Sunday, May 5, 2013

Wall Street analysts remains bullish on LinkedIn, investors not so sure

(Reuters) - Wall Street took a long-tem view on LinkedIn Corp's prospects on Friday, with at least six brokerages raising their price targets despite the company's slower-than-expected shift to a marketing model based on selling ads on news feeds.

LinkedIn on Thursday forecast a weaker-than-expected current quarter, even after first-quarter results blew past estimates.

The company's shares were down about 8 percent in early trading after company executives suggested that a revamped mobile app and other new products designed to keep smartphone users engaged would not deliver on advertising growth as quickly as anticipated.

However, analysts said the disappointing news had not changed the strong fundamentals of the social network for professionals.

"...We found nothing thesis-changing in the quarter and would encourage investment on the 10 percent after hours pull-back," Evercore Partners analysts Ken Sena and Andrew McNellis wrote in a research note.

Evercore maintained its "overweight" rating and $210 price target on the stock, which closed at $201.67 on Thursday, while lowering its estimate for revenue from marketing by $85 million for the year.

LinkedIn's Marketing Solutions unit contributed $74.8 million to overall revenue in the first quarter, or about 23 percent of the total.

J.P.Morgan, BMO Capital Markets, Northland Capital, Cantor Fitzgerald, Wedbush Securities and Canaccord Genuity all raised their price targets on the stock, by as much as $50. There were no target cuts among brokerages tracked by Thomson Reuters.

Analysts said the marketing shift aside, LinkedIn was poised for further growth due to recurring subscription revenue streams, vast addressable markets and attractive margins.

LinkedIn has introduced a series of enhancements recently, including news content for mobile devices.

But its mobile-oriented "newsfeed" ads -- or promotions that appear directly in a users' stream of content -- remain in testing and will only be introduced gradually.

"Given the success of Facebook's sponsored content program, we expect a rapid ramp in Marketing Solutions revenue," Needham & Co analyst Kerry Rice said, referring to the LinkedIn's advertising strategy. "Unfortunately, the rollout will be gradual, which should result in slower Marketing Solutions growth for the balance of 2013."

As consumers shift away from PCs, companies such as LinkedIn, Facebook Inc and Google Inc are stepping up efforts to better reach mobile users. More than a quarter of LinkedIn's Web traffic now comes from its mobile app.

And LinkedIn is ahead of the game in distinguishing between tablets and smartphones, creating different strategies for each, BMO Capital Markets analysts said.

As of Thursday's close, LinkIn's stock was trading at roughly 118 times estimated 2013 earnings per share.

The average price-earnings ratio for the sector is about 19, according to StarMine.

LinkedIn shares gained about 76 percent this year up to Thursday's close.

(Reporting by Supantha Mukherjee in Bangalore; Editing by Ted Kerr)

Source: http://news.yahoo.com/wall-street-analysts-remains-bullish-linkedin-investors-not-134628428.html

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Bargain-bin smartphones vault ZTE into the top 5 in U.S. market share

May 2 (Reuters) - Few sports fluctuate as much as horse racing and even fewer races are as unpredictable as the Kentucky Derby. This year's race, at Churchill Downs on Saturday, is no different and looms as one of the most open in decades. The early favorite is Orb, who won the Florida Derby, one of the key traditional lead-up races, in brilliant fashion. His main challenger, at least in betting circles, is the unbeaten Verrazano, but this is anything but a two-horse race. With a capacity-field of 20 impeccably bred three-year-olds, the 139th Kentucky Derby has all the makings of a classic. ...

Source: http://news.yahoo.com/bargain-bin-smartphones-vault-zte-top-5-u-235017159.html

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Thursday, May 2, 2013

Better without playoffs?

A playoff-less baseball season has at least one proponent: A's GM Billy Beane

BY JOE POSNANSKI

NBCSports.com

updated 9:31 a.m. ET May 1, 2013

Before I tell you about our big idea ? ?our? meaning Billy Beane and me ? let?s start with the inspiration. A week or so ago, my wife Margo asked a sports question. Margo used to be a pretty big sports fan, but that was before the PTA took up 98.9 percent of her time, so now she will emerge every month or two after fighting to the death with another weekly newsletter to ask something like, ?So, who won the Final Four?? or ?Whatever happened to Tim Tebow??

This time, though, her question was international.

?So,? she asked, ?when do the Premier League soccer playoffs begin??

The question came up in actual conversation ? it wasn?t just some crazy out of the blue thing, we were discussing how cool it would be to spend some time in England learning about the Premier League ? but the point was her reaction when I told her that the Premier League doesn?t have playoffs. She did not seem able to grasp the concept.

?What do you mean?? she asked.

?They don?t have playoffs. They never have.?

?So,? she asked, ?how do they pick a winner??

?Well, the team with the best record at the end of the season is the champion.?

She looked at me in sheer wonder ? the same look she gave me the first time I successfully put in a child car seat ? and finally said: ?That?s the greatest thing I?ve ever heard. Why don?t WE do that??

Let?s be honest: Most Americans do not want to do that. We are a playoff nation. We, as Americans, tend to love playoffs. We can?t get enough of them. We want tournaments expanded. We want wildcards added. We want five-game series stretched to seven. We want 68 teams in the NCAA Tournament rather than 64 even though it makes absolutely no sense*. People have been fighting harder for a college football playoff than pretty much any pressing issue in American life.

*And then the NCAA calls those play-in games the ?first round,? which is just ludicrous and stupid though, admittedly, probably not in the top five ?ludicrous and stupid? things the NCAA does.

Lots of people have written and talked about the difference in character and expectation between, say, English sports fans and American sports fans. The brilliant Bill Bryson, an American son of a sportswriter who has lived most of his adult life in England, once wrote about how Americans and English folks have different expectations when they go to the pharmacy to get medicine.

?(T)he British don?t expect over-the-counter drugs to change their lives,? Bryson wrote, ?whereas we Americans will settle for nothing less. ? You only have to watch any television channel for a few minutes, flip through a magazine, or stroll along the groaning shelf of any drugstore to realize that people in this country expect to feel more or less perfect all the time. Even our household shampoo, I notice, promises to ?change the way you feel.??

Well, we can embrace that. We want our meals supersized, our Powerade with advanced electrolytes, our Tylenol Maximum Strength, and our games do or die. Playoffs speak to us. They are not everyday games. They are extraordinary. They are pressure packed. They are television extravaganzas. They are important, hugely important, draped with Roman numerals. They give us heroes and goats, the thrills and the agonies in Costco-sized packages.

In the Premier League, meanwhile, everyone has pretty well known that Manchester United is going to win the league for roughly two months. There?s no drama. There are no second chances. But that fits what people expect. In England, they would no sooner add playoffs to the end of the Premier League season than give you free Diet Coke refills in restaurants. The lack of playoffs isn?t just a feature of the Premier League ? it?s at the very HEART of the Premier League. The best team wins the championship. The worst teams are relegated to the Football League Championship, sort of the Class AAA of British soccer.

In England, soccer mirrors life. It?s the day-to-day excellence that marks greatness, not a three or four-week run to glory.

Well, I think we should bring some of that spirit to America ? especially to baseball. I mean football is geared for the short season ? 16 games, an intense playoffs, a Super Bowl, that?s why it?s the biggest thing in America. But they play 162 games in baseball. One hundred sixty two. I mean, seriously, that?s a lot of baseball games. No other sport plays so many.

That?s more than enough game to determine who are the best teams in baseball. I mean, hey, I like all the playoffs too ? more baseball is more baseball ? but they feel cheap and gimmicky. They feel like you compete in a triathlon, and then, when everyone is finished, the Top 16 have a chili eating contest to determine the real champion.

It feels like SOMETHING could be done here. I?m not saying that they should get rid of the playoffs, but there should be some way to bring back some power and authority to the baseball regular season. I just needed an ally. And I knew exactly where to find one.

?Yeah, I think you and I are probably of the same mindset on this,? said Billy Beane, Oakland A?s general manager and real life version of the Brad Pitt ?Moneyball? character.

OK, yeah, that was kind of an obvious ploy going to Billy Beane. For one thing, everyone knows he?s an uber-fan of European soccer, particularly the Premier League. And everyone also knows he?s been CRUSHED by the playoffs more than anyone in baseball the last 15 or so years. Six times since 2000, the A?s have qualified for the playoffs ? six times they have lost. Five of those they lost in a heartbreaking Game 5 of the Division Series. The sixth time, they were swept by Detroit in the ALCS.

Beane has famously said that his ?s--- doesn?t work in the playoffs,? and he is very, very clear to not make excuses when I ask him questions about the playoffs vs. the regular season. This is how baseball picks their champions, and it?s his job and Oakland?s job to win in October.

But he does believe ? and I believe, too ? that the baseball playoffs are a crapshoot. They are what Beane poetically calls ?a gauntlet of randomness.? Every now and again there?s a team that?s so good ? say the legendary 1998 Yankees or the amazing 2009 Yankees ? that nothing can derail them, not randomness, not bad luck, not a short series, nothing. But that?s a rare, rare team. Going all the way back to the 1990 season, those two Yankees teams are the ONLY two teams that had the best record in baseball and won the World Series.*

*The 2007 World Champion Boston Red Sox tied the Cleveland Indians for the best record.

?I just happen to believe that last year, the New York Yankees were the best team in the American League last year because they had the best record over the season,? Beane says. ?I thought in 2001, the Seattle Mariners (who won 116 games but lost n the ALCS) were by far the best team in baseball. That?s just my opinion. (He added: ?I also happen to think that Georgetown was better than Villanova in 1985.?)

Billy Beane

Eric Risberg / AP

Nobody presently in baseball has been more snakebit by the playoffs the Billy Beane, whose A's teams have notoriously fallen short in postseason play.


?The playoffs are a great thing for our sport ? I want to make that clear. But let?s call it what it is: we allow small sample sizes and random events to determine the champion. That?s how it is in baseball.?

But does it HAVE to be that way? Isn?t there a way to get the thrills of the playoffs but also the justice of a champion chosen through a long season with a thousand, slumps and streaks, challenges and triumphs?

?Well,? Billy said, ?there is one thing you?re forgetting about European football. They really have the best of both worlds. They don?t have a playoff in the Premier League, but they do have the Champions League ??

Oh yeah. The UEFA Champions League. That is a huge tournament that features club teams from more than 50 countries all over Europe. They play in a fairly complicated tournament that eventually leads to a 16-team knockout round like the NCAA?s Sweet 16. So, yeah, soccer fans do get their playoff thrills and their valid regular season. They get the excitement of a consequential and important regular season, but they also get a wild and thrilling playoff.

?Hey, wait a minute,? I said to Beane. ?What if ??

?I think we?re thinking the same thing,? Billy Beane said before I finished.

He was right: We both had the same idea: Baseball can have the best of both worlds too. The playoffs can remain the playoffs ? it?s still the World Series, and you can make it as wide open as you like. But in the meantime, what if there was a trophy given and a serious distinction to the teams in each league with the best record.

What if, for instance, we called THEM the ?pennant winners?? That?s how it was until 1969, you know, the team with the best team in each division was said to have ?won the pennant.? Now, we tend to call the team that snakes through each league playoff as the pennant winner, but I think that should be changed. Getting to the World Series is reward enough. The ?pennant? should go to the team with the best record in each league.

Pennant winners over the last few years:

2012 pennant winners: New York and Washington

2011 pennant winners: New York and Philadelphia

2010 pennant winners: Tampa Bay and Philadelphia

2009 pennant winners: New York and Los Angeles Dodgers

2008 pennant winners: Los Angeles Angels and Chicago Cubs*

*The Cubs win the pennant!

This could be a really good thing. Of course, it has to be taken seriously. If two teams tie for the pennant, for instance, they should play a one-game playoff. The season should be viewed as its own thing, starts around the first of April, ends at the end of September. That?s it.

Now, if I had my way, the pennant winners would also get something special in the playoffs ? extra home field advantage or something ? but that?s playoff talk again. In the end, sure, of course, the World Series will still matter a lot more because it has history behind it and because, yes, we love our playoffs. But I?d love to see the 162-game champion recognized in a bigger way. I?d love to see a 2012 pennant flag waving in Washington right now.

?You know what,? Billy Beane said, ?you and I might be the only ones who feel that way.?

?Yeah,? I said, then added, ?Well, my wife too.?

Joe Posnanski is the national columnist for NBC Sports. Follow him on Twitter @JPosnanski. Click here to subscribe to Joe's stories.

? 2013 NBC Sports.com? Reprints

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Source: http://nbcsports.msnbc.com/id/51727826/ns/sports-baseball/

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Tuesday, April 16, 2013

NBC networks to televise EPL next season

Arlo White, left, listens as Rebecca Lowe speaks during a joint NBC and English Premier League (EPL) press conference on Tuesday, April 16, 2013 in New York. All 380 EPL games will be televised live by NBC and its networks next season as part of a multiyear contract. White will be the lead play-by-play voice during coverage and Lowe host the telecasts beginning Aug. 17. (AP Photo/Bebeto Matthews)

Arlo White, left, listens as Rebecca Lowe speaks during a joint NBC and English Premier League (EPL) press conference on Tuesday, April 16, 2013 in New York. All 380 EPL games will be televised live by NBC and its networks next season as part of a multiyear contract. White will be the lead play-by-play voice during coverage and Lowe host the telecasts beginning Aug. 17. (AP Photo/Bebeto Matthews)

Richard Scudamore, chief executive of the English Premier League, speaks during an interview at NBC studios on Tuesday, April 16, 2013 in New York. Scudamore and NBC executives announced that all 380 English Premier League games will be televised live by NBC and its networks next season as part of a multiyear contract. The telecasts begin Aug. 17 and will be carried on NBC, NBC Sports Network, Telemundo, Mun2 and various digital outlets. (AP Photo/Bebeto Matthews)

Richard Scudamore, left, chief executive of the English Premier League, listens as Mark Lazarus, NBC Sports chairman, speaks during a press conference on Tuesday, April 16, 2013 in New York. Lazarus announced that all 380 English Premier League games will be televised live by NBC and its networks next season as part of a multiyear contract. The telecasts begin Aug. 17 and will be carried on NBC, NBC Sports Network, Telemundo, Mun2 and various digital outlets. (AP Photo/Bebeto Matthews)

(AP) ? All 380 English Premier League games will be televised live by NBC and its networks next season as part of a multiyear contract.

The telecasts begin Aug. 17 and will be carried on NBC, NBC Sports Network, Telemundo, Mun2, other NBC television properties, and various digital outlets.

NBC is scheduled to air 20 games, with 154 on NBC Sports Network; 76 of the telecasts will be in Spanish on Telemundo or Mun2; and 22 will be shown on other NBC Sports Group channels.

Windows for the national telecasts are 7 a.m. and 10 a.m. ET Saturdays on NBCSN, and 12:30 p.m. on NBC; 8 a.m. Sundays on NBCSN and 11 a.m. on that channel and Telemundo; and 2:30 p.m. ET Mondays on NBCSN.

In addition, NBC is making available free to all carriers of NBC Sports Network a package of all EPL games played at 10 a.m. ET on Saturdays ? the primary starting time in the Premier League. Called Premier League Extra Time, it is similar to DirecTV's NFL Sunday Ticket.

"I can't wait for Aug. 17 to come and we get started," NBC Sports Group Chairman Mark Lazarus said Tuesday. "It's about making this one of the key pillars of our landscape."

The deal comes at a time when Fox and ESPN also have heavy involvement in soccer. But the world's most popular league in the world's most popular sport will belong solely to NBC for the next three years at a rights fee of $250 million.

Arlo White, who currently calls MLS games on NBCSN, will handle play-by-play from England. Former Premier League players Lee Dixon and Graeme Le Saux will handle analysis. Former England national team star Gary Lineker will be a special contributor.

Rebecca Lowe, a fixture on European soccer coverage in Europe, will host a studio show from NBC's international broadcast center in Stamford, Conn. But all game production will be done on-site in England, with NBC using England-based announcers on games White doesn't work.

"They went all in with us," Jon Miller, NBC Sports president of programming, said of the EPL, "and we're all in with them."

Associated Press

Source: http://hosted2.ap.org/APDEFAULT/347875155d53465d95cec892aeb06419/Article_2013-04-16-NBC-Premier%20League/id-64244ff37984488997bdbbd467ea5a5d

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Monday, April 15, 2013

Patrol: 16 hurt in bus crash near Yosemite park

FRESNO, Calif. (AP) ? A bus carrying visitors from Yosemite National Park crashed on a main highway south of the park, leaving 16 people injured, the California Highway Patrol said Sunday.

The bus was about 40 miles south of the park when it went off Highway 41 and over and embankment about 6 p.m. Saturday.

The patrol's Merced dispatch office described it as a minor injury crash, and said the 16 people were taken to local hospitals.

The bus was carrying 17 people, including a driver, when the crash occurred near local road 630.

No more police information was immediately available, but the Fresno Bee quoted officers as saying the bus was returning from a visit to the park when the bus driver, who was traveling about 40 mph, lost control of the bus.

Patrol Sgt. Edward Greene said the bus rolled onto an embankment and several passengers were thrown to the driver's side of the bus. It eventually came to a stop after hitting a tree.

"If the tree wasn't there to stop the bus, it would have continued down the ravine," Greene said.

The newspaper said the injured people ? the majority of whom were elderly ? were taken to three area hospitals with minor to moderate injuries.

The bus driver was the only one who was not hurt.

Source: http://news.yahoo.com/patrol-16-hurt-bus-crash-near-yosemite-park-091252978.html

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Sunday, April 14, 2013

California pension fund to divest from gunmakers

SAN FRANCISCO (Reuters) - California's pension fund for teachers made official on Friday its plan to divest holdings in firearms companies whose weapons are illegal in the state.

The California State Teachers' Retirement System will now sell holdings in two publicly traded gunmakers Sturm, Ruger & Co and Smith & Wesson Holding Corp. The investments are worth about $3 million.

The divestment plan has been in play since January at the $161.5 billion pension fund after State Treasurer Bill Lockyer advanced it in response to the mass shooting at the Sandy Hook Elementary School in Connecticut in December.

Lockyer sits on the board of the fund, best known as Calstrs, and also pressed it to divest holdings in manufacturers of high-capacity ammunition magazines that are illegal for the general public in California.

The Sandy Hook Elementary School shooting involved a type of semi-automatic rifle banned in California and sparked a national debate regarding gun control with some pension funds flexing their financial clout to weigh in on the issue.

Lockyer also sits on the board of the California Public Employees' Retirement System, the biggest U.S. public pension fund. Its investment committee voted in February to divest holdings in Sturm Ruger and Smith & Wesson in a move affecting about $5 million in investments.

(Reporting by Jim Christie)

Source: http://news.yahoo.com/california-pension-fund-divest-gunmakers-233048858--sector.html

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Saturday, April 13, 2013

L-carnitine significantly improves patient outcomes following heart attack

L-carnitine significantly improves patient outcomes following heart attack [ Back to EurekAlert! ] Public release date: 12-Apr-2013
[ | E-mail | Share Share ]

Contact: Rachael Zaleski
mcpmedia@elsevier.com
215-239-3658
Elsevier Health Sciences

Results of systematic review of 13 controlled studies reported in Mayo Clinic Proceedings

Rochester, MN, April 12, 2013 L-carnitine significantly improves cardiac health in patients after a heart attack, say a multicenter team of investigators in a study published today in Mayo Clinic Proceedings. Their findings, based on analysis of key controlled trials, associate L-carnitine with significant reduction in death from all causes and a highly significant reduction in ventricular arrhythmias and anginal attacks following a heart attack, compared with placebo or control.

Heart disease is the leading cause of death in the United States. Although many of the therapies developed in recent decades have markedly improved life expectancy, adverse cardiovascular events such as ventricular arrhythmias and angina attacks still occur frequently after an acute myocardial infarction (heart attack).

It is known that during ischemic events L-carnitine levels are depleted. Investigators sought to determine the effects of targeting cardiac metabolic pathways using L-carnitine to improve free fatty acid levels and glucose oxidation in these patients. By performing a systematic review and meta-analysis of the available studies published over several decades, they looked at the role of L-carnitine compared with placebo or control in patients experiencing an acute myocardial infarction.

L-carnitine is a trimethylamine which occurs in high amounts in red meat and is found in certain other foods, and is also widely available as an over-the-counter nutritional supplement which is claimed to improve energy, weight loss, and athletic performance. Its potential role in treating heart disease was first reported in the late 1970s.

A comprehensive literature search yielded 153 studies, 13, published from 1989-2007, were deemed eligible. All the trials were comparison trials of L-carnitine compared with placebo or control in the setting of acute myocardial infarction.

This systematic review of the 13 controlled trials in 3,629 patients, involving 250 deaths, 220 cases of new heart failure, and 38 recurrent heart attacks, found that L-carnitine was associated with:

  • Significant 27% reduction in all-cause mortality (number needed to treat 38)
  • Highly significant 65% reduction in ventricular arrhythmias (number needed to treat 4)
  • Significant 40% reduction in the development of angina (number needed to treat 3)
  • Reduction in infarct size

There were numerically fewer myocardial reinfarctions and heart failure cases associated with L-carnitine, but this did not reach statistical significance.

First author James J. DiNicolantonio, PharmD, Wegmans Pharmacy, Ithaca, NY, observes, "Although therapies for acute coronary syndrome (ACS), including percutaneous coronary intervention, dual antiplatelet therapy, b-blockers (BBs), statins, angiotensin-converting enzyme inhibitors (ACEIs), omega-3 fatty acids, and cardiac rehabilitation, have markedly improved clinical outcomes, adverse cardiovascular (CV) events still occur too frequently after ACS. One promising therapy for improving cardiac health involves using L-carnitine to improve free fatty acid levels and glucose oxidation."

"The potential mechanisms responsible for the observed beneficial impact of L-carnitine in acute myocardial infarction are likely multifactorial and may, in part, be conferred through the ability of L-carnitine to improve mitochondrial energy metabolism in the heart by facilitating the transport of long-chain fatty acids from the cytosol to the mitochondrial matrix, where b-oxidation occurs, removing toxic fatty acid intermediates, reducing ischemia induced by long-chain fatty acid concentrations, and replenishing depleted carnitine concentrations seen in ischemic, infarcted, and failing myocardium," says DiNicolantonio.

L-carnitine is proven to be safe and is readily available over the counter. The investigators agree that the overall results of this meta-analysis support the potential use of L-carnitine in acute myocardial infarction and possibly in secondary coronary prevention and treatment, including angina. They advocate for a larger randomized, multicenter trial to be performed to confirm these results in the modern era of routine revascularization and other intensive medical therapies following acute myocardial infarction. But, says DiNicolantonio, "L-carnitine therapy can already be considered in selected patients with high-risk or persistent angina after acute myocardial infarction who cannot tolerate treatment with ACE inhibitors or beta blockers, considering its low cost and excellent safety profile."

These findings may seem to contradict those reported in a study published earlier this month in Nature Medicine by Robert A. Koeth and others (Koeth, R. A. et al. Nature Med. http://dx.doi.org/10.1038/nm.3145), which demonstrated that metabolism by intestinal microbiota of dietary L-carnitine produced trimethylamine N-oxide (TMAO) and accelerated atherosclerosis in mice. They also noted that omnivorous human subjects produced more TMAO than did vegans or vegetarians following ingestion of L-carnitine, and suggested a possible direct link between L-carnitine, gut bacteria, TMAO, and atherosclerosis and risk of ischemic heart disease.

"The Nature Medicine paper is of interest," agrees senior investigator Carl J. Lavie, M.D.,FACC,FACP,FCCP, Medical Director of the Cardiac Rehabilitation and Prevention Center at the John Ochsner Heart and Vascular Institute at the University of Queensland School of Medicine in New Orleans, "but the main study reported there was in animals, and unlike our study, lacks hard outcomes." He also notes that "there are various forms of 'carnitine' and our relatively large meta-analysis specifically tested L-carnitine on hard outcomes in humans who had already experienced acute myocardial infarction."

###


[ Back to EurekAlert! ] [ | E-mail | Share Share ]

?


AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert! system.


L-carnitine significantly improves patient outcomes following heart attack [ Back to EurekAlert! ] Public release date: 12-Apr-2013
[ | E-mail | Share Share ]

Contact: Rachael Zaleski
mcpmedia@elsevier.com
215-239-3658
Elsevier Health Sciences

Results of systematic review of 13 controlled studies reported in Mayo Clinic Proceedings

Rochester, MN, April 12, 2013 L-carnitine significantly improves cardiac health in patients after a heart attack, say a multicenter team of investigators in a study published today in Mayo Clinic Proceedings. Their findings, based on analysis of key controlled trials, associate L-carnitine with significant reduction in death from all causes and a highly significant reduction in ventricular arrhythmias and anginal attacks following a heart attack, compared with placebo or control.

Heart disease is the leading cause of death in the United States. Although many of the therapies developed in recent decades have markedly improved life expectancy, adverse cardiovascular events such as ventricular arrhythmias and angina attacks still occur frequently after an acute myocardial infarction (heart attack).

It is known that during ischemic events L-carnitine levels are depleted. Investigators sought to determine the effects of targeting cardiac metabolic pathways using L-carnitine to improve free fatty acid levels and glucose oxidation in these patients. By performing a systematic review and meta-analysis of the available studies published over several decades, they looked at the role of L-carnitine compared with placebo or control in patients experiencing an acute myocardial infarction.

L-carnitine is a trimethylamine which occurs in high amounts in red meat and is found in certain other foods, and is also widely available as an over-the-counter nutritional supplement which is claimed to improve energy, weight loss, and athletic performance. Its potential role in treating heart disease was first reported in the late 1970s.

A comprehensive literature search yielded 153 studies, 13, published from 1989-2007, were deemed eligible. All the trials were comparison trials of L-carnitine compared with placebo or control in the setting of acute myocardial infarction.

This systematic review of the 13 controlled trials in 3,629 patients, involving 250 deaths, 220 cases of new heart failure, and 38 recurrent heart attacks, found that L-carnitine was associated with:

  • Significant 27% reduction in all-cause mortality (number needed to treat 38)
  • Highly significant 65% reduction in ventricular arrhythmias (number needed to treat 4)
  • Significant 40% reduction in the development of angina (number needed to treat 3)
  • Reduction in infarct size

There were numerically fewer myocardial reinfarctions and heart failure cases associated with L-carnitine, but this did not reach statistical significance.

First author James J. DiNicolantonio, PharmD, Wegmans Pharmacy, Ithaca, NY, observes, "Although therapies for acute coronary syndrome (ACS), including percutaneous coronary intervention, dual antiplatelet therapy, b-blockers (BBs), statins, angiotensin-converting enzyme inhibitors (ACEIs), omega-3 fatty acids, and cardiac rehabilitation, have markedly improved clinical outcomes, adverse cardiovascular (CV) events still occur too frequently after ACS. One promising therapy for improving cardiac health involves using L-carnitine to improve free fatty acid levels and glucose oxidation."

"The potential mechanisms responsible for the observed beneficial impact of L-carnitine in acute myocardial infarction are likely multifactorial and may, in part, be conferred through the ability of L-carnitine to improve mitochondrial energy metabolism in the heart by facilitating the transport of long-chain fatty acids from the cytosol to the mitochondrial matrix, where b-oxidation occurs, removing toxic fatty acid intermediates, reducing ischemia induced by long-chain fatty acid concentrations, and replenishing depleted carnitine concentrations seen in ischemic, infarcted, and failing myocardium," says DiNicolantonio.

L-carnitine is proven to be safe and is readily available over the counter. The investigators agree that the overall results of this meta-analysis support the potential use of L-carnitine in acute myocardial infarction and possibly in secondary coronary prevention and treatment, including angina. They advocate for a larger randomized, multicenter trial to be performed to confirm these results in the modern era of routine revascularization and other intensive medical therapies following acute myocardial infarction. But, says DiNicolantonio, "L-carnitine therapy can already be considered in selected patients with high-risk or persistent angina after acute myocardial infarction who cannot tolerate treatment with ACE inhibitors or beta blockers, considering its low cost and excellent safety profile."

These findings may seem to contradict those reported in a study published earlier this month in Nature Medicine by Robert A. Koeth and others (Koeth, R. A. et al. Nature Med. http://dx.doi.org/10.1038/nm.3145), which demonstrated that metabolism by intestinal microbiota of dietary L-carnitine produced trimethylamine N-oxide (TMAO) and accelerated atherosclerosis in mice. They also noted that omnivorous human subjects produced more TMAO than did vegans or vegetarians following ingestion of L-carnitine, and suggested a possible direct link between L-carnitine, gut bacteria, TMAO, and atherosclerosis and risk of ischemic heart disease.

"The Nature Medicine paper is of interest," agrees senior investigator Carl J. Lavie, M.D.,FACC,FACP,FCCP, Medical Director of the Cardiac Rehabilitation and Prevention Center at the John Ochsner Heart and Vascular Institute at the University of Queensland School of Medicine in New Orleans, "but the main study reported there was in animals, and unlike our study, lacks hard outcomes." He also notes that "there are various forms of 'carnitine' and our relatively large meta-analysis specifically tested L-carnitine on hard outcomes in humans who had already experienced acute myocardial infarction."

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Source: http://www.eurekalert.org/pub_releases/2013-04/ehs-lsi041113.php

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