MATTERS OF THE HEART

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When patients die of cardiac disease, the problem is often not that the heart has been denied blood but that it's been denied oxygen the blood carries. Lately, surgeons have experimented with a novel solution: drill some holes and let in some air.

In one of the most extensive tests of the technique to date, physicians at St. Vincent Hospital in Indianapolis, Ind., studied 160 patients suffering from angina, or heart-related chest pain. For about half the patients, they used traditional treatments, consisting largely of a complex menu of drugs. On the other half, they tried the new approach.

Opening the patients' chests, surgeons used a laser to sear dozens of 1-mm holes in the left ventricle, allowing blood to seep up from the pumping chamber and supply tissue with oxygen. Of the patients who received the surgery, 86% enjoyed a reduction in symptoms; of those who didn't, 12% improved. While the treatment is experimental, it could have a big impact: in the U.S., 100,000 people each year are driven to their beds--or their deaths--by angina.

GENETIC DETOUR

Once fatty plaque deposits have built to dangerous levels in blood vessels, standard treatments include bypass surgery--grafting detours around the blockages--or balloon angioplasty, in which deposits are squashed into vessel walls by a tiny expanding balloon. But doctors at St. Elizabeth's Medical Center in Boston have been testing a new, much less invasive therapy. They took eight patients with clogged vessels in their legs (a condition that can lead to gangrene and amputation) and injected them with genetic material--the same gene that governs blood-vessel growth in embryos. In 8 out of 10 blocked legs, blood flow improved, and in all but one of those, angiograms showed the improvement was due to new blood vessels that appeared at the site of the blockage, offering the blood a detour. The therapy may help some of the 200,000 Americans with severe leg-vessel problems--and if it helps heart vessels the same way, it could benefit the millions with coronary-artery disease as well.

A FISHY THERAPY AND A VEGGIE RED HERRING

There's little doubt that a diet high in meats and saturated fats can boost levels of bad cholesterol. What isn't so clear is whether the obvious alternative--a vegetarian diet--is the best way to keep the stuff to a minimum. A landmark study of East African Bantu people seemed to show that it wasn't: one group, which lived near a lake, ate huge amounts of fish and almost no meat; the other, which didn't, was vegetarian. The vegetarians, it turned out, had higher blood levels of lipoprotein "a," one of whose components is LDL, the bad stuff.

Still, a question remained. An individual's genetically determined blood chemistry is known to influence how much of this lipoprotein is present in the blood. Could it be that the vegetarians had bad chemistry to start with? The answer, it turns out, is no. A new analysis by a joint U.S.-Italian team shows that even when you correct for genetic differences, the fish eaters have an average 40% lower level of this particular lipoprotein. One study isn't definitive, of course. But it suggests that having that extra piece of red snapper can't hurt, and might even help.

AN OUNCE OF CARDIAC PREVENTION