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New Technique Can Spot a Heart Attack in the Making Long Before It Happens

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Cardiology experts have developed a noninvasive way of measuring the fat around a person's blood vessels, which could help determine their risk for dangerous cardiac events. The researchers described their technique today in the journal Science Translational Medicine.

Heart attacks are incredibly common, affecting around 750,000 Americans every year. Heart disease is the number one cause of mortality in the U.S., responsible for one out of every four deaths. There are many reasons for this. Among them is the difficulty of identifying at-risk patients before it's too late.

Cardiologists' current method of choice uses a metric called coronary calcification score (CCS) to measure the hardening of a patient's arteries. CCS is a reliable way to predict future heart problems, paper co-author Charalambos Antoniades said in a statement, but it has its limitations.

"When coronary calcification is detected," he said, "it is already too late, as the calcification is not reversible."

And so, rather than measuring calcification, many researchers have begun looking for a way to measure blood vessel inflammation, which is usually a pretty good—and early—predictor of heart disease.

The inflammation itself can be hard to see without entering a patient's body. But recent studies have shown that it rarely travels alone: Blood vessels that are inflamed are also often wrapped in larger fat cells than healthy vessels. 

With this link in mind, Antoniades and his colleagues decided to try measuring the fat cells instead. They reviewed computed tomography scans from 453 patients about to undergo heart surgery, and used these data to create what they call the fat attenuation index (FAI). The higher a patient's FAI, the more inflammation they had, and the more advanced or severe their heart disease. 

The researchers then compared the FAI of 40 additional patients with the results of invasive scans of the inflammation in their hearts. Sure enough, each patient's FAI matched the swelling onscreen.

There are many benefits to using FAI, the authors say. Not only is it noninvasive and accurate, but it can be used in tandem with CCS and other methods for an even more complete picture. The next step will be validating the test's safety and accuracy in clinical trials.

FAI scans "could help direct these new types of treatments to the appropriate subgroups of patients at greatest risk," Antoniades says, "reducing costs and targeting more powerful drugs to the patients who will benefit most."

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History
The Doctor Who Modernized Royal Births—in the 1970s
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When Prince William eventually ascends to the English throne, he’ll be the first British monarch ever born in a hospital. And he has a man named George Pinker to thank for that.

Royal births have always been fraught affairs due to the thorny issues of birthright and succession. Throughout history, English royal women were expected to give birth in rooms filled with spectators and witnesses—in part to avoid a pretender to the throne being switched with the royal baby at birth.

That made childbirth a grueling ceremony for queens, many of whom had to give birth to stillborn or dying children in the company of scores of strangers. In 1688, after 11 tragic attempts to produce an heir to James II’s throne, Mary of Modena gave birth in front of an audience of 67 people. (It was even worse for Marie Antoinette, who gave birth in 1778 in front of so many people the onlookers nearly crushed her.) And even after births became more private affairs, archbishops and officials attended them as late as 1936.

Of course, doctors have long been part of that crowd. The royal household—the group of support staff that helps royals at their various residences—has included physicians for hundreds of years, who have often been called upon to perform various gynecological duties for royal women. They have frequently been dispatched to serve other family members, too, especially those giving birth to important heirs.

Even when hospitals became popular places for childbirth at the turn of the last century, English royals continued having kids at home in their palaces, castles, and houses. Elizabeth II was delivered via Caesarean section in 1926 at her grandmother’s house in London. When she became queen, her royal surgeon gynecologists recommended she deliver her children at home, bringing in equipment to turn the space into a maternity ward.

Yet it was one of her gynecologists, John Peel, who ended up changing his tune on delivering children in hospitals, and in the 1970s he published an influential report that recommended all women do so. When he stepped down in 1973, the queen’s new royal gynecologist, George Pinker, insisted the royals get in line, too.

Pinker was different from his predecessors. For one, he skipped out on a potential career in opera to practice medicine. He had been offered a contract with an opera company, but when asked to choose between music and medicine, the choice was clear. Instead, he stayed involved with music—becoming assistant concert director at the Reading Symphony Orchestra and vice president of the London Choral Society—while maintaining his medical career.

He was also the youngest doctor ever to practice as royal surgeon gynecologist—just 48 when he was appointed. He supported controversial medical advances like in vitro fertilization. And he insisted that his patients’ welfare—not tradition—dictate royal births.

“It is very important for mothers to accept modern medical assistance and not to feel guilty if they need epidural or a Caesarean,” he told an interviewer. Pinker recommended that pregnant women lead as normal a life as possible—no easy task for royals whose every move was spied on and picked apart by the public. In fact, the doctor being anywhere near the queen or her family, even when he was not there to treat a pregnant woman, was seen as a sign that a royal was pregnant.

When Princess Diana delivered her first son, it was at a royal room in a hospital. “Most people marveled at the decision to have the royal baby in such surroundings rather than Buckingham Palace,” wrote The Guardian’s Penny Chorlton. Turns out the surroundings were pretty plush anyway: Diana delivered in her very own wing of the hospital.

Pinker served as the queen’s royal gynecologist for 17 years, delivering nine royal babies in all, including Prince William and Prince Harry. All were born at hospitals. So were William’s two children—under supervision of the royal gynecologist, of course.

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Big Questions
What Is the Difference Between Generic and Name Brand Ibuprofen?
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What is the difference between generic ibuprofen vs. name brands?

Yali Friedman:

I just published a paper that answers this question: Are Generic Drugs Less Safe than their Branded Equivalents?

Here’s the tl;dr version:

Generic drugs are versions of drugs made by companies other than the company which originally developed the drug.

To gain FDA approval, a generic drug must:

  • Contain the same active ingredients as the innovator drug (inactive ingredients may vary)
  • Be identical in strength, dosage form, and route of administration
  • Have the same use indications
  • Be bioequivalent
  • Meet the same batch requirements for identity, strength, purity, and quality
  • Be manufactured under the same strict standards of FDA's good manufacturing practice regulations required for innovator products

I hope you found this answer useful. Feel free to reach out at www.thinkbiotech.com. For more on generic drugs, you can see our resources and whitepapers at Pharmaceutical strategic guidance and whitepapers

This post originally appeared on Quora. Click here to view.

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