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ACE Inhibitors Unnecessary for Some Heart Patients
studies among mice, those bred to lack this enzyme produce sperm that can’t swim toward egg cells to fertilize them. The enzyme, known as GAPDS, is essentially the same as an enzyme produced in human sperm. Researchers believe that designing a drug to disable the enzyme might provide the basis for an effective new form of male contraception that doesn’t affect natural hormone levels. Similarly, an understanding of the enzyme and related chemical reactions might lead to insights into treatment for some forms of male infertility. GAPDS, short for Glyceraldehyde 3-phosphate dehydrogenase-Sperm, is a key enzyme in a series of biochemical reactions known as glycolysis. This series of reactions produces ATP, a kind of cellular fuel that supplies energy for the cell’s activities. GAPDS is found only in sperm and the precursor cells that give rise to sperm. However, a related enzyme is present in virtually all the cells in the body. The human form of GAPDS is known as GAPD2. A drug developed to affect GAPDS could interfere with sperm motility when taken by men. In another possibility, GAPDS could compose a drug that could be deposited in the female reproductive tract, which could stop the movement of sperm when they come in contact with it. Current attempts to design a male contraceptive pill involve drugs that temporarily halt the functioning of the testes. These drugs suppress not only sperm production but also production of the male hormone testosterone, necessary for normal reproductive functioning. Such treatments typically involve replacing the missing testosterone through artificial means—a process that could increase the risk for prostate cancer. A drug that interfered with GAPD2 would leave testosterone levels unaffected.
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AWHONN Lifelines
Similarly, studying the functioning of GAPD2 might provide insights that could lead to treatments for male infertility. A drug that restored GAPD2 functioning might provide a treatment for male infertility. Similar molecular defects in the glycolysis pathway that produces ATP might also interfere with sperm movement and might be the focus of other treatments.
ACE Inhibitors Unnecessary for Some Heart Patients
M
any heart disease patients who are already receiving state-ofthe-art therapy don’t benefit from additional treatment with angiotensinconverting enzyme (ACE) inhibitors, according to new research recently presented at the American Heart Association’s Scientific Sessions conference and published recently in the New England Journal of Medicine. The results could significantly change clinical care of perhaps millions of Americans with heart disease. The study provides the most definitive evidence to date of the effect of the drug in stable heart disease patients whose heart function was shown to be at normal or near-normal levels, and whose heart disease was already well managed. Researchers found that ACE inhibitors don’t lower the risk of cardiovascular death, heart attack or the need for coronary revascularization (bypass surgery or angioplasty to restore blood flow to clogged arteries) in these patients. The American Heart Association currently recommends ACE inhibitors for all patients who have had a heart attack and others with coronary or other vascular disease. ACE inhibitors are a type of drug called vasodilators, meaning they cause blood vessel walls to widen or relax, thereby lowering blood pressure; they are one of several
classes of drugs that are recommended for treating high blood pressure. Clinical studies have also found that ACE inhibitors improve survival and reduce the risk of heart attack among patients with heart failure, a condition in which the heart muscle is no longer pumping enough blood throughout the body. In addition, the drug has been shown to help prevent heart failure in some patients with moderate to severe ventricular dysfunction, or abnormalities in the lower chambers of the heart. “As such, lower-risk heart patients can avoid side effects and the added expense of ACE inhibitors without putting themselves at additional risk for cardiovascular complications,” presenters noted. The drug’s side effects include cough, fainting spells and a rare but serious allergic reaction known as angioedema. Heart disease is the single leading cause of death in the U.S. More than 13 million adults have coronary heart disease, putting them at increased risk for heart attack, sudden death, angina, heart failure and stroke. Most patients with coronary heart disease, including heart attack survivors, however, don’t have heart failure or ventricular dysfunction. The trial was designed to test whether ACE inhibitors provide added benefits to this group of heart disease patients with relatively good heart function and involved nearly 8,300 participants who did not have heart failure and who had normal or near normal left ventricular function, as evidenced by left ventricular ejection fraction of greater than 40 percent. The ejection fraction is an indication of the amount of blood that is pumped out of a filled ventricle; a normal rate is 50 percent or more. The average age of participants when they started the trial was 64 years. The study was conducted at 180 clinical
Volume 9
Issue 1
sites in the U.S., Canada, Puerto Rico and Italy. After an average follow-up of 4.8 years, the same proportion (about 22 percent) of participants in each group died from cardiovascular disease (CVD), had a heart attack or needed revascularization. The results did not differ when the researchers adjusted for the participants’ age, gender or history of heart attack, transient ischemic attack, diabetes or high blood cholesterol. Similarly, there were no differences based on which heart disease therapies participants followed during the study. Although trandolapril lowered systolic blood pressure (the top number in a blood pressure reading) by an average of 4.4 mm Hg, the reduction did not have a significant effect on the patients’ outcomes. Approximately 5 million Americans have heart failure. Common causes of heart failure include coronary heart disease and high blood pressure. Based on the NHLBI’s Framingham Heart Study, approximately 22 percent of men and 46 percent of women who survive a heart attack will be disabled by heart failure within six years.
Pregnancy Possible After UAE
P
regnancy is possible for women who undergo uterine artery embolization (UAE) for fibroids, according to a study published in the January issue of Obstetrics & Gynecology. Due to abnormal placental development in a few of the pregnancies, however, researchers suggest that postUAE pregnancies be managed conservatively and that the condition of the placenta be closely monitored during pregnancy. Fibroids are benign tumors of the uterus that affect up to one-fourth of
February | March 2005
Labor Longer for Overweight, Obese Women
P
regnant women who are overweight or obese progress through labor more slowly than do normal-weight women, according to a study by researchers at the University of North Carolina and the National Institute of Child Health and Human Development of the National Institutes of Health. Since a longer labor is one consideration for whether or not a pregnant woman will have a cesarean section, the new finding also means that health care providers need to take a woman’s weight into account before deciding whether to recommend her for the procedure, the study authors caution. The study appears in the November issue of Obstetrics and Gynecology. When taken together with other findings showing that extra body weight during pregnancy can pose serious and even life-threatening complications for both mother and infant, the current finding underscores the need for overweight or obese women who are either pregnant or contemplating pregnancy to seek medical attention. In the current study, researchers analyzed pregnancy and birth records from 612 North Carolina women who gave birth to their first child. The researchers undertook the study to determine why obese and overweight women are more likely to have a cesarean section. The increase in labor duration among overweight and obese women accounts, in part, for their increased C-section rate. The decision on whether a pregnant woman should deliver by C-section is extremely complicated. Attending providers need to consider a variety of factors before making the decision, such as how rapidly labor progresses, as well as any complications of pregnancy, researchers wrote. With almost half of all women of childbearing age overweight or obese, researchers cautioned that health care providers need to add to their other considerations a woman’s pre-pregnancy weight, as well as how much weight she’s gained during the pregnancy. To determine whether the women qualified as either obese or overweight, the researchers relied on BMI standards for pregnancy developed by the Institute of Medicine. Women with a BMI from 19.8 to 26 were defined as normal, from 26.1 to 29 as overweight and above 29 as obese. The researchers found that for both overweight and obese women, the active duration of labor took longer than it did for normal-weight women. Specifically, the researchers recorded the time it took for a woman’s cervix to dilate from 4 centimeters to 10 centimeters and found that the median labor for overweight women was 7.5 hours, for obese women 7.9 hours and for normal-weight women 6.2 hours.
AWHONN Lifelines
31
30
AWHONN Lifelines
Similarly, studying the functioning of GAPD2 might provide insights that could lead to treatments for male infertility. A drug that restored GAPD2 functioning might provide a treatment for male infertility. Similar molecular defects in the glycolysis pathway that produces ATP might also interfere with sperm movement and might be the focus of other treatments.
ACE Inhibitors Unnecessary for Some Heart Patients
M
any heart disease patients who are already receiving state-ofthe-art therapy don’t benefit from additional treatment with angiotensinconverting enzyme (ACE) inhibitors, according to new research recently presented at the American Heart Association’s Scientific Sessions conference and published recently in the New England Journal of Medicine. The results could significantly change clinical care of perhaps millions of Americans with heart disease. The study provides the most definitive evidence to date of the effect of the drug in stable heart disease patients whose heart function was shown to be at normal or near-normal levels, and whose heart disease was already well managed. Researchers found that ACE inhibitors don’t lower the risk of cardiovascular death, heart attack or the need for coronary revascularization (bypass surgery or angioplasty to restore blood flow to clogged arteries) in these patients. The American Heart Association currently recommends ACE inhibitors for all patients who have had a heart attack and others with coronary or other vascular disease. ACE inhibitors are a type of drug called vasodilators, meaning they cause blood vessel walls to widen or relax, thereby lowering blood pressure; they are one of several
classes of drugs that are recommended for treating high blood pressure. Clinical studies have also found that ACE inhibitors improve survival and reduce the risk of heart attack among patients with heart failure, a condition in which the heart muscle is no longer pumping enough blood throughout the body. In addition, the drug has been shown to help prevent heart failure in some patients with moderate to severe ventricular dysfunction, or abnormalities in the lower chambers of the heart. “As such, lower-risk heart patients can avoid side effects and the added expense of ACE inhibitors without putting themselves at additional risk for cardiovascular complications,” presenters noted. The drug’s side effects include cough, fainting spells and a rare but serious allergic reaction known as angioedema. Heart disease is the single leading cause of death in the U.S. More than 13 million adults have coronary heart disease, putting them at increased risk for heart attack, sudden death, angina, heart failure and stroke. Most patients with coronary heart disease, including heart attack survivors, however, don’t have heart failure or ventricular dysfunction. The trial was designed to test whether ACE inhibitors provide added benefits to this group of heart disease patients with relatively good heart function and involved nearly 8,300 participants who did not have heart failure and who had normal or near normal left ventricular function, as evidenced by left ventricular ejection fraction of greater than 40 percent. The ejection fraction is an indication of the amount of blood that is pumped out of a filled ventricle; a normal rate is 50 percent or more. The average age of participants when they started the trial was 64 years. The study was conducted at 180 clinical
Volume 9
Issue 1
sites in the U.S., Canada, Puerto Rico and Italy. After an average follow-up of 4.8 years, the same proportion (about 22 percent) of participants in each group died from cardiovascular disease (CVD), had a heart attack or needed revascularization. The results did not differ when the researchers adjusted for the participants’ age, gender or history of heart attack, transient ischemic attack, diabetes or high blood cholesterol. Similarly, there were no differences based on which heart disease therapies participants followed during the study. Although trandolapril lowered systolic blood pressure (the top number in a blood pressure reading) by an average of 4.4 mm Hg, the reduction did not have a significant effect on the patients’ outcomes. Approximately 5 million Americans have heart failure. Common causes of heart failure include coronary heart disease and high blood pressure. Based on the NHLBI’s Framingham Heart Study, approximately 22 percent of men and 46 percent of women who survive a heart attack will be disabled by heart failure within six years.
Pregnancy Possible After UAE
P
regnancy is possible for women who undergo uterine artery embolization (UAE) for fibroids, according to a study published in the January issue of Obstetrics & Gynecology. Due to abnormal placental development in a few of the pregnancies, however, researchers suggest that postUAE pregnancies be managed conservatively and that the condition of the placenta be closely monitored during pregnancy. Fibroids are benign tumors of the uterus that affect up to one-fourth of
February | March 2005
Labor Longer for Overweight, Obese Women
P
regnant women who are overweight or obese progress through labor more slowly than do normal-weight women, according to a study by researchers at the University of North Carolina and the National Institute of Child Health and Human Development of the National Institutes of Health. Since a longer labor is one consideration for whether or not a pregnant woman will have a cesarean section, the new finding also means that health care providers need to take a woman’s weight into account before deciding whether to recommend her for the procedure, the study authors caution. The study appears in the November issue of Obstetrics and Gynecology. When taken together with other findings showing that extra body weight during pregnancy can pose serious and even life-threatening complications for both mother and infant, the current finding underscores the need for overweight or obese women who are either pregnant or contemplating pregnancy to seek medical attention. In the current study, researchers analyzed pregnancy and birth records from 612 North Carolina women who gave birth to their first child. The researchers undertook the study to determine why obese and overweight women are more likely to have a cesarean section. The increase in labor duration among overweight and obese women accounts, in part, for their increased C-section rate. The decision on whether a pregnant woman should deliver by C-section is extremely complicated. Attending providers need to consider a variety of factors before making the decision, such as how rapidly labor progresses, as well as any complications of pregnancy, researchers wrote. With almost half of all women of childbearing age overweight or obese, researchers cautioned that health care providers need to add to their other considerations a woman’s pre-pregnancy weight, as well as how much weight she’s gained during the pregnancy. To determine whether the women qualified as either obese or overweight, the researchers relied on BMI standards for pregnancy developed by the Institute of Medicine. Women with a BMI from 19.8 to 26 were defined as normal, from 26.1 to 29 as overweight and above 29 as obese. The researchers found that for both overweight and obese women, the active duration of labor took longer than it did for normal-weight women. Specifically, the researchers recorded the time it took for a woman’s cervix to dilate from 4 centimeters to 10 centimeters and found that the median labor for overweight women was 7.5 hours, for obese women 7.9 hours and for normal-weight women 6.2 hours.
AWHONN Lifelines
31