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4 CARDIOVASCULAR UPDATE KING’S DAUGHTERS HEART AND VASCULAR CENTER
New recommendations for use of
heart failure drug Nesiritide
Nesiritide (Natrecor®) is a
recombinant form of human-type
natriuretic peptide (hBNP) that occurs
naturally in the ventricles of the heart.
Approved only for the treatment of acute
decompensated heart failure (ADHF) in
patients with dyspnea at rest, it has
previously been used in patients with
varying degrees of heart failure including
those seeking treatment in outpatient
clinics. Nesiritide causes a rapid decrease
in ventricular filling pressure, thus
reversing the dyspnea that heart failure
patients experience.
Two meta-analyses recently conducted
led to the concern that nesiritide may
cause renal dysfunction as well as increase
mortality. In response to this information
Scios (manufacturer of nesiritide) hired a
panel of experts to review all data
available on the medication.
There were several final
recommendations made by the panel:
1. Nesiritide should be restricted to
patients with Class IV heart failure –
patients with dyspnea at rest.
2. Nesiritide should NOT be used to
replace diuretics, nor should the
medication be used for intermittent
outpatient infusions, for scheduled
repetitive use, to improve renal function
or to enhance diuresis.
3. The drug manufacturer should
immediately begin educating physicians
about instances where nesiritide should
not be used and all future marketing
activities should be consistent with this
new information. The educational effort
by Scios is currently underway. If you
have questions regarding nesiritide, do not
hesitate to contact one of KDMC’s
cardiologists or Jen Van Cura, Pharmacy
director, at (606) 327-4485.
Diabetes on the rise, says CDC
New figures from the Centers for
Disease Control and Prevention (CDC)
reveal that 20.8 million Americans are
now living with diabetes, a 14 percent
increase from the 18.2 million the CDC
reported in 2003. Another 41 million
have pre-diabetes, a condition that
indicates an increased risk for developing
type 2 diabetes. It is estimated that two
out of three people with diabetes die from
heart disease and stroke.
Make the Link! Diabetes, Heart
Disease and Stroke is an initiative of the
American Diabetes Association and the
American College of Cardiology aimed at
increasing awareness of the link between
diabetes and heart disease. Make the Link!
stresses that diabetes management is more
than control of blood glucose. People with
diabetes need to know their ABC targets:
• A – A1C test, which should be done at
least twice a year. The results should be
seven percent or below.
• B – Blood pressure. This should be
120/80 and checked frequently.
• C – Cholesterol (LDL) should be below
100, and needs to be checked at least
once a year.
Type 2 diabetics should have
cardiac stress test
In an article in the Jan. 3 issue of the
Journal of the American College of
Cardiology, an Italian study showed that
contrary to current guidelines, aggressive
efforts to detect coronary artery disease
are worthwhile in asymptomatic patients
with type 2 diabetes.
Current coronary artery disease
screening guidelines from the American
Diabetes Association recommend stress
testing asymptomatic patients with
diabetes if they have two or more
additional risk factors. In an attempt to
“verify the effectiveness” of these
guidelines, the researchers studied 1,899
asymptomatic type 2 diabetic patients 60
years old or younger. The patients were
divided into two groups: group A
included 1,121 patients with two or more
CAD risk factors, and group B included
778 patients with no or only one risk
factor. All the subjects underwent cardiac
stress tests, and those with abnormal
results underwent angiography. According
to the researchers, the prevalence of
abnormal stress test findings were similar
between group A and group B, as was the
prevalence of significant CAD found
during angiography. This suggests that a
substantial number of asymptomatic
diabetic patients with few risk factors
might have occult coronary artery disease
that may be missed on the basis of current
ADA guidelines.
New study finds PCI cuts AMI death
risk in half
A study published recently in the New
England Journal of Medicine found that
when clot-busting drugs fail to stop a
heart attack, angioplasty, or PCI, is the
most effective treatment. The study also
found that patients benefited even when
they had to be transferred to another
facility to undergo angioplasty. Study
results also showed that PCI reduces by
half the risk of stroke, heart failure or
later heart attack. Giving more clotbusting
drugs when the first round did
not work offered virtually no benefit.
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