Archive for category Stroke Prevention

Shift work linked to increased risk of heart attack and stroke


ScienceDaily (July 26, 2012) — Shift work is associated with an increased risk of major vascular problems, such as heart attacks and strokes, concludes a study published on the website of the British Medical Journal.

This is the largest analysis of shift work and vascular risk to date and has implications for public policy and occupational medicine, say the authors.

Shift work has long been known to disrupt the body clock (circadian rhythm) and is associated with an increased risk of high blood pressure, high cholesterol and diabetes, but its association with vascular disease is controversial.

So a team of international researchers analyzed the results of 34 studies involving over two million individuals to investigate the association between shift work and major vascular events. Shift work was defined as evening shifts, irregular or unspecified shifts, mixed schedules, night shifts and rotating shifts. Control groups were non-shift (day) workers or the general population.

Differences in study design and quality were taken into account to minimize bias.

Among the 2,011,935 people in the studies more than 17,359 had some kind of coronary event, 6,598 had myocardial infarctions (heart attacks), and 1,854 had ischemic strokes caused by lack of blood to the brain. These events were more common among shift workers than other people: shift work was associated with an increased risk of heart attack (23%), coronary events (24%) and stroke (5%). These risks remained consistent even after adjusting for factors such as study quality, socioeconomic status and unhealthy behaviors in shift workers.

Night shifts were associated with the steepest increase in risk for coronary events (41%). However, shift work was not associated with increased death rates from any cause.

Although the relative risks were modest, the authors point out that the frequency of shift work in the general population mean that the overall risks are high. For Canada — where some of the study’s authors are based and where 32.8% of workers were on shifts during 2008-9 — 7.0% of myocardial infarctions, 7.3% of all coronary events, and 1.6% of ischemic strokes could be attributed to shift work.

The authors say their findings have several implications. For example, they suggest screening programs could help identify and treat risk factors, such as high blood pressure and cholesterol levels. Shift workers could also be educated about symptoms that could indicate early heart problems.

Finally, they say more work is needed to identify the most vulnerable groups of shift workers and the effects of modifying shift patterns on overall vascular health.

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The above story is reprinted from materials provided by BMJ-British Medical Journal.

Note: Materials may be edited for content and length. For further information, please contact the source cited above.


Journal Reference:

  1. M. V. Vyas, A. X. Garg, A. V. Iansavichus, J. Costella, A. Donner, L. E. Laugsand, I. Janszky, M. Mrkobrada, G. Parraga, D. G. Hackam. Shift work and vascular events: systematic review and meta-analysis. BMJ, 2012; 345 (jul26 1): e4800 DOI: 10.1136/bmj.e4800

Note: If no author is given, the source is cited instead.

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.

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CT angiography speeds emergency diagnosis of heart disease in low-risk patients


ScienceDaily (July 25, 2012) — Incorporating coronary CT angiography (CCTA) into the initial evaluation of low-risk patients coming to hospital emergency departments (EDs) with chest pain appears to reduce the time patients spend in the hospital without incurring additional costs or exposing patients to significant risks. The report of a study conducted at nine U.S. hospitals appears in the July 26 New England Journal of Medicine.

“We found that the use of CCTA in emergency department evaluation of acute chest pain very effectively identified which patients did or did not have coronary artery obstruction, allowing clinicians to focus the use of resources on patients with heart disease,” says Udo Hoffmann, MD, MPH, director of the Cardiac MR PET CT program at Massachusetts General Hospital (MGH) and corresponding author of the NEJM article. “Although the use of CCTA added to the amount of diagnostic testing used in the evaluation process, compared with current standard protocols it significantly reduced length of stay without increasing costs.”

CCTA combines advanced CT scanning with the use of intravenous contrast material to produce detailed images of blood vessels supplying the heart without the need for cardiac catheterization. Several previous studies, including an immediate predecessor to the current one, have indicated that CCTA can effectively distinguish chest pain patients that do not have coronary artery disease, but those studies all had such limitations as lack of a control group or limited analysis of factors like costs and radiation exposure. The current study — ROMICAT (Rule Out Myocardial Infarction/Ischemia Using Computer Assisted Tomography)-II — was designed to determine whether a CCTA-based evaluation strategy could improve clinical decision making at different hospitals across the country.

From April 2010 to January 2012, patients arriving at the participating hospitals’ EDs for evaluation of chest pain who had no history of cardiovascular disease and whose initial tests — ECG and measurement of the biomarker troponin — did not clearly indicate a heart attack were invited to participate in the trial. Those who agreed to participate were randomly assigned to one of two groups. The control group proceeded with standard evaluation, with all diagnostic and treatment decisions being made by hospital physicians not part of the study group. The other group had CCTA as part of their ED evaluation, with the results being shared with attending physicians who, again, made all clinical decisions. Participants who were discharged from the hospital within 24 hours of arrival were called within 72 hours to assess their status, and all participants were called 28 days after hospital discharge and asked whether any return ED visits or rehospitalizations had taken place. Participant responses were verified by checking their medical records. About 1,000 patients completed the study, including the 28-day followup.

The investigators found that participants in the CCTA group had significant reductions in the amount of time from ED arrival until discharge either from the ED or after a hospital stay, with half of the CCTA group being discharged within 8.6 hours but only 10 percent of the control group being released so quickly. The amount of time until a diagnosis of heart disease was either ruled out or confirmed was also shorter for the CCTA group than for the controls, and more patients receiving CCTA were discharged directly from the ED rather than being admitted to an observation unit. The percentage of patients actually diagnosed with heart disease was similar in both groups at around 8 percent, and there were no missed diagnoses in either group.

Analysis of total clinical resources used from arrival to discharge indicated that CCTA participants had more diagnostic procedures than control group members, but the difference was not statistically significant. Neither were there any significant differences between groups in total costs through the 28-day followup in those participants for whom cost information was available. CCTA group participants were exposed to higher cumulative doses of radiation, but the authors note that recent studies have indicated that CCTA can often be successfully performed using lower doses and suggest that future studies test the utility of low-dose CCTA examination.

“It’s very important to strive for the greatest efficiency in diagnostic testing, and in this study, additional testing was primarily carried out in patients found to have coronary artery disease,” Hoffmann says. “There also were fewer adverse clinical events in those receiving CCTA, although the study group was too small to conclude that CCTA reduced those risks.

“Showing at a variety of clinical sites that CCTA is at least as good as standard ED evaluation without increasing costs elevates the procedure from one appropriate only for specialized settings to one that can be applied in many centers,” he adds. “I’d really like to commend the commitment and teamwork of all the participating sites and departments, which was essential to the successful completion of this study.” Hoffmann is an associate professor of Radiology at Harvard Medical School.

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Story Source:

The above story is reprinted from materials provided by Massachusetts General Hospital.

Note: Materials may be edited for content and length. For further information, please contact the source cited above.


Journal Reference:

  1. Udo Hoffmann, Quynh A. Truong, David A. Schoenfeld, Eric T. Chou, Pamela K. Woodard, John T. Nagurney, J. Hector Pope, Thomas H. Hauser, Charles S. White, Scott G. Weiner, Shant Kalanjian, Michael E. Mullins, Issam Mikati, W. Frank Peacock, Pearl Zakroysky, Douglas Hayden, Alexander Goehler, Hang Lee, G. Scott Gazelle, Stephen D. Wiviott, Jerome L. Fleg, James E. Udelson. Coronary CT Angiography versus Standard Evaluation in Acute Chest Pain. New England Journal of Medicine, 2012; 367 (4): 299 DOI: 10.1056/NEJMoa1201161

Note: If no author is given, the source is cited instead.

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.

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