WEDNESDAY, April 29 (HealthDay News) -- A urine test to detect coronary artery disease has worked well in a small trial, German researchers report.

The test looks for fragments of the protein collagen, which plays a major role in blocking heart arteries, said study author Dr. Constantin von zur Muehlen, a fellow in cardiology at University Hospital Freiberg. He was scheduled to report the findings Wednesday at an American Heart Association meeting in Washington, D.C.

"Collagen forms a fibrous cap on the epithelium, the lining of the arteries," Muehlen explained. "These fibrous caps produce collagen fragments."

High concentrations of those fragments, called proteomes, in urine can signal atherosclerosis (hardening of the arteries), which can lead to a heart attack, Muehlen said.

The urine test was done for 67 people with symptoms of coronary artery disease, he said. Two techniques to detect proteins, mass spectrometry and capillary electrophoresis, were used to find levels of 17 protein fragments that the researchers had identified as being associated with atherosclerosis.

When the results were compared to coronary angiography, an X-ray exam that is a standard method for diagnosing atherosclerosis, the urine tests were found to be 84 percent accurate, Muehlen said.

But a urine test to detect heart disease will not be developed quickly, he said. The German researchers have gone back to the laboratory, working with a strain of mice genetically engineered to develop coronary artery disease as they age.

"We went to this mouse model and found that, over time, the pattern of proteomes becomes more heavily expressed," Muehlen said. "The older the animal, the more extreme the pattern will be."

While he hopes to do a larger human study, no timetable for one has been set, Muehlen said.

More animal studies are needed to fill in knowledge gaps, he said. "We don't know if stable regions of atherosclerosis produce more collagen than unstable regions," Muehlen explained. Unstable collagen is more likely to rupture, blocking an artery completely.

This is not the first report of a urine test for coronary artery disease. In 2007, physicians at Brigham and Women's Hospital in Boston found that the presence of the protein albumin in urine of people with stable cardiovascular disease indicated an increased risk of death.

Albumin is normally found in blood, but not in urine. Leakage of albumin into the urine indicates damage to the blood vessels of the kidney, and so points to an increased risk of cardiovascular death, the researchers said.

The German study is "interesting, but I'd be cautious," said Dr. Alan Daugherty, director of the Cardiovascular Research Center at the University of Kentucky.

"In general, it obviously would be desirable to be able to diagnose coronary artery disease without an angiogram," Daugherty said. "There has been a tremendous amount of effort looking for biomarkers."

But a good deal of work is needed to move the results of the study toward clinical use, he said. "We've been trying to do something like this for decades," Daugherty noted.

More information

Learn about coronary artery disease from the U.S. National Heart, Lung, and Blood Institute.

TUESDAY, April 28 (HealthDay News) -- American heart patients who receive their primary care at a community health clinic are less likely to be referred for a consultation with a cardiologist than patients who receive their primary care at a hospital.

This difference is especially true among women, say researchers who reviewed the electronic medical records of 9,761 adult heart patients who received community clinic-based or hospital-based care between 2000 and 2005.

The overall rates for cardiology consultations were 79.6 percent for patients with coronary artery disease (CAD) and 90.3 percent for congestive heart failure (CHF) patients, said the researchers from Harvard Medical School and the U.S. National Heart, Lung, and Blood Institute (NHLBI).

However, patients seen at community health clinics were less likely (CAD patients 21 percent less, and CHF patients 23 percent less) to receive an initial cardiology consultation than those treated at hospital clinics.

Women with CAD and CHF were 11 percent less likely than men (11 percent and 7 percent, respectively) to be referred for an initial cardiology consultation. Black and Hispanic patients were as likely as whites to receive an initial cardiology consultation.

When they looked at ongoing cardiac consultations, the researchers found that:

• Women had 15 percent fewer follow-up consultations than men.
• Patients treated at community clinics had 20 percent fewer follow-up consultations than those treated at hospital-based practices.
• Blacks and Hispanics had 13 percent fewer follow-up consultations than whites.
• Women, blacks and Hispanics with fewer follow-up consultations had lower cardiac performance measures over five years.

The study was published in the April 27 online issue of Circulation.

"Access to a cardiology specialist is often a prerequisite for obtaining cardiovascular procedures. In this group, consultation with cardiology specialists improved the quality of medical care and reduced disparities in treatment of women," lead author Dr. Nakela Cook, a clinical medical officer at NHLBI, said in an institute news release.

More information

The U.S. Centers for Disease Control and Prevention has more about heart disease.

SATURDAY, April 25 (HealthDay News) -- Eating a low-salt diet is one of the most important lifestyle changes people with heart failure can make, but only a third adhere to the recommendation, a new study has found.

Researchers asked 116 people with heart failure to write down everything they ate for three days. Though the recommended daily intake of sodium for people with heart failure is 2,000 milligrams, participants in the study were consuming an average of 2,671 mg a day.

Many weren't purposefully ignoring doctor's recommendations, said study co-author Carolyn M. Reilly, a postdoctoral fellow at Emory University in Atlanta. Most thought they were taking steps to reduce their sodium by putting less salt on their foods, but she said they were focused on the wrong target.

About 70 percent of the sodium in the American diet comes from processed foods such as canned soups, lunch meats and fast food, not from salt added to home-cooked meals.

Sodium is added to foods to give them a longer shelf life, enhance texture and mask bitterness.

"There is so much salt hidden in foods that patients aren't aware of," Reilly said in a news release from the American Heart Association.

The research was to be presented Saturday at the American Heart Association's 10th Scientific Forum on Quality of Care and Outcomes Research in Cardiovascular Disease and Stroke in Washington, D.C.

The American Heart Association recommends that healthy people try to eat less than 2,300 mg of salt a day. Some people -- including blacks, middle-aged and older adults and people with high blood pressure -- should aim for less than 1,500 mg a day.

"The patients themselves were shocked to find out they were eating more than 2,000 mg of sodium a day," Reilly said.

Some of the highest-sodium foods eaten by the study participants included hot dogs, sausage and bacon, canned soups, salad dressings, condiments, fast food, lunch meat, bread, pizza, processed entrees, prepared grits and cornbread.

More information

The American Heart Association has more on low-sodium diets  .

FRIDAY, April 24 (HealthDay News) -- People with heart failure, and those who care for them, want more attention paid to their psychological needs, a new study finds.

"Heart failure patients and their caretakers suffer in a variety of ways," said Dr. David Bekelman, an assistant professor of medicine at the University of Colorado Health Sciences Center, who was to present the study Friday at an American Heart Association meeting in Washington, D.C. "They are interested in palliative care, reducing their suffering and improving their quality of life, and how such care could be provided."

Interviews with 33 people diagnosed with heart failure, which is the progressive loss of the heart's ability to pump blood, and 20 of their caregivers uncovered a desire for the kind of palliative care devoted to reducing suffering that is commonly given to people with cancer, Bekelman said.

"We asked them what was most distressing about having heart failure, and what was most helpful for dealing with the condition," he said. "We asked about symptoms and how they dealt with them, what it is like to live with heart failure, whether they got anxious and worried."

Four major needs emerged from the interviews, Bekelman said. "They need help adjusting to the limitations imposed by heart failure," he said. "They wanted to know what they might expect in terms of progression. They wanted help in alleviating physical and emotional symptoms. And they wanted better communication with medical personnel."

Treatment of heart failure usually focuses on the medical aspects of the condition, Bekelman said. The group he leads is "still looking at understanding the different needs of patients and caregivers," he said. "Some caregivers are open to questioning for planning purposes. Some patients often are not interested in their prognosis."

Bekelman said he hopes to pilot a program to address the different needs of those with heart failure and their caretakers. If he can obtain funding, the program would start "sometime next year," he said.

"It would have a nursing care manager who is competent in cardiac care and trained in community psychosocial care," he said. "There would be regular meetings in which they would talk about the future prospects. The benefits for patients could be better control of some symptoms and better coping with the limitations imposed by heart failure."

A successful program could make financial sense, Bekelman said. "We hope that, because patients and their caregivers would be less distressed, they would be better able to manage at home without medical care visits, so that would reduce costs," he said. "By reducing caregiver distress, it may help caregivers to be more productive at work and understand better how to care for the patient."

Family members who look after people with heart failure are important in the overall picture of medical care, said Dr. Gregg Fonarow, director of the Ahmanson-UCLA Cardiomyopathy Center and associate chief of the UCLA Division of Cardiology at the University of California, Los Angeles.

"We recognize that patients who do well have engaged family members," Fonarow said. "They assist in monitoring and frequently in medical follow-up. Caregivers can be critically important because traditional delivery systems might not be adequate."

More information

The Cleveland Clinic has more on heart failure treatment  .