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MONDAY, Aug. 18 (HealthDay News) -- Threading a catheter into the heart from the wrist rather than the groin reduces the incidence of bleeding problems during angioplasty, a new study finds.

The approach, using the radial artery in the wrist, is not widely practiced in the United States, according to an analysis of almost 600,000 catheterizations in a national database, said a report in the August issue of the Journal of the American College of Cardiology.

"It's done in about 1.5 percent of all procedures in the U.S.," said study author Dr. Sunil V. Rao, director of the cardiac catheterization laboratory at the Durham VA Medical Center.

The study found that bleeding complications in angioplasties done through the femoral artery in the groin were twice as common as for the radial approach, with 1.83 percent of persons having the femoral approach suffering excess bleeding, compared to 0.79 percent with the radial approach. The angioplasty success rate was as high for the wrist method as for the groin approach.

The study also found that bleeding complications with the radial approach were less common in people at higher risk, such as the elderly and those with acute coronary syndromes.

In angioplasty, a balloon-tipped catheter is threaded into a blocked heart artery and is inflated to reopen the artery. In most cases, a stent, a flexible tube, is inserted to help keep the artery open.

"We need powerful blood techniques to help prevent restenosis," Rao said. "Bleeding is a major problem. The majority of bleeding problems are related to the access site, and a bleeding problem is related to long-term survival."

Rao said he uses the wrist artery for angioplasty in about 85 percent of his cases. He reserves the groin approach when it appears that using the wrist artery will compromise blood flow to the hand.

The radial approach is more common in Canada, Europe and southeast Asia than in the United States, Rao said, although statistics on its use are not generally available. "Traditionally, that has been the way our people do it," he said of the groin method.

There are several reasons why the wrist method is not popular in the United States, said Dr. Howard A. Cohen, director of cardiovascular intervention at the Lenox Hill Heart and Vascular Center in New York, who uses it for most angioplasties.

"Generally, it hasn't been taught here," Cohen said. "There is a steep learning curve. You need 100 to 200 cases to feel confident with the technique. It takes a couple of years in a practice with a high volume. Also, it is technically more difficult in terms of the whole operation."

Safety is the main reason for using the wrist approach, Cohen said. "Also, it is much preferred by patients," he said. "It doesn't prolong the period of bed rest they need."

Another possible reason why the radial approach is not widely used in the United States is that the companies which sell equipment for angioplasties tend to emphasize the groin method, Rao said.

The radial approach "doesn't appear on their radar screen," Rao said. "They have equipment for the radial approach, but they just don't push it. Now that this study has been published, there might be an incentive to do it."

More information

Angioplasty is explained by the U.S. Heart, Lung, and Blood Institute.

THURSDAY, Aug. 14 (HealthDay News) -- Giving a high dose of the anti-clotting drug tirofiban to heart attack victims while on route to the hospital could improve their chances of survival, a new report says.

The study, published in a special cardiology issue of The Lancet this week, showed that patients given tirofiban in addition to the standard triple treatment of the anti-clotting agents aspirin, heparin and clopidogrel had significant less blockage affecting their heart than those given only the three standard medicines and a placebo.

The researchers -- lead by Arnoud van't Hof, Isala Klinieken of the department of cardiology, Zwolle, Netherlands -- found that major bleeding did not differ significantly between the two groups (4 percent of patients in the tirofiban group and 3 percent in standard group).

"Our trial was not powered on a difference in clinical outcome between the two groups. However, we noted a better clinical outcome in the tirofiban group than in the placebo group, with lower overall mortality and less urgent repeat [primary coronary angioplasty]," the authors wrote.

In an accompanying comment, Gilles Montalescot of the Institute of Cardiology Piti-Salptrire Hospital, INSERM 856 and University of Paris 6, Paris, wrote that the study "reveals that high-dose clopidogrel is not effective enough and confirms the need for fast and strong platelet inhibition. It reminds us also that the first contact with the patient must be rapid and medical. Until now, only well-organized hospital systems have been able to provide such a service."

The special issue of The Lancet also features an article about a study that says while a combination therapy of angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARB) reduces more excess protein in the urine (proteinuria) than either therapy alone in patients at high vascular risk, it could also result in greater kidney damage.

Proteinuria can be a sign of kidney damage, as malfunctioning kidneys allow proteins into the urine. Diabetes is the most common cause of proteinuria, although a range of other conditions can cause it.

An accompanying comment by doctors from University of Thessaloniki in Greece and the University of Chicago concluded "these data should not lead to guideline modifications ... Combined with previous studies, [this study] supports the notion that use of single agents to block the renin-angiotensin system is well-tolerated."

More information

The U.S. Heart, Blood, and Lung Institute has more about current heart attack treatments.

MONDAY, July 28 (HealthDay News) -- Large-scale studies should be conducted to determine the exact link between sleep apnea and heart disease, says a joint statement from the American Heart Association and the American College of Cardiology.

The statement was published in the journal Circulation.

"There have been a number of studies on sleep apnea in the last decade, and those looking at cardiovascular diseases and their associations with sleep apnea are especially compelling," Dr. Virend K. Somers, chairman of the joint statement writing committee, said in an AHA/ACC news release.

"We feel it is important to alert the cardiovascular community to the implications of this emerging area of research. It is possible that diagnosing and treating sleep apnea may prove to be an important opportunity to advance our efforts at preventing and treating heart disease," said Somers, a professor of medicine and cardiovascular diseases at the Mayo Clinic in Rochester, Minn.

The committee issued the statement because of increasing evidence of an association between sleep apnea and heart disease, the widespread prevalence of sleep apnea, and rising levels of obesity in the United States, particularly among young people.

Obesity is a major cause of sleep apnea, and "the epidemic of childhood obesity may be changing the epidemiology of obstructive sleep apnea in children," Somers said.

"We need to more clearly define the cause and effect relationship between sleep apnea and cardiovascular diseases and risk factors," he noted. "There is evidence that sleep apnea may be a cause of some cases of high blood pressure, but for other cardiovascular conditions, the evidence is largely circumstantial."

"Until we know the cause-and-effect relationship between sleep apnea and cardiovascular disease, it would be best to take a two-pronged approach and treat patients from both perspectives: In other words, treat both their sleep apnea and their cardiovascular disease," Somers said.

More information

The U.S. National Heart, Lung, and Blood Institute has more about sleep apnea.

WEDNESDAY, July 23 (HealthDay News) -- Men and women suffering from coronary heart disease seem to fare worse on measures of cognitive function.

And the longer the person had had heart disease, the worse the performance in such mental processes as reasoning, vocabulary and verbal fluency, according to a study in the July 23 issue of the European Heart Journal.

The research, however, had some limitations that may affect its value.

"It's a very well-designed study with a very large number of individuals, so they were able to appreciate small differences in cognitive function," said Dr. Kathryn J. Kotrla, chairwoman of psychiatry and behavioral science for the Texas A&M Health Science Center College of Medicine. "But they didn't control for some key variables such as alcohol and tobacco, which are well-known to impact blood vessel disease. Also depression, which is linked to both coronary heart disease and cognitive functioning."

"This makes the study tantalizing but incomplete," Kotrla added.

Previous studies have given conflicting results regarding the relationship between heart disease and cognitive function. Some have found coronary heart disease (CHD) to be a risk factor, while others have not.

According to the researchers, from University Hospital London and INSERM in France, this is the first large study to look at the association. And, previously, research had focused more on cerebrovascular disease (which includes stroke) rather than just CHD, even though CHD is responsible for most cardiovascular disease. That prior research had found a strong relationship between cerebrovascular disease and cognitive deficit and dementia.

The researchers looked at almost 6,000 British civil servants, aged 35 to 55 at the beginning of the project, taking part in a long-term study.

Both men and women with a history of CHD turned up lower scores for reasoning, vocabulary and overall cognitive function when compared with people who did not have CHD. Women had added problems in verbal fluency.

Men who experienced their first CHD more than a decade prior had even lower scores for reasoning, vocabulary and semantic fluency (categorizing words).

The risk of declining performance in the realm of reasoning went down by about 30 percent for every five years after a diagnosis of CHD.

Women with a longer history of CHD showed a trend for lower scores in semantic fluency, but the data here was based on a smaller number of people.

The authors don't yet know what the biological mechanisms behind this connection might be.

Also unclear from the study was how these changes in cognitive performance affected actual day-to-day function and quality of life, Kotrla said.

But the take-home message is still a familiar one: People should focus on preventing CHD by not smoking and avoiding or controlling diabetes, high cholesterol and high blood pressure. And the focus should start early, before it's too late.

More information

Visit the American Heart Association   for more on coronary heart disease.