"The study justifies why we are so aggressive in treating patients during and after myocardial infarction," says Howard S Weintraub, MD, FACC, clinical director of Center for the Prevention of Cardiovascular Disease at New York University Langone Medical Center. "If you survive the first thirty days, your risk is lowered over the next months to years."

According to Dr. Weintraub, patients at risk for sudden cardiac death during the first month are those with recurrent chest pain (similar to the symptoms they had with their heart attack) and heart failure. "Identification of people at risk is very important," says Dr. Weintraub. "Patients should be very vigilant reporting symptoms of shortness of breath, especially when lying down, ankle swelling, recurrent symptoms of chest pain, symptoms similar to initial heart attack experience, or problems during exertion or at rest." They should also understand that using the medications that were prescribed on discharge may be influential in preventing recurrent ischemia and the risk of sudden cardiac death.

The use of defibrillator vests may be a possible preventive tool for high risk patients during the first 30 days following a heart attack, according to Dr. Judith S. Hochman, M.D., clinical chief of cardiology and director of Cardiovascular Clinical Research at New York University School of Medicine. "Implanted defibrillators have not shown reduced risk of sudden death if implanted within 30 days. There is an ongoing NIH funded trial testing these vests. NYU has been using external vests for selected high risk patients during the first month."

Tips for Prevention:

Listen to your body Have appropriate careful surveillance by your physician Take your prescribed medication to reduce future cardiac events (that may include aspirin, Plavix, high dose statins, Beta blockers, ACE-inhibitors or angiotensin receptor blockers) No smoking Watch your diet Consider starting an exercise program -consult your physician first Possible use of external defibrillator vest

med.nyu

Patel reported evidence of metabolic programming in 2002, when his laboratory showed that in rats, consumption of a milk formula high in carbohydrates during the critical early weeks of postnatal life caused permanent changes in pancreatic islets, leading to overproduction of insulin and development of obesity in adulthood.

"Metabolic signals are reset in response to a high carbohydrate milk formula given to newborn rats during the suckling period, which induces permanent changes at the molecular level in our rat model," Patel said. "The HC (high carbohydrate) phenotype is maintained for life and is spontaneously transmitted to succeeding generations."

Unlike many models investigating the role of maternal obesity on their offspring, the mother rats used in this study consumed normal laboratory chow during pregnancy, Patel noted.

"Our findings that malprogramming effects induced during fetal development in the altered intrauterine environment in obese mother rats predispose the offspring for adult-onset obesity underscore the importance of women maintaining optimal conditions during their pregnancies," said Patel.

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