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Tag: Cardiology

  • Research reveals undertreatment of women with heart disease

    Research reveals undertreatment of women with heart disease

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    Women with heart disease are less often treated with cholesterol-lowering drugs than men, according to research presented today at ESC Preventive Cardiology 2024, a scientific congress of the European Society of Cardiology (ESC).

    Cholesterol-lowering drugs save lives and prevent heart attacks, and should be prescribed to all patients with coronary artery disease. Unfortunately, our study shows that women are missing out on these essential medications.”


    Dr. Nina Johnston, study author of Uppsala University, Sweden

    Patients with coronary artery disease, also called chronic coronary syndrome, require medication to alleviate symptoms and prevent heart attacks and death. ESC guidelines recommend statins for all patients to lower cholesterol levels in the blood. If levels are not sufficiently lowered with the maximum tolerated dose of statin, then patients should receive a statin plus another cholesterol-lowering drug called ezetimibe. The recommendations are the same for women and men.

    Despite having the same recommendations for treatment and for target levels of low-density lipoprotein (LDL; “bad”) cholesterol, previous studies have shown that women are less likely to meet target levels than men. This study examined whether women and men receive the same treatments.

    This was a retrospective observational study that included 1,037 men and 415 women with a chronic coronary syndrome diagnosed between 2012 and 2020, and who had never had a heart attack. The median age was 68 years in men and 70 years in women. Electronic health records were used to obtain data on cholesterol levels. Information on dispensed medications was obtained from the Swedish National Prescribed Drug Registry.

    Participants were followed up for three years following their diagnosis. The researchers found that at the end of the third year of follow-up, just 54% of women were treated with cholesterol-lowering drugs compared with 74% of men. Additionally, 5% of women were treated with statin plus ezetimibe compared with 8% of men. Factors which may explain the observed sex differences are under further investigation by the research group.

    The researchers also examined treatments and cholesterol levels of women and men diagnosed with a chronic coronary syndrome at different ages (less than 60, 60 to 69.9, 70-79.9, 80 years or older). In all age groups, prescription of cholesterol-lowering treatment was highest at diagnosis and declined over the following three years. This decline in treatment over time was steeper in women compared with men. For example, in patients under 60 years of age, 65% of women and 79% of men were treated with cholesterol-lowering treatment the week after diagnosis, compared with 52% of women and 78% of men three years later. Achievement of LDL cholesterol targets was also lower in women than men.

    Dr. Johnston said: “Our findings should be a wake-up call about the undertreatment of women with heart disease. Equal prescribing practices are needed so that women receive all recommended therapies and are protected from adverse outcomes.”

    Contrary to common belief, cardiovascular disease kills more women than men, accounting for 45% of all deaths in women which is more than all cancers combined in the 57 ESC member countries.

    Source:

    European Society of Cardiology

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  • Simple sore throat can lead to serious damage to the heart valves

    Simple sore throat can lead to serious damage to the heart valves

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    A simple sore throat from a bacterial streptococcal infection can lead to serious damage to the heart valves, a condition known as RHD. It mainly affects children and young adults with poor living conditions and limited access to health care. In Namibia, which was studied for the thesis, it is estimated that about 1% of the population lives with RHD.

    In our research, we have reviewed health records from the Ministry of Health and Social Affairs and the Department of Cardiology for the years 2010 to 2020. We also interviewed patients with RHD at the cardiology clinic between 2019 and 2020 to understand how RHD affects them. Furthermore, we have reviewed international studies to assess the effectiveness of different prevention strategies that have been evaluated.”

    Panduleni Penipawa Shimanda, dissertation author, Department of Epidemiology and Global Health

    Main findings of the study suggest that there is poor documentation and detection of people with RHD in Namibia.

    “From a survey of patients, we could see that treatment of RHD means that people can live a good life. Another observation is that there are few preventive interventions that have been evaluated worldwide. Our findings also suggest that school-based screening to detect early symptoms such as sore throat and RHD at an early stage is likely to be cost-effective”.

    Overall, RHD was observed in children and young adults in Namibia’s northern regions, possibly due to living conditions and access to medical care.

    To improve the situation in Namibia and other countries, ministries of health and health organizations need to work together for better data collection practices, raise awareness of RHD among families and health professionals, and ensure early detection and treatment. Incorporating RHD services into existing health care programs, such as for maternal and child health care, can save resources.

    “This is important in countries like Namibia, where RHD prevention is limited. Prevention of RHD can save young lives, and for this we need to find efficient and effective strategies,” says Panduleni Penipawa Shimanda.

    The dissertation will take place on 26 April 2024, 09.00. Thesis title: Rheumatic heart disease in Namibia: Evaluation of the burden and cost-effectiveness of a prevention strategy. Opponent Phillip Moons, KU Leuven, Belgium.

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  • Delving into burning issues about heart disease and much more

    Delving into burning issues about heart disease and much more

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    The hottest science in the prevention of heart disease awaits at ESC Preventive Cardiology 2024, a scientific congress of the European Society of Cardiology (ESC). The annual congress of the European Association of Preventive Cardiology (EAPC), a branch of the ESC, takes place 25 to 27 April at the Megaron – Athens International Conference Centre, Greece. Explore the scientific programme.

    Don’t miss the late breaking science sessions for cutting-edge research in preventive cardiology, including unhealthy food and beverage trends in adolescents and the links between physical activity and smoking in children. Novel research will be presented in hundreds of scientific abstracts including data on stair climbing, insomnia, dairy products, and the potential connections between air pollution, mental health, and cardiovascular disease. Plus scientific sessions delving into burning issues about heart disease, sex, and much more…

    Patients often have insecurities after a heart event and we will discuss important questions such as when sexual activity can be resumed after a heart attack. We know that exercise helps prevent cardiovascular disease, so is sexual activity enough ‘exercise’?”

    Dr. Nicolle Kränkel, Congress Programme Committee Chair

    Hear experts examine the links between the heart and brain in a session exploring common pathways between depression and heart disease, and how patients with cardiac conditions can stop worrying.

    Dr. Kränkel said: “After a heart attack, patients are often scared and depressed. Depression and anxiety can also impact heart health. Additionally, awareness and cognition of one’s heart health play a large role in adhering to a healthy lifestyle. There is also crosstalk between the heart and other organs. That’s why this year’s congress theme is ‘Cardiovascular risk: The heart and beyond’ – exploring how we can harness these interactions to improve heart health and overall wellbeing.”

    Other important questions that you should attend to hear the answers to:

    Heart health and the young:

    • How do energy drinks affect the hearts of adolescents?
    • Is doping dangerous for the heart? Find out in a session dedicated to stimulants and their effects on the heart.
    • What is the impact of e-cigarettes on young hearts?

    Lifestyle issues:

    • Weight loss update: different approaches to weight loss are needed from childhood to old age – hear how one size does not fit all. And it’s not only about losing fat: learn about personalising exercise in obese patients.
    • What’s new in smoking cessation, including digital tools?
    • Can heart healthy diets be affordable? And the latest evidence on demographic and socio-economic disparities in nutrition. Check out nutrition for a better heart.

    And finally, could a vaccine prevent heart disease? Get up-to-the-minute scientific evidence on immunity and cardiovascular risk and what’s on the horizon.

    Source:

    European Society of Cardiology (ESC)

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  • Bidirectional Mendelian randomization uncovers link between plasma metabolites and heart attack risk

    Bidirectional Mendelian randomization uncovers link between plasma metabolites and heart attack risk

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    Myocardial infarction, more commonly known as a heart attack, is a leading cause of death worldwide. Biomarkers called plasma metabolites may play a key role in the physiological pathways involved in myocardial infarctions. Recently published research used a methodological approach called bidirectional Mendelian randomization to understand more about these biomarkers and what they can tell doctors about heart attack risk.

    The research was published in the Journal of Geriatric Cardiology on February 28.

    Bidirectional Mendelian randomization studies represent a robust methodological approach, with numerous advantages not commonly present in traditional research methodologies. These include mitigating the impact of confounding factors on conclusions and exploring reverse causation, thereby providing a more reliable foundation for casual inferences. This study employed a bidirectional Mendelian randomization approach to investigate the relationship between plasma metabolites and myocardial infarction, offering new insights into the early diagnosis and potential treatment of myocardial infarction.”


    Qiang Wu from the Senior Department of Cardiology, the Sixth Medical Center, Chinese PLA General Hospital, Beijing, China

    By using data sets from large-scale genome-wide association studies, researchers were able to cast a wide net to try and understand more about the role plasma metabolites play in myocardial infarction. The data source included 461,823 individuals of European descent. Of those, 20,917 individuals had myocardial infarction and 440,906 individuals did not. A total of 24,172,914 single nucleotide polymorphisms were identified in that data set to be associated with myocardial infarction. Bidirectional Mendelian randomization narrows down this large amount of data and determines the relationship between plasma metabolites and myocardial infarction.

    This analysis uncovered 198 unique plasma metabolites that were identified to have a significant association with myocardial infarction, of which 14 plasma metabolites had a direct relationship with myocardial infarction risk. “We identified 14 plasma metabolites associated with myocardial infarction, of which 8 plasma metabolites were linked to a decreased risk and 6 plasma metabolites were linked to an increased risk, underscoring the complicated nature of metabolic pathways influencing heart attack risk,” said Dong-Hua LI from Department of Cardiovascular Medicine, Minzu Hospital of Guangxi Zhuang Autonomous Region, Guangxi, China. “The robustness of our findings was strengthened by the application of bidirectional Mendelian randomization, enabling a thorough exploration of causality.” 

    Of the 14 plasma metabolite biomarkers identified in this study, 13 plasma metabolite biomarkers had never been identified as potential biomarkers associated with myocardial infarction before. These biomarkers offer a new option for developing diagnostic tests, routine screenings, and treatments for heart attack.

    Looking to next steps, researchers are hoping to learn more about the mechanisms of these plasma metabolites and how they are related to myocardial infarction. For example, there were 8 plasma metabolites that were associated with a decreased risk of myocardial infarction and researchers speculate that anti-inflammatory properties associated with metabolites are at play, reducing oxidative stress in the body. However, additional research is needed to confirm this hypothesis.

    “Timely detection using metabolic signatures could usher in a new era of preventive cardiology, where interventions are tailored to an individual’s metabolic profile. Furthermore, understanding the metabolic underpinnings of myocardial infarction will contribute to the development of point-of-care diagnostic tools, providing rapid and accessible assessments. Thus, the findings of the study can revolutionize clinical practice by enabling early and precise diagnoses, ultimately causing more effective and tailored treatment strategies,” said Qiang SU from Department of Cardiology, Jiangbin Hospital of Guangxi Zhuang Autonomous Region, Guangxi, China.

    Other contributors include Jing-Sheng LAN, You-Yi HUANG, Lan-Jin WU, Zhi-Qing QIN, and Ying HUANG from Minzu Hospital of Guangxi Zhuang Autonomous Region in Guangxi, China; Shuo CHEN and Xin HAO from Chinese PLA General Hospital in Beijing, China; and Wan-Zhong HUANG, Ting ZENG, and Hua-Bin SU from Jiangbin Hospital of Guangxi Zhuang Autonomous Region in Guangxi, China.

    The Guangxi Natural Science Foundation, the Key Research and Development Program of Guangxi, and the Chongzuo Science and Technology Bureau Planning Project funded this research.

    Source:

    Tsinghua University Press

    Journal reference:

    Li, D.-H., et al. (2024). Plasma metabolites and risk of myocardial infarction: a bidirectional Mendelian randomization study. Journal of Geriatric Cardiology. doi.org/10.26599/1671-5411.2024.02.002.

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  • Intraoperative anemia linked to higher female mortality after heart bypass surgery

    Intraoperative anemia linked to higher female mortality after heart bypass surgery

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    Women are at higher risk of death when undergoing heart bypass surgery than men. Researchers at Weill Cornell Medicine have determined that this disparity is mediated, to a large extent, by intraoperative anemia-;the loss of red blood cells during surgery. The study, published on March 5, in the Journal of the American College of Cardiology, suggests that strategies for minimizing anemia that occurs during this procedure could lead to better outcomes for women with cardiovascular disease.

    This study set out to discover why women are less likely to survive coronary artery bypass grafting, a surgical procedure for restoring blood flow to the heart. The team, led by senior author Dr. Mario Gaudino, the Stephen and Suzanne Weiss Professor in Cardiothoracic Surgery at Weill Cornell Medicine, analyzed information obtained from the Society of Thoracic Surgeons Adult Cardiac Surgery Database on more than one million patients. Dr. Lamia Harik, fellow in Cardiothoracic Surgery Research at Weill Cornell Medicine, was first author on the paper.

    They examined patient demographics (such as age and ethnicity), risk factors (including disease severity, previous heart attacks and the co-occurrence of other health conditions) and surgical data (including the time spent on the bypass machine and the volume of the components of blood, such as red blood cells).

    Crunching the numbers, Dr. Gaudino and his team previously confirmed that women had a higher mortality associated with the procedure than men: 2.8 percent versus 1.7 percent, a nearly 50 percent difference. Now, using sophisticated statistical analyses to assess all the possible variables, the researchers found that a substantial portion of this enhanced risk-;38 percent-;could be attributed to severe intraoperative anemia. This depletion of red blood cells is an inevitable side effect of using blood-diluting fluids to prime the heart-lung bypass machine that takes over the job of pumping blood throughout the body during surgery. Women may be even more susceptible to the effects of intraoperative anemia because they tend to arrive in surgery with lower red blood cell counts and have smaller body size compared to their male counterparts.

    The study does not establish that intraoperative anemia is causing greater female mortality, but the two factors are associated. It suggests that clinicians and researchers should consider interventions to prevent or minimize severe intraoperative anemia, which can lead to dangerously reduced oxygen delivery to the body’s tissues, including the heart.

    Using heart-lung bypass machines with shorter circuits, for example, would limit the volume of blood-diluting solution needed to run the pump. Randomized trials to assess whether methods for curtailing anemia could improve outcomes for women undergoing heart bypass surgery are “urgently needed,” wrote Dr. Gaudino, who is also a cardiovascular surgeon at NewYork-Presbyterian/Weill Cornell Medical Center.

    This research was supported in part by the National Heart, Lung, and Blood Institute grant T32 HL160520-01A1, the National Institutes of Health, the Canadian Health and Research Institutes, and the Starr Foundation.

    Source:

    Journal reference:

    Harik, L., et al. (2024). Intraoperative Anemia Mediates Sex Disparity in Operative Mortality After Coronary Artery Bypass Grafting. Journal of the American College of Cardiology. doi.org/10.1016/j.jacc.2023.12.032.

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  • Patient-centered cardiovascular care enhances outcomes

    Patient-centered cardiovascular care enhances outcomes

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    Adult cardiovascular care centered on the patient can improve individuals’ experiences and their medical outcomes, according to a new American Heart Association Scientific Statement published today in Circulation.

    Patient-centered care means seeing the patient as a person and being respectful of their beliefs, preferences and values. Patient-centered care combines the health care professional’s expertise with consideration of the patient’s health priorities. It involves empowering patients to make informed decisions by providing information and developing an active partnership among the patient, family and the health care team. Patient-centered care does not mean that patients can choose what they want, when they want.”


    Michael J. Goldfarb, M.D., M.Sc., chair of the scientific statement writing committee and associate professor of cardiology at the Jewish General Hospital and McGill University in Montreal, Quebec, Canada

    “There is a need for health care professionals managing adults with heart disease to receive guidance and practical tools on how to incorporate a person-centered care approach into routine clinical practice,” said Goldfarb.

     The new scientific statement describes several elements that are essential to patient-centered care, including shared decision-making, medication management and patient-oriented outcomes.

    Shared decision-making is a collaborative partnership among patients, family and health care professionals based on trust, mutual respect and open and honest communication. Health professionals need to consider their patient’s level of health literacy and provide clear, jargon-free and relevant information about risk factors, current health conditions and the realities, risks and benefits of possible screening and treatment options. Patients must have the opportunity to ask questions, express their values, preferences and goals, and work together with the medical team to agree on a plan for managing their heart disease.

    Although the benefits of using medication to prevent and treat heart disease are well known, for a myriad of reasons, more than half of patients with cardiovascular disease do not always take their medications as prescribed. Conditions such as high blood pressure and high cholesterol raise the risk of heart attack and stroke, but undertreatment of these silent conditions is common.

    Patient-centered discussions of current and proposed medications may also help to improve adherence to needed medications and minimize drug costs and side effects. In some cases, a combination pill may reduce the number of tablets that must be taken each day, or a less expensive but equally effective medication may be substituted for a more expensive option. An open, honest discussion about medication may also lead to the decision to eliminate a longstanding medication that may no longer be needed.

    “Prior to starting, adjusting or stopping cardiovascular medications, there is a need to establish and take into account patient preferences and goals,” said Goldfarb.

    While physical examinations and lab tests provide important data about how a patient with heart disease is doing, patient-centered care incorporates people’s own reports of their physical functioning, symptom burden, emotional well-being, social functioning and quality of life. Collecting this information gives health care professionals a more complete picture of how a patient is doing so they may detect subtle changes in the progression of heart disease and assess the impact (negative or positive) of current or proposed treatments.

    “While some care outcomes are important for health care professionals and health systems, these may not always reflect what is important to the patient. For example, while the length of a hospital stay is often recorded as a marker of care quality, the patient may prioritize their physical functioning and quality of life after a heart attack,” said Goldfarb.

    Ensuring patient-centered care for all

    The statement gives special consideration to overcoming barriers to patient-centered care and in applying patient-centered care to the people who carry an outsized burden of cardiovascular disease. For example:

    • People from underrepresented and historically underserved races and ethnicities have the highest rates of cardiovascular disease and death and are often affected by adverse social determinants of health (SDOH, including measures such as economic stability, education, neighborhood safety and access to quality health care ). Effective patient-centered care may involve the use of tools to assess SDOH, followed by care provided by culturally and linguistically competent multidisciplinary teams that include social workers, interpreters and patient navigators.

    • Older adults often face other complex aging-related health issues in addition to heart disease. Patient-centered care needs to consider age-associated risks (such as multiple medications, frailty, dementia, falls, social isolation) when evaluating the pros and cons of various medications and interventions.

    • Women can benefit from patient-centered cardiovascular care throughout adulthood, including care to prevent and treat pregnancy-related heart issues, and care at time of menopause.

    • Individuals with behavioral and mental health disorders may face psychological challenges that often impact heart health. Patient-centered care for these individuals should include behavioral health services in addition to specialized cardiovascular care.

    • Adults with congenital heart disease are an increasing group of patients who, throughout their lifetimes, benefit from a patient-centered approach as they transition from pediatric into adult care and face decisions about high-level medical and surgical treatment.

    • People with physical disabilities often have reduced access to health services and report worse overall health than adults without disabilities. According to the statement, the health care system should address inadequate access to preventive care and the treatment of heart disease and other chronic conditions for individuals with disabilities.

    Barriers to patient-centered care

    There are many barriers to incorporating patient-centered care, including those arising from patients, clinicians and health systems.

    • Patients, who may distrust or lack access to the health system, have limited health literacy, limited English proficiency or cultural barriers to communicating with health care professionals, be more concerned about their caregivers and family than themselves, or hold medical beliefs and preferences that conflict with best health practices.

    • Clinicians, who operate under time pressures and increasing demands for documentation, may have different incentives than patients and may also work in settings where the workforce lacks the diversity of the patients served.

    • Health systems may be fragmented, provide limited access to specialty care, have limited space or inadequate systems to share information and/or lack team-based care.

    “Patient-centered care is possible-;and already occurs to a certain extent-;in today’s care delivery systems. Further development and inclusion of patient-centered outcomes measures will be important for optimizing care for patients, their families and caregivers,” said Goldfarb.

    This scientific statement was prepared by the volunteer writing group on behalf of the American Heart Association’s Council of Clinical Cardiology; the Council on Cardiovascular and Stroke Nursing; the Council on Hypertension; the Council on Lifestyle and Cardiometabolic Health; the Council on Peripheral Vascular Disease; and the Council on Quality of Care and Outcomes Research. American Heart Association scientific statements promote greater awareness about cardiovascular diseases and stroke issues and help facilitate informed health care decisions. Scientific statements outline what is currently known about a topic and what areas need additional research. While scientific statements inform the development of guidelines, they do not make treatment recommendations. American Heart Association guidelines provide the Association’s official clinical practice recommendations.

    Source:

    American Heart Association

    Journal reference:

    Goldfarb, M. J., et al. (2024) Patient-Centered Adult Cardiovascular Care: A Scientific Statement From the American Heart Association. Circulation. doi.org/10.1161/CIR.0000000000001233.

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  • How diet and hypertension sway risks for heart disease and cancer

    How diet and hypertension sway risks for heart disease and cancer

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    In a recent research review published in Nature Reviews Cardiology, researchers reviewed epidemiological studies on shared mechanisms and modifiable risk factors for cardiovascular disease (CVD) and cancer.

    CVD and cancer are leading causes of morbidity and death worldwide, and both illnesses are increasingly understood to be fundamentally linked. Understanding the risk factors and processes that link CVD and cancers allows for the prediction, prevention, and treatment of both, which is critical for advancing the area of cardio-oncology and improving the standard of care.

    In the present review, researchers reviewed existing data on the association between CVD and cancer.

    Cardiovascular disease and cancer: shared risk factors and mechanisms. Image Credit: ESB Professional / ShutterstockCardiovascular disease and cancer: shared risk factors and mechanisms. Image Credit: ESB Professional / Shutterstock

    Shared modifiable factors contributing to cardiovascular disease and cancer risk

    Hypertension contributes to CVD and several cancer types, including colorectal, breast, and renal cell cancers. Cancer patients and survivors have higher hypertension rates than healthy individuals. Hyperlipidemia is also associated with atherosclerotic CVD and low-density cholesterol (LDL)–lowering treatment can decrease CVD-related and any-cause deaths. Studies indicate that hyperlipidemia increases breast and colorectal cancer risk.

    Obesity, an independent CVD risk factor, exacerbates other risk factors such as diabetes, hypertension, and hyperlipidemia. Diabetes, an established contributory factor for cardiovascular disease, increases colorectal, breast, endometrial, and gallbladder cancer risk. Smoking elevates CVD risk and cancer incidence, increasing cardiovascular morbidities and deaths and malignancies in the upper respiratory organs.

    The link between alcohol intake and CVD risk is ambiguous; however, excessive drinking can increase CVD risk. The Mediterranean diet and increased exercise are dose-dependent and significantly related to a lower risk of cardiovascular disease, tumors, and related deaths. Socioeconomic determinants of health (SDOH) measures are strongly related to worsened cardiovascular health and poorer cancer outcomes.

    The dysregulation of systems regulating cellular aging, proliferation, metabolism, and damage connect cardiovascular disease and cancer. Oxidative stress in CVD raises noncommunicable disease risk, whereas clonal hematopoiesis causes chronic inflammation, which leads to atherosclerosis and inflammation. Microbial dysbiosis in cancer is associated with increased cell turnover, genotoxic metabolite production, inadequate immune surveillance, and chronic inflammation. Metabolic instability in cancer cells can result in circulating oncometabolites and cardiovascular remodeling. Environmental factors such as diet and medication use can influence dysbiosis. Circulating soluble chemicals are potential mediators of accelerated tumor growth and increased cancer risk in CVD patients.  

    Epidemiological evidence concerning shared factors increasing CVD and cancer risk

    Each 5.0 mmHg decrease in systolic blood pressure (SBP) lowers major adverse cardiovascular events [MACE, hazard ratio (HR) 0.9 without prior CVD; HR 0.9 with prior CVD] risk. A 10-mm Hg drop in SBP lowers CVD [relative risk (RR) 0.8] and any-cause mortality (RR 0.9) risks. Hypertension raises the chance of developing kidney, colorectal, and breast cancers.

    Elevated serum triglyceride raises colorectal cancer risk (HR 1.2), but increased high-density cholesterol (HDL) lowers colorectal (adjusted HR 0.8) and breast cancer incidences (RR 0.9). A 5.0 kg/m2 rise in body mass index (BMI) increases CVD risk factor risk, including hypertension, heart failure, ischemic stroke, atrial fibrillation, rectal cancer, and biliary tract cancers with RR values of 1.5, 1.4, 1.4, 1.2, 1.1, and 1.6, respectively. Elevated BMI is also associated with coronary artery diseases (HR, 1.2) and CVD-related deaths (HR, 1.5).

    Diabetes mellitus is associated with increased cardiovascular and any-cause deaths (HR 1.2). Smoking raises significant CVD risk (RR 1.6) and related deaths (HR 2.8). Quitting cigarette smoking within five years lowers the incidence of new-onset CVD (HR 0.6). Low-level drinking (1.3–5.0 g of alcohol daily) reduces coronary heart disease-related death risk compared to non-drinkers (RR 0.8); however, drinking >50 g of alcohol daily increases the risk of oropharyngeal, oesophageal, colorectal, laryngeal, and breast cancers.

    The Mediterranean diet, which includes olive oil and mixed nuts, lowers the incidence of CVD (HR 0.7). Mediterranean diets reduce the risk of nonfatal MI (RR 0.5), CVD mortality [odds ratio (OR) 0.6], all-cause mortality (OR 0.7), colorectal and breast cancers, and cancer death (RR 0.9). Low cardiorespiratory fitness raises all-cause mortality and CVD events (HR 1.7). High leisure-time physical activity lowers the incidence of 13 malignancies, with the most robust relationships seen in esophageal, lung, and kidney cancers (HR 0.6). The presence of at least one SDOH increases 90-day mortality after heart failure hospitalization (HR 2.8). Three or more SDOHs raise the likelihood of fatal events (CVD HR 1.5) and cancer-related mortality (HR 1.3 for those over 65 years).

    Based on the findings, CVD and cancer have a bidirectional link, with shared processes and risk factors producing both conditions. CVD raises the risk of certain types of cancer and cancer-related mortality, whereas cancer raises the risk of certain types of CVD and CVD-related death. Common risk factors include hypertension, high cholesterol, diabetes, obesity, smoking, nutrition, physical activity, and SDOH. Addressing shared risk factors for CVD and cancer has far-reaching public health consequences, as technological discoveries have made cancer a chronic illness, and an increasing population of aging adult survivors may acquire comorbid CVD.

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  • High blood levels of TMAO predicts chronic kidney disease risk in future

    High blood levels of TMAO predicts chronic kidney disease risk in future

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    New findings from Cleveland Clinic and Tufts University researchers show high blood levels of TMAO (trimethylamine N-oxide) predicts future risk of developing chronic kidney disease over time.

    The findings build on more than a decade of research spearheaded by Stanley Hazen, M.D., Ph.D., and a team related to the gut microbiome’s role in cardiovascular health and disease, including the adverse effects of TMAO, a byproduct formed by the gut bacteria from nutrients abundant in red meat, eggs and other animal source foods.

    The study, published in the Journal of the American Society of Nephrology, was a collaboration between a Cleveland Clinic research team led by Dr. Hazen and investigators from the Food is Medicine Institute at the Friedman School of Nutrition Science and Policy at Tufts University, including first author Meng Wang, Ph.D., and co-senior author Dariush Mozaffarian, M.D., Dr.PH.

    The large-scale study measured blood levels of TMAO over time in two large National Institutes of Health populations and followed the kidney function of more than 10,000 U.S. adults with normal kidney function at baseline over an average follow-up period of 10 years. The investigators found that participants with elevated TMAO blood levels were at increased risk for future development of chronic kidney disease.

    Higher TMAO levels were also associated with a faster rate of declining kidney function in people with normal or impaired kidney function at baseline. These associations were independent of sociodemographic characteristics, lifestyle habits, diet and other known risk factors for kidney disease. The findings also are consistent with earlier reported preclinical model studies showing TMAO directly fosters both kidney functional decline and tissue fibrosis.

    The findings indicate a remarkably strong clinical link between elevated TMAO and increased risk for developing chronic kidney disease. The results are from individuals of diverse ethnic and sociodemographic backgrounds who had normal kidney function at the start. The diversity of the participants helps ensure the results are generalizable.”


    Dr. Stanley Hazen, chair of the Department of Cardiovascular and Metabolic Sciences and at Cleveland Clinic’s Lerner Research Institute and co-section head of Preventive Cardiology in the Heart, Vascular & Thoracic Institute

    Chronic kidney disease is a major and growing public health challenge in both the U.S. and globally, affecting about 10-15% of the population worldwide. It also is a strong risk factor for cardiovascular disease. The study showed that TMAO levels were as strong or even stronger an indicator of chronic kidney disease risk than the well-known risk factors such as diabetes, hypertension, advancing age and race.

    The study results reinforce the growing body of evidence indicating that lowering TMAO with prescribed drugs could be an effective treatment in patients at risk for, or with early signs of, kidney disease.

    “Our study is a crucial complement to studies in preclinical models supporting TMAO as a novel biological risk factor for chronic kidney disease,” said Dr. Wang, research assistant professor at the Friedman School. “TMAO levels are highly modifiable by both lifestyle-like diet and pharmacologic interventions. Besides using novel drugs to lower TMAO in patients, using dietary interventions to lower TMAO in the general population could be a cost-efficient and low-risk preventive strategy for chronic kidney disease development.”

    Plans for future studies include examining genetic data to help assess the potential cause-and-effect relationship between TMAO and chronic kidney disease, as well as studying more definitively whether lifestyle changes may prevent chronic kidney disease development and progression.

    Dr. Hazen also directs Cleveland Clinic’s Center for Microbiome and Human Health and holds the Jan Bleeksma Chair in Vascular Cell Biology and Atherosclerosis.

    This research was supported by grants from the National Institutes of Health, as well as the American Heart Association Postdoctoral Fellowship.

    Source:

    Journal reference:

    Wang, M., et al. (2024). The Gut Microbial Metabolite Trimethylamine N-oxide, Incident CKD, and Kidney Function Decline. Journal of the American Society of Nephrology. doi.org/10.1681/ASN.0000000000000344.

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  • Study shows reduced bleeding risk with ticagrelor monotherapy after percutaneous coronary intervention

    Study shows reduced bleeding risk with ticagrelor monotherapy after percutaneous coronary intervention

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    People who have had a heart attack or who are at risk for a heart attack and who stopped taking aspirin alongside the P2Y12 inhibitor ticagrelor one month after undergoing percutaneous coronary intervention (PCI) saw a significantly reduced risk of clinically meaningful bleeding with no increased risk of clotting-related adverse events at 12 months compared with patients who continued taking aspirin and ticagrelor for a full year, in a study presented at the American College of Cardiology’s Annual Scientific Session.

    The ULTIMATE-DAPT study is the first placebo-controlled trial designed to examine ticagrelor monotherapy following one month of dual antiplatelet therapy (DAPT) after PCI, a procedure to open blocked arteries. The study focused on patients who underwent PCI for acute coronary syndromes (ACS)—life-threatening conditions which include heart attacks and chest pain caused by decreased blood flow to the heart—with stents containing drugs to prevent further plaque buildup.

    In treating a broad range of patients with acute coronary syndromes in the era of contemporary drug-eluting stents, among those who were stable after one month of DAPT, continuing treatment with ticagrelor alone reduced bleeding with no increase in adverse ischemic thrombotic events. These data suggest that a 12-month duration of DAPT is not only not necessary in most patients with ACS but is harmful.”


    Gregg Stone, MD, professor of cardiology and population health sciences at Icahn School of Medicine at Mount Sinai, New York and co-chair of the trial

    Antiplatelet medications reduce clotting-related cardiovascular problems such as heart attacks and strokes by preventing platelets from sticking together. To reduce the risk of such events after PCI, current guidelines recommend that most patients should take two antiplatelet medications—aspirin and a P2Y12 inhibitor—for a full year. However, the bleeding risk associated with antiplatelet medications has fueled efforts to further optimize the duration of post-PCI antiplatelet therapy and the medications used to balance the benefits and risks.

    For ULTIMATE-DAPT, researchers enrolled 3,400 patients who experienced no adverse cardiovascular or bleeding events in the first month following PCI for ACS at 58 medical centers in four countries in Asia and Europe. During the first 30 days after PCI, all patients took aspirin and ticagrelor, a potent P2Y12 inhibitor. Participants were then randomly assigned to continue with this same regimen for 11 more months or to switch to ticagrelor and a placebo.

    The trial met its two primary endpoints, one assessing efficacy in terms of bleeding risk and the other assessing safety in terms of clotting-related events. The first endpoint, clinically relevant bleeding, occurred in 4.6% of patients assigned to continuing DAPT and 2.1% of patients assigned to take ticagrelor and a placebo, a significant reduction in favor of ticagrelor alone. The second endpoint, a composite of major adverse cardiovascular events and cerebrovascular events, showed no significant difference between groups, with 3.7% of patients who continued DAPT and 3.6% of those taking ticagrelor and a placebo experiencing such events.

    The streamlined therapy of treating patients with ACS with ticagrelor alone one month after PCI was equally safe and effective in patients who presented with a heart attack (the highest risk group) or were at risk of a heart attack. Together, these findings suggest that patients who stopped taking aspirin after the first month had a substantially reduced risk of bleeding without any increased risk of thrombotic events, researchers said.

    “The next question is how will physicians incorporate these results into their daily practice, and what will guideline committees ultimately do with these data,” Stone said. “I believe these results are very convincing and align with prior studies done without a placebo; hopefully they will impact guidelines and lead to the routine use of only one month of DAPT followed by a potent P2Y12 inhibitor such as ticagrelor in most patients with ACS after successful PCI.”

    Since the trial only involved ticagrelor, researchers said that separate studies would be necessary to investigate the safety and efficacy of a similar approach using other P2Y12 inhibitors, such as prasugrel and clopidogrel.

    The study was funded by the Chinese Society of Cardiology, the National Natural Scientific Foundation of China and the Jiangsu Provincial & Nanjing Municipal Clinical Trial Project. Stents were supplied by Medtronic Corp. (Minnesota, U.S.) and Microport Medical (Shanghai, China). Study medications were supplied by Yung Shin Pharmaceutical Industrial Co. (Kunshan, China) and Shenzhen Salubris Pharmaceuticals Co., Ltd (Shenzhen, China).

    This study was simultaneously published online in The Lancet at the time of presentation.

    Stone will be available to the media in a press conference on Sunday, April 7, 2024, at 11:15 a.m. ET / 15:15 UTC in Room B203.

    Stone will present the study, “One-month Ticagrelor Monotherapy After PCI in Acute Coronary Syndromes: Principal Results from the Double-blind, Placebo-controlled Ultimate DAPT Trial,” on Sunday, April 7, 2024, at 9:45 a.m. ET / 13:45 UTC in the Hall B-1 Main Tent.

    Source:

    American College of Cardiology

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  • Impella CP pump shows survival benefit in cardiogenic shock

    Impella CP pump shows survival benefit in cardiogenic shock

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    Implantation of the Impella CP micro-axial flow pump in the hours after a heart attack significantly increased the rate of survival at six months among people suffering cardiogenic shock, according to a study presented at the American College of Cardiology’s Annual Scientific Session.

    Cardiogenic shock occurs in about 5% to 10% of heart attacks and is among the main drivers of heart attack-related deaths. It occurs when the heart suddenly cannot pump enough blood to meet the body’s needs, depriving the heart and other vital organs of oxygen and often leading to death without immediate treatment. The study, which met its primary endpoint, suggests that by helping to restore the flow of oxygen-rich blood to the body, the device can help to improve survival in these severe cases.

    “This is the first time in a very long time that we have a positive study for managing cardiogenic shock,” said Jacob E. Møller, MD, professor in the Department of Cardiology at the Odense University Hospital in Denmark, consultant at the cardiac intensive care unit of Copenhagen University Hospital Rigshospitalet and the study’s lead author. “I think this will be a routine device that will be used in these desperately ill patients.”

    The Impella CP is a small percutaneous pump placed within the heart’s left chamber, where it expels oxygenated blood from the left ventricle to the body with a flow rate of up to 3.5 liters per minute. Previous trials evaluating the potential benefits of this and other heart pumps for cardiogenic shock have had mixed results. The new trial, called DanGer Shock, is the first trial powered to examine whether the use of micro-axial flow pumps can improve survival in ST-elevation myocardial infarctions (STEMI, the most serious type of heart attack) that are complicated by cardiogenic shock.

    The trial enrolled 360 patients treated for STEMI with cardiogenic shock at 14 centers in Denmark, Germany and the United Kingdom. Patients who suffered out-of-hospital cardiac arrest with coma and increased risk of brain damage were excluded from the trial. Researchers randomly assigned patients to receive standard care or standard care plus treatment with an Impella CP pump. Participants were randomized before, during or up to 12 hours after receiving treatment in the cardiac catheterization laboratory, depending on when cardiogenic shock was diagnosed.

    Among 355 patients who were included in the analysis, 58.5% of those who received standard care alone and 45.8% of those who received the Impella pump had died at six months after randomization; there was a 13 percentage point absolute reduction in the rate of death, the study’s primary endpoint, in favor of the heart pump. In addition, the results showed a reduction in a composite endpoint of additional mechanical heart support, heart transplant or death among patients who received the heart pump, but there was no difference between the two groups in the number of days out of the hospital.

    What was a surprise for us was that the benefit seems to persist beyond 30 days. It’s not only that we are saving lives, it looks like we are also saving myocardium [heart muscle] so the patients keep surviving, and the survival curves continue to separate beyond the first 30 days.”


    Jacob E. Møller, MD, Professor, Department of Cardiology, Odense University Hospital in Denmark

    However, the results also showed significantly higher rates of complications among patients who received the heart pump, including bleeding, limb ischemia, renal replacement therapy and sepsis.

    “It doesn’t come without a cost—we see significantly more serious complications in the Impella treated patients,” Møller said. “Overall, we have more complications, but we also save lives.”

    Møller said that the study is not generalizable to all cases of cardiogenic shock as the trial was more selective than previous trials in identifying patients who were most likely to be able to benefit from the use of a heart pump, for example, by excluding those with a risk of brain damage. However, within this patient population, he said the results are likely translatable beyond northern Europe to large centers with the necessary expertise to employ the device.

    Subgroup analyses suggested that patients with very low blood pressure and those with lesions in more than one coronary artery may see a greater benefit from the Impella pump. Møller said that further studies are needed to assess the benefits in more diverse patient populations and to examine how the duration of mechanical support might affect the rate of severe complications and identify opportunities to further optimize practices to minimize complications.

    The study was funded by the Danish Heart Foundation and Abiomed/Johnson & Johnson, maker of the Impella CP.

    This study was simultaneously published online in the New England Journal of Medicine at the time of presentation.

    Møller will be available to the media in a press conference on Sunday, April 7, 2024, at 11:15 a.m. ET / 15:15 UTC in Room B203.

    Møller will present the study, “Percutaneous Transvalvular Micro-axial Flow Pump in Infarct Related Cardiogenic Shock. Results of the Danger-shock Trial,” on Sunday, April 7, 2024, at 9:45 a.m. ET / 13:45 UTC in the Hall B-1 Main Tent.

    Source:

    American College of Cardiology

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