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Old Standby Reduces Heart Attack Damage

Insulin reduces inflammation in hours after event

TUESDAY, Feb. 24, 2004 (HealthDayNews) -- Researchers say they have a miracle drug capable of preventing the inflammatory process that can push heart attack victims over the edge into death.

That drug is insulin.

"We have been putting this together in bits and pieces over the last four years," says research leader Dr. Paresh Dandona, a professor of medicine at the University of Buffalo, N.Y. "This is a hormone that is known to lower blood sugar, but nobody knew it had this amazing anti-inflammatory activity."

Proof of that ability comes from a study whose results appear in the Feb. 24 issue of Circulation.

"We actually succeeded in demonstrating that damage to the heart muscle is markedly reduced by giving insulin in the hours after a heart attack," Dandona says.

The study included 32 patients who came to the emergency department of Millard Fillmore Hospital in Buffalo suffering from heart attacks. Half of them were given standard treatment for a heart attack, including a clot-dissolving drug. The other half had an infusion of insulin in addition to conventional treatment.

Over the next 48 hours, the doctors monitored blood levels of two significant molecular markers of inflammation, C-reactive protein (CRP) and serum amyloid A (SAA). They also monitored levels of creatinine kinase, a protein that is released by damaged heart muscle cells.

Concentrations of CRP and SAA were reduced by 40 percent and 50 percent, respectively, in the patients who received the insulin infusion, while creatinine kinase readings indicated that heart muscle damage was reduced by 50 percent, the researchers report.

Insulin has several beneficial effects, Dandona says. One is to block the production of plasminogen activator inhibitor, a molecule that lessens the effect of clot-dissolving drugs. Another is to reduce the damage caused by free radicals, molecules that attack the heart muscle.

One of the striking aspects of the insulin treatment is its low cost "in an era when every new medication costs thousands of dollars," Dandona says. "We used 120 units of insulin per patient. The cost was $1.50."

The insulin treatment is now in routine use for heart attack patients brought to the Buffalo hospital, Dandona says.

"Now we are trying to sell this idea to clinicians," he says.

The selling effort includes additional, larger clinical studies.

"We have scheduled a consortium meeting in New York City at the end of March to discuss this with other medical leaders," Dandona says.

A second study appearing in the same issue of Circulation finds yet another inflammatory biomarker that can cause heart trouble. The study, led by researchers at the Baylor College of Medicine, found the marker, called Lp-PLA2, doubled the risk of a coronary event even in people who had low levels of LDL, the so-called "bad" cholesterol.

More information

The signs and symptoms that indicate the need for immediate help for a heart attack are described by the American Heart Association, which also has a page on treatments.

SOURCES: Paresh Dandona, M.D., professor, medicine, University of Buffalo, N.Y.; Feb. 24, 2004, Circulation
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