University Times

UPMC presents findings at Heart Assn. meeting

University of Pittsburgh Medical Center researchers presented the following findings at the American Heart Association (AHA) meeting last month.

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Referral to cardiologist improves outcome of congestive heart failure

Patients hospitalized with congestive heart failure (CHF) have lower rates of re-admission if therapy is coordinated by a cardiologist, according to UPMC researchers.

Moreover, hospital charges for inpatient CHF care over a six-month period were less for patients treated by cardiologists, despite the fact that cardiologists were taking care of sicker patients. Analysis of 298 patient charts demonstrated higher rates of CHF re-admissions for patients who initially were treated by internists, even after adjusting the data to compensate for severity of CHF and other factors such as gender, race and co-morbidities (diabetes, coronary artery disease, hypertension and past CHF).

Steven D. Reis, Pitt assistant professor of medicine, presented the findings.

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Has the decline in coronary heart disease mortality ended in the United States?

Since 1970, the steady decline of heart attack deaths among white American men aged 35-44 probably resulted from lifestyle changes, according to the Allegheny County Coronary Heart Disease Mortality Study, in which Pitt researchers followed a steady population of 75,000 Pennsylvanians.

In the past 25 years, this downward trend has stopped, leaving public health researchers with the task of convincing new generations of young men to start and maintain a heart-healthy lifestyle if death rates from heart attacks in this age group are to drop, said Lewis Kuller, principal investigator for the study and chairperson of epidemiology in the Graduate School of Public Health.

"The incidence of coronary heart disease mortality in these men dropped significantly from 93 cases per 100,000 in the early 1970s to 37 cases per 100,000 in the late 1980s. Unfortunately, during the 1990s, this decline ceased. Lifestyle changes such as quitting smoking, getting regular exercise and eating healthy are probably responsible for this impressive decline," Kuller said.

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First evidence presented that gene therapy can prevent complication leading to transplant failure

Activity of the gene iNOS (inducible nitric oxide synthase) can prevent the deadly complication called transplant arteriosclerosis in rats receiving aortic grafts, according to a Pitt surgery department team.

Chronic organ rejection is marked by transplant arteriosclerosis, the buildup of smooth muscle cells within blood vessels. This buildup blocks blood flow inside coronary arteries. Without oxygen-enriched blood, a transplanted heart begins to die. Transplant arteriosclerosis occurs in 10-15 percent of heart transplant recipients each year. After three years, about 45 percent of heart recipients suffer this condition, according to Larry Shears, who was the presenter at the meeting.

iNOS triggers mass production of nitric oxide, a potent chemical that suppresses transplant arteriosclerosis.

In addition to finding that iNOS fought transplant arteriosclerosis in rats, researchers discovered that the common anti-rejection drug cyclosporine apparently inhibits the rats' ability to produce iNOS. Typically, to block organ rejection physicians give higher doses of anti-rejection drugs (cyclosporine, FK506 or steroids) which, by inhibiting production of iNOS, actually reduce patients' ability to defend themselves against rejection.

Besides Shears, the Pitt research team included Si Pham, assistant professor; Edith Tzeng, research associate; Nobuyoshi Kawaharada, research associate; and Timothy Billiar, associate professor.

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Nursing school gets $1.2 million to study smoking cessation for pregnant teens

Pitt's School of Nursing has received a $1.2 million grant from the National Institutes of Health and the National Institute of Nursing Research to evaluate and compare the effectiveness of three approaches to cigarette smoking cessation among pregnant teenagers.

"Sixty percent of teenage girls who become pregnant also smoke cigarettes and 60 to 80 percent of them continue to smoke throughout their pregnancies," said Susan Albrecht, assistant professor of nursing and principal investigator of the study. "Smoking's damaging effects on the fetus are well documented. Smoking mothers are more likely to deliver low-birthweight and premature infants with potential for other health problems. Perinatal death rates are twice as high in smokers as in non-smokers. And because of higher-risk pregnancies in teens, the teen smoker presents a double obstetrical risk." The four-year study is evaluating the short- and long-term effectiveness of usual care and education given to pregnant teens who are not undergoing formal smoking cessation programs to that of two specific smoking intervention strategies tailored to pregnant teens.

Albrecht's study team includes Saul Shiffman, professor of psychology, co-principal investigator; Marie Cornelius, assistant professor of epidemiology and psychiatry; Jacqueline Lamb, assistant professor of nursing; Thelma Patrick, assistant professor of nursing; Clement Stone, of Computing and Information Services, all from Pitt; and study consultant Patricia Dolan Mullen, a public health professor at the University of Texas Health Sciences Center.