Legion of Angels News Archive

Blockages in the heart’s arteries commonly cause chest pains called angina. Cardiologists possess ever-improving invasive tools for restoring blood flow, including angioplasty (blowing up balloons to expand the artery at sites of plaque), stenting (insertion of cylindrical props of metal mesh), and bypass surgery, increasingly through very small incisions.

But while these invasive treatments decisively relieve symptoms in most patients, they actually prevent heart attacks and deaths only in special circumstances — notably, when patients are treated within a few hours of an acute heart attack. At the same time, we now have several effective classes of drugs that reduce the heart’s workload, improve blood flow by dilating arteries, and increasingly target the diseased artery itself.

So the question that patients and their physicians now confront is when to turn to the invasive strategies that have long been a mainstay of angina management. A recent analysis of data from pivotal clinical trial called COURAGE provides some important new insights.

In this study, over 2,000 patients with stable angina were randomized into groups receiving aggressive drug therapy with or without additional angioplasty and stenting. The primary results, published in 2007, showed no additional benefit to invasive treatments with regard to heart attack or deaths in the group during 4.6 years of follow-up.

The new data, published last month in The New England Journal of Medicine, addressed whether adding invasive treatment to intense medical treatment reduced the frequency of angina and improved quality of life and well-being in these patients.

Shortly after treatment, the patients who had had invasive revascularization reported slightly less angina and slightly better quality of life. But by the end of the 4.6 years of follow-up, the patients who did not receive invasive treatments were faring as well as those who did (although about one-fifth of those originally treated without surgery ultimately required mechanical revascularization).

This study teaches us two remarkable lessons. First, starting aggressive therapy, be it with drugs or drugs plus revascularization, improved symptoms and quality of life in both groups — promptly in the case of surgical revascularization, but rapidly even for drug therapy alone. This is extremely good news for patients with angina: modern therapy is quick, effective and results in an excellent quality of life in most individuals.

The surprising and progressive benefit of non-invasive therapy may come about because some of the newer drugs favorably alter the biology of the artery and plaque (notably statins and agents that interrupt the action of the hormone angiotensin). Statins lower “bad cholesterol” (LDL), one of the drivers of atherosclerosis, and also appear to calm inflammation in the plaque independent of effects on LDL. Blocking angiotensin action may also provide a benefit to arterial health beyond just lowering blood pressure.

The second message: we don’t need to rush into surgery as a first step in people with stable angina. We can apply aggressive lifestyle and drug therapy, and turn to invasive strategies if these non-invasive measures don’t do the trick. These new data, in the context of many other studies, allow us to take a staged approach to the management of stable angina with confidence that we do not jeopardize longevity or increase risk of heart attacks.

Source — The New York Times

WASHINGTON - Former Republican Sen. Phil Gramm isn’t the first friend to give a presidential candidate heartburn. And based on recent history, another one will be along before John McCain or Barack Obama know it.

“You’ve heard of mental depression; this is a mental recession,” Gramm, a leading supporter of McCain, said recently, a less-than- sympathetic description of an election-year economy that features rising joblessness, a spike in mortgage foreclosures and a declining stock market.

“We have sort of become a nation of whiners,” he added — not all that helpfully in the opinion of the man he is trying to help win the White House.

“I strongly disagree,” McCain told reporters in Michigan, a state with an unemployment rate of 8.5 percent in May. “Phil Gramm does not speak for me. I speak for me.”

McCain’s the one discomforted this time.

But Obama’s known the same feeling. An unpaid adviser quickly became an unpaid former adviser this spring after calling Hillary Rodham Clinton a monster.

Not that Clinton escaped this type of embarrassment, either, in her bid for the White House. One of her national co-chairman once opined that Republicans would be looking for information on Obama’s admitted youthful drug use, a comment that caused a candidate-to-candidate apology.

The circumstances in these episodes vary, but often follow a predictable arc.

For starters, the surrogate or supporter usually serves a political purpose, which explains their presence within the campaign. Gramm, for example, is well-known for his conservative economic beliefs, and can presumably help McCain strengthen his ties to advocates of tax cuts who might otherwise view the presidential contender with suspicion.

In many cases, the person who instigates the controversy follows up with a claim of being quoted out of context. Or misunderstood. Or speaking off the record. None of these constitutes a denial, though, which would be an invitation to further difficulty in an Internet era.

An apology may be forthcoming, although Gramm has yet to make one. Sometimes there is a parting of the ways.

With or without an apology, the candidate makes clear his disagreement, as McCain did, and hopes the controversy fades.

Yet often, and understandably, a rival campaign seizes on the incident in hopes of gaining a political advantage.

Obama did in the current case. “Let’s be clear,” he told an audience in Virginia as McCain struggled to escape the fallout of Gramm’s remarks. “This economic downturn is not in your head.”

McCain’s had some practice at this sort of thing.

Not long ago, he rejected an endorsement from Texas pastor John Hagee after an audio recording made in the late 1990s surfaced in which the preacher suggested God sent Adolf Hitler to help Jews reach the promised land. “Crazy and unacceptable,” McCain said of his erstwhile endorser. Hagee quickly said the parting was “best for both of us and the country.”

Or at least for McCain’s campaign.

Clinton went down the same path in the case of Billy Shaheen, a prominent New Hampshire Democrat and national co-chairman who said last winter that if Obama won the nomination, Republicans would work hard to uncover unsavory aspects of his youth.

“It’ll be, ‘When was the last time? Did you ever give drugs to anyone? Did you sell them to anyone?’” said Shaheen, whose wife, Jeanne, is a former New Hampshire governor and is running for the U.S. Senate this year.

A round of apologies ensued, one from Shaheen and another from Clinton to Obama.

“As soon as I found out that one of my supporters and co-chairs in New Hampshire made a statement, asked a series of questions, I made it clear it was not authorized, it was in no way condoned, I didn’t know about it and he stepped down,” she said.

Obama’s moment came when Samantha Power offered an unvarnished opinion of Clinton in a newspaper interview. “She’s a monster — that is off the record — she is stooping to anything,” was the quote.

An apology soon followed in a statement in which Power called her own remarks inexcusable and contradictory to her admiration for Clinton.

By then, Obama had already called to bid his adviser good riddance.

And Clinton’s campaign followed up with an e-mail to supporters informing then of what had happened and seeking campaign donations “to show that there is a price to this kind of attack politics.”

Of course, there are variations on the theme.

In the last few days, the Rev. Jesse Jackson mused in front of an open microphone about wanting to emasculate Obama, whom he said sometimes appears to be talking down to black audiences.

A novel idea, perhaps, of expressing support for a presidential candidate.

This time, it appeared the damage was done to the supporter, rather than the candidate.

Obama accepted an apology from Jackson.

And what did Jackson really mean?

“My support for Senator Obama’s campaign is wide, deep and unequivocal.”

Source — Yahoo!