV trial). Bratisl Lek Listy 2012;113:156–158.
Downloaded from http://eurheartj.oxfordjournals.org/ at Uniwersytet Warszawski Biblioteka Uniwersytecka on April 13, 2015
Professor Milos Taborsky from the Czech Republic presented results from the In Vino Veritas (IVV) study at ESC Congress 2014. He stated ‘this is the first randomised trial comparing the effects of red and white wine on markers of atherosclerosis in people at mild to moderate risk of CVD. We found that moderate wine drinking was only protective in people who exercised. Red and white wine produced the same results’. Evidence suggesting that mild-to-moderate consumption of wine protects against cardiovascular disease has been accumulating since the early 1990s. In particular, retrospective studies have found that wine increases levels of HDL. But until now there has been no longterm, prospective, randomized study comparing the effects of red and white wine on HDL cholesterol and other markers of atherosclerosis. The IVV study1 is the first long-term, prospective randomized trial comparing the effect of red and white wine on markers of atherosclerosis. The study included 146 people with mild-to-moderate risk of cardiovascular disease according to the HeartScore. Participants were randomized to 1 year of moderate consumption of red wine (Pinot Noir) or white wine (Chardonnay-Pinot) from the same year and wine region of the Czech Republic. Moderate consumption was the World Health Organization definition of 0.2 L for women and 0.3 L for men, a maximum of five times a week. The primary endpoint was the level of HDL cholesterol at 1 year. Secondary endpoints were levels of other markers of atherosclerosis including LDL cholesterol. Participants consumed their usual diet. Participants kept a logbook on their consumption of wine and other alcoholic beverages, medication use, and amount and type of
198
CardioPulse
Book Review Arrhythmias in Women – Diagnosis and Management Editors-in-Chief: Yong-Mei Cha, Margaret A. Lloyd, Ulrika M. Birgersdotter-Green. Publisher: Mayo Clinic Scientific Press ISBN: 9780199321971
Our understanding of cardiac arrhythmias has significantly improved over the last decades. Until the late 1980s invasive electrophysiology procedures were mainly diagnostic, while antiarrhythmic drugs and pacemakers constituted the mainstay of therapy. Significant improvements in catheter ablation of cardiac arrhythmias and complex cardiac rhythm devices have paved the way for new therapeutic options in this field. Indeed, the expertise in arrhythmia management has grown rapidly in recent years and numerous books about this topic have been published. However, specific aspects regarding the diagnosis and treatment of cardiac conditions in women have not been paid sufficient tribute to date. ‘Arrhythmias in Women—Diagnosis and Management’ fulfils the requirement of a comprehensive, easily understandable, and clinically useful information resource on cardiac arrhythmias and their management, with a particular focus on the female gender, which has not been sufficiently addressed in most other books. The editors—key female opinion leaders in the field of electrophysiology from Mayo Clinic and the University of California, San Diego—have to be congratulated for composing this very informative source of knowledge. The book consists of 15 chapters covering various aspects of cardiac arrhythmias in women including sex-specific electrophysiologic properties, risk stratification for sudden cardiac death, catheter ablation, cardiac rhythm device management, and important issues related to pregnancy and cardiac arrhythmias. ‘Arrhythmias in Women—Diagnosis and Management’ includes elaborate data on important clinical trials with a particular focus on gender-specific differences, illustrative tables and figures, global perspectives, and a chapter dedicated to the concept of a Women’s Heart Clinic. While reading this textbook it is important to keep in mind—and the reader is frequently reminded thereof by the authors—that historically, women have been underrepresented in many landmark
clinical trials in the field. For this reason, most of our diagnostic and therapeutic strategies in cardiac arrhythmias are derived from data on males and often extrapolated to the female gender. As a result, questions remain as to whether women really benefit from current diagnostic and therapeutic strategies in cardiac electrophysiology to the same extent as men. Therefore, this book also emphasizes the need for well-designed prospective studies enrolling more women—a strategy that has been followed by leading institutions such as the NIH Department of Health and Human Services since the 1990s—and single-gender randomized controlled studies to answer important questions in the field. As a cardiologist with a special expertise in cardiac electrophysiology, I found this textbook of great value as I was not fully aware of some important gender-specific aspects related to cardiac arrhythmias. I therefore recommend this unique book to everyone who seeks to better understand and manage cardiac arrhythmias in women, a topic which to date has not been paid sufficient attention.
CardioPulse contact: Andros Tofield, Managing Editor. Email: [email protected]
Downloaded from http://eurheartj.oxfordjournals.org/ at Uniwersytet Warszawski Biblioteka Uniwersytecka on April 13, 2015
Paperback, 296 pages
The European Society of Cardiology and European Heart Journal at the Spanish Society of Cardiology Congress 2014
As with most National Societies, the Spanish Society of Cardiology (Sociedad Espan˜ola de Cardiologı´a) has been holding an annual meeting for many years. In Spain, the location of the congress changes every year. Last year (2014), El Congreso de las Enfermedades Cardiovasculares SEC 2014 took place in Santiago de Compostela from 30 October to 1 November 2014 under the leadership of its current president Jose´ Ramo´n Gonza´lez-Juanatey, MD, PhD, FESC. Lina Badimon from Barcelona, a well-known cardiovascular scientist trained at the Mayo Clinic in Rochester, MN (1990–1992) and Director of the Cardiology Research Laboratory at the Mount Sinai Hospital in New York (1983–1992) and at the Massachusetts General Hospital in Boston (1992–1995), and currently the Director of the Barcelona Cardiovascular Research Center, CSIC-ICCC at the Hospital Sta. Creu i S. Pau and Vice-President of the Spanish Society of Cardiology, was responsible for the programme. In addition to numerous cardiologists and researchers from Spain, many experts from other European countries and the USA, as well as representatives of the European Society of Cardiology and the American College of Cardiology, were part of the faculty. A total of 3300 participants attended the National Congress, of which 2300 were clinical cardiologists and scientists.
Speakers at Hot Topics Session (from left to right: Stewart Peacock, J.R. Gonzalez-Juanatey, Lina Badimon, Fausto Pinto, Pat O’Gara, and Keith Fox)
Franz-Josef Neumann at SEC 2014
Published on behalf of the European Society of Cardiology. All rights reserved. & The Author 2015. For permissions please email: [email protected].
Downloaded from http://eurheartj.oxfordjournals.org/ at Uniwersytet Warszawski Biblioteka Uniwersytecka on April 13, 2015
Spanish Society of Cardiology
Keith Fox, chairman of the program committee of the European Society of Cardiology’s annual congress in Barcelona, gave a brilliant review of the important presentations at this congress, while Fausto Pinto, the current president of the European Society of Cardiology, reviewed the current state of the art of cardiovascular imaging. Pat O’Gara, President of ACC, reviewed the most important presentations of the ACC meeting in Washington in 2014. Another prominent lecturer was Stewart Peacock from London. Furthermore, the incoming president of the American College of Cardiology, Dr Kim A. Williams, from Rush University in Chicago, discussed nuclear imaging in cardiac patients. The European Heart Journal was represented by its editor-in-chief Prof. Thomas F. Lu¨scher who together with Antoni Baye´s-Genis from Barcelona chaired a session on ‘Lo mejor del European Heart Journal y Revista Espan˜ola de Cardiologı´a’ (The Best of the European Heart Journal and Revista Espan˜ola de Cardiologı´a). The most important publications from the European Heart Journal and the official journal of the Spanish Society of Cardiology, as well as other important works, were reviewed by four expert cardiologists from Germany, Greece, and Spain. John Parissis from Athens, Greece, reviewed the most important papers in the field of heart failure, whilst Franz-Josef Neumann, Director of the University Heart Center, Freiburg-Bad Krozingen, Germany, discussed important publications in interventional cardiology.
192
CardioPulse
The arrhythmias were reviewed by Dr Ferna´ndez Lozano from Madrid, while Dr Javier Bermejo Thomas also from Madrid discussed important publications in cardiac imaging. The Revista Espan˜ola de Cardiologı´a has made a remarkable impact during the last years thanks to the late Dr Magda Heras Fortuny, who until her unfortunate and untimely death was editor-in-chief of the Spanish national journal. The Revista Espan˜ola de Cardiologı´a publishes all papers in English and Spanish, thereby
being attractive to cardiologists not only in Spain, but also in Central and South America. Next year’s congress of the Spanish Society of Cardiology will be held in Bilbao in the Basque country, again under the program leadership of Lina Badimon and its current president Jose´ Ramo´n Gonza´lez-Juanatey. Andros Tofield
A new position was created on the EHJ Editorial Board to facilitate the selection and management of clinical review articles and to reduce their time to publication On 1 November 2014, Freek W.A. Verheugt, MD, FESC, FACC, FAHA was appointed as Associate Editor of European Heart Journal for Clinical Review papers. He is Emeritus Professor of Cardiology at the Heart-Lung Centre of the University Medical Centre of Nijmegen and was Chairman of the Department of Cardiology, Onze Lieve Vrouwe Gasthuis (OLVG) in Amsterdam, Netherlands. He is an editorial adviser of Lancet, New England Journal of Medicine, and Circulation. Bringing with him his broad clinical, editorial, and scientific experience the journal will benefit from his skills in this field. Professor Verheugt was born and raised in Amsterdam, The Netherlands, and graduated from the Ignatius Gymnasium in 1967. He studied Medicine at the University of Leiden and Amsterdam, where he received his MD in 1974. He wrote a thesis on platelet and granulocyte antigens and antibodies and trained in cardiology at the Thoraxcenter of the Erasmus University in Rotterdam. With his special interest in platelets and coagulation in heart disease, he went to the USA, where he has been a Professor at the University of Colorado Health Sciences Center in Denver, Colorado.
In 1982 he returned to Amsterdam and became Professor of Cardiology at the Free University, then in 1997 he was appointed Chief of Cardiology at the Heart-Lung Centre of the University Medical Centre of Nijmegen. He has been President of the Netherlands Society of Cardiology during 1999– 2001. Prof. Verheugt has published over 500 papers in peer-reviewed international journals including New England Journal of Medicine, Lancet, Circulation, Journal of the American College of Cardiology, and European Heart Journal, of which he is an Editorial Board Member. He has over 23 000 citations and an H-index of 63. His main fields of scientific interest are pharmacological and interventional treatments of acute coronary syndromes and atrial fibrillation. The journal plans to expand the number of Clinical Reviews because they are popular, highly cited, and often downloaded. Prof. Verheugt’s experience will be valuable to facilitate the review process. Andros Tofield
The Belgian Society of Cardiology (BSC) Guy Van Camp, BCS president, discusses the Society’s position which is at the centre of the European Community in Brussels The BCS is a scientific organization and its main goal is the promotion in Belgium of: scientific activities educational activities initiatives aiming to increase the quality of care for patients suffering from cardiovascular diseases. Guy Van Camp
Belgian Society of Cardiology
The management of the BSC is organized by its board (http://www. bscardio.be).
Downloaded from http://eurheartj.oxfordjournals.org/ at Uniwersytet Warszawski Biblioteka Uniwersytecka on April 13, 2015
EHJ Associate Editor review articles: Professor Freek W.A. Verheugt
193
CardioPulse
† Belgian Working Group of Interventional Cardiology (http://www. bwgic.org), † Belgian Heart Rhythm Association (http://www.behra.eu/en), † Belgian Working Group on Non-Invasive Cardiac Imaging (https:// sites.google.com/site/bwgnici), † Belgian Working Group on Heart Failure and Cardiac Function (http://bwghf.be/), † Belgian Working Group on Cardiovascular Prevention and Rehabilitation, † Belgian Interdisciplinary Working Group on Acute Cardiology (http://www.biwac.be), † Belgian Working Group on Adult Congenital Heart Disease (http:// www.bwgachd.be), † Belgian Working Group on Cardiovascular Nursing and the Young Cardiologists Club (http://www.ycc.be), † These working groups are the cornerstones of the BSC, each organizing educational and scientific events. An overview of the working
groups and their activities can be found at the website of the BSC and on the individual websites: http://www.bscardio.be. The BSC is proud to have its own international journal for the society: Acta Cardiologica. All information about the journal and how to submit your scientific work can be found at the website: http://www .actacardiologica.be. The financial crisis in Europe requires that the BSC also has an important supplementary task. Close contacts with the government and reimbursement institutions in Belgium are becoming more and more important. The main goal is to guarantee the maintenance of a high-quality level of care for patients with cardiovascular diseases, following the ESC guidelines and recommendations. Linear restrictions in reimbursement of cardiovascular technical procedures on the one hand and the lack of a prospective strategy for reimbursement of new innovative techniques illustrates the difficulties the BSC has to face in this domain. Despite these economic constraints, the growing number of members of the BSC and of the participants during the scientific meetings organized by the BSC and its Working Groups illustrate the dynamic nature and enthusiasm of the cardiological community in Belgium. This is also reflected by the very active role of several BSC members within the ESC, in the past and now in the present. It is the ambition of the BSC to maintain this tradition of excellent collaboration with the ESC. The central place of Belgium within Europe and the recent opening of a ‘European Heart House’ within Brussels are stimulating factors promoting this close collaboration. Guy Van Camp Cardiovascular Center OLV Aalst, Belgium President of the BSC. [email protected]
Profile: Marc A. Pfeffer, MD PhD Marc Pfeffer is the Dzau Professor of Medicine at Harvard Medical School and Senior Physician in Cardiology at the Brigham and Women’s Hospital in Boston, Massachusetts. He is a globally recognized expert clinical investigator with interests in the pathophysiology of progressive cardiac dysfunction following myocardial infarction and in the design and conduct of clinical trials to improve therapeutic decision-making. Marc Pfeffer was born in Brooklyn, a borough of New York City. Although his parents were not wealthy, he was encouraged to pursue an education to strive for ‘an occupation where you wear a tie’. He did well at high school gaining acceptance to a tuition-free education at Brooklyn College. However, a chance encounter with the Director of Admissions from Rockford College, Illinois, and subsequent scholarship, offered an alternative. He took a leap of faith and left Brooklyn for the first time to travel to Rockford. He found the relaxed style of learning at this small liberal arts college to his liking and he thrived there. Importantly, he met his first wife, Janice Sikorski, a fellow biology major.
Janice and Marc Pfeffer In 1969, the Pfeffers graduated from Rockford College, were married, and moved to the University of Oklahoma, where Marc was awarded a scholarship in medical physiology. Janice accepted a position in the lab of Edward Frohlich, MD, the Director of Clinical and Experimental Hypertension. Pfeffer rotated through several laboratories at Oklahoma and chose to work in Frohlich’s lab alongside Janice. This marked the start of an auspicious professional collaboration and Pfeffer would become Frohlich’s first graduate student with his thesis on the changes in cardiac function with ageing in the spontaneously hypertensive rat. Janice became Frohlich’s second PhD
Downloaded from http://eurheartj.oxfordjournals.org/ at Uniwersytet Warszawski Biblioteka Uniwersytecka on April 13, 2015
The BSC works in close collaboration with the College of Cardiology, the official organization responsible for quality control within cardiology in Belgium and with the Belgian patient’s organization BCL-LCB (http://www.liguecardioliga.be). The number of cardiologists who are members of the BSC is continuously increasing and in January 2014, 498 cardiologists were members of the BSC. The scientific highlight is the annual meeting of the BSC which takes place during the last Thursday and Friday of January in the centre of Brussels. About 600 cardiologists and cardiologists in training participate in this scientific happening. National and international speakers each year guarantee important high-level scientific information. The daily activities are however organized by the different working groups:
194
and provided the rationale and justification for Pfeffer’s first major clinical outcomes study—Survival and Ventricular Enlargement (SAVE). In this international trial, he and his collaborators demonstrated that the use of an ACE inhibitor could prolong survival in patients experiencing an acute myocardial infarction. Since then, the randomized-controlled clinical trial has been Pfeffer’s major investigative tool. After SAVE, Pfeffer went from strength to strength. His output was as prolific as it was influential with key leadership roles in trials such as: CARE, CHARM, VALIANT, PEACE, ARISE, TREAT, ALTITUDE, RED-HF TOPCAT, and other well-known studies. Through these activities and others such as data safety monitoring committees, he has developed strong collaborations and friendships in the international cardiovascular community. In 2006, he was identified by Science Watch as having the most ‘Hot Papers’ in all of clinical medicine and he is currently one of the most highly cited medical scientists. He says the ‘proof of a good trial is that it generates sufficiently robust evidence to improve the practice of medicine’. When Janice Pfeffer died in 2000, Pfeffer lost his loving wife, foremost collaborator, and research inspiration, and the scientific community a leading light. Her friends and colleagues and notably mentors, Edward Frohlich and Eugene Braunwald, assisted Pfeffer in establishing a permanent endowment scholarship fund at Rockford College as a memorial to Janice’s distinguished career. Its aim is to foster women’s education in science—a cause which was close to Janice’s heart as she had to address financial issues to pursue her education. With a scholarship awarded each year, there have already been over six graduates pursuing their passion in science. The Pfeffers’ children, Katie, a nutritionist in the Boston area, and Michael, a second-year medical student in the Ochsner/Queensland University programme, also contribute to her legacy. Pfeffer has remarried and he enjoys saying that his wife, US Federal Magistrate Judge the Honourable Marianne Bowler, ‘conducts more trials than he does’. Pfeffer’s ability to collaborate and build teams and advance young investigative careers is a great asset for a clinical researcher and has been a source of pride. He believes he has had a CHARMed life with wonderful opportunities, had and still has, world-class mentors, and has been afforded the privilege of working with quality individuals sharing the common purpose of generating meaningful information to improve prognosis of patients with cardiovascular disease. He believes that this wonderful aspect of academic medicine remains open to young investigators who will also have many opportunities to share their academic journey with others.
Reference 1. Pfeffer MA, Lamas GA, Vaughan DE, Parisi AF, Braunwald E. Effect of captopril on progressive ventricular dilatation after anterior myocardial infarction. N Engl J Med 1988; 319:80 –86.
Downloaded from http://eurheartj.oxfordjournals.org/ at Uniwersytet Warszawski Biblioteka Uniwersytecka on April 13, 2015
student and her thesis was entitled, ‘Longitudinal Changes in Cardiac Function and Geometry during the Natural Development of Left Ventricular Hypertrophy in the Spontaneously Hypertensive Rat’. At that time there was very little work on haemodynamics in the rat or assessment of cardiac performance in animals with genetic hypertension and the Pfeffers were keen to explore this area. Under Frohlich’s influence Pfeffer went on to complete a medical degree to enable him to translate his lab work into developing therapies for cardiovascular diseases. By the mid-1970s and at a relatively young age, the couple had amassed a substantial body of work on hypertension, hypertrophy, and cardiac function which eventually brought them to the attention of Eugene Braunwald, MD. Pfeffer gave a presentation at a scientific meeting outlining work that appeared to contradict an aspect of Braunwald’s findings regarding cardiac function during the development of ventricular hypertrophy. He had no idea the eminent cardiologist was in the audience until Braunwald approached him and invited him to Boston to discuss these findings. Consequently, Braunwald offered Pfeffer, then a medical student, an internship at the then Peter Bent Brigham Hospital currently Brigham and Women’s Hospital. Pfeffer says he ‘moved to Boston to be under the mentorship of Braunwald, the person, rather than Harvard, the Institution’. This was an exciting time and place as Braunwald was actively generating the scientific evidence for the salvage of myocytes during an acute MI—the foundation of modern acute clinical MI care. Although the Pfeffers were in awe of Braunwald, they were determined to plough their own furrow exploring the long-term consequences of a myocardial infarction on ventricular size, shape, and function rather than acute infarct size limitation. He said: ‘We all knew that during an acute myocardial infarction there was a relationship between the loss of myocytes and the degree of diminished ventricular function. The long-term consequences of structure and the function of the ventricle following an infarction were less well established. One of their major discoveries was that there was a time dependent process of adverse left ventricular enlargement and shape distortion (remodelling) following myocardial infarction’. They then demonstrated in an experimental model that an angiotensin-converting enzyme inhibitor could attenuate this deleterious process. This concept of adverse ventricular remodelling and its modification is now a central tenet in the discovery of drugs purported to improve ventricular function. Pfeffer gives credit to Janice for the genesis of this now entrenched concept. The couple applied their understanding of adverse remodelling to rodents and used captopril to favourably modify the relation between infarct size and long-term LV performance. The discovery that captopril also prolonged survival in the rat model attracted funding for a small clinical randomized trial to determine whether an ACE inhibitor could reduce ventricular enlargement following a myocardial infarction in humans. This was Pfeffer’s first clinical trial, which showed both progressive enlargement in patients with acute MI as well as the favourable modification of this process with an ACE inhibitor. These findings published in the New England Journal of Medicine,1 did not go unnoticed,
CardioPulse
195
CardioPulse
National Institute for Health and Care Excellence Professor Martin R. Cowie MD FESC discusses the UK’s NICE (The National Institute for Health and Care Excellence) Institution which produces the NICE practice guidelines for clinical care
(1) Centre for Clinical Practice—develops clinical guidelines on the treatment and care of specific disease or conditions for people working in the NHS. (2) Centre for Public Health—develops guidance on the prevention of disease and promotion of good health for those working in the NHS, local authorities, the wider public and private, and voluntary sectors. (3) Centre for Health Technology Evaluation—develops guidance on the use of new and existing treatments and procedures, such as medicines, medical devices, diagnostic techniques, and surgical procedures. The Scientific Advice Programme sits here along with the research and development team and the Highly Specialised Technologies Programme. The Scientific Advice programme was established in 2009, and has advised 27 different manufactures on 94 different projects in 57 disease areas. (4) Communications directorate—responsible for raising awareness of NICE work among key audiences and external partners and for dissemination of NICE guidance, and press and public enquiries. (5) Health and Social Care Directorate—the most recent addition, producing guidance, and advice for the social care sector. (6) Evidence Resources Directorate—this manages digital evidence services called the ‘NICE Evidence Series’ with very helpful
search facilities for health and social care evidence, and clinical knowledge summaries on topics aimed at general practitioners. (7) NICE International—which supports other countries to use evidence-based decision-making in healthcare policy, with 13 projects taking place in the past year in countries such as China, Vietnam, and India. This is a not-for-profit fee-for-service activity. NICE works with patients, carer-givers, experts from the NHS, local authorities, and others in the public, private, voluntary, and community sectors, and the life science industries, to make independent decisions in a transparent way, based on the best available evidence. The topics that are examined are selected based on the burden of disease, the impact on resources, and whether there is inappropriate variation in practice across England. The guidance is then produced by independent advisory committees, set up by NICE. NICE currently employs approximately 560 people, with a total annual budget of around £70 million. The core teams that run the organization are relatively small, with nearly all of the work performed by advisory committees set up for specific purposes. The NICE website (www.nice.org.uk) contains all of the guidance issues by NICE, and NICE Pathways—flow charts of the key stages in the patient pathway and the evidence related to these steps. It receives more than 4 million page views each month. Smartphone users can download the NICE Guidance ‘App’, and other Apps such as the British National Formulary, which provides rapid and easy access to the latest prescribing information in the UK. This App has been downloaded more than 230 000 times since it was made available. @NICEcomms has 43 000 Twitter followers. Has NICE made a difference? Undoubtedly it helps to decrease variation in practice across England, and helps highlight where there are problems. It permits easy access to best practice guidelines for healthcare professionals, patients, and care-givers. However, implementation of NICE guidance is sometimes slower and more variable than expected because of local funding constraints and the way services are configured. Recently, NICE has set up the NICE Implementation Collaborative, a partnership between the NHS, the life sciences industry, healthcare professional bodies, key health organizations, and the public. Its aim is to identify and remove barriers to the successful implementation of NICE guidance. A recent example of its work relates to encouraging faster adoption of novel oral anticoagulation therapy for stroke prevention in atrial fibrillation.
Downloaded from http://eurheartj.oxfordjournals.org/ at Uniwersytet Warszawski Biblioteka Uniwersytecka on April 13, 2015
NICE was established in 1999 as a public body independent of the UK Government, with the remit to reduce the variation in the availability and quality of National Health Service (NHS) treatments and care in England. Since that time it has provided national guidance and advice, with the aim of promoting high-quality healthcare and public health. In 2013 its remit broadened to include issuing guidance and quality standards for social care. Its name has changed three times since it was set up, and now stands for the ‘National Institute for Health and Care Excellence’. In 2013–14 NICE published 20 new clinical guidelines, 31 technology appraisals, guidance on 34 interventional procedures, and 4 medical technologies, and advice on 8 public health topics. Guidance was also given on four diagnostic assessment topics along with the first piece of social care guidance on ‘Managing medicines in care homes’. Twenty-eight ‘Quality Standards’ were issued—concise sets of statements, with accompanying metrics, designed to drive and measure quality improvements within a particular area of care, such as heart failure. They are derived from the best available evidence, particularly NICE’s own guidance and, where this does not exist, from other evidence sources accredited by NICE. The work programme is organized around several ‘virtual’ centres, including:
196
CardioPulse
Cardiac health benefits of light drinking brought into question A reduction in alcohol consumption, even for light-to-moderate drinkers, could be linked to improved cardiovascular health, according to research published in The BMJ in 2014 1
The research, led by the London School of Hygiene & Tropical Medicine with University College London and University of Pennsylvania, looked at evidence from over 50 studies into the drinking habits and cardiovascular health of over 260 000 people. They found that individuals who carry a genetic variant which tends to lower their alcohol consumption have, on average, a more favourable cardiovascular profile. The authors say this suggests that a reduction in alcohol consumption, even for light-to-moderate drinkers, is beneficial for cardiovascular health. Specifically, the researchers found that these individuals had on average a 10% lower risk of having coronary heart disease, lower blood pressure, and a lower body mass index (BMI). In this study, the researchers used a gene to serve as an indicator of alcohol consumption. Individuals who carry a genetic variant of the ‘alcohol dehydrogenase 1B’ gene are known to breakdown alcohol at a different pace. This causes unpleasant symptoms including
nausea and facial flushing, and has been found to lead to lower levels of alcohol consumption in the long term. By using this genetic variant as an indicator of lower alcohol consumption, they were able to find associations between these individuals and improved cardiovascular health. The authors say that their study’s genetic approach parallels the principles of a randomized control trial and therefore makes it less prone to some of the limitations of previous observational studies. These limitations are partly due to bias from the effects of other good health behaviours associated with a lifestyle of low-to-moderate alcohol consumption. This may explain why a protective effect has been observed in past studies, but does not mean that alcohol itself is protective. The current study’s results strongly suggest that reduction of alcohol consumption is beneficial for cardiovascular health, and is closer to establishing causality than observational studies; however, further replication of similar genetic studies using large-scale prospective studies, such as the UK Biobank, will be needed. The study was an international collaboration that included 155 investigators from the UK, continental Europe, North America, and Australasia and was funded by the British Heart Foundation and the Medical Research Council. Andros Tofield, ESC Press Office
Reference References are available as supplementary material at European Heart Journal online.
Downloaded from http://eurheartj.oxfordjournals.org/ at Uniwersytet Warszawski Biblioteka Uniwersytecka on April 13, 2015
These latest findings challenge the results of previous observational studies which found that the consumption of light-to-moderate amounts of alcohol (12 –25 units per week) may have a protective effect on cardiovascular health.
197
CardioPulse
Wine and cardiovascular disease Wine only protects against cardiovascular disease in people who exercise according to the In Vino Veritas (IVV) study from the Czech Republic exercise. They were required to return the corks from the wine bottles to confirm that they had drank the wine rather than sold it. The researchers found that there was no difference between HDL cholesterol levels at the beginning of the study compared with 1 year in either the red or white wine groups. LDL cholesterol was lower in both groups at 1 year while total cholesterol was lower only in the red wine group. Professor Taborsky said: ‘A rise in HDL cholesterol is the main indication of a protective effect against CVD, therefore we can conclude that neither red nor white wine had any impact on the study participants as a whole’. He added: ‘The only positive and continuous result was in the subgroup of patients who exercised regularly at least twice a week, plus the wine consumption. In this group HDL cholesterol increased and LDL and total cholesterol decreased in the red and white wine groups. There may be some synergy between the low dose of alcohol in wine and exercise which is protective against CVD’. He continued: ‘In a future study we will compare the effects of red and white wine on markers of atherosclerosis in patients at high risk for CVD who take statins and do regular physical activity. We hope to find that moderate wine consumption is safe in these patients’. Professor Taborsky concluded: ‘Our current study shows that the combination of moderate wine drinking plus regular exercise improves markers of atherosclerosis, suggesting that this combination is protective against cardiovascular disease’. Andros Tofield, ESC Press Office
Reference 1. Taborsky M, Ostadal P, Petrek M. A pilot randomized trial comparing long-term effects of red and white wines on biomarkers of atherosclerosis (In Vino Veritas: IVV trial). Bratisl Lek Listy 2012;113:156–158.
Downloaded from http://eurheartj.oxfordjournals.org/ at Uniwersytet Warszawski Biblioteka Uniwersytecka on April 13, 2015
Professor Milos Taborsky from the Czech Republic presented results from the In Vino Veritas (IVV) study at ESC Congress 2014. He stated ‘this is the first randomised trial comparing the effects of red and white wine on markers of atherosclerosis in people at mild to moderate risk of CVD. We found that moderate wine drinking was only protective in people who exercised. Red and white wine produced the same results’. Evidence suggesting that mild-to-moderate consumption of wine protects against cardiovascular disease has been accumulating since the early 1990s. In particular, retrospective studies have found that wine increases levels of HDL. But until now there has been no longterm, prospective, randomized study comparing the effects of red and white wine on HDL cholesterol and other markers of atherosclerosis. The IVV study1 is the first long-term, prospective randomized trial comparing the effect of red and white wine on markers of atherosclerosis. The study included 146 people with mild-to-moderate risk of cardiovascular disease according to the HeartScore. Participants were randomized to 1 year of moderate consumption of red wine (Pinot Noir) or white wine (Chardonnay-Pinot) from the same year and wine region of the Czech Republic. Moderate consumption was the World Health Organization definition of 0.2 L for women and 0.3 L for men, a maximum of five times a week. The primary endpoint was the level of HDL cholesterol at 1 year. Secondary endpoints were levels of other markers of atherosclerosis including LDL cholesterol. Participants consumed their usual diet. Participants kept a logbook on their consumption of wine and other alcoholic beverages, medication use, and amount and type of
198
CardioPulse
Book Review Arrhythmias in Women – Diagnosis and Management Editors-in-Chief: Yong-Mei Cha, Margaret A. Lloyd, Ulrika M. Birgersdotter-Green. Publisher: Mayo Clinic Scientific Press ISBN: 9780199321971
Our understanding of cardiac arrhythmias has significantly improved over the last decades. Until the late 1980s invasive electrophysiology procedures were mainly diagnostic, while antiarrhythmic drugs and pacemakers constituted the mainstay of therapy. Significant improvements in catheter ablation of cardiac arrhythmias and complex cardiac rhythm devices have paved the way for new therapeutic options in this field. Indeed, the expertise in arrhythmia management has grown rapidly in recent years and numerous books about this topic have been published. However, specific aspects regarding the diagnosis and treatment of cardiac conditions in women have not been paid sufficient tribute to date. ‘Arrhythmias in Women—Diagnosis and Management’ fulfils the requirement of a comprehensive, easily understandable, and clinically useful information resource on cardiac arrhythmias and their management, with a particular focus on the female gender, which has not been sufficiently addressed in most other books. The editors—key female opinion leaders in the field of electrophysiology from Mayo Clinic and the University of California, San Diego—have to be congratulated for composing this very informative source of knowledge. The book consists of 15 chapters covering various aspects of cardiac arrhythmias in women including sex-specific electrophysiologic properties, risk stratification for sudden cardiac death, catheter ablation, cardiac rhythm device management, and important issues related to pregnancy and cardiac arrhythmias. ‘Arrhythmias in Women—Diagnosis and Management’ includes elaborate data on important clinical trials with a particular focus on gender-specific differences, illustrative tables and figures, global perspectives, and a chapter dedicated to the concept of a Women’s Heart Clinic. While reading this textbook it is important to keep in mind—and the reader is frequently reminded thereof by the authors—that historically, women have been underrepresented in many landmark
clinical trials in the field. For this reason, most of our diagnostic and therapeutic strategies in cardiac arrhythmias are derived from data on males and often extrapolated to the female gender. As a result, questions remain as to whether women really benefit from current diagnostic and therapeutic strategies in cardiac electrophysiology to the same extent as men. Therefore, this book also emphasizes the need for well-designed prospective studies enrolling more women—a strategy that has been followed by leading institutions such as the NIH Department of Health and Human Services since the 1990s—and single-gender randomized controlled studies to answer important questions in the field. As a cardiologist with a special expertise in cardiac electrophysiology, I found this textbook of great value as I was not fully aware of some important gender-specific aspects related to cardiac arrhythmias. I therefore recommend this unique book to everyone who seeks to better understand and manage cardiac arrhythmias in women, a topic which to date has not been paid sufficient attention.
CardioPulse contact: Andros Tofield, Managing Editor. Email: [email protected]
Downloaded from http://eurheartj.oxfordjournals.org/ at Uniwersytet Warszawski Biblioteka Uniwersytecka on April 13, 2015
Paperback, 296 pages
