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Do hospitals that conduct the most angioplasties necessarily produce the best results for patients? Maybe not.

Prior research had suggested that “practice makes perfect” when it comes to artery-opening procedures, but a new study involving over 30,000 patients finds low- and high-volume hospitals performing more or less equally.

The study included patients with what are called primary angioplasties, cared for at 166 hospitals across the United States between 2001 and 2007.

The researchers found no significant difference in outcome between medical centers that did high volumes of such procedures and those that didn’t do all that many.

“The message here is that volume alone is not a sufficient target marker for outcome,” said study senior author Dr. Deepak Bhatt, chief of cardiology at the VA Boston Healthcare System and associate professor of medicine at Harvard Medical School. His team reported the findings in the Nov. 25 issue of the Journal of the American Medical Association.

Studies done several years ago did find better results at high-volume hospitals, “but I think things have changed,” Bhatt said. “Devices and techniques, and overall results have improved.”

Hospitals were classified in three groups: low-volume, with fewer than 36 primary angioplasties a year; middle-volume, between 36 and 70 procedures; and high-volume, with 70 or more procedures a year.

The in-hospital death rate was 3 percent for high-volume hospitals, 3.2 percent for medium-volume hospitals and 3.9 percent for low-volume hospitals, a difference that is not statistically significant, the report said.

The length of hospital stays was virtually the same for all hospitals: 4.6 days for low-volume, 4.5 days for medium-volume, 4.7 days for high-volume. But there was a difference in the interval between arrival at the hospital and beginning of angioplasty: 98 minutes for low-volume hospitals, 90 minutes for medium-volume and 88 minutes for high-volume. And high-volume hospitals were more likely to fulfill the guideline recommending start of an angioplasty within 90 minutes of arrival at a hospital.

Overall, the new findings are “really good news for patients in general, because it means that whatever hospital you go to, the result is likely to be good,” said Dr. Issam D. Moussa, associate professor of medicine and director of the endovascular service at Weill Medical College of Cornell University, New York City, and a spokesman for the Society for Cardiovascular Angiography and Interventions.

The study results also confirm current guidelines about emergency treatment for heart attacks, Moussa said. “When they pick you up, they should take you to the nearest hospital,” he said. “This study doesn’t change that.”

But he also said the findings of the study were not unshakable because of the relatively small number of people treated in low-volume hospitals.

“Low-volume hospitals [in the study] included only 3,000 patients,” Moussa said. “Because of that low number, the results cannot be conclusive.”

The difference between in-hospital death rates found in the study might have been statistically significant had the numbers been higher, he said. And the study also excluded about 120 hospitals because they reported too few primary angioplasties, Moussa said.

The study also looked only at in-hospital deaths, Bhatt noted. “If we looked at longer-term outcomes, differences might emerge,” he said.

Still, the study casts some doubt on the notion that in cardiology, practice makes perfect, Bhatt noted. “Within the range we studied and the kinds of hospitals we studied, the difference was not there,” he said.

In a related study published in the same issue of the journal, Norwegian researchers say that giving out-of-hospital cardiac arrest patients intravenous epinephrine therapy does not boost long-term survival.

A team from Oslo University compared outcomes for over 850 patients experiencing out-of-hospital cardiac arrest. Half received standard IV epinephrine as part of advanced cardiac life support, while the other half did not. The team found that about 10 percent of patients survived to hospital discharge, whether or not they had received the IV treatment.

In a study in older adults, dietary intake of vitamins C and E was linked with muscle strength, leading the researchers to suggest at a meeting in Atlanta this past weekend that a diet high in antioxidants could play an important role in preserving muscle function in older adults

“Muscle strength is really a marker of aging,” one of the investigators, Dr. Anne Newman of the University of Pittsburgh, told Reuters Health. “Muscle strength starts declining when people are in their 40s, but it decreases dramatically after age 60.”

This decline is “a major risk factor” for becoming frail and disabled, she said, but certain strategies may slow down the loss.

In previous work, Newman and her associates identified physical activity and, separately, dietary protein as important for maintaining muscle strength.

For their current study, to evaluate the potential benefits of micronutrients, the researchers asked more than 2,000 men and women in their 70s about their long term eating habits. They also measured participants’ grip strength at the outset and two years later.

On Saturday at the Gerontological Society of America’s annual meeting, the researchers reported a significant positive link between dietary intake of vitamins C and E and subsequent change in muscle strength, regardless of participants’ initial strength levels.

At this point, it’s not clear whether vitamins C and E specifically help preserve muscle strength, or if intake of these micronutrients is a marker of a healthy diet, Newman said. “Since they’re in the food, they could be directly related, or they could be marking diets high in fruits and vegetables and low in sodium — all of which would have beneficial effects.”

The average daily dietary intakes of vitamins C and E in the study were 144 milligrams and 11 milligrams, respectively. “For vitamin E at least, our cohort’s intake was on average a little lower than the recommended daily allowance,” Newman pointed out. “So while it’s possible to get enough of this micronutrient in the diet, you have to pay attention and be sure to include foods rich in that vitamin.”

The team is trying now to determine “the optimal level of physical activity and optimal nutrients in the diet that will preserve muscle strength,” Newman said.

Meanwhile, she added, the current findings provide “another reason for doctors to encourage patients to eat a balanced diet, rich in fruits and vegetables.”

Newman cautioned consumers not to start taking high-dose supplement of vitamins C and E. “In clinical trials with very high doses of antioxidants, you don’t see any benefits and in some cases, they’re potentially harmful,” the researcher said.

Having children may slow the progression of multiple sclerosis, new research suggests.

Belgian researchers followed 330 women who had experienced their first MS symptoms between the ages of 22 and 38.

Women who had given birth to at least one child were 34 percent less likely to have the disease progress to a stage in which they needed walking assistance, such as a cane or brace, than women without children.

While having a baby either before or after the onset of MS symptoms seemed to help, women who had a child after they began experiencing MS symptoms were even better off. During the study, women with MS symptoms who’d had a baby were 39 percent less likely to have their disease progress to the point of needing walking assistance. In the study, women had the disease for an average of 18 years.

“Women with MS who have children seem to have a more benign MS course than those who don’t,” said study author Marie D’hooghe, of the department of neurology at Nationaal MS Centrum in Melsbroek, Belgium.

The research appears in the Nov. 24 online issue of the Journal of Neurology, Neurosurgery & Psychiatry.

Multiple sclerosis is an autoimmune disease in which the body’s own defense system attacks myelin, or the protective fatty substance that surrounds nerve fibers in the central nervous system, according to the National Multiple Sclerosis Society. The damage causes a disruption to nerve signals traveling to and from the brain, which causes the numbness, walking problems, blurry vision and fatigue.

About 85 percent of those with MS start with a relapsing-remitting course, in which attacks are followed by partial or total recovery, according to the study. More than half go on to develop a more progressive form of the disease, in which symptoms worsen over time and there are fewer, shorter periods without symptoms. Eventually, the disease can lead to loss of vision and paralysis.

Women are twice as likely to develop MS as men, though women tend to have less severe cases than men, according to the study.

About three-quarters of the women in the study had children. The researchers measured the time it took for women to reach level 6 on the Expanded Disability Status Scale (EDSS), a rating system used by doctors to describe symptoms, with level 1 being the least severe and 10 being death due to MS. Level 6 is defined as needing a cane, crutch or brace to walk.

Women who did not have children took an average of 13 to 15 years to progress to EDSS 6, while women who had children took an average of 22 to 23 years to reach that stage, the researchers found.

“Having one or more children does seem to be beneficial,” said Patricia O’Looney, director of biomedical research for the National Multiple Sclerosis Society. “But we don’t know enough about the patient demographics to really draw some major conclusions.”

Among the unknowns are the treatments the women in the study were getting for MS or if perhaps the women who decided to have children were feeling better and having fewer symptoms.

Though much remains to be learned about the role of pregnancy in MS, a possible reason why it may help slow the progression of the disease is that during pregnancy, the immune system is “downregulated,” in part to prevent the mother’s body from rejecting the fetus, O’Looney explained. Suppressing the immune system may also help to control MS, O’Looney noted.

Treatments for MS, such as interferon beta-1a and -1b, work by suppressing the immune system.

A second possibility for why childbirth might help delay the progression of MS is that during pregnancy, estrogen levels rise. Previous research has suggested estrogen may help protect from MS by stimulating the cells that make myelin. The MS Society is currently funding a clinical trial in which women with MS are given estriol, a form of estrogen, along with standard MS treatments.

“The sex hormones do seem to have some neuroprotective role, though we are not quite sure how,” O’Looney said.

Still, O’Looney stressed that women should not interpret the results as reason to have a baby to delay the progression of the disease, or blame themselves if they decided not to have children.

“We still don’t know a lot about the great variability of MS — why does one person become more progressive while another follows a more benign course,” O’Looney said. “What’s certain is that one should not conclude it’s based on whether or not you have a child. There are so many other factors, including possibly genetic factors, that determine that.”

Abnormal cholesterol levels can significantly increase the risk of heart failure, a new study has found.

U.S. researchers analyzed data on 6,860 participants in the National Heart, Lung, and Blood Institute’s Framingham Heart Study. None of the participants, average age 44, had coronary heart disease at the start of the study. After about 26 years of follow-up, 680 people had developed heart failure.

The incidence of heart failure was:
12.8 percent in participants with low levels of high-density lipoprotein (HDL, or “good”) cholesterol. Low HDL is less than 40 milligrams per deciliter (mg/dL) in men and less than 50 mg/dL in women.
6.1 percent among participants with desirable HDL levels (at least 55 mg/dL in men and 65 mg/dL in women).
13.8 percent in participants with high levels (at least 190 mg/dL) of non-HDL cholesterol, which includes triglycerides and low-density lipoprotein (LDL, or “bad”) cholesterol.
7.9 percent in those with desirable levels (less than 160 mg/dL) of non-HDL cholesterol.

When the researchers factored in age, sex, body mass index, blood pressure, diabetes and smoking, the risk of heart failure was 29 percent higher in participants with high non-HDL cholesterol than in those with lower levels, and 40 percent lower in those with high HDL-cholesterol than in those with lower levels.

Further analysis showed that the risk of heart attack was 13 percent higher in participants with high non-HDL cholesterol and 25 percent lower in those with high HDL cholesterol.

“This study goes a step further in implicating cholesterol levels (both HDL and non-HDL) in heart failure and suggests that cholesterol-altering therapy may have long-term benefits in preventing heart failure above and beyond its effects on preventing [heart attack],” study senior author Dr. Daniel Levy, director of the Framingham Heart Study, said in a news release from the American Heart Association.