(Circulation. 2002;105:e9071.)
© 2002 American Heart Association, Inc.
Cardiovascular News
Circulation Newswriter
Weight Loss Decreases C-Reactive Protein Levels
The value of weight loss has been touted for decades, and nothing is more important than the effect it has on lowering the risk of cardiovascular disease. Now, in an article this week’s Circulation (Circulation. 2002;105:564–569), André Tchernof, PhD, and colleagues from the University of Vermont in Burlington describe a study in which they found that obese women who had high levels of circulating C-reactive protein saw those levels decrease when they lost a substantial amount of weight.
In a sample of 61 obese, menopausal women with an average body mass index of 35.6 kg/m2, levels of C-reactive protein circulating in the serum were positively associated with measures of total body fat and intra-abdominal body fat. Of the 61 women, 25 completed a weight loss protocol, with an average weight loss of 14.5 kg, of which 10.4 kg were fat and 2.8 kg were fat-free mass. Both visceral and subcutaneous fat were reduced. In these women, plasma C-reactive protein levels were reduced on average by 32.3%.
The authors concluded, "Weight loss may represent an important intervention to reduce CRP [C-reactive protein] levels, which may mediate part of its [ie, weight loss] cardioprotective effects in obese postmenopausal women."
Chelation Therapy Loses Again
Chelation therapy, a widely touted but unproved treatment for ischemic heart disease, again failed to prove its value in a study in the January 23/30, 2002, issue of the Journal of the American Heart Association. (JAMA. 2002;287:481–486). The trial was carried out by the Program to Assess Alternative Treatment Strategies to Achieve Cardiac Health (PATCH) investigators.
A total of 84 patients who had undergone cardiac catheterization (among other diagnostic modalities) were recruited from a cohort of 3140. To qualify, patients had to be at least 21 years of age with coronary artery disease proved by angiography, as well as a documented myocardial infarction and stable angina while on optimal medical therapy. Patients were randomly assigned to receive either an infusion with weight-adjusted EDTA chelation therapy or placebo for 3 hours per treatment, twice a week for 15 weeks and once a month for an additional 3 months.
A total of 39 patients in each group completed the 27-week protocol. Therapy was discontinued in one patient because of a transient serum creatinine increase. The mean baseline exercise time to ischemia was 527 seconds in the placebo group and 589 seconds in the chelation group. After 27 weeks of treatment, the mean baseline exercise time to ischemia improved by 54 seconds in the placebo group and by 63 seconds in the chelation group, a difference that was not statistically significant. Exercise capacity and quality-of-life scores improved by similar degrees in the two groups.
"Chelation therapy is practiced and promoted as a form of complementary or alternative medicine in many developed countries," the authors wrote. "Additional vitamins and mineral supplements are recommended for patients undergoing chelation therapy. In our study both groups received multivitamins; we cannot exclude the possibility that these supplements could be partially responsible for the improvement that we saw in both groups. In the literature, numerous authors have reported positive results in uncontrolled studies."
The authors concluded, "Based on exercise time to ischemia, exercise capacity, and quality of life measurements, there is no evidence to support a beneficial effect of chelation therapy in patients with ischemic heart disease, stable angina, and a positive treadmill test for ischemia."
They noted that prior estimates have shown that as many as half a million people in the United States are being treated with EDTA chelation therapy for heart disease each year. A Canadian study, they said, indicated that 8% of people who have undergone cardiac catheterization have tried chelation therapy.
"Assuming 8% of the 1.25 million US residents who have undergone cardiac catheterization have tried chelation therapy, we project that 100 000 have tried chelation therapy. Estimating a cost of $4000 for the usual series of treatments sums to an annual expenditure of approximately $400 million," the authors wrote, noting that the figures are likely to be significantly higher because not all cardiac patients undergo catheterization.
Bush Plans to Strengthen National Health Service Corps
The up-and-down fortunes of the National Health Service (NHS) Corps seemed on a more vertical course in late January when US Department of Health and Human Services Secretary Tommy G. Thompson promised that the Bush Administration’s 2003 budget for the National Health Service Corps will total $191.5 million—a $44 million increase.
The NHS supports doctors and clinicians who serve in rural and inner-city areas where health care providers are scarce. In response to a growing dearth of registered nurses, the budget also will include $15 million—a 50% increase over last year’s funding—for the Nursing Education Loan Repayment Program.
The increased funding for the NHS means that the Corps will be able to provide scholarships or loans to 1800 physicians, dentists, and other clinicians who agree to practice in underserved areas.
"The President’s proposal recognizes the importance of increasing access to quality health care in local communities and improving the health of the nation’s underserved individuals," Secretary Thompson said in a released statement. "The National Health Service Corps has served millions of people, and expanding this program will help even more uninsured individuals and those in underserved areas to get the health care they need."
The additional nursing fund will support 800 new nursing education loan agreements. The program repays the education loans of clinical care nurses who agree to work for 2 years in designated public or nonprofit health facilities that face a critical shortage of nurses.
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