Bruce Jancin

CHICAGO – Keeping the bedroom warm at night during the cold winter months curbs the morning surge in blood pressure, according to a randomized Japanese trial.

This finding may help explain the well-established increased mortality due to heart disease and stroke during the winter months. The data from this study indicate that if the ambient bedroom temperature is lower, morning blood pressure will be higher, the morning blood pressure surge will be greater, and there will be increased blood pressure variability during the 24-hour day, increasing the risk of a cardiac or cerebrovascular event, Dr. Keigo Saeki asserted at the annual scientific sessions of the American Heart Association.

The investigators randomized 140 healthy 18- to 65-year-old participants to spend a night in either an inadequately heated room at 12° C (54° F) or a room maintained at 22° C (72° F). Participants were required to remain in the room between 9 p.m. and 6 a.m., stay awake until 11 p.m., and rise by 6 a.m. Blood pressure was measured every 30 minutes through the night. The subjects had access to all the clothing and blankets they needed to stay comfortable, said Dr. Saeki of Nara (Japan) Medical University.

Mean systolic blood pressure during the first 2 hours after awakening in the morning was 121.1 mm Hg in subjects who slept in the cold room, significantly higher than the 114.0 mm Hg for those in the warm room. The morning systolic blood pressure surge also was significantly higher in subjects after a night in the inadequately heated room: 21.9 mm Hg, compared with 14.3 mm Hg after a night in the warm room. However, there was no difference between the two study groups in terms of lowest sleeping systolic blood pressure, which averaged 99 mm Hg across three readings.

Dr. Saeki declared having no relevant financial interests.

CHICAGO – Keeping the bedroom warm at night during the cold winter months curbs the morning surge in blood pressure, according to a randomized Japanese trial.

This finding may help explain the well-established increased mortality due to heart disease and stroke during the winter months. The data from this study indicate that if the ambient bedroom temperature is lower, morning blood pressure will be higher, the morning blood pressure surge will be greater, and there will be increased blood pressure variability during the 24-hour day, increasing the risk of a cardiac or cerebrovascular event, Dr. Keigo Saeki asserted at the annual scientific sessions of the American Heart Association.

The investigators randomized 140 healthy 18- to 65-year-old participants to spend a night in either an inadequately heated room at 12° C (54° F) or a room maintained at 22° C (72° F). Participants were required to remain in the room between 9 p.m. and 6 a.m., stay awake until 11 p.m., and rise by 6 a.m. Blood pressure was measured every 30 minutes through the night. The subjects had access to all the clothing and blankets they needed to stay comfortable, said Dr. Saeki of Nara (Japan) Medical University.

Mean systolic blood pressure during the first 2 hours after awakening in the morning was 121.1 mm Hg in subjects who slept in the cold room, significantly higher than the 114.0 mm Hg for those in the warm room. The morning systolic blood pressure surge also was significantly higher in subjects after a night in the inadequately heated room: 21.9 mm Hg, compared with 14.3 mm Hg after a night in the warm room. However, there was no difference between the two study groups in terms of lowest sleeping systolic blood pressure, which averaged 99 mm Hg across three readings.

Dr. Saeki declared having no relevant financial interests.

CHICAGO – Keeping the bedroom warm at night during the cold winter months curbs the morning surge in blood pressure, according to a randomized Japanese trial.

This finding may help explain the well-established increased mortality due to heart disease and stroke during the winter months. The data from this study indicate that if the ambient bedroom temperature is lower, morning blood pressure will be higher, the morning blood pressure surge will be greater, and there will be increased blood pressure variability during the 24-hour day, increasing the risk of a cardiac or cerebrovascular event, Dr. Keigo Saeki asserted at the annual scientific sessions of the American Heart Association.

The investigators randomized 140 healthy 18- to 65-year-old participants to spend a night in either an inadequately heated room at 12° C (54° F) or a room maintained at 22° C (72° F). Participants were required to remain in the room between 9 p.m. and 6 a.m., stay awake until 11 p.m., and rise by 6 a.m. Blood pressure was measured every 30 minutes through the night. The subjects had access to all the clothing and blankets they needed to stay comfortable, said Dr. Saeki of Nara (Japan) Medical University.

Mean systolic blood pressure during the first 2 hours after awakening in the morning was 121.1 mm Hg in subjects who slept in the cold room, significantly higher than the 114.0 mm Hg for those in the warm room. The morning systolic blood pressure surge also was significantly higher in subjects after a night in the inadequately heated room: 21.9 mm Hg, compared with 14.3 mm Hg after a night in the warm room. However, there was no difference between the two study groups in terms of lowest sleeping systolic blood pressure, which averaged 99 mm Hg across three readings.

Dr. Saeki declared having no relevant financial interests.

CHICAGO – Acute coronary syndrome patients randomized to dual antiplatelet therapy with ticagrelor and aspirin had fewer hospital bed days, revascularization procedures, and total health care costs over the course of 1 year, compared with patients assigned to clopidogrel plus aspirin, according to an economic substudy of the Platelet Inhibition and Patient Outcomes trial.

Mean 1-year total health care costs, excluding the cost of the drugs, were $18,666 in the clopidogrel (Plavix) arm and $17,988 with ticagrelor (Brilinta), an investigational, reversibly binding, oral P2Y12 receptor antagonist, based on Swedish costs per resource used. The resultant mean $678 savings in the ticagrelor group was significant, Dr. Magnus Janzon said at the annual scientific sessions of the American Heart Association.

The Platelet Inhibition and Patient Outcomes (PLATO) trial was a 43-country, double-blind randomized trial of 18,624 patients with acute coronary syndrome. The previously reported primary composite study end point consisting of MI, stroke, or death due to vascular causes occurred in 9.8% of patients in the ticagrelor arm and 11.7% with clopidogrel, for a significant 16% relative risk reduction favoring the newer agent (N. Engl. J. Med. 2009;361:1045-57). This benefit came without any significant cost in terms of major bleeding rates, which were similar in the two treatment arms, noted Dr. Janzon, head of cardiology at Linkoping (Sweden) University Hospital.

The economic substudy included the 10,686 PLATO participants with detailed 1-year follow-up data. During that time frame, the ticagrelor group collectively had 1,149 fewer hospital bed days, including 333 fewer days in the intensive care unit and 379 fewer days in the coronary care unit. The ticagrelor group also had 95 fewer percutaneous coronary interventions and 41 fewer coronary artery bypass graft procedures.

Because health care costs vary so widely from country to country, Dr. Janzon and his colleagues also calculated the 1-year mean total costs using U.S. values, which were nearly twice as high as in Sweden: $34,938 in the ticagrelor plus aspirin group, compared with $33,961 for clopidogrel plus aspirin, for a $977 reduction per patient in the ticagrelor arm.

In December the Food and Drug Administration declined to approve ticagrelor, and requested additional analyses of PLATO despite an earlier 7-1 vote in favor of approval by the FDA’s Cardiovascular and Renal Drugs Advisory Committee.

The PLATO trial was sponsored by AstraZeneca. Dr. Janzon declared having no relevant financial interests.

CHICAGO – Acute coronary syndrome patients randomized to dual antiplatelet therapy with ticagrelor and aspirin had fewer hospital bed days, revascularization procedures, and total health care costs over the course of 1 year, compared with patients assigned to clopidogrel plus aspirin, according to an economic substudy of the Platelet Inhibition and Patient Outcomes trial.

Mean 1-year total health care costs, excluding the cost of the drugs, were $18,666 in the clopidogrel (Plavix) arm and $17,988 with ticagrelor (Brilinta), an investigational, reversibly binding, oral P2Y12 receptor antagonist, based on Swedish costs per resource used. The resultant mean $678 savings in the ticagrelor group was significant, Dr. Magnus Janzon said at the annual scientific sessions of the American Heart Association.

The Platelet Inhibition and Patient Outcomes (PLATO) trial was a 43-country, double-blind randomized trial of 18,624 patients with acute coronary syndrome. The previously reported primary composite study end point consisting of MI, stroke, or death due to vascular causes occurred in 9.8% of patients in the ticagrelor arm and 11.7% with clopidogrel, for a significant 16% relative risk reduction favoring the newer agent (N. Engl. J. Med. 2009;361:1045-57). This benefit came without any significant cost in terms of major bleeding rates, which were similar in the two treatment arms, noted Dr. Janzon, head of cardiology at Linkoping (Sweden) University Hospital.

The economic substudy included the 10,686 PLATO participants with detailed 1-year follow-up data. During that time frame, the ticagrelor group collectively had 1,149 fewer hospital bed days, including 333 fewer days in the intensive care unit and 379 fewer days in the coronary care unit. The ticagrelor group also had 95 fewer percutaneous coronary interventions and 41 fewer coronary artery bypass graft procedures.

Because health care costs vary so widely from country to country, Dr. Janzon and his colleagues also calculated the 1-year mean total costs using U.S. values, which were nearly twice as high as in Sweden: $34,938 in the ticagrelor plus aspirin group, compared with $33,961 for clopidogrel plus aspirin, for a $977 reduction per patient in the ticagrelor arm.

In December the Food and Drug Administration declined to approve ticagrelor, and requested additional analyses of PLATO despite an earlier 7-1 vote in favor of approval by the FDA’s Cardiovascular and Renal Drugs Advisory Committee.

The PLATO trial was sponsored by AstraZeneca. Dr. Janzon declared having no relevant financial interests.

CHICAGO – Acute coronary syndrome patients randomized to dual antiplatelet therapy with ticagrelor and aspirin had fewer hospital bed days, revascularization procedures, and total health care costs over the course of 1 year, compared with patients assigned to clopidogrel plus aspirin, according to an economic substudy of the Platelet Inhibition and Patient Outcomes trial.

Mean 1-year total health care costs, excluding the cost of the drugs, were $18,666 in the clopidogrel (Plavix) arm and $17,988 with ticagrelor (Brilinta), an investigational, reversibly binding, oral P2Y12 receptor antagonist, based on Swedish costs per resource used. The resultant mean $678 savings in the ticagrelor group was significant, Dr. Magnus Janzon said at the annual scientific sessions of the American Heart Association.

The Platelet Inhibition and Patient Outcomes (PLATO) trial was a 43-country, double-blind randomized trial of 18,624 patients with acute coronary syndrome. The previously reported primary composite study end point consisting of MI, stroke, or death due to vascular causes occurred in 9.8% of patients in the ticagrelor arm and 11.7% with clopidogrel, for a significant 16% relative risk reduction favoring the newer agent (N. Engl. J. Med. 2009;361:1045-57). This benefit came without any significant cost in terms of major bleeding rates, which were similar in the two treatment arms, noted Dr. Janzon, head of cardiology at Linkoping (Sweden) University Hospital.

The economic substudy included the 10,686 PLATO participants with detailed 1-year follow-up data. During that time frame, the ticagrelor group collectively had 1,149 fewer hospital bed days, including 333 fewer days in the intensive care unit and 379 fewer days in the coronary care unit. The ticagrelor group also had 95 fewer percutaneous coronary interventions and 41 fewer coronary artery bypass graft procedures.

Because health care costs vary so widely from country to country, Dr. Janzon and his colleagues also calculated the 1-year mean total costs using U.S. values, which were nearly twice as high as in Sweden: $34,938 in the ticagrelor plus aspirin group, compared with $33,961 for clopidogrel plus aspirin, for a $977 reduction per patient in the ticagrelor arm.

In December the Food and Drug Administration declined to approve ticagrelor, and requested additional analyses of PLATO despite an earlier 7-1 vote in favor of approval by the FDA’s Cardiovascular and Renal Drugs Advisory Committee.

The PLATO trial was sponsored by AstraZeneca. Dr. Janzon declared having no relevant financial interests.

DENVER – High school girl athletes are at 3.3-fold greater risk of incurring an anterior cruciate ligament injury than are boys playing the same or similar sports, according to a national study.

Of the nine sports assessed in the study, the highest ACL injury rate occurred in girls’ soccer, with 13.0 cases per 100,000 athletic exposures. In contrast, the rate in boys’ soccer was 4.8 cases per 100,000 athletic exposures, with an athletic exposure defined as one practice or game, Natalie McIlvain explained at the annual meeting of the American Public Health Association.

In girls’ basketball, the ACL injury rate was 9.1/100,000 athletic exposures. Yet in boys’ basketball, a sport with similar rules and equipment but bigger, heavier participants, the rate was just 2.2/100,000, said Ms. McIlvain of the Center for Injury Research and Policy at Nationwide Children’s Hospital in Columbus, Ohio.

Each year more than 7 million high school students participate in interscholastic sports. ACL injuries are the costliest type of sports injury occurring in these young athletes, as they often require expensive surgery and lengthy physical rehabilitation.

In order to better understand the epidemiology of high school ACL injuries, Ms. McIlvain and her coinvestigators analyzed data from the Centers for Disease Control and Prevention–sponsored National High School Sports-Related Injury Surveillance Study. In this study, certified athletic trainers at 100 nationally representative high schools used an online data-collection system to record the details of all athletic injuries, large or small, occurring during the 2007-2008 through 2009-2010 academic years. During the study period, the trainers documented 397 ACL injuries, extrapolating to an estimated 128,374 ACL injuries occurring nationally each year among high school athletes.

ACL injuries accounted for 3.1% of all sports injuries and 21% of all knee injuries. Seventy-seven percent of the ACL injuries required surgery. Nearly 50% of athletes with an ACL injury were medically disqualified for the season. Another 26% returned to play after 3 weeks or longer.

The overall incidence of ACL injury was 6.7/100,000 exposures. The rate was 18.0/100,000 exposures in competition, more than seven times the incidence of 2.5/100,000 during practices.

Forty-five percent of ACL injuries resulted from player-player contact. "That’s interesting, especially given that seven of the nine sports we studied were noncontact sports," Ms. McIlvain observed.

A striking gender-related difference in mechanism of injury was noted only in soccer. Forty-three percent of ACL injuries in girls’ soccer players involved player-player contact, and 11% were due to player-surface contact; in contrast, only 28% of ACL injuries in boys’ soccer involved player-player contact, while fully 42% resulted from player-surface contact. The explanation for this difference is unknown.

ACL injuries occurred in girls’ softball at a rate of 2.7/100,000 athletic exposures, compared with 0.7/100,000 exposures in boys’ baseball. For boys, football had by far the highest rate of ACL injuries: 11.1/100,000 athletic exposures. Wrestling had a 4.8/100,000 rate. ACL injuries occurred in girls’ volleyball at a rate of 3.1/100,000 athletic exposures.

The data used were from a study sponsored by the Centers for Disease Control and Prevention. Ms. McIlvain declared having no relevant financial relationships.

DENVER – High school girl athletes are at 3.3-fold greater risk of incurring an anterior cruciate ligament injury than are boys playing the same or similar sports, according to a national study.

Of the nine sports assessed in the study, the highest ACL injury rate occurred in girls’ soccer, with 13.0 cases per 100,000 athletic exposures. In contrast, the rate in boys’ soccer was 4.8 cases per 100,000 athletic exposures, with an athletic exposure defined as one practice or game, Natalie McIlvain explained at the annual meeting of the American Public Health Association.

In girls’ basketball, the ACL injury rate was 9.1/100,000 athletic exposures. Yet in boys’ basketball, a sport with similar rules and equipment but bigger, heavier participants, the rate was just 2.2/100,000, said Ms. McIlvain of the Center for Injury Research and Policy at Nationwide Children’s Hospital in Columbus, Ohio.

Each year more than 7 million high school students participate in interscholastic sports. ACL injuries are the costliest type of sports injury occurring in these young athletes, as they often require expensive surgery and lengthy physical rehabilitation.

In order to better understand the epidemiology of high school ACL injuries, Ms. McIlvain and her coinvestigators analyzed data from the Centers for Disease Control and Prevention–sponsored National High School Sports-Related Injury Surveillance Study. In this study, certified athletic trainers at 100 nationally representative high schools used an online data-collection system to record the details of all athletic injuries, large or small, occurring during the 2007-2008 through 2009-2010 academic years. During the study period, the trainers documented 397 ACL injuries, extrapolating to an estimated 128,374 ACL injuries occurring nationally each year among high school athletes.

ACL injuries accounted for 3.1% of all sports injuries and 21% of all knee injuries. Seventy-seven percent of the ACL injuries required surgery. Nearly 50% of athletes with an ACL injury were medically disqualified for the season. Another 26% returned to play after 3 weeks or longer.

The overall incidence of ACL injury was 6.7/100,000 exposures. The rate was 18.0/100,000 exposures in competition, more than seven times the incidence of 2.5/100,000 during practices.

Forty-five percent of ACL injuries resulted from player-player contact. "That’s interesting, especially given that seven of the nine sports we studied were noncontact sports," Ms. McIlvain observed.

A striking gender-related difference in mechanism of injury was noted only in soccer. Forty-three percent of ACL injuries in girls’ soccer players involved player-player contact, and 11% were due to player-surface contact; in contrast, only 28% of ACL injuries in boys’ soccer involved player-player contact, while fully 42% resulted from player-surface contact. The explanation for this difference is unknown.

ACL injuries occurred in girls’ softball at a rate of 2.7/100,000 athletic exposures, compared with 0.7/100,000 exposures in boys’ baseball. For boys, football had by far the highest rate of ACL injuries: 11.1/100,000 athletic exposures. Wrestling had a 4.8/100,000 rate. ACL injuries occurred in girls’ volleyball at a rate of 3.1/100,000 athletic exposures.

The data used were from a study sponsored by the Centers for Disease Control and Prevention. Ms. McIlvain declared having no relevant financial relationships.

DENVER – High school girl athletes are at 3.3-fold greater risk of incurring an anterior cruciate ligament injury than are boys playing the same or similar sports, according to a national study.

Of the nine sports assessed in the study, the highest ACL injury rate occurred in girls’ soccer, with 13.0 cases per 100,000 athletic exposures. In contrast, the rate in boys’ soccer was 4.8 cases per 100,000 athletic exposures, with an athletic exposure defined as one practice or game, Natalie McIlvain explained at the annual meeting of the American Public Health Association.

In girls’ basketball, the ACL injury rate was 9.1/100,000 athletic exposures. Yet in boys’ basketball, a sport with similar rules and equipment but bigger, heavier participants, the rate was just 2.2/100,000, said Ms. McIlvain of the Center for Injury Research and Policy at Nationwide Children’s Hospital in Columbus, Ohio.

Each year more than 7 million high school students participate in interscholastic sports. ACL injuries are the costliest type of sports injury occurring in these young athletes, as they often require expensive surgery and lengthy physical rehabilitation.

In order to better understand the epidemiology of high school ACL injuries, Ms. McIlvain and her coinvestigators analyzed data from the Centers for Disease Control and Prevention–sponsored National High School Sports-Related Injury Surveillance Study. In this study, certified athletic trainers at 100 nationally representative high schools used an online data-collection system to record the details of all athletic injuries, large or small, occurring during the 2007-2008 through 2009-2010 academic years. During the study period, the trainers documented 397 ACL injuries, extrapolating to an estimated 128,374 ACL injuries occurring nationally each year among high school athletes.

ACL injuries accounted for 3.1% of all sports injuries and 21% of all knee injuries. Seventy-seven percent of the ACL injuries required surgery. Nearly 50% of athletes with an ACL injury were medically disqualified for the season. Another 26% returned to play after 3 weeks or longer.

The overall incidence of ACL injury was 6.7/100,000 exposures. The rate was 18.0/100,000 exposures in competition, more than seven times the incidence of 2.5/100,000 during practices.

Forty-five percent of ACL injuries resulted from player-player contact. "That’s interesting, especially given that seven of the nine sports we studied were noncontact sports," Ms. McIlvain observed.

A striking gender-related difference in mechanism of injury was noted only in soccer. Forty-three percent of ACL injuries in girls’ soccer players involved player-player contact, and 11% were due to player-surface contact; in contrast, only 28% of ACL injuries in boys’ soccer involved player-player contact, while fully 42% resulted from player-surface contact. The explanation for this difference is unknown.

ACL injuries occurred in girls’ softball at a rate of 2.7/100,000 athletic exposures, compared with 0.7/100,000 exposures in boys’ baseball. For boys, football had by far the highest rate of ACL injuries: 11.1/100,000 athletic exposures. Wrestling had a 4.8/100,000 rate. ACL injuries occurred in girls’ volleyball at a rate of 3.1/100,000 athletic exposures.

The data used were from a study sponsored by the Centers for Disease Control and Prevention. Ms. McIlvain declared having no relevant financial relationships.

DENVER – High school girl athletes are at 3.3-fold greater risk of incurring an anterior cruciate ligament injury than are boys playing the same or similar sports, according to a national study.

Of the nine sports assessed in the study, the highest ACL injury rate occurred in girls’ soccer, with 13.0 cases per 100,000 athletic exposures. In contrast, the rate in boys’ soccer was 4.8 cases per 100,000 athletic exposures, with an athletic exposure defined as one practice or game, Natalie McIlvain explained at the annual meeting of the American Public Health Association.

In girls’ basketball, the ACL injury rate was 9.1/100,000 athletic exposures. Yet in boys’ basketball, a sport with similar rules and equipment but bigger, heavier participants, the rate was just 2.2/100,000, said Ms. McIlvain of the Center for Injury Research and Policy at Nationwide Children’s Hospital in Columbus, Ohio.

Each year more than 7 million high school students participate in interscholastic sports. ACL injuries are the costliest type of sports injury occurring in these young athletes, as they often require expensive surgery and lengthy physical rehabilitation.

In order to better understand the epidemiology of high school ACL injuries, Ms. McIlvain and her coinvestigators analyzed data from the Centers for Disease Control and Prevention–sponsored National High School Sports-Related Injury Surveillance Study. In this study, certified athletic trainers at 100 nationally representative high schools used an online data-collection system to record the details of all athletic injuries, large or small, occurring during the 2007-2008 through 2009-2010 academic years. During the study period, the trainers documented 397 ACL injuries, extrapolating to an estimated 128,374 ACL injuries occurring nationally each year among high school athletes.

ACL injuries accounted for 3.1% of all sports injuries and 21% of all knee injuries. Seventy-seven percent of the ACL injuries required surgery. Nearly 50% of athletes with an ACL injury were medically disqualified for the season. Another 26% returned to play after 3 weeks or longer.

The overall incidence of ACL injury was 6.7/100,000 exposures. The rate was 18.0/100,000 exposures in competition, more than seven times the incidence of 2.5/100,000 during practices.

Forty-five percent of ACL injuries resulted from player-player contact. "That’s interesting, especially given that seven of the nine sports we studied were noncontact sports," Ms. McIlvain observed.

A striking gender-related difference in mechanism of injury was noted only in soccer. Forty-three percent of ACL injuries in girls’ soccer players involved player-player contact, and 11% were due to player-surface contact; in contrast, only 28% of ACL injuries in boys’ soccer involved player-player contact, while fully 42% resulted from player-surface contact. The explanation for this difference is unknown.

ACL injuries occurred in girls’ softball at a rate of 2.7/100,000 athletic exposures, compared with 0.7/100,000 exposures in boys’ baseball. For boys, football had by far the highest rate of ACL injuries: 11.1/100,000 athletic exposures. Wrestling had a 4.8/100,000 rate. ACL injuries occurred in girls’ volleyball at a rate of 3.1/100,000 athletic exposures.

The data used were from a study sponsored by the Centers for Disease Control and Prevention. Ms. McIlvain declared having no relevant financial relationships.

DENVER – High school girl athletes are at 3.3-fold greater risk of incurring an anterior cruciate ligament injury than are boys playing the same or similar sports, according to a national study.

Of the nine sports assessed in the study, the highest ACL injury rate occurred in girls’ soccer, with 13.0 cases per 100,000 athletic exposures. In contrast, the rate in boys’ soccer was 4.8 cases per 100,000 athletic exposures, with an athletic exposure defined as one practice or game, Natalie McIlvain explained at the annual meeting of the American Public Health Association.

In girls’ basketball, the ACL injury rate was 9.1/100,000 athletic exposures. Yet in boys’ basketball, a sport with similar rules and equipment but bigger, heavier participants, the rate was just 2.2/100,000, said Ms. McIlvain of the Center for Injury Research and Policy at Nationwide Children’s Hospital in Columbus, Ohio.

Each year more than 7 million high school students participate in interscholastic sports. ACL injuries are the costliest type of sports injury occurring in these young athletes, as they often require expensive surgery and lengthy physical rehabilitation.

In order to better understand the epidemiology of high school ACL injuries, Ms. McIlvain and her coinvestigators analyzed data from the Centers for Disease Control and Prevention–sponsored National High School Sports-Related Injury Surveillance Study. In this study, certified athletic trainers at 100 nationally representative high schools used an online data-collection system to record the details of all athletic injuries, large or small, occurring during the 2007-2008 through 2009-2010 academic years. During the study period, the trainers documented 397 ACL injuries, extrapolating to an estimated 128,374 ACL injuries occurring nationally each year among high school athletes.

ACL injuries accounted for 3.1% of all sports injuries and 21% of all knee injuries. Seventy-seven percent of the ACL injuries required surgery. Nearly 50% of athletes with an ACL injury were medically disqualified for the season. Another 26% returned to play after 3 weeks or longer.

The overall incidence of ACL injury was 6.7/100,000 exposures. The rate was 18.0/100,000 exposures in competition, more than seven times the incidence of 2.5/100,000 during practices.

Forty-five percent of ACL injuries resulted from player-player contact. "That’s interesting, especially given that seven of the nine sports we studied were noncontact sports," Ms. McIlvain observed.

A striking gender-related difference in mechanism of injury was noted only in soccer. Forty-three percent of ACL injuries in girls’ soccer players involved player-player contact, and 11% were due to player-surface contact; in contrast, only 28% of ACL injuries in boys’ soccer involved player-player contact, while fully 42% resulted from player-surface contact. The explanation for this difference is unknown.

ACL injuries occurred in girls’ softball at a rate of 2.7/100,000 athletic exposures, compared with 0.7/100,000 exposures in boys’ baseball. For boys, football had by far the highest rate of ACL injuries: 11.1/100,000 athletic exposures. Wrestling had a 4.8/100,000 rate. ACL injuries occurred in girls’ volleyball at a rate of 3.1/100,000 athletic exposures.

The data used were from a study sponsored by the Centers for Disease Control and Prevention. Ms. McIlvain declared having no relevant financial relationships.

DENVER – High school girl athletes are at 3.3-fold greater risk of incurring an anterior cruciate ligament injury than are boys playing the same or similar sports, according to a national study.

Of the nine sports assessed in the study, the highest ACL injury rate occurred in girls’ soccer, with 13.0 cases per 100,000 athletic exposures. In contrast, the rate in boys’ soccer was 4.8 cases per 100,000 athletic exposures, with an athletic exposure defined as one practice or game, Natalie McIlvain explained at the annual meeting of the American Public Health Association.

In girls’ basketball, the ACL injury rate was 9.1/100,000 athletic exposures. Yet in boys’ basketball, a sport with similar rules and equipment but bigger, heavier participants, the rate was just 2.2/100,000, said Ms. McIlvain of the Center for Injury Research and Policy at Nationwide Children’s Hospital in Columbus, Ohio.

Each year more than 7 million high school students participate in interscholastic sports. ACL injuries are the costliest type of sports injury occurring in these young athletes, as they often require expensive surgery and lengthy physical rehabilitation.

In order to better understand the epidemiology of high school ACL injuries, Ms. McIlvain and her coinvestigators analyzed data from the Centers for Disease Control and Prevention–sponsored National High School Sports-Related Injury Surveillance Study. In this study, certified athletic trainers at 100 nationally representative high schools used an online data-collection system to record the details of all athletic injuries, large or small, occurring during the 2007-2008 through 2009-2010 academic years. During the study period, the trainers documented 397 ACL injuries, extrapolating to an estimated 128,374 ACL injuries occurring nationally each year among high school athletes.

ACL injuries accounted for 3.1% of all sports injuries and 21% of all knee injuries. Seventy-seven percent of the ACL injuries required surgery. Nearly 50% of athletes with an ACL injury were medically disqualified for the season. Another 26% returned to play after 3 weeks or longer.

The overall incidence of ACL injury was 6.7/100,000 exposures. The rate was 18.0/100,000 exposures in competition, more than seven times the incidence of 2.5/100,000 during practices.

Forty-five percent of ACL injuries resulted from player-player contact. "That’s interesting, especially given that seven of the nine sports we studied were noncontact sports," Ms. McIlvain observed.

A striking gender-related difference in mechanism of injury was noted only in soccer. Forty-three percent of ACL injuries in girls’ soccer players involved player-player contact, and 11% were due to player-surface contact; in contrast, only 28% of ACL injuries in boys’ soccer involved player-player contact, while fully 42% resulted from player-surface contact. The explanation for this difference is unknown.

ACL injuries occurred in girls’ softball at a rate of 2.7/100,000 athletic exposures, compared with 0.7/100,000 exposures in boys’ baseball. For boys, football had by far the highest rate of ACL injuries: 11.1/100,000 athletic exposures. Wrestling had a 4.8/100,000 rate. ACL injuries occurred in girls’ volleyball at a rate of 3.1/100,000 athletic exposures.

The data used were from a study sponsored by the Centers for Disease Control and Prevention. Ms. McIlvain declared having no relevant financial relationships.

CHICAGO – The 5-year mortality of diabetes patients with stable angina is double that of stable angina patients without diabetes, according to a large, prospective, real-world, clinical practice registry.

Among 2,002 consecutive patients with stable angina and newly diagnosed, angiographically confirmed coronary artery disease enrolled in the German 50-center STAR Registry, 26% had diabetes. Their 5-year mortality rate was 29%, compared with the 15% rate in the nondiabetic patients, Dr. Anselm K. Gitt reported at the annual scientific sessions of the American Heart Association.

The patients with diabetes were on average older and had significantly higher rates of multivessel disease, impaired left ventricular function, and comorbid conditions than their counterparts without diabetes. But even after these factors were adjusted for in a multivariate Cox regression analysis, diabetes remained an independent predictor of mortality associated with a striking 1.8-fold increased risk, second only to the 2.5-fold risk conferred by a left ventricular ejection fraction of less than 40%, according to Dr. Gitt, senior staff physician at the Ludwigshafen (Germany) Heart Center.

Other independent predictors of 5-year mortality in STAR participants with stable angina were prior stroke, with a 1.5-fold increased risk; prior MI, with a 1.4-fold risk; age, which increased mortality risk by 7% per year; and female gender, which was associated with a significant 25% protective effect against mortality.

Patients in both groups had similar rates of statin, beta-blocker, aspirin, and antiotensin-converting enzyme inhibitor therapy. Those with diabetes had lower rates of percutaneous coronary intervention, but higher use of coronary artery bypass graft surgery.

Dr. Gitt declared having no relevant financial interests.

CHICAGO – The 5-year mortality of diabetes patients with stable angina is double that of stable angina patients without diabetes, according to a large, prospective, real-world, clinical practice registry.

Among 2,002 consecutive patients with stable angina and newly diagnosed, angiographically confirmed coronary artery disease enrolled in the German 50-center STAR Registry, 26% had diabetes. Their 5-year mortality rate was 29%, compared with the 15% rate in the nondiabetic patients, Dr. Anselm K. Gitt reported at the annual scientific sessions of the American Heart Association.

The patients with diabetes were on average older and had significantly higher rates of multivessel disease, impaired left ventricular function, and comorbid conditions than their counterparts without diabetes. But even after these factors were adjusted for in a multivariate Cox regression analysis, diabetes remained an independent predictor of mortality associated with a striking 1.8-fold increased risk, second only to the 2.5-fold risk conferred by a left ventricular ejection fraction of less than 40%, according to Dr. Gitt, senior staff physician at the Ludwigshafen (Germany) Heart Center.

Other independent predictors of 5-year mortality in STAR participants with stable angina were prior stroke, with a 1.5-fold increased risk; prior MI, with a 1.4-fold risk; age, which increased mortality risk by 7% per year; and female gender, which was associated with a significant 25% protective effect against mortality.

Patients in both groups had similar rates of statin, beta-blocker, aspirin, and antiotensin-converting enzyme inhibitor therapy. Those with diabetes had lower rates of percutaneous coronary intervention, but higher use of coronary artery bypass graft surgery.

Dr. Gitt declared having no relevant financial interests.

CHICAGO – The 5-year mortality of diabetes patients with stable angina is double that of stable angina patients without diabetes, according to a large, prospective, real-world, clinical practice registry.

Among 2,002 consecutive patients with stable angina and newly diagnosed, angiographically confirmed coronary artery disease enrolled in the German 50-center STAR Registry, 26% had diabetes. Their 5-year mortality rate was 29%, compared with the 15% rate in the nondiabetic patients, Dr. Anselm K. Gitt reported at the annual scientific sessions of the American Heart Association.

The patients with diabetes were on average older and had significantly higher rates of multivessel disease, impaired left ventricular function, and comorbid conditions than their counterparts without diabetes. But even after these factors were adjusted for in a multivariate Cox regression analysis, diabetes remained an independent predictor of mortality associated with a striking 1.8-fold increased risk, second only to the 2.5-fold risk conferred by a left ventricular ejection fraction of less than 40%, according to Dr. Gitt, senior staff physician at the Ludwigshafen (Germany) Heart Center.

Other independent predictors of 5-year mortality in STAR participants with stable angina were prior stroke, with a 1.5-fold increased risk; prior MI, with a 1.4-fold risk; age, which increased mortality risk by 7% per year; and female gender, which was associated with a significant 25% protective effect against mortality.

Patients in both groups had similar rates of statin, beta-blocker, aspirin, and antiotensin-converting enzyme inhibitor therapy. Those with diabetes had lower rates of percutaneous coronary intervention, but higher use of coronary artery bypass graft surgery.

Dr. Gitt declared having no relevant financial interests.

CHICAGO – The 5-year mortality of diabetes patients with stable angina is double that of stable angina patients without diabetes, according to a large, prospective, real-world, clinical practice registry.

Among 2,002 consecutive patients with stable angina and newly diagnosed, angiographically confirmed coronary artery disease enrolled in the German 50-center STAR Registry, 26% had diabetes. Their 5-year mortality rate was 29%, compared with the 15% rate in the nondiabetic patients, Dr. Anselm K. Gitt reported at the annual scientific sessions of the American Heart Association.

The patients with diabetes were on average older and had significantly higher rates of multivessel disease, impaired left ventricular function, and comorbid conditions than their counterparts without diabetes. But even after these factors were adjusted for in a multivariate Cox regression analysis, diabetes remained an independent predictor of mortality associated with a striking 1.8-fold increased risk, second only to the 2.5-fold risk conferred by a left ventricular ejection fraction of less than 40%, according to Dr. Gitt, senior staff physician at the Ludwigshafen (Germany) Heart Center.

Other independent predictors of 5-year mortality in STAR participants with stable angina were prior stroke, with a 1.5-fold increased risk; prior MI, with a 1.4-fold risk; age, which increased mortality risk by 7% per year; and female gender, which was associated with a significant 25% protective effect against mortality.

Patients in both groups had similar rates of statin, beta-blocker, aspirin, and antiotensin-converting enzyme inhibitor therapy. Those with diabetes had lower rates of percutaneous coronary intervention, but higher use of coronary artery bypass graft surgery.

Dr. Gitt declared having no relevant financial interests.

CHICAGO – The 5-year mortality of diabetes patients with stable angina is double that of stable angina patients without diabetes, according to a large, prospective, real-world, clinical practice registry.

Among 2,002 consecutive patients with stable angina and newly diagnosed, angiographically confirmed coronary artery disease enrolled in the German 50-center STAR Registry, 26% had diabetes. Their 5-year mortality rate was 29%, compared with the 15% rate in the nondiabetic patients, Dr. Anselm K. Gitt reported at the annual scientific sessions of the American Heart Association.

The patients with diabetes were on average older and had significantly higher rates of multivessel disease, impaired left ventricular function, and comorbid conditions than their counterparts without diabetes. But even after these factors were adjusted for in a multivariate Cox regression analysis, diabetes remained an independent predictor of mortality associated with a striking 1.8-fold increased risk, second only to the 2.5-fold risk conferred by a left ventricular ejection fraction of less than 40%, according to Dr. Gitt, senior staff physician at the Ludwigshafen (Germany) Heart Center.

Other independent predictors of 5-year mortality in STAR participants with stable angina were prior stroke, with a 1.5-fold increased risk; prior MI, with a 1.4-fold risk; age, which increased mortality risk by 7% per year; and female gender, which was associated with a significant 25% protective effect against mortality.

Patients in both groups had similar rates of statin, beta-blocker, aspirin, and antiotensin-converting enzyme inhibitor therapy. Those with diabetes had lower rates of percutaneous coronary intervention, but higher use of coronary artery bypass graft surgery.

Dr. Gitt declared having no relevant financial interests.

CHICAGO – The 5-year mortality of diabetes patients with stable angina is double that of stable angina patients without diabetes, according to a large, prospective, real-world, clinical practice registry.

Among 2,002 consecutive patients with stable angina and newly diagnosed, angiographically confirmed coronary artery disease enrolled in the German 50-center STAR Registry, 26% had diabetes. Their 5-year mortality rate was 29%, compared with the 15% rate in the nondiabetic patients, Dr. Anselm K. Gitt reported at the annual scientific sessions of the American Heart Association.

The patients with diabetes were on average older and had significantly higher rates of multivessel disease, impaired left ventricular function, and comorbid conditions than their counterparts without diabetes. But even after these factors were adjusted for in a multivariate Cox regression analysis, diabetes remained an independent predictor of mortality associated with a striking 1.8-fold increased risk, second only to the 2.5-fold risk conferred by a left ventricular ejection fraction of less than 40%, according to Dr. Gitt, senior staff physician at the Ludwigshafen (Germany) Heart Center.

Other independent predictors of 5-year mortality in STAR participants with stable angina were prior stroke, with a 1.5-fold increased risk; prior MI, with a 1.4-fold risk; age, which increased mortality risk by 7% per year; and female gender, which was associated with a significant 25% protective effect against mortality.

Patients in both groups had similar rates of statin, beta-blocker, aspirin, and antiotensin-converting enzyme inhibitor therapy. Those with diabetes had lower rates of percutaneous coronary intervention, but higher use of coronary artery bypass graft surgery.

Dr. Gitt declared having no relevant financial interests.

CHICAGO – A high-normal hematocrit was associated with an increased risk of new-onset heart failure in a Framingham Heart Study analysis.

"To our knowledge, this is the only study to show such a relationship in men and women in middle age. ... Our results should prompt consideration of a cautious and measured approach to the aggressive treatment of low hematocrit in a variety of disease states," Dr. Erin E. Coglianese said at the annual scientific sessions of the American Heart Association.

The mechanism by which a hematocrit (HCT) within normal range is linked to heart failure is unclear. However, animal studies suggest one possibility – that a high-normal HCT could impair vasodilation as a result of scavenging of nitric oxide by hemoglobin, according to Dr. Coglianese of Massachusetts General Hospital, Boston.

To explore the relationship between HCT and the risk of heart failure, she and her coinvestigators turned to the Framingham Heart Study. They documented a strong, graded relationship between HCT level and the risk of developing heart failure in 3,523 Framingham participants aged 50-65 who were free of a history of heart failure at baseline and were followed prospectively for up to 20 years.

Indeed, individuals with a high-normal baseline HCT had almost double the risk of new-onset heart failure during follow-up, compared with those with a low HCT, even after adjustment for conventional risk factors for heart failure.

A low HCT was defined as 39% to less than 44% in men and 36% to less than 40% in women. Men with an HCT of 44% to less than 46% and women with a level of 40% to less than 42% were deemed as having a low-normal level. A normal HCT was defined as 46% to less than 50% in men and 42% to less than 46% in women. And a high-normal HCT was one greater than 50% in men or 46% in women.

When these definitions were used, the incidence of new-onset heart failure was 25/10,000 person-years in individuals with a low HCT level, 31/10,000 with a low-normal HCT, 38/10,000 with a normal HCT, and 48/10,000 in Framingham participants with high-normal HCT.

In a multivariate logistic regression analysis, the risk of new-onset heart failure, compared with the risk in those with a low HCT, was 27% greater in those with a low-normal HCT, 47% greater in those with a normal HCT, and 78% greater in those with a high-normal level. The analysis was adjusted for age, sex, total cholesterol, hypertension, body mass index, left ventricular hypertrophy, pack-years of smoking, and physical activity.

The big limitation of this study is that the original Framingham cohort, included in this analysis, looks in some ways quite different from contemporary patient populations. Specifically, roughly half of the men in the original cohort were smokers, Dr. Coglianese noted.

In contrast to these new findings regarding HCT and risk of new-onset heart failure, numerous studies have shown that in patients who already have heart failure, a low HCT is associated with an increased risk of heart failure hospitalization as well as all-cause mortality. It remains unclear, however, whether this increased risk of poor outcomes is due to pathophysiologic changes induced by low HCT, or if a low HCT is merely a marker of greater disease severity, she said.

Dr. Coglianese said he had no relevant financial disclosures.

CHICAGO – A high-normal hematocrit was associated with an increased risk of new-onset heart failure in a Framingham Heart Study analysis.

"To our knowledge, this is the only study to show such a relationship in men and women in middle age. ... Our results should prompt consideration of a cautious and measured approach to the aggressive treatment of low hematocrit in a variety of disease states," Dr. Erin E. Coglianese said at the annual scientific sessions of the American Heart Association.

The mechanism by which a hematocrit (HCT) within normal range is linked to heart failure is unclear. However, animal studies suggest one possibility – that a high-normal HCT could impair vasodilation as a result of scavenging of nitric oxide by hemoglobin, according to Dr. Coglianese of Massachusetts General Hospital, Boston.

To explore the relationship between HCT and the risk of heart failure, she and her coinvestigators turned to the Framingham Heart Study. They documented a strong, graded relationship between HCT level and the risk of developing heart failure in 3,523 Framingham participants aged 50-65 who were free of a history of heart failure at baseline and were followed prospectively for up to 20 years.

Indeed, individuals with a high-normal baseline HCT had almost double the risk of new-onset heart failure during follow-up, compared with those with a low HCT, even after adjustment for conventional risk factors for heart failure.

A low HCT was defined as 39% to less than 44% in men and 36% to less than 40% in women. Men with an HCT of 44% to less than 46% and women with a level of 40% to less than 42% were deemed as having a low-normal level. A normal HCT was defined as 46% to less than 50% in men and 42% to less than 46% in women. And a high-normal HCT was one greater than 50% in men or 46% in women.

When these definitions were used, the incidence of new-onset heart failure was 25/10,000 person-years in individuals with a low HCT level, 31/10,000 with a low-normal HCT, 38/10,000 with a normal HCT, and 48/10,000 in Framingham participants with high-normal HCT.

In a multivariate logistic regression analysis, the risk of new-onset heart failure, compared with the risk in those with a low HCT, was 27% greater in those with a low-normal HCT, 47% greater in those with a normal HCT, and 78% greater in those with a high-normal level. The analysis was adjusted for age, sex, total cholesterol, hypertension, body mass index, left ventricular hypertrophy, pack-years of smoking, and physical activity.

The big limitation of this study is that the original Framingham cohort, included in this analysis, looks in some ways quite different from contemporary patient populations. Specifically, roughly half of the men in the original cohort were smokers, Dr. Coglianese noted.

In contrast to these new findings regarding HCT and risk of new-onset heart failure, numerous studies have shown that in patients who already have heart failure, a low HCT is associated with an increased risk of heart failure hospitalization as well as all-cause mortality. It remains unclear, however, whether this increased risk of poor outcomes is due to pathophysiologic changes induced by low HCT, or if a low HCT is merely a marker of greater disease severity, she said.

Dr. Coglianese said he had no relevant financial disclosures.

CHICAGO – A high-normal hematocrit was associated with an increased risk of new-onset heart failure in a Framingham Heart Study analysis.

"To our knowledge, this is the only study to show such a relationship in men and women in middle age. ... Our results should prompt consideration of a cautious and measured approach to the aggressive treatment of low hematocrit in a variety of disease states," Dr. Erin E. Coglianese said at the annual scientific sessions of the American Heart Association.

The mechanism by which a hematocrit (HCT) within normal range is linked to heart failure is unclear. However, animal studies suggest one possibility – that a high-normal HCT could impair vasodilation as a result of scavenging of nitric oxide by hemoglobin, according to Dr. Coglianese of Massachusetts General Hospital, Boston.

To explore the relationship between HCT and the risk of heart failure, she and her coinvestigators turned to the Framingham Heart Study. They documented a strong, graded relationship between HCT level and the risk of developing heart failure in 3,523 Framingham participants aged 50-65 who were free of a history of heart failure at baseline and were followed prospectively for up to 20 years.

Indeed, individuals with a high-normal baseline HCT had almost double the risk of new-onset heart failure during follow-up, compared with those with a low HCT, even after adjustment for conventional risk factors for heart failure.

A low HCT was defined as 39% to less than 44% in men and 36% to less than 40% in women. Men with an HCT of 44% to less than 46% and women with a level of 40% to less than 42% were deemed as having a low-normal level. A normal HCT was defined as 46% to less than 50% in men and 42% to less than 46% in women. And a high-normal HCT was one greater than 50% in men or 46% in women.

When these definitions were used, the incidence of new-onset heart failure was 25/10,000 person-years in individuals with a low HCT level, 31/10,000 with a low-normal HCT, 38/10,000 with a normal HCT, and 48/10,000 in Framingham participants with high-normal HCT.

In a multivariate logistic regression analysis, the risk of new-onset heart failure, compared with the risk in those with a low HCT, was 27% greater in those with a low-normal HCT, 47% greater in those with a normal HCT, and 78% greater in those with a high-normal level. The analysis was adjusted for age, sex, total cholesterol, hypertension, body mass index, left ventricular hypertrophy, pack-years of smoking, and physical activity.

The big limitation of this study is that the original Framingham cohort, included in this analysis, looks in some ways quite different from contemporary patient populations. Specifically, roughly half of the men in the original cohort were smokers, Dr. Coglianese noted.

In contrast to these new findings regarding HCT and risk of new-onset heart failure, numerous studies have shown that in patients who already have heart failure, a low HCT is associated with an increased risk of heart failure hospitalization as well as all-cause mortality. It remains unclear, however, whether this increased risk of poor outcomes is due to pathophysiologic changes induced by low HCT, or if a low HCT is merely a marker of greater disease severity, she said.

Dr. Coglianese said he had no relevant financial disclosures.

CHICAGO – A high-normal hematocrit was associated with an increased risk of new-onset heart failure in a Framingham Heart Study analysis.

"To our knowledge, this is the only study to show such a relationship in men and women in middle age. ... Our results should prompt consideration of a cautious and measured approach to the aggressive treatment of low hematocrit in a variety of disease states," Dr. Erin E. Coglianese said at the annual scientific sessions of the American Heart Association.

The mechanism by which a hematocrit (HCT) within normal range is linked to heart failure is unclear. However, animal studies suggest one possibility – that a high-normal HCT could impair vasodilation as a result of scavenging of nitric oxide by hemoglobin, according to Dr. Coglianese of Massachusetts General Hospital, Boston.

To explore the relationship between HCT and the risk of heart failure, she and her coinvestigators turned to the Framingham Heart Study. They documented a strong, graded relationship between HCT level and the risk of developing heart failure in 3,523 Framingham participants aged 50-65 who were free of a history of heart failure at baseline and were followed prospectively for up to 20 years.

Indeed, individuals with a high-normal baseline HCT had almost double the risk of new-onset heart failure during follow-up, compared with those with a low HCT, even after adjustment for conventional risk factors for heart failure.

A low HCT was defined as 39% to less than 44% in men and 36% to less than 40% in women. Men with an HCT of 44% to less than 46% and women with a level of 40% to less than 42% were deemed as having a low-normal level. A normal HCT was defined as 46% to less than 50% in men and 42% to less than 46% in women. And a high-normal HCT was one greater than 50% in men or 46% in women.

When these definitions were used, the incidence of new-onset heart failure was 25/10,000 person-years in individuals with a low HCT level, 31/10,000 with a low-normal HCT, 38/10,000 with a normal HCT, and 48/10,000 in Framingham participants with high-normal HCT.

In a multivariate logistic regression analysis, the risk of new-onset heart failure, compared with the risk in those with a low HCT, was 27% greater in those with a low-normal HCT, 47% greater in those with a normal HCT, and 78% greater in those with a high-normal level. The analysis was adjusted for age, sex, total cholesterol, hypertension, body mass index, left ventricular hypertrophy, pack-years of smoking, and physical activity.

The big limitation of this study is that the original Framingham cohort, included in this analysis, looks in some ways quite different from contemporary patient populations. Specifically, roughly half of the men in the original cohort were smokers, Dr. Coglianese noted.

In contrast to these new findings regarding HCT and risk of new-onset heart failure, numerous studies have shown that in patients who already have heart failure, a low HCT is associated with an increased risk of heart failure hospitalization as well as all-cause mortality. It remains unclear, however, whether this increased risk of poor outcomes is due to pathophysiologic changes induced by low HCT, or if a low HCT is merely a marker of greater disease severity, she said.

Dr. Coglianese said he had no relevant financial disclosures.

CHICAGO – A high-normal hematocrit was associated with an increased risk of new-onset heart failure in a Framingham Heart Study analysis.

"To our knowledge, this is the only study to show such a relationship in men and women in middle age. ... Our results should prompt consideration of a cautious and measured approach to the aggressive treatment of low hematocrit in a variety of disease states," Dr. Erin E. Coglianese said at the annual scientific sessions of the American Heart Association.

The mechanism by which a hematocrit (HCT) within normal range is linked to heart failure is unclear. However, animal studies suggest one possibility – that a high-normal HCT could impair vasodilation as a result of scavenging of nitric oxide by hemoglobin, according to Dr. Coglianese of Massachusetts General Hospital, Boston.

To explore the relationship between HCT and the risk of heart failure, she and her coinvestigators turned to the Framingham Heart Study. They documented a strong, graded relationship between HCT level and the risk of developing heart failure in 3,523 Framingham participants aged 50-65 who were free of a history of heart failure at baseline and were followed prospectively for up to 20 years.

Indeed, individuals with a high-normal baseline HCT had almost double the risk of new-onset heart failure during follow-up, compared with those with a low HCT, even after adjustment for conventional risk factors for heart failure.

A low HCT was defined as 39% to less than 44% in men and 36% to less than 40% in women. Men with an HCT of 44% to less than 46% and women with a level of 40% to less than 42% were deemed as having a low-normal level. A normal HCT was defined as 46% to less than 50% in men and 42% to less than 46% in women. And a high-normal HCT was one greater than 50% in men or 46% in women.

When these definitions were used, the incidence of new-onset heart failure was 25/10,000 person-years in individuals with a low HCT level, 31/10,000 with a low-normal HCT, 38/10,000 with a normal HCT, and 48/10,000 in Framingham participants with high-normal HCT.

In a multivariate logistic regression analysis, the risk of new-onset heart failure, compared with the risk in those with a low HCT, was 27% greater in those with a low-normal HCT, 47% greater in those with a normal HCT, and 78% greater in those with a high-normal level. The analysis was adjusted for age, sex, total cholesterol, hypertension, body mass index, left ventricular hypertrophy, pack-years of smoking, and physical activity.

The big limitation of this study is that the original Framingham cohort, included in this analysis, looks in some ways quite different from contemporary patient populations. Specifically, roughly half of the men in the original cohort were smokers, Dr. Coglianese noted.

In contrast to these new findings regarding HCT and risk of new-onset heart failure, numerous studies have shown that in patients who already have heart failure, a low HCT is associated with an increased risk of heart failure hospitalization as well as all-cause mortality. It remains unclear, however, whether this increased risk of poor outcomes is due to pathophysiologic changes induced by low HCT, or if a low HCT is merely a marker of greater disease severity, she said.

Dr. Coglianese said he had no relevant financial disclosures.

CHICAGO – A high-normal hematocrit was associated with an increased risk of new-onset heart failure in a Framingham Heart Study analysis.

"To our knowledge, this is the only study to show such a relationship in men and women in middle age. ... Our results should prompt consideration of a cautious and measured approach to the aggressive treatment of low hematocrit in a variety of disease states," Dr. Erin E. Coglianese said at the annual scientific sessions of the American Heart Association.

The mechanism by which a hematocrit (HCT) within normal range is linked to heart failure is unclear. However, animal studies suggest one possibility – that a high-normal HCT could impair vasodilation as a result of scavenging of nitric oxide by hemoglobin, according to Dr. Coglianese of Massachusetts General Hospital, Boston.

To explore the relationship between HCT and the risk of heart failure, she and her coinvestigators turned to the Framingham Heart Study. They documented a strong, graded relationship between HCT level and the risk of developing heart failure in 3,523 Framingham participants aged 50-65 who were free of a history of heart failure at baseline and were followed prospectively for up to 20 years.

Indeed, individuals with a high-normal baseline HCT had almost double the risk of new-onset heart failure during follow-up, compared with those with a low HCT, even after adjustment for conventional risk factors for heart failure.

A low HCT was defined as 39% to less than 44% in men and 36% to less than 40% in women. Men with an HCT of 44% to less than 46% and women with a level of 40% to less than 42% were deemed as having a low-normal level. A normal HCT was defined as 46% to less than 50% in men and 42% to less than 46% in women. And a high-normal HCT was one greater than 50% in men or 46% in women.

When these definitions were used, the incidence of new-onset heart failure was 25/10,000 person-years in individuals with a low HCT level, 31/10,000 with a low-normal HCT, 38/10,000 with a normal HCT, and 48/10,000 in Framingham participants with high-normal HCT.

In a multivariate logistic regression analysis, the risk of new-onset heart failure, compared with the risk in those with a low HCT, was 27% greater in those with a low-normal HCT, 47% greater in those with a normal HCT, and 78% greater in those with a high-normal level. The analysis was adjusted for age, sex, total cholesterol, hypertension, body mass index, left ventricular hypertrophy, pack-years of smoking, and physical activity.

The big limitation of this study is that the original Framingham cohort, included in this analysis, looks in some ways quite different from contemporary patient populations. Specifically, roughly half of the men in the original cohort were smokers, Dr. Coglianese noted.

In contrast to these new findings regarding HCT and risk of new-onset heart failure, numerous studies have shown that in patients who already have heart failure, a low HCT is associated with an increased risk of heart failure hospitalization as well as all-cause mortality. It remains unclear, however, whether this increased risk of poor outcomes is due to pathophysiologic changes induced by low HCT, or if a low HCT is merely a marker of greater disease severity, she said.

Dr. Coglianese said he had no relevant financial disclosures.

DENVER – An underappreciated consequence of the childhood obesity epidemic is an increase in pediatric forearm fractures resulting from a fall from standing height.

Photo credit: Flickr user Alex1961 (Creative Commons)

A retrospective study of Washington, D.C.–area children and adolescents who were treated for an isolated forearm fracture in the emergency department of Children’s Hospital National Medical Center demonstrated that kids with a forearm fracture resulting from a standing-height fall were 2.4-fold more likely to be at or above the 95th percentile for weight for age and sex than were kids whose forearm fracture resulted from major trauma, Dr. Leticia M. Ryan reported at the annual meeting of the American Public Health Association.

This finding provides yet another sound rationale for aggressively addressing the pediatric obesity epidemic, added Dr. Ryan of the division of emergency medicine at George Washington University in Washington.

Of the 929 youths younger than age 18 years without known bone mineralization disorders who were treated in the ED for an isolated forearm fracture during 2003-2006, 24.3% were injured through a standing-height fall. The comparison group consisted of the 5.8% of patients whose forearm fracture resulted from major trauma.

The radius was the only forearm bone broken in 52% of patients with a standing-height fall, whereas another 46% had fractures of both the radius and ulna, and the remaining 2% had fractures of the ulna only. In contrast, only one-third of patients with major trauma had a radius-only forearm fracture.

The prevalence of weight for age and sex in the 95th percentile or above was 32.4% among patients with a standing-height fall as their fracture mechanism, compared with 15.7% in those with major trauma.

The largest number of forearm fractures occurred in children aged 5-9 and 10-14 years. Children aged 5-9 years with a standing-height fall were 5.2-fold more likely to meet or exceed the 95th percentile of weight for age and sex, compared with kids in the same age group with major trauma. Among 10- to 14-year-olds with a forearm fracture, those who experienced a standing-height fall were 1.7-fold more likely to be in at least the 95th percentile.

This study was funded by the National Institutes of Health and Children’s National Medical Center. Dr. Ryan declared having no relevant financial interests.

DENVER – An underappreciated consequence of the childhood obesity epidemic is an increase in pediatric forearm fractures resulting from a fall from standing height.

Photo credit: Flickr user Alex1961 (Creative Commons)

A retrospective study of Washington, D.C.–area children and adolescents who were treated for an isolated forearm fracture in the emergency department of Children’s Hospital National Medical Center demonstrated that kids with a forearm fracture resulting from a standing-height fall were 2.4-fold more likely to be at or above the 95th percentile for weight for age and sex than were kids whose forearm fracture resulted from major trauma, Dr. Leticia M. Ryan reported at the annual meeting of the American Public Health Association.

This finding provides yet another sound rationale for aggressively addressing the pediatric obesity epidemic, added Dr. Ryan of the division of emergency medicine at George Washington University in Washington.

Of the 929 youths younger than age 18 years without known bone mineralization disorders who were treated in the ED for an isolated forearm fracture during 2003-2006, 24.3% were injured through a standing-height fall. The comparison group consisted of the 5.8% of patients whose forearm fracture resulted from major trauma.

The radius was the only forearm bone broken in 52% of patients with a standing-height fall, whereas another 46% had fractures of both the radius and ulna, and the remaining 2% had fractures of the ulna only. In contrast, only one-third of patients with major trauma had a radius-only forearm fracture.

The prevalence of weight for age and sex in the 95th percentile or above was 32.4% among patients with a standing-height fall as their fracture mechanism, compared with 15.7% in those with major trauma.

The largest number of forearm fractures occurred in children aged 5-9 and 10-14 years. Children aged 5-9 years with a standing-height fall were 5.2-fold more likely to meet or exceed the 95th percentile of weight for age and sex, compared with kids in the same age group with major trauma. Among 10- to 14-year-olds with a forearm fracture, those who experienced a standing-height fall were 1.7-fold more likely to be in at least the 95th percentile.

This study was funded by the National Institutes of Health and Children’s National Medical Center. Dr. Ryan declared having no relevant financial interests.

DENVER – An underappreciated consequence of the childhood obesity epidemic is an increase in pediatric forearm fractures resulting from a fall from standing height.

Photo credit: Flickr user Alex1961 (Creative Commons)

A retrospective study of Washington, D.C.–area children and adolescents who were treated for an isolated forearm fracture in the emergency department of Children’s Hospital National Medical Center demonstrated that kids with a forearm fracture resulting from a standing-height fall were 2.4-fold more likely to be at or above the 95th percentile for weight for age and sex than were kids whose forearm fracture resulted from major trauma, Dr. Leticia M. Ryan reported at the annual meeting of the American Public Health Association.

This finding provides yet another sound rationale for aggressively addressing the pediatric obesity epidemic, added Dr. Ryan of the division of emergency medicine at George Washington University in Washington.

Of the 929 youths younger than age 18 years without known bone mineralization disorders who were treated in the ED for an isolated forearm fracture during 2003-2006, 24.3% were injured through a standing-height fall. The comparison group consisted of the 5.8% of patients whose forearm fracture resulted from major trauma.

The radius was the only forearm bone broken in 52% of patients with a standing-height fall, whereas another 46% had fractures of both the radius and ulna, and the remaining 2% had fractures of the ulna only. In contrast, only one-third of patients with major trauma had a radius-only forearm fracture.

The prevalence of weight for age and sex in the 95th percentile or above was 32.4% among patients with a standing-height fall as their fracture mechanism, compared with 15.7% in those with major trauma.

The largest number of forearm fractures occurred in children aged 5-9 and 10-14 years. Children aged 5-9 years with a standing-height fall were 5.2-fold more likely to meet or exceed the 95th percentile of weight for age and sex, compared with kids in the same age group with major trauma. Among 10- to 14-year-olds with a forearm fracture, those who experienced a standing-height fall were 1.7-fold more likely to be in at least the 95th percentile.

This study was funded by the National Institutes of Health and Children’s National Medical Center. Dr. Ryan declared having no relevant financial interests.

CHICAGO – Using N-terminal prohormone brain natriuretic peptide levels to guide therapy in patients with systolic heart failure proved superior to standard of care management in terms of cardiovascular event rates, quality of life, and echocardiographic parameters in the randomized prospective PROTECT trial.

"If duplicated in larger cohorts, treatment guided by NT-proBNP may represent a new paradigm for heart failure care," Dr. James L. Januzzi Jr. said at the annual scientific sessions of the American Heart Association.

PROTECT (the ProBNP Outpatient Tailored Chronic Heart Failure Therapy study) was a single-center unblinded trial of 151 patients with systolic heart failure and a mean left ventricular ejection fraction of 27%. They were randomized to standard guideline-driven management on the basis of heart failure signs and symptoms or to the same approach with the added goal of reducing NT-proBNP levels to 1,000 pg/mL or less, a threshold previously shown to predict risk in heart failure patients.

Participants were scheduled for quarterly clinic visits, with extra ones as needed to achieve therapeutic goals, said Dr. Januzzi, director of the cardiac intensive care unit at Massachusetts General Hospital, Boston.

The study was halted early for ethical reasons after 10 months. At that point a total of 100 cardiovascular events – worsening heart failure, heart failure hospitalization, acute coronary syndrome, ventricular arrhythmias, cerebral ischemia, or cardiovascular death – had occurred in the standard-treatment group, compared with 58 events in patients on NT-proBNP–guided therapy. The major difference between the two study arms was the sharply lower likelihood of worsening heart failure or heart failure hospitalization in the NT-proBNP–guided arm.

Importantly, the reduction in cardiovascular events was similar in patients over age 75 and in those who were younger.

The secondary outcome of quality of life, assessed using the Minnesota Living with Heart Failure Questionnaire, also showed significantly greater improvement in the guided-treatment arm. In all, 61% of subjects in the NT-proBNP–guided arm achieved at least a 10-point improvement over baseline, considered clinically meaningful, compared with 39% on standard management.

The guided-treatment group also did significantly better in terms of secondary echocardiographic end points, with larger improvements in left ventricular ejection fraction and in ventricular remodeling as reflected by changes in LV end-systolic and end-diastolic volume index, the cardiologist continued.

NT-proBNP–guided therapy proved safe and was well tolerated, with no significant increase in adverse events.

Patients in the guided-treatment arm had a median of six clinic visits, compared with five with standard management. The median baseline NT-proBNP level in the guided-therapy arm was 2,344 pg/mL. It fell to 1,125 pg/mL, with 44% of subjects in the guided-therapy arm attaining an NT-proBNP of 1,000 pg/mL or less.

Up-titration of heart failure medications was common in both study arms, but was significantly greater in the NT-proBNP group. A total of 63% of patients in the guided-therapy arm were placed on an aldosterone blocker, compared with 45% of controls.

Session cochair Dr. Gregg C. Fonarow said in an interview that he views PROTECT as a successful proof-of-concept study. But before biomarker-guided treatment of heart failure becomes part of guideline-recommended, routine outpatient care, it will be necessary to see if the Massachusetts General Hospital experience can be extended to other settings, including primary care practices, where many patients with heart failure receive their treatment. This will require a large multicenter trial with a diverse group of clinicians; randomization by site; and hard clinical end points, including mortality. A proposal for such a study has been presented to the National Heart, Lung, and Blood Institute for funding consideration.

"It’s a large and expensive trial, but the impact is potentially profound," said Dr. Fonarow, professor of medicine and director of the Ahmanson-UCLA Cardiomyopathy Center, Los Angeles. "Given the costs of heart failure and the tremendous number of outpatient visits for this disease, if we truly had a well-validated guide using biomarkers, that would be a phenomenal advance."

The PROTECT trial was sponsored in part by Roche Diagnostics. Dr. Januzzi declared he serves as a consultant to and speaker for the company.

CHICAGO – Using N-terminal prohormone brain natriuretic peptide levels to guide therapy in patients with systolic heart failure proved superior to standard of care management in terms of cardiovascular event rates, quality of life, and echocardiographic parameters in the randomized prospective PROTECT trial.

"If duplicated in larger cohorts, treatment guided by NT-proBNP may represent a new paradigm for heart failure care," Dr. James L. Januzzi Jr. said at the annual scientific sessions of the American Heart Association.

PROTECT (the ProBNP Outpatient Tailored Chronic Heart Failure Therapy study) was a single-center unblinded trial of 151 patients with systolic heart failure and a mean left ventricular ejection fraction of 27%. They were randomized to standard guideline-driven management on the basis of heart failure signs and symptoms or to the same approach with the added goal of reducing NT-proBNP levels to 1,000 pg/mL or less, a threshold previously shown to predict risk in heart failure patients.

Participants were scheduled for quarterly clinic visits, with extra ones as needed to achieve therapeutic goals, said Dr. Januzzi, director of the cardiac intensive care unit at Massachusetts General Hospital, Boston.

The study was halted early for ethical reasons after 10 months. At that point a total of 100 cardiovascular events – worsening heart failure, heart failure hospitalization, acute coronary syndrome, ventricular arrhythmias, cerebral ischemia, or cardiovascular death – had occurred in the standard-treatment group, compared with 58 events in patients on NT-proBNP–guided therapy. The major difference between the two study arms was the sharply lower likelihood of worsening heart failure or heart failure hospitalization in the NT-proBNP–guided arm.

Importantly, the reduction in cardiovascular events was similar in patients over age 75 and in those who were younger.

The secondary outcome of quality of life, assessed using the Minnesota Living with Heart Failure Questionnaire, also showed significantly greater improvement in the guided-treatment arm. In all, 61% of subjects in the NT-proBNP–guided arm achieved at least a 10-point improvement over baseline, considered clinically meaningful, compared with 39% on standard management.

The guided-treatment group also did significantly better in terms of secondary echocardiographic end points, with larger improvements in left ventricular ejection fraction and in ventricular remodeling as reflected by changes in LV end-systolic and end-diastolic volume index, the cardiologist continued.

NT-proBNP–guided therapy proved safe and was well tolerated, with no significant increase in adverse events.

Patients in the guided-treatment arm had a median of six clinic visits, compared with five with standard management. The median baseline NT-proBNP level in the guided-therapy arm was 2,344 pg/mL. It fell to 1,125 pg/mL, with 44% of subjects in the guided-therapy arm attaining an NT-proBNP of 1,000 pg/mL or less.

Up-titration of heart failure medications was common in both study arms, but was significantly greater in the NT-proBNP group. A total of 63% of patients in the guided-therapy arm were placed on an aldosterone blocker, compared with 45% of controls.

Session cochair Dr. Gregg C. Fonarow said in an interview that he views PROTECT as a successful proof-of-concept study. But before biomarker-guided treatment of heart failure becomes part of guideline-recommended, routine outpatient care, it will be necessary to see if the Massachusetts General Hospital experience can be extended to other settings, including primary care practices, where many patients with heart failure receive their treatment. This will require a large multicenter trial with a diverse group of clinicians; randomization by site; and hard clinical end points, including mortality. A proposal for such a study has been presented to the National Heart, Lung, and Blood Institute for funding consideration.

"It’s a large and expensive trial, but the impact is potentially profound," said Dr. Fonarow, professor of medicine and director of the Ahmanson-UCLA Cardiomyopathy Center, Los Angeles. "Given the costs of heart failure and the tremendous number of outpatient visits for this disease, if we truly had a well-validated guide using biomarkers, that would be a phenomenal advance."

The PROTECT trial was sponsored in part by Roche Diagnostics. Dr. Januzzi declared he serves as a consultant to and speaker for the company.

CHICAGO – Using N-terminal prohormone brain natriuretic peptide levels to guide therapy in patients with systolic heart failure proved superior to standard of care management in terms of cardiovascular event rates, quality of life, and echocardiographic parameters in the randomized prospective PROTECT trial.

"If duplicated in larger cohorts, treatment guided by NT-proBNP may represent a new paradigm for heart failure care," Dr. James L. Januzzi Jr. said at the annual scientific sessions of the American Heart Association.

PROTECT (the ProBNP Outpatient Tailored Chronic Heart Failure Therapy study) was a single-center unblinded trial of 151 patients with systolic heart failure and a mean left ventricular ejection fraction of 27%. They were randomized to standard guideline-driven management on the basis of heart failure signs and symptoms or to the same approach with the added goal of reducing NT-proBNP levels to 1,000 pg/mL or less, a threshold previously shown to predict risk in heart failure patients.

Participants were scheduled for quarterly clinic visits, with extra ones as needed to achieve therapeutic goals, said Dr. Januzzi, director of the cardiac intensive care unit at Massachusetts General Hospital, Boston.

The study was halted early for ethical reasons after 10 months. At that point a total of 100 cardiovascular events – worsening heart failure, heart failure hospitalization, acute coronary syndrome, ventricular arrhythmias, cerebral ischemia, or cardiovascular death – had occurred in the standard-treatment group, compared with 58 events in patients on NT-proBNP–guided therapy. The major difference between the two study arms was the sharply lower likelihood of worsening heart failure or heart failure hospitalization in the NT-proBNP–guided arm.

Importantly, the reduction in cardiovascular events was similar in patients over age 75 and in those who were younger.

The secondary outcome of quality of life, assessed using the Minnesota Living with Heart Failure Questionnaire, also showed significantly greater improvement in the guided-treatment arm. In all, 61% of subjects in the NT-proBNP–guided arm achieved at least a 10-point improvement over baseline, considered clinically meaningful, compared with 39% on standard management.

The guided-treatment group also did significantly better in terms of secondary echocardiographic end points, with larger improvements in left ventricular ejection fraction and in ventricular remodeling as reflected by changes in LV end-systolic and end-diastolic volume index, the cardiologist continued.

NT-proBNP–guided therapy proved safe and was well tolerated, with no significant increase in adverse events.

Patients in the guided-treatment arm had a median of six clinic visits, compared with five with standard management. The median baseline NT-proBNP level in the guided-therapy arm was 2,344 pg/mL. It fell to 1,125 pg/mL, with 44% of subjects in the guided-therapy arm attaining an NT-proBNP of 1,000 pg/mL or less.

Up-titration of heart failure medications was common in both study arms, but was significantly greater in the NT-proBNP group. A total of 63% of patients in the guided-therapy arm were placed on an aldosterone blocker, compared with 45% of controls.

Session cochair Dr. Gregg C. Fonarow said in an interview that he views PROTECT as a successful proof-of-concept study. But before biomarker-guided treatment of heart failure becomes part of guideline-recommended, routine outpatient care, it will be necessary to see if the Massachusetts General Hospital experience can be extended to other settings, including primary care practices, where many patients with heart failure receive their treatment. This will require a large multicenter trial with a diverse group of clinicians; randomization by site; and hard clinical end points, including mortality. A proposal for such a study has been presented to the National Heart, Lung, and Blood Institute for funding consideration.

"It’s a large and expensive trial, but the impact is potentially profound," said Dr. Fonarow, professor of medicine and director of the Ahmanson-UCLA Cardiomyopathy Center, Los Angeles. "Given the costs of heart failure and the tremendous number of outpatient visits for this disease, if we truly had a well-validated guide using biomarkers, that would be a phenomenal advance."

The PROTECT trial was sponsored in part by Roche Diagnostics. Dr. Januzzi declared he serves as a consultant to and speaker for the company.