Tag: Cardiovascular Disease

Good sleep patterns cut heart disease risk, study finds
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A recent study published in JAMA Network Open reveals that persistently favorable sleep patterns may reduce the risk of cardiovascular disease (CVD), even in individuals with higher genetic susceptibility.

Study: Changes in Sleep Patterns, Genetic Susceptibility, and Incident Cardiovascular Disease in China. Image Credit: aslysun / Shutterstock.com

How does sleep affect CVD?

CVD is a leading cause of morbidity and mortality worldwide, with about 33% of all deaths in 2019 attributed to CVD throughout the world. Similarly, the estimated mortality rate due to CVD in China currently exceeds 40%. Thus, the global burden of CVD emphasizes the importance of identifying modifiable risk factors that can be implemented to prevent CVD.

Growing evidence indicates that an unhealthy lifestyle, including impaired sleep patterns, can potentially increase the risk of CVD. Despite these studies, a single sleep measurement was often used to define sleep patterns, which may not adequately reflect sleep with CVD, as sleep habits can evolve. Furthermore, there remains a lack of data on how different sleep patterns in retired and older populations affect their risk of CVD.

Study design

The current study was conducted between 2008 and 2018 in China and included 15,306 middle-aged and older individuals without diagnosed cardiovascular complications. Self-reported sleep information was collected at baseline between 2008 and 2010 and at the first follow-up visit in 2013.

Sleep patterns of the study participants were defined as “favorable” and “unfavorable” based on bedtime, sleep duration, sleep quality, and midday napping. Study participants were categorized into four groups: persistent unfavorable, favorable-unfavorable (transitioning from favorable to unfavorable), unfavorable-favorable (transitioning from unfavorable to favorable), and persistent favorable.

Polygenic risk scores for coronary heart disease and stroke were calculated to determine the genetic susceptibility of the study participants to these diseases. Additionally, an expert panel of physicians was appointed to assess incident CVD, defined as a composite outcome of incident coronary heart disease and incident stroke, until the end of 2018.

Important observations

A total of 3,669 incident CVD cases, including 2,986 coronary heart disease cases and 683 stroke cases, were documented during the five-year study period from 2013 to 2018.

The assessment of five-year changes in sleep patterns found that 35.8% of participants practiced persistent unfavorable sleep patterns, whereas 25.8% had persistent favorable sleep patterns. Young age, female gender, and higher educational background were associated with persistent favorable sleep patterns.

Study participants with persistent unfavorable sleep patterns were at a greater risk of CVD than those with persistent favorable, favorable-unfavorable, or unfavorable-favorable sleep patterns. More specifically, a 16% and 34% reduced risk of coronary heart disease and stroke were observed among participants with persistent favorable sleep patterns. A subgroup analysis conducted after adjusting for participant’s age and sex revealed similar associations between changes in sleep patterns and CVD risk.

Genetic risk factors were not found to significantly influence the association between sleep pattern changes and cardiovascular disease risk. However, a combination of sleep pattern changes and polygenic risk scores was associated with cardiovascular risk in a dose-dependent manner.

To this end, individuals with persistent favorable sleep patterns and an intermediate genetic risk had a 36% reduced risk of stroke. In contrast, those with persistent favorable sleep patterns and a high genetic risk had a 45% reduced risk of stroke. Further analysis revealed that participants with persistent favorable sleep patterns and low genetic risk had a 35% reduced risk of coronary heart disease and a 52% lower risk of stroke compared to those with persistently unfavorable sleep patterns and high genetic risk.

Conclusions

The current study found that individuals with persistent favorable sleep patterns were at the lowest risk of incident CVD, coronary heart disease, and stroke during the subsequent five years. The benefits of persistent favorable sleep patterns remain unchanged for those with high genetic susceptibility to cardiovascular complications, thus demonstrating that individuals with higher genetic risk may benefit from persistent favorable sleep patterns.

Importantly, the study population included middle-aged and older Chinese retirees, which may restrict the generalizability of these findings. Furthermore, the current study does not include any information about participants’ sleep disorders and depression levels, which may have confounded the observed associations.
Journal reference:

Diao, T., Liu, K., Lyu, J., et al. (2024). Changes in Sleep Patterns, Genetic Susceptibility, and Incident Cardiovascular Disease in China. JAMA Network Open. doi:10.1001/jamanetworkopen.2024.7974
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April 26, 2024
Cancer history raises cardiovascular disease risk in hypertensive patients

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A study published in the journal Hypertension Research reveals that having a cancer history can increase the risk of cardiovascular disease in individuals with hypertension.

Study: Risk of cancer history in cardiovascular disease among individuals with hypertension. Image Credit: Black Salmon / Shutterstock

Background

A growing pool of evidence highlights the link between hypertension and cancer since both hypertension and cancer risks increase with advancing age, and that certain anti-cancer medications increase the risk of hypertension.

Several epidemiological studies have found that hypertension can increase the risk of certain types of cancers and that individuals with a cancer history are more likely to develop cardiovascular complications.

Given the potential link between the risks of hypertension, cardiovascular disease, and cancer, the scientists in this study have assessed the risk of cardiovascular disease events in hypertensive individuals with a history of cancer.

Study design

The study population included 747,620 individuals who were diagnosed with hypertension between January 2005 and May 2022. Patient information was collected from the JMDC Claims Database, a nationwide healthcare database in Japan.

Appropriate statistical analyses were conducted to determine the risk of Composite cardiovascular disease events, including myocardial infarction, angina pectoris, stroke, heart failure, and atrial fibrillation, based on the participant’s history of cancer and chemotherapy.

A history of cancer was defined as being diagnosed with malignancies before the initial health check-up.

Self-reported information on comorbidities (obesity, diabetes, and dyslipidemia), alcohol intake and smoking status, and physical activity level was collected from participants during the health check-up.

Important observations

A total of 26,531 individuals with a history of cancer were identified from the entire study population of 747,620 participants with hypertension. Participants with a history of cancer were more likely to be older adults, less likely to be men, and more likely to have diabetes. In contrast, participants without a history of cancer were more likely to have obesity and current smoking status.

A total of 67,154 composite cardiovascular disease events were detected during the study follow-up period until May 2022. Hypertensive patients with a history of cancer showed a significantly higher risk of developing composite cardiovascular disease events. However, the risk of developing myocardial infarction was not statistically significant.

The highest risk of developing cardiovascular disease events except myocardial infarction was observed among cancer survivors who received chemotherapy compared to those who did not receive chemotherapy or those without a history of cancer.

Regarding myocardial infarction, a higher risk was observed among cancer patients receiving chemotherapy compared to those without a history of cancer.

Five types of cancers, including colorectal cancer, prostate cancer, stomach cancer, renal, pelvic, and ureteral cancer, and lung cancer, showed the highest prevalence in men. In women, the highest prevalence was observed for breast cancer, colorectal cancer, thyroid cancer, corpus uteri cancer, and cervix uteri cancer.

A significantly higher risk of composite cardiovascular events was observed among men with a history of lung cancer and women with a history of breast cancer compared to those without a history of cancer.

A sensitivity analysis conducted after adjusting for age, sex, smoking status, alcohol intake, and physical inactivity showed a similar positive association between having a cancer history and risk of composite cardiovascular disease events.

Study significance

The study finds that hypertensive patients with a history of cancer have a higher risk of developing various cardiovascular disease events than those without a history of cancer. The risk of cardiovascular disease events is even higher in cancer patients receiving chemotherapy.

The study findings highlight the need for early screening of cancer in patients with hypertension. Physicians should manage hypertensive individuals more carefully as cancer comorbidity not only adversely affects cancer mortality but also significantly increases the risk of cardiovascular disease.

The coexistence of cancer and hypertension is a significant public health crisis in Asian countries. Implementation of appropriate healthcare policies is needed to prevent detrimental cardiovascular health consequences, particularly in developing countries with advanced aging.

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April 26, 2024
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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April 25, 2024
Researchers identify a ‘gene module’ involved in both depression and cardiovascular disease

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Depression and cardiovascular disease (CVD) are serious concerns for public health. Approximately 280 million people worldwide have depression, while 620 million people have CVD. It has been known since the 1990s that the two diseases are somehow related. For example, people with depression run a greater risk of CVD, while effective early treatment for depression cuts the risk of subsequently developing CVD by half. Conversely, people with CVD tend to have depression as well. For these reasons, the American Heart Association (AHA) advises to monitor teenagers with depression for CVD.

What wasn’t yet known is what causes this apparent relatedness between the two diseases. Part of the answer probably lies in lifestyle factors common in patients with depression and which increase the risk of CVD, such as smoking, alcohol abuse, lack of exercise, and a poor diet. But it’s also possible that both diseases might be related at a deeper level, through shared developmental pathways.

Now, scientists have shown that depression and CVD do indeed share part of their developmental programs, having at least one functional ‘gene module’ in common. This result, published in Frontiers in Psychiatry, provides new markers for depression and CVD, and could ultimately help to find drugs to target both diseases.

“We looked at gene expression profile in the blood of people with depression and CVD and found 256 genes in a single gene module whose expression at levels higher or lower than average puts people at greater risk of both diseases,” said first author Dr Binisha H Mishra, a postdoctoral researcher at Tampere University in Finland.

The authors define a gene module as a group of genes with similar expression patterns across different conditions and hence likely to be functionally related.

Young Finns study

Mishra and colleagues studied gene expression data in the blood of 899 women and men between 34 and 49 years old who were participants in the Young Finns study, one of largest studies of cardiovascular risk factors from childhood to adulthood to date. The Young Finns study began in 1980 with a cohort of almost 4,000 children and adolescents, then between three and 18 years old, randomly selected from five cities in Finland. The health of these participants has been followed ever since.

Finland has the highest estimated incidence of mental disorders in the EU, and is the ninth-highest ranking country in the world for the prevalence of depression. In contrast, the country has a relatively low prevalence of CVD, ranking in the bottom 20% worldwide for this class of diseases.

In 2011, the researchers running the Young Finns study tested the participants for symptoms of depression with a tried-and-tested questionnaire: Beck’s depression inventory (BDI-II), whose score increases with more severe symptoms. They also tested them for the risk of developing CVD through AHA’s ‘ideal cardiovascular health’ score, on a scale from zero (highest risk) to seven (lowest risk). Mishra et al. further analyzed these data for the present study.

It’s all in the blood

In 2011, whole blood had also been taken from each participant, and Mishra and colleagues here analyzed these samples with state-of-the-art gene expression methods.

They used advanced statistics to identify 22 distinct gene modules, of which just one was associated with both a high score for depressive symptoms and a low score for cardiovascular health.

The top three genes from this gene module are known to be associated with neurodegenerative diseases, bipolar disorder, and depression. Now we have shown that they are associated with poor cardiovascular health as well.”

Dr Binisha H Mishra, Postdoctoral Researcher, Tampere University in Finland

These genes are involved in biological processes such as inflammation that are involved in pathogenesis of both depression and cardiovascular disease. This helps to explain why both diseases often occur together.

Other genes in the shared module have been shown to be involved in brain diseases such as Alzheimer’s, Parkinson’s, and Huntington’s disease.

“We can use the genes in this module as biomarkers for depression and cardiovascular disease. Ultimately, these biomarkers may facilitate the development of dual-purpose preventative strategies for both the diseases,” said Mishra.

Source:

Journal reference:

Mishra, B. H., et al. (2024) Identification of gene networks jointly associated with depressive symptoms and cardiovascular health metrics using whole blood transcriptome in the Young Finns Study. Frontiers in Psychiatry. doi.org/10.3389/fpsyt.2024.1345159.

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April 25, 2024
Public health experts urge universities and schools to ban alcohol industry-funded education programs

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Public health experts are calling for a ban on alcohol industry-funded education programmes in UK universities and schools, which they say normalize drinking and downplay the long-term health risks of alcohol.

They include an industry-backed “freshers’ week survival guide” for university students and a theatre-based educational program in schools funded by Diageo, one of the world’s biggest alcoholic beverage companies, reports an investigation by The BMJ.

The call follows a successful campaign in Ireland that has led to educational programs funded by the alcohol industry being removed from schools.

But in the UK, universities continue to welcome initiatives funded by Drinkaware – a charity funded by major alcohol producers and retailers, venues and restaurant groups – intended to educate students about “responsible” drinking skills.

In universities, for example, Drinkaware materials are distributed to students, including a free cup to measure alcohol units and a wheel with the number of units and calories in popular drinks, while a “freshers’ week survival guide,” advises students to eat carbohydrates or protein before going out and drink plenty of water.

Drinkaware told The BMJ that “the cup and wheel help people understand how much they are drinking.” It added that it had quoted directly from the chief medical officer’s guidelines and that the stated aim of the guidelines is to inform people but not to stop them drinking alcohol, “as it is considered a normal activity.”

But Mark Petticrew at the London School of Hygiene and Tropical Medicine, said this focuses on the short-term effects of getting drunk. “Food has no relevance to the longer-term harms of alcohol, including cardiovascular disease, cancers and fetal alcohol spectrum disorders,” he argues.

May van Schalkwyk at the London School of Hygiene and Tropical Medicine added that the material selectively quotes from the chief medical officer’s advice.

The Department for Education said that universities are private institutions and the government has no remit to review materials distributed to students in England.

In Wales, universities were given a toolkit to assess whether they are keeping students safe from alcohol created by the Welsh government, NUS Wales, and Drinkaware.

But Mark Petticrew criticized the toolkit as “misinformation” given it omits any information about the risks of cancer, cardiovascular disease, injury, and death associated with alcohol. “The framing of the entire document is to preserve the industry reputation and not about protecting young people at universities from harm,” he says.

Karen Tyrell, chief executive of Drinkaware, described its work in UK universities as “a pragmatic and worthwhile contribution to reducing alcohol-related harm across the UK.”

We work with the grain of public opinion and treat people like adults capable of making informed choices. While some may not like it, alcohol is a part of our society and there is currently no public desire to change that. We make no apologies for delivering a range of activities which support our charitable objectives and organizational purpose.”

Karen Tyrell, chief executive of Drinkaware

In the absence of a specific ban, as in Ireland, industry-related alcohol education charities have also been active in schools, providing information to pupils as young as 9, the investigation finds.

There is a concern in the public health community that these industry-backed programs are poorly evaluated, says John Holmes, professor of alcohol policy at the University of Sheffield. Well-designed and effective programs have a role to play.

“Alongside that, we need other measures such as reducing the affordability of alcohol, reducing its availability, and better restriction of alcohol marketing,” he says.

Source:

Journal reference:

Davies, M., et al. (2024). Big alcohol: Universities and schools urged to throw out industry-funded public health advice. BMJ. doi.org/10.1136/bmj.q851.

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April 25, 2024
Replacing dinner calcium with breakfast intake could reduce heart disease risk, study finds

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In a recent study published in BMC Public Health, researchers investigated whether the quantity of calcium consumed at breakfast and dinner was associated with cardiovascular disease (CVD) in the general population.

Study: Association of dietary calcium intake at dinner versus breakfast with cardiovascular disease in U.S. adults: the national health and nutrition examination survey, 2003–2018. Image Credit: Goskova Tatiana/Shutterstock.com

Background

Cardiovascular disease is the primary cause of mortality globally and the most prevalent chronic illness among individuals living in the United States.

Calcium, a crucial dietary element, helps prevent and manage CVD by regulating blood vessels, muscular contraction, nerve transmission, hormone production, fat mass, blood pressure, and blood lipids. Circadian clocks in animals govern circadian rhythms, which are biological rhythmic patterns that last 24 hours.

Diet is a significant external element that influences the synchronization of circadian clocks. Recent research indicates that calcium intake can influence physiological variations in circadian pacemaker-type neuronal cells and alter the expression of the biological clock genes.

However, the relationship between calcium consumption at various times of the day and cardiovascular disease is unclear.

About the study

The present study examined the relationship between dietary calcium consumption at dinner and breakfast and CVD.

The study comprised 36,164 United States individuals (17,456 males, 18,708 females, and 4,040 cardiovascular disease patients) from the 2013–2018 National Health and Nutrition Examination Surveys. They stratified the participants into five groups based on their calcium intakes from night and early morning meals.

The study focused on the fraction of calcium consumption in night and morning meals (Δ=calcium intake from dinner /calcium intake from breakfast).

The study’s endpoint was cardiovascular disease, based on a self-reported history of angina, heart failure, stroke, coronary artery disease, or heart attack.

Potential confounders included age, sex, educational attainment, smoking status, physical activity, marital status, annual income, alcohol consumption, body mass index (BMI), high-density lipoprotein (HDL), uric acid (UA), total cholesterol (TC), hypertension, and type 2 diabetes (T2DM).

Following confounder adjustment, the researchers used logistic regression to calculate the odds ratios (OR) for the relationship between the calcium intake percentage at night and morning and cardiovascular disease.

They used dietary replacement models to investigate changes in cardiovascular disease risk by replacing 5.0% calcium from dinner with calcium consumption in the morning.

The team conducted home interviews with individuals and collected data at a mobile testing facility. They excluded individuals under 20 years, pregnant women, those with incomplete data, those consuming more than 4,500 kcal per day, and those using calcium supplements.

They assessed dietary consumption using a 24-hour diet recall completed on two non-consecutive days. They assessed nutrient intake using the Food and Nutrient Database for Dietary Studies recommendations by the United States Department of Agriculture. They performed sensitivity studies to investigate the validity of the study findings.

Results and discussion

Individuals in the uppermost quartile showed a higher likelihood of having cardiovascular disease than those in the lowermost quintile, with adjusted OR values of cardiovascular disease of 1.2.

While keeping total calcium consumption constant, substituting a 5.0% calcium consumption from dinner meals with calcium consumption at breakfast reduced CVD risk by 6.0%.

Breakfast meals with morning snacks or dinner meals with evening snacks reduced CVD risk by 6% (OR, 0.9). Compared to the lowermost quintile, having breakfast and morning snacks as breakfast or dinner and evening snacks as dinner in the uppermost Δ quintile significantly reduced CVD risk, with adjusted ORs of 1.1 and 1.1, respectively.

Consuming dinner with evening snacks and breakfast with morning snacks yielded an adjusted OR of 1.1. Among overweight and obese individuals, the adjusted odds ratio of cardiovascular disease in the uppermost Δ quintile was 1.2 after adjusting for various confounding variables.

The circadian clock governs several cardiovascular processes, including endothelial function, thrombus development, blood pressure, and heart rate. Basic helix-loop-helix ARNT-like protein 1 (Bmal1), a primary clock gene, regulates calcium absorption and metabolism.

Sleep periods improve calcium retention capability. Circadian rhythm influences the inflammatory nuclear factor kappa B (NFκB) pathway, metabolism, and immune system adaptability.

The study found that those in the top percentile of calcium consumption at dinner and breakfast are more likely to develop cardiovascular disease. The findings imply that allocating calcium intake to both meals is critical.

The study demonstrated a positive correlation between the Δ value and cardiovascular disease risk. Replacing 5.0% of calcium consumption from dinner meals with the same amount at breakfast reduced CVD risk by 6.0%. However, further research is required to corroborate these findings across races and nations.

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April 23, 2024
US study links extended sitting and lack of coffee to higher death rates

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The researchers of a recent study published in BMC Public Health examined the independent and combined effects of daily sedentary times and coffee consumption on cardiovascular disease (CVD)-related and any-cause mortality in the United States.

Study: Association of daily sitting time and coffee consumption with the risk of all-cause and cardiovascular disease mortality among US adults. Image Credit: ViDI Studio/Shutterstock.com

Background

Sedentary behavior and coffee drinking are associated with chronic illnesses, but their combined links with mortality are poorly understood.

Prolonged sitting raises the risk of all-cause and heart disease-related mortality, particularly in individuals who do not meet the recommended physical activity levels. According to studies, death rates are increasing for all causes, including cancer.

Coffee consumption varies depending on lifestyle and demographics, with age playing a primary role. Its antioxidant qualities can lower chronic disease morbidity and mortality.

However, further study is required to discover the best coffee intake technique and dose. The growing incidence of sedentary behavior and coffee drinking raises concerns about their relationship.

About the study

In the present prospective cohort study, researchers investigated the combination effects of daily sedentary times and coffee consumption on death from all causes and CVDs.

The researchers examined data from the National Health and Nutrition Examination Surveys (NHANES) conducted between 2007 and 2018, including 10,639 participants.

They excluded individuals with missing data on exposure factors, outcome variables, and covariates and those with inconsistent daily energy intake. They gathered mortality data from interviews and physical examinations until 31 December 2019 and assessed self-reported daily sedentary time data.

All participants had offline interviews, physical examinations, and laboratory investigations at testing sites. They collected coffee beverage data from one-day food recall questionnaires and used the Global Physical Activity Questionnaire (GPAQ) to assess sedentary time.

The primary study outcomes were cardiovascular disease and all-cause death, established using ICD-10 numbers.

The team used Cox proportional hazard regressions to calculate hazard ratios (HR) values adjusted for sociodemographic variables, lifestyle factors, and medical history covariates. Sociodemographic variables included sex, ethnicity, race, educational attainment, marital status, poverty income ratio, body mass index (BMI), and waist circumference].

Lifestyle factors included smoking habits, alcohol intake, the Healthy Eating Index (HEI) 2015 values, and physical activity. Medical history included hypertension, diabetes, hypercholesterolemia, cancer, and medications.

Results

Individuals being sedentary for six hours or more daily showed a higher likelihood of being white, non-Hispanic, and educated beyond high school. They also exhibited a larger waist circumference, abdominal obesity, and a higher BMI.

Coffee users showed higher odds of being non-Hispanic, Caucasian, older, and educated beyond high school. Only 52% of US people drink coffee, and over half report sitting for at least six hours daily. Twenty-three percent of Americans stated they sat for six hours or more daily and did not drink coffee.

Over a 13-year follow-up, 945 fatalities occurred among research participants, with 284 of these being due to CVD.

Sedentary times of >8.0 hours daily were linked to increased death rates from all causes (HR, 1.5) and CVD-related (HR, 1.8) compared to sitting times of <4.0 hours daily, according to multivariate analysis. Individuals in the uppermost quartile for coffee consumption had decreased odds of any-cause deaths (HR, 0.7) and CVD-related fatalities (HR, 0.5) compared to non-coffee users.

Joint analyses revealed that coffee non-drinkers sitting for at least six hours per day had a 1.6-fold higher likelihood of any-cause mortalities than coffee consumers who sat for <6.0 hours daily.

The findings indicate that the relationship between sitting time and increased death risk was exclusive for adult non-consumers of coffee, not among coffee drinkers.

Any-cause death risk was considerably greater in those aged >65 years inactive for >8.0 hours daily (HR, 1.7). Individuals aged >65 years, females, those with truncal obesity, former alcohol consumers, former cigarette smokers, and insufficient physical activity had higher HR values for all-cause death risk as their daily sedentary time increased, and the trend showed statistical significance.

Subgroup analyses stratified by coffee intake showed that the relationship between coffee drinking and all-cause death risk was considerably more robust among black and non-Hispanic individuals consuming coffee (HR 0.6).

Conclusions

The study showed sedentary behavior associated with increased any-cause and heart disease-related mortality. However, any-cause fatalities were lower in the highest percentile of coffee consumption, and the lower risk was strongly associated with any amount of coffee consumed.

The relationship was exclusively to individuals who did not drink coffee. Over a 13-year follow-up, the researchers found a statistically significant link between individuals sitting for more than eight hours per day and an elevated risk of any cause and cardiovascular death.

Prolonged and unbroken sitting tends to decrease glucose metabolism and exacerbate inflammation. Coffee consumption reduces the risk of metabolic syndrome, which promotes inflammation.

Prospective cohort studies are needed to analyze the influence of coffee intake on health benefits in sedentary populations, and further research, especially multicenter studies, is required to investigate the effects of individual coffee types on mortality and causal linkages.

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April 23, 2024
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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April 22, 2024
Korean fermented food Doenjang shows promise in alleviating menopausal symptoms
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In a recent study published in the journal Nutrients, researchers compare the efficacy between traditional and commercial Doenjang in alleviating menopausal syndrome.

Study: Evaluation of menopausal syndrome relief and anti-obesity efficacy of the Korean fermented food doenjang: a randomized, double-blind clinical trial. Image Credit: mino choi / Shutterstock.com

Treating menopause

Menopause leads to hormonal changes that may cause psychological and physical symptoms like hot flashes, sleep disturbances, insomnia, sweating, atrophy of the genitourinary system, and anxiety. Menopausal symptoms are often treated with hormone replacement therapy (HRT), primarily progesterone and estrogen.

Soy consumption, especially in Asian countries, is associated with lower rates of menopausal symptoms, thereby offering a natural substitute for HRT when it may be contraindicated or otherwise undesirable due to possible side effects such as breast cancer or cardiovascular disease.

Doenjang, a form of soybean paste consumed in Korea, is rich in antioxidants and fermented with beneficial microorganisms like Bacillus subtilis, Aspergillus oryzae, Rhizopus, and Mucor. Previously, Doenjang has been identified as a potential solution for alleviating menopausal symptoms; however, careful evaluation is needed to identify formulations that may be most effective for this purpose.

About the study

In the current study, researchers conducted an eight-week randomized and double-blind clinical trial involving postmenopausal women with menopausal syndrome.

The Kupperman index is a widely accepted diagnostic tool for menopausal syndrome that measures a wide range of vasomotor, urinary tract, psychoneurological, motor, digestive, and systemic symptoms. Scores below 20 indicate mild symptoms, while those between 20 and 40 signify moderate severity. Scores exceeding 40 indicate severe symptoms and scores of 60 or more denote a particularly severe manifestation of the syndrome.

Participants received Doenjang supplementation in three forms, including high-content beneficial microorganism traditional Doenjang (HDC), low-content beneficial microorganism traditional Doenjang (LDC), and commercially available Doenjang (CD).

Medication compliance, vital signs, and side effects were evaluated after four weeks of supplementation. Researchers collected measures of menopausal syndrome relief, including the Kupperman index, at the beginning and end of the trial, along with bioelectrical impedance analysis (BIA) results, weight, lipid profiles, serum blood markers, and inflammatory markers.

Safety assessments included blood chemistry, hematological tests, and monitoring for side effects. Obesity indicators and inflammation markers were also assessed, as were changes in the gut microbiome analyzed through stool tests.

Doenjang pills were prepared through a traditional fermentation process and freeze-dried for clinical trials. Statistical analysis included chi-square tests, analysis of variance (ANOVA), and paired t-tests to compare baseline and post-intervention data.

Study findings

A total of 56 individuals were included in the study and received HDC, LDC, or CD, none of whom reported any adverse events. Anthropometric parameters, including age, weight, and body mass index (BMI), did not differ significantly among the study participants.

Safety assessments indicated no adverse effects on liver or kidney function, with some improvements in blood urea nitrogen (BUN), uric acid, and total protein levels in the HDC group. Doenjang was not associated with anti-obesity effects; however, its use reduced LDL cholesterol levels.

Kupperman index scores significantly decreased in all groups following the administration of Doenjang, with improvements observed in various symptoms. Microbiome analysis showed decreased Firmicutes and increased Bacteroidetes across all groups, with beneficial bacteria increasing and harmful bacteria decreasing, particularly in the CD group.

Short-chain fatty acid analysis indicated varied effects across groups. Overall, while Doenjang showed promise in alleviating menopausal symptoms and modifying gut microbiota, its effects on obesity and inflammation were limited.

Conclusions

Traditional Doenjang fermented with beneficial microorganisms was found to be superior in its ability to mitigate menopausal symptoms as compared to commercial Doenjang. Nevertheless, a significant reduction in Kupperman index scores was observed across all groups, with the most notable improvement observed in LDC recipients.

LDL cholesterol levels decreased in both traditional Doenjang groups, thus indicating its potential cardiovascular benefits. Although Doenjang was not associated with anti-obesity or anti-inflammatory effects, its treatment positively influenced gut microbiota by increasing beneficial bacteria and reducing the levels of harmful bacteria.

Taken together, these findings demonstrate that traditional Doenjang has the potential to effectively alleviate menopausal symptoms, particularly when considering cardiovascular health, with implications for improving intestinal health through its impact on gut microbiota.

Some limitations of the current study include the inability to control participants’ lifestyle factors, the short study duration, and the small sample size. Thus, future studies with larger samples and longer durations to elucidate the therapeutic potential of Doenjang.
Journal reference:

Han, A.L., Ryu, M.S., Yang, H., et al. (2024). Evaluation of menopausal syndrome relief and anti-obesity efficacy of the Korean fermented food doenjang: a randomized, double-blind clinical trial. Nutrients. doi:10.3390/nu16081194
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April 22, 2024
Climate change predicted to spike cardiovascular deaths in China
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A new study published in the journal eBioMedicine aims to predict the extent to which climate change may impact the risk of cardiovascular disease (CVD) mortality in China.

Study: Projecting heat-related cardiovascular mortality burden attributable to human-induced climate change in China. Image Credit: Piyaset / Shutterstock.com

Climate change and CVD

Current estimates indicate that about 19 million people die each year due to CVD, five million of whom reside in China. Furthermore, CVD causes over 390 million disability-adjusted life years (DALYs) globally.

Due to climate change, the global temperature at the earth’s surface has risen by 1.15 °C above that in the pre-industrial era. Previous studies have reported an adverse impact of climate change on overall mortality that is dependent on age, sex, and cause of death, as well as deaths due to CVD.

Heat affects the cardiovascular system in multiple ways, including the excretion of salt and water as sweat, higher cholesterol levels, and hemodynamic strain. Moreover, climate change-related heat can increase the risk of atherosclerotic thrombosis of the heart and brain vessels and, as a result, the rate of strokes and heart attacks.

About the study

The present study attempted to predict CVD mortality associated with climate change in a Chinese setting. Current temperatures were measured at 161 disease surveillance points (DSPs).

These projections were based on the Coupled Model Intercomparison Project Phase 6 (CMIP6), which is under the World Climate Research Programme (WCRP). WCRP examines natural climate change and the combined scenario with both natural and anthropogenic impacts on the climate.

A total of 22 General Climate Models (GCMs) were used to determine projected temperatures from 2010 to 2100 in both human-induced and natural scenarios. Human-induced scenarios were calculated based on the difference between the combined and natural impacts.

Recognizing that economic and social change is closely related to climate change, the Intergovernmental Panel on Climate Change (IPCC) has presented a series of integrated scenarios that combine both shared socioeconomic pathways (SSPs) and climate representative concentration pathways (RCPs).

Study findings

The mean annual temperature at the DSPs varied from 12.6 to 28.4 °C, during which time about 330,000 CVD deaths occurred.

Under natural conditions, the summer temperatures in China would not significantly change. Similarly, in this scenario, the proportion of CVD deaths related to heat would decline by 0.5% in the 2090s as compared to 2010 death rates due to CVD.

Conversely, summer temperatures increased by 5-6 °C with the combined scenarios, depending on the region. The predicted CVD mortality fraction in the 2090s rose from 10% to 30%, depending on the modeled scenario.

The death rate among CVD patients followed a J-shaped curve beyond a critical minimum temperature. The most significant increase relative to baseline temperature was in the South and East of China.

The proportion of heat-related deaths due to CVD with human-induced climate change continued to rise during each decade from about 31% in the 2010s to an estimated 70-90% in the 2090s under different scenarios.

Individuals who were considered to be most vulnerable to heat-related CVD mortality included those living in rural areas, those with lower education levels, stroke patients, females, older adults, and those residing in Southern and Eastern China. Importantly, individuals with lower levels of education are more likely to work outdoor jobs, have unequal access to healthcare, and be diagnosed with chronic diseases.

Conclusions

“This study provides evidence that human activities will amplify future heat-related cardiovascular mortality burden.”

Anthropogenic climate change resulting in CVD deaths could account for as much as 90% of excess mortality due to excessive heat by 2090. Simultaneously, the CVD burden associated with natural climate change may not change significantly. Nevertheless, the study findings emphasize the importance of limiting carbon emissions to prevent further global warming ultimately.

“Active adaptation and mitigation measures towards future warming could yield substantial health benefits for the patients with CVD.”

Future studies are needed to identify populations and groups at the greatest risk of climate-related health effects and the different types of risk that may be associated with global climate change. These data will assist in implementing integrated and sensitive public health policies to ultimately reach environmental targets.
Journal reference:

Zhu, Q., Zhou, M., Sakhvidi, M. J. Z., et al. (2024). Projecting heat-related cardiovascular mortality burden attributable to human-induced climate change in China. eBioMedicine. doi:10.1016/j.ebiom.2024.105119.
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April 22, 2024