TUESDAY, Dec. 18 (HealthDay News) -- While cardiovascular disease (CVD) death rates in the United States are declining, the illness is still the leading cause of death in the nation, according to the American Heart Association.

Controlling heart disease risk factors remains a major challenge for many people, according to the American Heart Association's Heart Disease and Stroke Statistics -- 2008 Update, published online Dec. 17 in the journal Circulation.

CVD -- which includes heart disease, stroke, high blood pressure, heart failure and several other conditions -- has been the leading cause of death in the United States every year since 1900, with the exception of 1918, when there was a worldwide flu pandemic, the AHA noted.

In 2004, the most recent year for which final data was available, the age-adjusted CVD death rate in the United States was 288 people per 100,000, compared with 307.7 per 100,000 in 2003, the report said. In 2004, CVD was listed as the underlying cause of death in 869,724 deaths, compared to 911,163 deaths in 2003.

Cancer was the second leading cause of death, claiming 553,888 lives in 2004. When looked at separately from other cardiovascular diseases, stroke was the third leading cause of death, claiming 150,074 lives.

While CVD deaths appear to be decreasing, rates of many CVD risk factors are remaining the same or increasing, the report said. For example, rates of overweight and obesity in adults and in children have been rising for several decades. The report found that 66 percent of American adults are overweight, and 31.4 percent are obese. It also found that 17 percent of youngsters ages 12 to 19 are overweight, along with 17.5 percent of children ages 6 to 11, and 14 percent of children ages 2 to 5.

Poor dietary habits -- such as insufficient consumption of fruits and vegetables -- are contributing to overweight and obesity, the report warned. It cited U.S. Centers for Disease Control and Prevention data from 2005 that showed that only 21.4 percent of male high school students and 18.7 of female high school students reported eating at least five daily servings of fruits and vegetables.

Other 2005 data from the CDC revealed that fewer than one in three adults eat fruit two or three times a day, and only 27.2 percent eat vegetables two or more times per day.

Smoking, which increases the risk of coronary heart disease by two to three times, is another highly prevalent CVD risk factor. More than 46 million American adults are daily smokers, and about 4,000 people ages 12 to 17 begin smoking every day, the report said.

It also noted that the United States has increasing rates of diabetes, a major cardiovascular risk factor. It's estimated that the prevalence of diabetes in the United States will more than double between 2005 and 2050.

"Although we have made some substantial strides in understanding the causes of cardiovascular disease, the data in this publication show that we have a long way to go to capture people's attention and to implement the prevention and treatment programs we need," Dr. Donald Lloyd-Jones, one of the report authors and an associate professor in the department of preventive medicine at Northwestern University's Feinberg School of Medicine in Chicago, said in a prepared statement.

The report included good news about improvements in the quality of hospital care for CVD patients. A study of 159,168 heart failure patients treated at 285 U.S. hospitals during 2002-2004 found improvements in clinical outcomes and in the number of patients receiving counseling at discharge, smoking cessation counseling, prescription of beta blockers, and assessment of left ventricular function.

More information

The American Heart Association offers heart healthy lifestyle tips  .

TUESDAY, Dec. 18 (HealthDay News) -- When doctors in the emergency room believe that someone is having a heart attack, they are mistaken 9.2 percent of the time, a new study indicates.

Given that minutes matter with these patients and doctors have to act quickly in this setting, that percentage is tolerable, say researchers from the Minneapolis Heart Institute Foundation.

"Our conclusion is that an 8 to 10 percent false positive rate is acceptable," said study co-author Dr. Timothy Henry, who is director of the institute.

However, every effort should be taken to reduce the number of false positive diagnoses of heart attack, Henry added. The report, which is published in the Dec. 19 issue of the Journal of the American Medical Association, gives a benchmark for other institutions to meet, he said.

"The whole issue of false positive has never been presented," Henry said. "This is the first time it has been presented in a systematic way."

Henry and his colleagues studied the medical records of 1,345 people treated for suspected heart attacks in a regional system between 2003 and 2006, looking at emergency room decisions to activate the cardiac catheterization laboratory to treat for suspected heart attacks. Such decisions usually must be made in a matter of minutes, often without a record of a patient's previous cardiac history.

All the patients were suspected of having a STEMI heart attack, characterized by a specific electrocardiogram pattern. It turned out that 187 of them (14 percent) did not have obvious blockage of a coronary artery, with 127 (9.5 percent) having no significant coronary artery disease and 149 (11.2 percent) having negative results on cardiac biomarker tests. There was a significant difference in survival, with a 4.6 percent 30-day death rate for those with a blocked artery and 2.7 percent for those without blockage.

Hospitals should run a continuing check on such emergency room diagnoses and decisions, Henry said. "If they are too high, corrective action should be taken," he said.

Heart attack diagnosis has been the focus of "a number of quality improvement initiatives," said Dr. Frederick A. Masoudi, an associate professor of medicine at the Denver Health Medical Center, who wrote an accompanying editorial.

"It is well known that timing is of the essence in treating these patients," Masoudi said. "The outcome is better when the artery is opened in a timely way."

False positives are inevitable in some cases, he said. "It is really impossible to say from this one study whether there are too many or too few," Masoudi said. "Ultimately, it is important for us to evaluate the extent to which it occurs and why it occurs. We must build into the system a balance, so that only those patients who need reperfusion get it."

More information

Heart attacks, STEMI and otherwise, are described by the Cleveland Clinic  .

THURSDAY, Dec. 13 (HealthDay News) -- The new and powerful cancer drug sunitinib (Sutent), which fights stomach tumors, can also create heart problems for some patients, a new study finds.

All patients taking sunitinib, but especially those who have risks for heart disease, need careful monitoring and treatment for high blood pressure and other signs of heart problems, researchers say.

"All drugs have risks and benefits," noted lead researcher Dr. Ming Hui Chen, an assistant professor of medicine at Harvard Medical School and a cardiologist at Children's Hospital Boston. "This drug is lifesaving for people with metastatic, gastrointestinal stromal tumors," she added.

But it is important for both doctors and patients to be aware that sunitinib can have cardiac effects, Chen noted.

"The people at greatest risk are the people who have a history of coronary artery disease," Chen said. "Aggressive control of blood pressure in these patients is very important."

In a statement released Thursday, sunitinib's maker, Pfizer Inc., agreed that these heart risks do exist. However, they added that the cardiovascular events "were medically manageable in most patients and underscore the importance of having a collaborative team of healthcare professionals working together to appropriately manage patients, who have limited available options" in treating their cancer.

The new, collaborative study was supported by Children's Hospital Boston; the Dana-Farber Cancer Institute; Thomas Jefferson University; the U.S. National Heart, Lung, and Blood Institute; the Finnish Heart Foundation; and the American Heart Association.

Sunitinib is one of a family of new and powerful anti-cancer drugs called tyrosine-kinase inhibitors, which target key molecular pathways thought to encourage tumor growth. Other drugs in this family include imatinib, better known as Gleevec, and dasatinib (Sprycel).

In the study, which is published in the Dec. 15 issue of The Lancet, Chen's team looked at 75 patients with metastatic, gastrointestinal stromal tumors that had not responded to standard therapy with Gleevec. The patients had taken part in a phase I/II trial studying the efficacy of sunitinib.

The researchers looked back at the medical records of these patients, noting those who died from heart disease or had suffered heart attacks or congestive heart failure. They also looked at the effect of sunitinib on the heart's ability to pump blood and on blood pressure.

Chen's group found that eight patients given repeated cycles of sunitinib had cardiovascular events. Two had heart attacks, and six had heart failure. Of 36 patients given the approved dose of sunitinib, 10 had a 10 percent or more reduction in the ability of their heart to pump blood, and seven had a 15 percent or more reduction in heart function.

In addition, sunitinib was associated with increases in blood pressure, with a total of 35 (47 percent) of the patients developing hypertension. However, these effects were not permanent: When sunitinib treatment was stopped and patients began therapy to ease heart problems, levels of heart failure and heart functioning improved, the researchers found.

"Most of the patients who had heart problems were able to resume taking sunitinib with either a modification in their dose or initiation of heart failure medication," Chen said.

In addition, in experiments with mice and rat heart cells, Chen's team found that sunitinib triggered heart cells damage and death.

However, in their statement, Pfizer noted that, "Lower incidences of cardiovascular effects have been observed in subsequent randomized Phase 3 prospective Sutent studies in both renal cell carcinoma and gastrointestinal stromal tumor[s]." That includes a lower incidence of events such as congestive heart failure, impaired heart function, and high blood pressure that were noted in Chen's retrospective analysis, the company said.

Chen stressed that patients taking sunitinib who develop shortness of breath and fatigue and swelling of the arms or legs should be checked for heart problems. "These symptoms can be ascribed to cancer, but since this drug may have a cardiovascular effect, these may be signs of heart problems," she said.

One expert said the findings must be approached with caution.

"The findings are intriguing, but one has to be careful about generalizing them," said Dr. James Brugarolas, an assistant professor in the division of oncology at Simmons Comprehensive Cancer Center at the University of Texas Southwestern Medical Center at Dallas. "It's a small group of patients, many of whom were taking other drugs that can have cardiac effects," he said.

However, patients who have coronary artery disease who are going to be given sunitinib should be very carefully monitored for the development of heart failure, Brugarolas said. "There should be a proactive attitude on the part of the physician to manage hypertension," he added.

Brugarolas also noted that sunitinib has been shown to slow the progression of gastrointestinal stromal tumors but not to extend patients' overall survival. "These side effects may be affecting survival," he said. "If survival is compromised by adverse effects of the drug, then it may not be beneficial to patients."

More information

For more on sunitinib, visit the U.S. National Library of Medicine.

TUESDAY, Dec. 11 (HealthDay News) -- With just two weeks of so-called constraint-induced movement therapy, some stroke patients can have significant improvement in the functioning of their affected hand and a better quality of life, a new study finds.

For the study, participants wore a mitt on the less-affected hand. This forced them to use their affected hand while doing a repetitive task -- such as grooming or eating -- with the hope of improving the use of their hand and rebuilding strength. The mitt was worn for most of their waking hours for two weeks.

"The folks who have extremity constraint-induced movement therapy have significant improvements in the use of their impaired upper extremity that persist after two weeks of training," said lead researcher Steven Wolf, a professor of rehabilitation medicine at Emory University School of Medicine.

The researchers found that these gains were still evident two years later. "Over two years, strength-based measures improved further, and many measures of quality of life improved substantially," Wolf said.

The report was published online Dec. 11 in The Lancet Neurology.

In the EXCITE (extremity constraint-induced movement therapy evaluation) trial, 106 patients were randomly assigned to extremity constraint-induced movement therapy or usual therapy, which ranged from no treatment after concluding formal rehabilitation to drugs or continued physiotherapy.

The new study was an extension of the EXCITE trial, which demonstrated that people who underwent extremity constraint-induced therapy had better results in hand function after one year, compared with people who received usual care.

Wolf's team found that two years after treatment, there was no decline in the improvements seen after one year. In fact, the participants continued to gain strength and improvement in ability, the researchers said.

Moreover, quality of life was significantly better two years after treatment. Improvements were seen in social participation, activities of daily living, and overall physical function, Wolf said.

Wolf said the restraint therapy can be used on about 30 percent of stroke patients -- or those with mild to moderate impairment. "People who will benefit are those who can begin to open their hand six weeks after the stroke," he said. "Extremity constraint-induced movement therapy can, over a short period of time, lead to improvements that are sustainable."

One stroke expert thinks the study results are impressive, but more research needs to be done before the technique is adopted widely.

"In stroke rehabilitation, we don't have a lot of things to offer these folks," said Dr. Michael W. O'Dell, acting chief of rehabilitation medicine at New York-Presbyterian Hospital, Weill Cornell Medical Center in New York City. "It's pretty remarkable that a treatment that was provided for two weeks, two years ago, is still having an effect on people's ability to function on a day-to-day basis."

O'Dell said it's important to note that the patients in the EXCITE trial did have some movement in the affected hand before the study began. "They were not the worst of the worst," he said. "But it's really encouraging that there is some possibility for further recovery."

O'Dell noted there are some drawbacks to extremity constraint-induced therapy. For one, insurance companies and Medicare won't pay for it. "It's too expensive," he said.

Also, the therapy is very frustrating for patients. "So, you have to have an incredibly motivated patient to do this," O'Dell said.

More information

To learn more about stroke, visit the American Stroke Association  .