CONFERENCE COVERAGE: NEWS FROM THE AMERICAN COLLEGE OF CARDIOLOGY (ACC) 58TH ANNUAL SCIENTIFIC SESSION
March 29 to 31, 2009 - Orlando, Fla.

Elevated Triglycerides in Childhood Predict Future Cardiovascular Events
Children with elevated triglycerides may be at increased risk of cardiovascular disease (CVD) events in early adulthood, according to research presented at ACC.

This finding is based on a 25- to 30-year follow-up study of 808 out of 1,756 individuals first evaluated as school children between 1973 and 1976. Researchers restudied eligible participants to compare childhood and adult CVD risk factors in those who did and did not develop CVD in their 30s and 40s. Of these, 19 reported cardiovascular events as adults, the most common being myocardial infarctions, angioplasties, and bypass surgeries.

"Pediatric triglycerides are an exceptionally strong, independent predictor of early onset cardiovascular events," said John Morrison, PhD, Professor Emeritus of Preventive Cardiology, Cincinnati Children's Hospital. "Those who developed CVD events tended to have higher levels of triglycerides and were more likely to be overweight or obese in childhood."

Compared with the 789 CVD-free control individuals, participants who developed CVD had higher average childhood triglycerides (127 vs 76 mg/dL, P<.0001) and body mass index (BMI) (24.3 vs 20.0 kg/m2, P=.012). The differences in triglycerides and BMI remained significant after matching the controls and cases (15 to 1) by childhood age, sex, and race.

"In the last decade, we have started to appreciate more the role of triglyceride-rich remnant particles in cardiovascular risk, and how they can accelerate the formation of lipid deposits in the arteries," Dr. Morrison said.

Physicial Activity, Better Diet Improve Academic Performance
A school-based intervention that incorporates healthy lifestyle education, nutritious food options, and increased physical activity can improve academic performance among elementary-aged children, according to research presented at ACC.

The HOPS (Healthier Options for Public Schoolchildren) study was a school-based obesity intervention targeting 6- to 12-year-olds. First implemented in 2004, this prevention program is now active in 80 schools in seven states. HOPS incorporates school-based wellness and healthy lifestyle education; development of school gardens; nutritious school meals including more high-fiber items such as whole grains, fresh fruits and vegetables, fewer items with high-glycemic effects such as high-sugar cereals and processed flour bakery goods, and lower amounts of total, saturated and trans fats—all consistent with the United States Department of Agriculture Dietary Guidelines for Americans.

"The good news is that kids will accept healthy food when it's presented in an exciting manner, and this results in less weight gain and teaches them to make better choices," said Arthur S. Agatston, MD, Agatston Research Foundation, Miami Beach, Fla.

"Overweight/obesity among schoolchildren can predict many problems later in life, including heart disease and diabetes. By intervening early and presenting a food of the month, showing kids where food comes from by planting organic school gardens, and educating them about the importance of nutrition and physical activity, we can improve health overall."

Eprotirome Turns in Good Report on Lipid Lowering
Eprotirome, a medication that makes use of the thyroid hormone's central role in regulating lipid metabolism, significantly reduced LDL cholesterol, triglycerides, and other markers of cardiovascular risk, according to research presented here.

An investigational drug that targets thyroid hormone receptors in the liver is producing impressive reductions in blood lipid levels even in patients already taking statins, suggesting it has the potential to open a new avenue for treating CVD.

"This study provides hope for a new add-on treatment of dyslipidemia for patients who are inadequately controlled with, or intolerant to, current lipid-lowering therapy," said Jens Kristensen, MD, PhD, Vice President of Clinical Development for Karo Bio, a Swedish pharmaceutical company. "The study results are a breakthrough after more than 50 years of attempting to develop a thyroid hormone receptor agonist whose function is restricted to the liver."

In the liver, the thyroid hormone receptor regulates transporters and enzymes that increase the uptake of cholesterol from the blood, inhibit uptake of cholesterol from the diet, and increase elimination of cholesterol through bile. The thyroid receptor is also active in organs outside the liver, such as the heart, muscles, and bones. Eprotirome is designed to selectively act on the liver, thereby mimicking the beneficial effects of thyroid hormone on lipid levels without side effects on other organs.

Polypill May Halve Cardiovascular Risk With No Additional Side Effects

Healthy individuals may be able to cut their risk of cardiovascular disease by 50% to 60% by taking a single pill that combines three blood pressure-lowering drugs at low doses, a statin, and aspirin ("polypill") with no additional side effects, according to research presented at ACC.

TIPS (The Indian Polycap Study)—the first to evaluate the tolerability of the polypill and test whether it leads to meaningful changes in cardiovascular risk factors—enrolled 2,053 participants. During the 3-month study, researchers compared the impact of the polypill and eight other pharmacologic therapies on blood pressure, cholesterol levels, and heart rate, among other measures. The combination pill (Polycap), which includes low doses of thiazide (12.5 mg/day), atenolol (50 mg/day), ramipril (5 mg/day), simvastatin

(20 mg/day) and aspirin (100 mg/day), significantly reduces LDL, blood pressure, and platelet aggregability.

"The thought that people might be able to take a single pill to reduce multiple cardiovascular risk factors has generated a lot of excitement; it could revolutionize heart disease prevention as we know it," said Salim Yusuf, DPhil, FRCPC, of the Population Health Research Institute at McMaster University and Hamilton Health Sciences, Hamilton, Ontario, and cochair and principal investigator of the study. "Before this study, there were no data about whether it was even possible to put five active ingredients into a single pill, in terms of feasibility, the bioavailability of different agents, and possible interactions, and we found that it works. And side effects with the polypill were no different than when taking one or two medications."

DASH Diet with Weight Management Can Improve Blood Pressure, Markers of Cardiovascular Risk
Overweight or obese patients who closely follow the DASH (Dietary Approaches to Stop Hypertension) diet in combination with exercise and weight loss can significantly lower their blood pressure and improve other markers of cardiovascular risk, according to new data presented.

The DASH diet is an eating plan that is low in saturated fat, cholesterol, and total fat and emphasizes fruits, vegetables, and fat-free or low-fat milk products. The DASH diet alone results in significant blood pressure lowering, however, the addition of exercise and weight loss leads to an even greater blood pressure reduction. Although the DASH diet is widely recommended for the treatment of high blood pressure, the extent to which weight loss and exercise further enhance the diet's cardiovascular benefits are unknown. The ENCORE trial, a randomized, controlled study, is the first to systematically examine the effects of the DASH diet alone or in combination with a weight reduction program on lowering blood pressure and other key cardiovascular risks (eg, left ventricular mass, arterial stiffness, autonomic function, and glucose and cholesterol levels).

"Our data shows that the DASH diet with or without a behavioral weight loss program results in clinically significant reductions in blood pressure. Adding exercise and weight management to the DASH diet also appears to confer even greater reductions in blood pressure, as well as additional improvements in left ventricular wall thickness, arterial stiffness, and other markers of cardiovascular risk," said James Blumenthal, PhD, Professor of Medical Psychology and Duke University and lead investigator. "This is an important finding because a concerning complication of hypertension is the accompanying structural changes in the blood vessels and heart.

Implantable Device Lowers Medically Refractory Hypertension
Two years of chronic treatment with the Rheos Hypertension System (CVRx, Minneapolis) an implantable pulse generator that activates baroreceptors of the carotid sinus, produced significant reductions in systolic blood pressure in patients with refractory hypertension, according to research presented at ACC.

Hypertension that remains uncontrolled despite optimal medical treatment is a serious health threat for patients. This long-term study sought to confirm initial observations that were seen with the Rheos system, which represents an alternative to pharmacological therapy for refractory hypertensive patients.

"One of the virtues of this device is that it allows the patient to control the rhythms of blood pressure as they occur naturally. For instance, during sleep the blood pressure goes down 10 to 15 points and this device takes this into account. It is a new take on the principle of a pacemaker, but instead of being installed in the heart, it is wrapped around the carotid sinus," said Marcos Rothstein, MD, Professor of Medicine at Washington University School of Medicine, St. Louis. "When a new antihypertensive agent comes on the market and drops the blood pressure 3 or 5 mm Hg, it is considered a successful drug. This device, on average, drops the blood pressure 20 mm Hg. This is nothing short of revolutionary in the treatment of hypertension."

News briefs compiled from information provided by ACC.