Surgical Cardiovascular and Peripheral Vascular Procedures Volumes to 2021

This report presents procedure volumes forecasts for some of the most common cardiovascular and peripheral vascular surgical procedures performed in the five EU countries of France, Germany, Italy, Spain, and the UK (5EU). The forecast period covered by this report is for the years 2016 through 2021.
This report also presents an overview of the etiology and epidemiology of selected cardiovascular and peripheral vascular diseases/disorders, prevailing surgical approaches/techniques, and evolving procedural utilization trends.
Cardiovascular surgical procedures discussed include cardiac resynchronization therapy, congenital heart defect repair, coronary artery bypass graft surgery, implantation of implantable cardioverter defibrillators, pacemakers, and ventricular-assist devices, heart valve repair/replacement, percutaneous coronary intervention with or without stenting, thrombectomy/thrombolysis, and transmyocardial revascularization.
Peripheral vascular interventional/surgical procedures covered include femoropopliteal bypass and stenting, percutaneous transluminal angioplasty, and stent grafting.

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Stress and Heart Disease

Having too much stress, for too long, is terrible for your heart.

If you’re often stressed, and you don’t have good ways to manage it, you are more likely to have heart disease, high blood pressure, chest pain, or irregular heartbeats.

The stress itself can be a problem. It raises your blood pressure, and it’s not good for your body to continually be exposed to stress hormones. Studies also link stress to changes in the way blood clots, which makes a heart attack more likely.

The way you handle stress also matters. If you respond to it in unhealthy ways — such as smoking, overeating, or not exercising — that makes matters worse. On the other hand, if you exercise, connect with people, and find meaning despite the stress, that makes a difference in your emotions and in your body.

Causes of Stress

Stress can be caused by a physical or emotional change or a change in your environment that requires you to adjust or respond. Things that make you feel stressed are called “stressors.”

Stressors can be minor hassles, significant lifestyle changes, or a combination of both. Being able to identify stressors in your life and releasing the tension they cause are the keys to managing stress.

Below are some everyday stressors that can affect people at all stages of life.

Illness, either personal or of a family member or friend.

• Death of a friend or loved one.
• Problems in a personal relationship.
• Work overload.
• Starting a new job.
• Unemployment.
• Retirement.
• Pregnancy.
• Crowds.
• Relocation.
• Daily hassles.
• Legal problems.
• Financial concerns.
• Perfectionism.
• Warning Signs of Stress

When you are exposed to long periods of stress, your body gives warning signals that something is wrong. These physical, cognitive, emotional and behavioral warning signs should not be ignored. They tell you that you need to slow down. If you continue to be stressed and you don’t give your body a break, you are likely to develop health problems like heart disease.

Coping with Stress

After you’ve identified the cause of stress in your life, the next step is to learn techniques that can help you cope with stress while fighting heart disease. There are many techniques you can use to manage stress. Some of which you can learn yourself, while other techniques may require the guidance of a trained therapist.

Some conventional techniques for coping with stress include:

Eat and drink sensibly. Abusing alcohol and food may seem to reduce stress, but it actually adds to it.

Assert yourself. You do not have to meet others’ expectations or demands. It’s OK to say “no.” Remember, being assertive allows you to stand up for your rights and beliefs while respecting those of others.

Stop smoking. Aside from the obvious health risks of cigarettes, nicotine acts as a stimulant and brings on more stress symptoms.

Exercise regularly. Choose a non-competitive exercise and set reasonable goals. Aerobic exercise has been shown to release endorphins (natural substances that help you feel better and maintain a positive attitude).

Relax every day. Choose from a variety of different techniques (see below).

Take responsibility. Control what you can and leave behind what you cannot control.

Reduce the causes of stress. Many people find life is filled with too many demands and too little time. For the most part, these demands are ones we have chosen. Effective time-management skills involve asking for help when appropriate, setting priorities, pacing yourself, and taking time out for yourself.

Examine your values and live by them. The more your actions reflect your beliefs, the better you will feel, no matter how busy your life is.

Set realistic goals and expectations. It’s OK, and healthy, to realize you cannot be 100% successful at everything all at once.

Sell yourself to yourself. When you are feeling overwhelmed, remind yourself of what you do well. Have a healthy sense of self-esteem.

Get enough rest. Even with proper diet and exercise, you can’t fight stress effectively without rest. You need time to recover from exercise and stressful events. The time you spend resting should be long enough to relax your mind as well as your body. Some people find that taking a nap in the middle of the day helps them reduce stress.

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Can stress cause a heart attack?

Everyone knows that keeping stress levels low is an essential component of a healthy lifestyle. Managing stress can have all sorts of positive effects on your health, like lowering blood pressure and cholesterol levels, which can lead to a decrease in the risk of heart disease.

But have you ever wondered if stress itself can directly cause a heart attack? The answer is - not exactly. But sudden, severe stress can cause something called stress cardiomyopathy (also known as "broken heart syndrome" or " takotsubo cardiomyopathy"), an under-diagnosed health condition with symptoms that are very similar to those of a heart attack.

What is it?

The word cardiomyopathy refers to heart muscle that is weakened, resulting in the heart not working as well as it should. Stress cardiomyopathy refers to the weakening of the heart as a result of intense physical or emotional stress.

The intense grief that comes with the death of a loved one is a common cause of this condition. However, emotions like extreme anger, fear, and surprise can also cause it. Physical stress to the body includes stroke, dehydration, or low blood sugar.

What happens?

After a person experiences an intense emotional event, stress hormones (such as adrenaline) are released into the body at levels that can be 10 to 30 times the normal levels. Stress hormones usually help the body cope with stress. However, at these toxic levels of hormones, it's thought that the heart becomes overwhelmed and "stunned" to the point where it can no longer pump properly.

It is not sure what exactly happens to result in the heart pumping inadequately. It may be due to a decreased oxygen supply to the heart or due to too much calcium entering the heart cells. In any case, it can result in shock, heart failure, and heart rhythm problems, all of which can be life-threatening if not treated.

But with treatment, most patients make a full recovery, sometimes in just a matter of weeks. The effects of excess stress hormones on the heart are brief and do not cause permanent damage to the heart.

What are the symptoms?

Symptoms of stress cardiomyopathy include sudden onset of chest pain, sweating, nausea, vomiting, shortness of breath, low blood pressure, and abnormal heart rhythms. These symptoms frequently occur soon after a severely stressful event. Because many of these symptoms are also symptoms of a heart attack, it is easy to mistake stress cardiomyopathy for a heart attack.

Stress cardiomyopathy vs. heart attack

Heart attacks and stress cardiomyopathy can have very similar symptoms but they are different conditions. Most heart attacks are caused by blockages or blood clots in the coronary arteries (the blood vessels that supply the heart), resulting in a decreased flow of blood to the heart that can lead to heart muscle cells to die. This is what can cause permanent damage to the heart muscle cells.

On the other hand, the heart is not permanently damaged with stress cardiomyopathy. Stress cardiomyopathy does not seem to be a result of artery blockages or blood clots. For most people that suffer stress cardiomyopathy, the heart weakness usually stops within a couple of weeks and there is no permanent damage.

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What are the best foods for heart health?

Heart disease is still the number one killer in the United States. In this Spotlight, we outline 16 foods that, when consumed as part of a well-rounded diet, might help to keep your heart healthy.
There are many things you can do to help keep your heart healthy and disease-free.
You can schedule an annual checkup, exercise daily, quit smoking, or take steps to reduce the level of stress in your life.

All of these things can have a positive effect on heart health. But, one of the most straightforward lifestyle changes that will benefit your heart is watching what you eat.

Nearly 6 million people are currently living with heart failure, and around half of these will die within 5 years of being diagnosed.
The Centers for Disease Control and Prevention (CDC) warn that eating foods high in fat, cholesterol, or sodium can be very bad for the heart. So, when taking steps to minimize the risk of heart disease, diet is an excellent place to start.

In this article, we examine some of the best foods for ensuring that you keep a robust and healthy heart.

1. Asparagus
Asparagus is a natural source of folate, which helps to prevent an amino acid called homocysteine from building up in the body. High homocysteine levels have been linked with an increased risk of heart-related conditions, such as coronary artery disease and stroke.

2. Beans, peas, chickpeas, and lentils

Beans, peas, chickpeas, and lentils — otherwise known as pulses or legumes — can all significantly reduce levels of low-density lipoprotein (LDL) or "bad cholesterol." They are also packed with fiber, protein, and antioxidant polyphenols, all of which have beneficial effects on the heart and general health.

3. Berries
Berries are also full of antioxidant polyphenols, which help to reduce heart disease risk. Berries are a great source of fiber, folate, iron, calcium, vitamin A, and vitamin C, and they are low in fat.

4. Broccoli
Some studies suggest that regularly eating steamed broccoli can lower cholesterol levels and prevent heart disease.

5. Chia seeds and flaxseeds
These seeds are a rich plant-based source of omega-3 fatty acids, such as alpha-linolenic acid. Omega-3s have many beneficial effects, such as helping to lower levels of triglycerides, LDL, and total cholesterol. They also reduce blood pressure and minimize the buildup of fatty plaques in the arteries.

6. Dark chocolate
Dark chocolate is a rare example of a food that tastes amazing and is right for you (in moderation).
Scientists now believe that dark chocolate has protective benefits against atherosclerosis, which is when plaque builds up inside the arteries, increasing risk of heart attack and stroke.
Dark chocolate seems to prevent two of the mechanisms implicated in atherosclerosis: stiffness of the arteries and white blood cell adhesion, which is when white blood cells stick to the walls of blood vessels.
What is more, studies have found that increasing dark chocolate's flavanol content — which is the compound that makes it tasty and moreish — does not diminish these protective benefits.

7. Coffee
Also in the "almost too good to be true" camp is coffee. One recent study found that regularly drinking coffee was linked with a decreased risk of developing heart failure and stroke.
However, it is essential to bear in mind that this study — w which used machine learning to assess data from the Framingham Heart Study — can only observe an association between factors, and cannot conclusively identify cause and effect.

8. Fish high in omega-3s
Fish is a reliable source of heart-helping omega-3 fatty acids and protein but it is low in saturated fat. People who have heart disease, or are at risk of developing it, are often recommended to increase their intake of omega-3s by eating fish; this is because they lower the risk of abnormal heartbeats and slow the growth of plaque in the arteries.
According to the American Heart Association (AHA), we should eat a 3.5-ounce serving of fatty fish — such as salmon, mackerel, herring, lake trout, sardines, or albacore tuna — at least twice per week.

9. Green tea
A 2011 systematic review found that drinking green tea is associated with a small reduction in cholesterol, which, as we know, is a leading contributor to heart disease and stroke. But the review could not pinpoint how much green tea someone would have to drink to receive any health benefits.
In 2014, another review studied the effects of drinking green tea on people with high blood pressure. The report concluded that green tea was associated with a reduction in blood pressure. But, the authors were unable to determine if this modest reduction could help to prevent heart disease.

10. Nuts
Almonds, hazelnuts, peanuts, pecans, pistachios, and walnuts are all heart-healthy nut options. These nuts are full of protein, fiber, minerals, vitamins, and antioxidants. Like fish and flaxseeds, walnuts are also ripe with omega-3 fatty acids, making them a heart-healthy snack to have on the go.

11. Liver
Of all the organ meats, the liver is the most nutrient-dense. In particular, the liver is bulging with folic acid, iron, chromium, copper, and zinc, which increase the blood's hemoglobin level and help to keep our heart healthy.

12. Oatmeal
Because oatmeal is rich in soluble fiber, it may help to reduce the risk of heart disease. A 2008 review of the evidence concluded that oat-based products significantly reduce LDL and total cholesterol without any adverse effects.

13. Red wine (sort of)
Many studies have noted the potential health benefits of the antioxidants in red wine. However, it is unlikely that the benefits of the antioxidants outweigh the dangers of alcohol.
Recently, however, a new study proposed that these same antioxidants could form the basis of a new stent for use during angioplasty — the process where narrow or obstructed veins are widened to treat atherosclerosis.
The researchers behind that study are currently developing a new kind of stent that releases red wine-like antioxidants into the blood to promote healing, prevent blood clotting, and reduce inflammation during angioplasty.
It is worth noting that drinking alcohol, in general, is not healthy for your heart. In fact, it is vitally important for cardiovascular health to drink alcohol in moderation, if at all.

14. Spinach
You can help to maintain a healthy heart rhythm by regularly consuming good sources of magnesium. Spinach is one of the best sources of dietary magnesium, and consumption of Popeye's favorite food is associated with a raft of health benefits.

15. Tomatoes
Tomatoes have lots of nutrients that might help keep our hearts healthy. The little red fruits are chock-full of fiber, potassium, vitamin C, folate, and choline, which are all good for the heart.
As well as helping to keep heart disease at bay, potassium benefits muscles and bones and helps prevent kidney stones from forming.
Scientists have argued that increasing potassium intake while decreasing sodium intake is the most important dietary change when attempting to reduce the risk of heart disease.

16. Vegetables
The AHA advises that we eat eight or more servings of fruit and vegetables each day. Vegetables are low in fat and calories but rich in fiber, minerals, and vitamins. A healthful amount of veggies in the diet can help to moderate weight and blood pressure.

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The MitraClip Shows Promise in Managing Severe Heart Failure

A clothespin-like device that reduces mitral valve leakage may offer a new treatment option to those seriously ill with heart failure.

The nearly 2 million Americans with severe heart failure face unique challenges.

Simple tasks such as short walks and climbing the stairs at home can lead to shortness of breath. Those with the condition often live in fear of heart attack or stroke.

Fortunately, there is a device that seems to offer promise in the management of severe heart failure in people for whom currently available treatments have been unsuccessful. Amazingly, the device, called the MitraClip, is similar in design to the clothespins you may use to hang your laundry to dry.

“The MitraClip is a small cardiac implant that can be opened and closed, and it is used to grasp the two leaflets of the mitral valve and bring them closer together, thereby reducing mitral regurgitation or leaking of the mitral valve,” explains Jason H. Rogers, MD, the director of interventional cardiology at the University of California Davis Medical Center in Sacramento. “The procedure [to insert the device] is done through a small catheter that is inserted into the right groin, and the recovery is rapid, with most patients being discharged home the following day.”

Half as Many Hospitalizations Observed in COAPT Study

Although the MitraClip still has to be approved by the U.S. Food and Drug Administration (FDA) for the treatment of secondary mitral regurgitation — or mitral valve leaking due to heart disease — the results of the most recent clinical trial of the device, which were released on September 23, appear promising.

Indeed, the findings of the so-called Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation (COAPT) trial, published by the New England Journal of Medicine (NEJM), indicate that people in whom the device was used in combination with medical therapy as directed by currently accepted treatment guidelines required nearly half as many hospitalizations due to heart failure as those who received medical therapy alone.

In all, the COAPT trial enrolled 614 study subjects, 302 of whom were implanted with the MitraClip and 312 of whom continued medical therapy alone. Notably, 151 of the study participants in the medical therapy group were hospitalized for heart failure within two years of the start of the study, and 61 died. In comparison, only 92 of the participants in the MitraClip group were hospitalized over the same two-year period, and only 28 died.

An Earlier, Smaller Study Showed Higher Hospitalizations

As promising as these findings are for those with severe heart failure, though, it should be noted that not all of the studies of the MitraClip yielded the same results. Another, smaller trial, also published in NEJM, on August 27, found that hospitalizations due to heart failure increased among those who were implanted with the device.

Still, cardiologists like Dr. Rogers believe the MitraClip provides a promising new option for those with severe heart disease who may have few others. Rogers emphasizes that the MitraClip “works in conjunction with” existing and effective therapies and is not a “stand-alone” therapy for the condition.

“Until the results of the recent COAPT study were released, available options for patients with heart failure and a leaking mitral valve were limited to medications, pacemakers, and in some cases artificial heart pumps or heart transplant, which are highly invasive surgical therapies,” Rogers notes. “The MitraClip is a relatively straightforward and safe procedure that can have a profound benefit in properly selected patients by reducing death and hospitalization, and improving quality of life.”

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