WEDNESDAY, April 9 (HealthDay News) -- Carotid stenting -- inserting a tube into the main artery to the brain to prevent a stroke -- is as effective over the long term for high-risk patients as a surgery called endarterectomy, a study shows.

But endarterectomy -- the removal of plaque from the artery -- will continue to be the treatment of choice for the 70 percent to 80 percent of the patients who are not classified as high-risk, the experts say.

"Surgery has been around for 50 years," said Dr. Hitinder S. Gurm, an assistant professor of medicine at the University of Michigan and lead author of a report in the April 10 issue of the New England Journal of Medicine. "It's better to go with something you know more about," he reasoned.

The report described a three-year follow-up of a study that compared stenting with endarterectomy in 334 people who had narrowing of the carotid artery and were at high risk of complications from surgery. Data on 260 of the participants showed that the incidence of heart attacks, strokes and death was about the same in the two groups, occurring in 24.6 percent of those who were stented and 26.9 percent of those who had surgery.

The study was funded by Cordis Corp., a unit of the pharmaceutical company Johnson & Johnson, which markets stents. The company had no role in data analysis, the researchers said.

Participants were at high risk because of the location of the potential blockage (either very high or very low in the carotid artery); because they had radiation therapy; or because they had undergone a previous endarterectomy, Gurm said. Someone with very serious heart or lung disease might also be at risk from surgery, he said.

It's not yet possible to extend those results to people who are not at high risk, said study senior author Dr. Donald E. Cutlip, an associate professor of medicine at Harvard Medical School.

"You can't answer that question on the basis of our study," Cutlip said. "What we can say is that the results are similar in high-risk patients at one-year and now at three-year outcomes."

The real answer probably will come from an ongoing major government-funded study of several thousand low- and moderate-risk participants, Gurm and Cutlip said. Results from that effort are expected in "two to three years," Gurm said.

"Also, there are several registries from randomized studies that are going on," Cutlip said. "Their results might sway opinion."

In the meantime, most people who have a carotid artery procedure at a community hospital rather than a specialized center will continue to have surgery, agreed Dr. Deepak Bhatt, associate director of the Cleveland Clinic's Cardiovascular Coordinating Center.

At least one study has shown that carotid stenting can be done as effectively by community physicians as by specialists. And it is possible for someone who needs a procedure and would prefer stenting to have it done in the name of research, by enrolling in a trial comparing the two procedures, Bhatt said.

"If you don't really want surgery you can have a stent, but under the umbrella of research, where you are followed closely," he said.

More information

The various carotid artery procedures are described by the Cleveland Clinic  .

TUESDAY, April 8 (HealthDay News) -- Just four weeks of moderate exercise is enough to boost the cardiac performance and breathing capacity of patients with heart failure, a new study finds.

This slightly more strenuous exercise program -- in standard use in Europe for people with heart failure -- works at least as well as the less intense American regimen, the researchers noted. They presented the findings Tuesday at the Experimental Biology conference in San Diego.

In heart failure, the heart progressively loses the ability to pump blood. In the United States, doctors typically recommend three-times-a-week exercise sessions for eight to 12 weeks to help ease the condition, noted study author Stephen F. Crouse, a professor of kinesiology and internal medicine at Texas A&M University, in College Station.

His team looked at data from an Austrian rehabilitation center where 366 heart failure patients (average age 63) exercised 14 to 22 minutes on stationery bicycles six times a week. Participants also did a brisk 45-minute walk each day.

Four weeks of that regimen were enough to produce a significant increase in the participants' breathing capacity, Crouse said.

"This is something that we can recommend continuing for the rest of their lives," he added.

The benefits of exercise for people with heart failure are well-established, Crouse acknowledged. "There are some data from U.S. studies showing that the European regimen has at least equal benefits," he said.

The study used such standard measures of heart function as VO2max, which measures oxygen consumed; resting heart rate; and blood pressure. But of greater interest was the measurement of blood levels of the protein NT-proBNP, which is secreted when heart muscle cells are stressed, Crouse said.

"We have this biomarker in the blood that can be followed very well and that correlates with [cardiac] performance," he said.

Levels of NT-proBNP went down as standard measures of heart performance went up, Crouse said. Blood levels of the protein dropped by 33 percent in the study group after four weeks of the exercise regimen.

Measuring NT-proBNP "is something we would suggest could become a routine clinical test, of treatment and performance," Crouse said. A blood test for the protein is not expensive and is a better alternative for more costly tests such as echocardiography, he said.

The longer-term effects of a continued exercise program for heart failure will be assessed by the Texas A&M team, Crouse said. "We need data to follow them out," he said.

The results were not surprising and will not affect advice on exercise now given to people with heart failure, said Dr. William E. Kraus, research director at the Duke University Center for Living. His center is currently leading a major trial of long-term exercise training for people with heart failure, with results expected later this year.

Use of NT-proBNP as a measure of performance is "a new wrinkle, but not so much of one that it makes me want to change practice," Kraus added.

More information

Guidelines for exercise in heart failure are provided by the Cleveland Clinic  .

FRIDAY, March 28 (HealthDay News) -- A signaling protein called Gi plays a critical role in protecting the heart during a heart attack, say researchers at Thomas Jefferson University in Philadelphia.

It was already known that Gi increased activity in a failing heart, but it wasn't clear whether the protein was helping the heart adapt to damage or if it actually caused more heart cells to die.

In this study, the researchers created mice that lacked a working Gi gene, simulated a heart attack, and then restored blood flow to the heart. These mice suffered more heart damage than mice with a normally functioning Gi gene.

"It appears that in this setting, Gi is an important protective mechanism," team leader Walter Koch, a professor of medicine and director of the Center for Translational Medicine at Jefferson Medical College, said in a prepared statement.

"The heart wants to activate Gi and attempt to protect cardiac myocytes from dying. We found that in this acute setting, heart attacks are bigger when Gi is blocked," he said.

The study was published in the March 18 issue of Circulation.

Gi plays an important role in intracellular signaling, similar to a molecular switch, explained Koch. Gi is not a new drug target, but the activation of certain receptors (such as beta-2 adrenergic receptors) that also turn on Gi could be drug targets.

Koch said developing a "class-specific Gi inhibitor" is a vital step in learning more about Gi's role and behavior.

"We don't have to worry about what the receptor we are blocking; we're blocking a receptor that couples with Gi. We never had the tools before to tell if Gi activation was good or bad. We think that we can now begin to test the role of Gi in cardiac injury," Koch said.

More information

The American Heart Association has more about heart attack  .

THURSDAY, Feb. 21 (HealthDay News) -- Fish oil won't help prevent a stroke, but a high-fiber diet might make a difference, say two new studies designed to assess the impact of nutrition on stroke.

"Fish oils are not as good as people claim them to be," said Dr. Craig Anderson, lead author of the fish oil study and director of the neurological and mental health division at the George Institute for International Health at the University of Sydney, in Australia.

On the other hand, "eating 20 to 35 grams of fiber per day may reduce the risk of stroke and may result in better outcomes if you do have a stroke," said Angela Besanger, lead author of the fiber study and a nutritionist at Massachusetts General Hospital in Boston.

Both studies were expected to be presented Thursday at the American Stroke Association's International Stroke Conference in New Orleans.

Every year, more than 700,000 Americans have a stroke, according to the National Institute of Neurological Disorders and Stroke (NINDS). Stroke is the third-leading killer in the United States and is the leading cause of disability.

Known risk factors for stroke include cigarette smoking, high blood pressure, heart disease and diabetes. Past research has suggested that fish oil -- either directly from fish or from supplements -- could improve cardiovascular health and possibly decrease the risk of stroke.

To assess whether or not fish oil truly has an impact on stroke risk, the Australian researchers randomized 102 people who'd had a stroke to take either a daily fish oil supplement or a placebo for 12 weeks.

They found no evidence of benefit on markers of cardiovascular risk in people taking fish oil supplements when compared to the placebo group.

"From our research and on the basis of other data, I do not recommend low-medium doses of fish oil to my patients. Conversely, though, I do not discourage them if they personally wish to take the treatment as it might encourage other lifestyle changes," Anderson said.

The fiber study, which Besanger said is the first of its kind, included 50 people who'd just had a stroke. The researchers asked them to recall everything they'd eaten within 24 hours of having a stroke and compared that information to their disability level and general health at six months.

They found that those with the highest levels of fiber intake had better outcomes, but study co-author Dr. Karen Furie, director of the stroke service at Massachusetts General, pointed out that "this wasn't a clinical trial. We didn't give people fiber. The association was pretty dramatic, but this was a small sample size, and it's only observational data. These findings need to be replicated in a larger study."

However, Furie also noted that a recommendation to increase the amount of fiber in your diet is "a recommendation that's pretty easy to endorse. There are no downsides to increasing fiber intake."

"People attracted to these ideas [more fiber and fish oil] could be healthier to begin with," said Dr. Keith Siller, an assistant professor of neurology at New York University Medical Center in New York City. "It's very hard to validate whether taking fiber or fish oil has a direct effect on stroke risk. They're probably more a marker of people that live a healthier lifestyle."

More information

To learn more about stroke and how to prevent one, visit the National Institute of Neurological Disorders and Stroke.