Their findings were presented Nov. 12 at the American Heart Association Scientific Sessions conference in New Orleans.
"This is one of the strongest predictors of new-onset heart failure we've been able to find, and it holds up even when you control for other biomarkers and risk factors including high blood pressure and diabetes," says Javed Butler, MD, MPH, associate professor of medicine and director of heart failure research at Emory University School of Medicine.
The finding comes out of the Health ABC (Aging and Body Composition) study, sponsored by the National Institute on Aging of the National Institutes of Health. The Health ABC study followed 3000 elderly people in the Pittsburgh and Memphis areas over seven years starting in 1998.
Although scientists don't know the exact function of resistin, it appears to be associated with both inflammation and insulin resistance, says Vasiliki Georgiopoulou, MD, a post-doctoral research fellow with Butler who presented these findings. "Recent laboratory studies have also shown that resistin decreases the ability of rats' heart muscles to contract," she adds.
In the Health ABC study, the risk of new onset heart failure increased by 38 percent for every 10 nanograms per milliliter increase in resistin levels in blood. Resistin was a stronger predictor of heart failure risk than other inflammatory markers linked to heart disease, such as C-reactive protein, the researchers found.
"Considering the increasing number of people who are obese or have diabetes, very many of them are going to be at some level of risk for heart failure later in life," Butler says. "The value of a marker such as resistin may be in accurately identifying among this large population of at-risk individuals who is at the highest risk and then targeting interventions to those people."
emory
The research is part of several C-PORT projects investigating the safety of performing angioplasty in hospitals without heart-surgery backup, all led by Aversano, an associate professor at the Johns Hopkins University School of Medicine and its Heart and Vascular Institute.
He notes that even in lower volume hospitals, at no more than 46 procedures per year, the death rate is 4 percent. Previous research by Aversano, published in the Journal of the American Medical Association in 2002, showed that heart attack patients who were treated with a clot-busting drug to open up the artery, the alternative to primary angioplasty, had a 6.7 percent death rate.
"Even in low-volume community hospitals, survival rates are better for primary angioplasty than thrombolytic therapy," says Aversano.
"Our results serve as one potential motivation for expanding elective angioplasty to community hospitals without on-site cardiac surgery so that institutional volume is not restricted to emergency cases," he says.
For the last two decades, surgical backup has been required for nonemergency angioplasty because, in rare instances, the procedure leads to a tear in a vessel or closing of an artery rather than opening it. The risk that angioplasty patients will need emergency heart bypass surgery is less than 1 to 2 in every 1,000 cases.
But Aversano and other researchers say medical advances have led to nonsurgical means of treating many of these complications, including the use of stents to keep arteries open, thus minimizing the need for on-site cardiac surgery backup.
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