Featured Research

from universities, journals, and other organizations

Intensive therapy for narrowed arteries linked to fewer heart events

Date:
December 20, 2009
Source:
JAMA and Archives Journals
Summary:
Intensive medical therapy, including aggressive control of blood pressure and cholesterol levels, for patients with asymptomatic plaque buildup in their carotid arteries (which supply blood to the brain) appears to be associated with reduced rates of cardiovascular events and reduced risk of microemboli (microscopic-sized blood clots) in the brain arteries, according to a new study.

Intensive medical therapy, including aggressive control of blood pressure and cholesterol levels, for patients with asymptomatic plaque buildup in their carotid arteries (which supply blood to the brain) appears to be associated with reduced rates of cardiovascular events and reduced risk of microemboli (microscopic-sized blood clots) in the brain arteries, according to a report posted online now that will appear in the February 2010 print issue of Archives of Neurology, one of the JAMA/Archives journals.

Patients with this plaque buildup, known as asymptomatic carotid stenosis, are at increased risk of heart attack, stroke and death, according to background information in the article. Microscopic-sized blood clots known as microemboli appear to be associated with the risk of stroke in these patients. A surgical procedure known as carotid endarterectomy can remove plaque and may reduce stroke risk; however, its benefit and risks for those without symptoms remains under debate.

J. David Spence, M.D., of the Stroke Prevention and Atherosclerosis Research Centre, Robarts Research Institute, London, Ontario, Canada, and colleagues studied 468 patients (average age 69.7) with asymptomatic carotid stenosis. Each patient's plaque areas were assessed when they enrolled in the study and then approximately annually throughout the study. They also underwent a procedure known as transcranial Doppler to detect microemboli in the brain arteries.

Of the participants, 199 were enrolled between 2000 and 2002. The other 269 were enrolled between 2003 and 2007. By 2003, the clinic at which the study was conducted implemented an intensive medical treatment program for asymptomatic carotid stenosis. The approach involved showing plaque measurements and images to the patients to motivate them to make diet, exercise and other lifestyle changes; more aggressive pharmacotherapy for cholesterol levels and insulin resistance; and optimizing blood pressure control. All were followed up for at least one year, through July 2008.

Patients who began the study following the implementation of this intensive medical therapy were less likely to have microemboli (3.7 percent after 2003 vs. 12.6 percent before 2003). This decline in microemboli coincided with better control of blood cholesterol levels and slower progression of the total plaque area in the carotid artery (23 square millimeters vs. 69 square millimeters in the first year of follow-up). "Since 2003, there have been significantly fewer cardiovascular events among patients with asymptomatic carotid stenosis: 17.6 percent had stroke, death, myocardial infarction or carotid endarterectomy for symptoms before 2003, vs. 5.6 percent since 2003," the authors write.

Study participants with microemboli had significantly more cardiovascular events in both time periods -- 32.4 percent of patients with microemboli had a stroke or heart attack, died or underwent carotid endarterectomy for symptoms, compared with 8.6 percent of those without microemboli.

"The arguments against routine revascularization [through a procedure such as carotid endarterectomy] of patients with asymptomatic carotid stenosis have previously been reviewed," the authors write. "Given our finding that intensive medical therapy has reduced the prevalence of microemboli to only 3.7 percent and markedly reduced cardiovascular events, particularly stroke, we suggest that such intensive medical therapy be regarded as the first line of therapy for patients with asymptomatic carotid stenosis. Given that with intensive medical therapy, the risk of stroke in patients without microemboli is less than the risk of endarterectomy or stenting, we think that revascularization should be considered only for the rare patients with microemboli."

This work was supported by grants from the Heart and Stroke Foundation of Ontario. It was also supported by donations to the Stroke Prevention and Atherosclerosis Research Centre.


Story Source:

The above story is based on materials provided by JAMA and Archives Journals. Note: Materials may be edited for content and length.


Journal Reference:

  1. J. David Spence; Victoria Coates; Hector Li; Arturo Tamayo; Claudio Munoz; Daniel G. Hackam; Maria DiCicco; Janine DesRoches; Chrysi Bogiatzi; Jonathan Klein; Joaquim Madrenas; Robert A. Hegele. Effects of Intensive Medical Therapy on Microemboli and Cardiovascular Risk in Asymptomatic Carotid Stenosis. Arch Neurol, Published online 2009 [link]

Cite This Page:

JAMA and Archives Journals. "Intensive therapy for narrowed arteries linked to fewer heart events." ScienceDaily. ScienceDaily, 20 December 2009. <www.sciencedaily.com/releases/2009/12/091214162326.htm>.
JAMA and Archives Journals. (2009, December 20). Intensive therapy for narrowed arteries linked to fewer heart events. ScienceDaily. Retrieved September 2, 2014 from www.sciencedaily.com/releases/2009/12/091214162326.htm
JAMA and Archives Journals. "Intensive therapy for narrowed arteries linked to fewer heart events." ScienceDaily. www.sciencedaily.com/releases/2009/12/091214162326.htm (accessed September 2, 2014).

Share This




More Health & Medicine News

Tuesday, September 2, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

Get on Your Bike! London Cycling Popularity Soars Despite Danger

Get on Your Bike! London Cycling Popularity Soars Despite Danger

AFP (Sep. 1, 2014) Wedged between buses, lorries and cars, cycling in London isn't for the faint hearted. Nevertheless the number of people choosing to bike in the British capital has doubled over the past 15 years. Duration: 02:27 Video provided by AFP
Powered by NewsLook.com
Can You Train Your Brain To Eat Healthy?

Can You Train Your Brain To Eat Healthy?

Newsy (Sep. 1, 2014) New research says if you condition yourself to eat healthy foods, eventually you'll crave them instead of junk food. Video provided by Newsy
Powered by NewsLook.com
We've Got Mites Living In Our Faces And So Do You

We've Got Mites Living In Our Faces And So Do You

Newsy (Aug. 30, 2014) A new study suggests 100 percent of adult humans (those over 18 years of age) have Demodex mites living in their faces. Video provided by Newsy
Powered by NewsLook.com
Liberia Continues Fight Against Ebola

Liberia Continues Fight Against Ebola

AFP (Aug. 30, 2014) Authorities in Liberia try to stem the spread of the Ebola epidemic by raising awareness and setting up sanitation units for people to wash their hands. Duration: 00:41 Video provided by AFP
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:
from the past week

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile: iPhone Android Web
Follow: Facebook Twitter Google+
Subscribe: RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins