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Tag: Cardiovascular Disease

  • DASH diet may lower the risk of cardiovascular disease in breast cancer survivors

    DASH diet may lower the risk of cardiovascular disease in breast cancer survivors

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    A new paper in JNCI Cancer Spectrum, published by Oxford University Press, finds that following a healthy diet lowers the risk of cardiovascular disease in breast cancer survivors.

    Cardiovascular disease is the top non-breast cancer related cause of death in women with breast cancer. There are more than 3.8 million female breast cancer survivors in the United States. These women are at higher risk for cardiovascular disease than women who have not had breast cancer. This is likely due to the cardiotoxic effects of breast cancer treatment, as well as common risk factors for both breast cancer and cardiovascular disease, such as aging, lack of exercise, and smoking. Dietary guidance for breast cancer survivors is limited and until recently has been based primarily on research related to cancer prevention.

    Researchers used data from the Pathways Study, a prospective cohort study of women diagnosed with invasive breast cancer, to examine associations between diet quality and cardiovascular-related events. The analysis included 3,415 women diagnosed with invasive breast cancer at Kaiser Permanente Northern California between 2005 and 2013 and monitored through 2021.

    To assess diet quality, researchers used a scoring system based on the Dietary Approaches to Stop Hypertension (DASH) diet which was developed in the 1990s to manage and treat hypertension. The diet emphasizes fruits, vegetables, whole grains, lean protein, and low-fat dairy. It also limits sodium, red and processed meats, and sugar sweetened beverages. The diet is similar to that recommended by the American Cancer Society, but also encourages consumption of low-fat dairy and nuts, and discourages sodium. The study evaluated heart health tied to these two diets as well as a plant-based diet, the 2020 Healthy Eating Index, and the alternate Mediterranean diet. 

    The researchers found that women whose diets were most similar to DASH at the time of their breast cancer diagnosis had a 47% lower risk of heart failure, a 23% lower risk of arrhythmia, a 23% lower risk of cardiac arrest, a 21% lower risk of valvular heart disease, and a 25% lower risk of venous thromboembolic disease than the women whose diets were least aligned with DASH.

    In a closer examination the researchers found that higher consumption of low-fat dairy reduced the risk for cardiovascular disease-related death, after adjusting for all other food groups. They also found that the relationship between DASH and cardiovascular disease appeared to be modified by the type of chemotherapy treatment a woman received. For example, women whose treatment included an anthracycline and had diets closely aligned with the diet had a lower risk of cardiovascular disease than women least aligned with DASH, a relationship that was not apparent among women on other types of chemotherapy regimens.

    Our findings suggest that we need to begin talking to breast cancer survivors about the potential heart benefits of the DASH diet. We know that breast cancer survivors have an elevated risk for cardiovascular disease, and the diet might be able to help improve the overall health of this population.”


    Isaac J. Ergas, PhD, paper’s lead author, staff scientist at the Kaiser Permanente Division of Research

    Source:

    Oxford University Press USA

    Journal reference:

    Ergas, I. J., et al. (2024) Diet quality and cardiovascular disease risk among breast cancer survivors in the Pathways Study. JNCI Cancer Spectrum. doi.org/10.1093/jncics/pkae013.

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  • Sugary beverages linked to higher risk of atrial fibrillation

    Sugary beverages linked to higher risk of atrial fibrillation

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    In a recent study published in the European Journal of Clinical Nutrition, researchers used Mendelian randomization (MR) to explore the associations between the intake of pure fruit juices (PFJ) and sugar-sweetened beverages (SSBs) with cardiovascular disease (CVD).

    Study: Association between sugar-sweetened beverages and pure fruit juice with risk of six cardiovascular diseases: a Mendelian randomization study. Image Credit: Andrii Zastrozhnov/Shutterstock.comStudy: Association between sugar-sweetened beverages and pure fruit juice with risk of six cardiovascular diseases: a Mendelian randomization study. Image Credit: Andrii Zastrozhnov/Shutterstock.com

    Background

    Cardiovascular illnesses are a major worldwide health problem, with risk factors including high body mass index (BMI), alcohol use, and smoking habits.

    SSBs and PFJ are associated with CVD; however, the causative relationship is uncertain. SSBs may be an elastic dietary target for lowering the CVD risk among females; however, PFJ may be a primary predictor.

    However, several investigations have found no direct link between SSBs and CVD. PFJ use can increase important nutrient intake; however, one should limit intake due to the high free sugar and energy content.

    The health consequences of PFJ consumption are inconsistent, and dietary advice differs among nations. The link between PFJ use and CVD mortality is unclear.

    About the study

    The present study researchers investigated whether SSB and PFJ consumption increased CVD risk.

    The researchers assessed genetically estimated causal relationships between sugar-sweetened beverages, pure fruit juices [obtained from genome-wide association studies (GWAS) of European individuals], and six CVDs [hypertension, angina pectoris, atrial fibrillation (AF), coronary atherosclerosis (CA), acute myocardial infarction (AMI), and heart failure (HF)] using mendelian randomization.

    The team obtained dietary intake data from the United Kingdom Biobank based on the Oxford WebQ 24-hour diet recall questionnaires filled out by 85,852 individuals. GWAS data on atrial fibrillation included 3,818 cases, with 333,381 control individuals. Angina data included 10,083 patients and 452,927 disease-free individuals.

    AMI data included 3,927 patients and 333,272 control individuals. Coronary atherosclerosis data included 14,334 patients with 346,860 controls. Heart failure GWAS data included 1,405 patients with 359,789 control individuals. GWAS data on hypertension included 54,358 patients with 408,652 controls.

    The researchers used the inverse variance weighted (IVW) approach for analysis, supplemented by the Cochran Q test, weighted median, MR Egger regressions, MR pleiotropy, Bonferroni corrections, and funnel plots.

    To ensure that the primary analysis findings were robust, they calculated F-values as complementary tests to establish looser cut-offs for exposing the instrumental variables (IVs) and selected IVs by detecting single nucleotide polymorphisms (SNPs) strongly associated with PFJ and SSBs.

    They determined odds ratios (OR) for the associations between SSB, PFJ intake, and CVD.

    Results and discussion

    The MR analysis showed genetically causal positive associations between sugar-sweetened beverages and atrial fibrillation (OR, 1.02) and negative associations between pure fruit juice and angina pectoris (OR, 0.97).

    However, there were no causal relationships between SSB and PFJ intake and other cardiovascular disease risks. Supplementary MR methods yielded similar results.

    The leave-one-out analysis showed that individual SNP removal did not alter the causal associations, indicating that the primary findings were reliable and robust.

    SSB and PFJ intakes have distinct substance compositions, which can raise the chance of developing AF while decreasing the risk of angina. SSBs contain dietary additives such as sodium citrate, which may increase the risk of AF over time.

    Excessive intake of SSBs can activate an inflammatory response, resulting in higher levels of circulating inflammatory markers such as interleukin-6 (IL-6), C-reactive protein (CRP), and tumor necrosis factor receptors 1 and 2 (TNF-r1, r2). Higher IL-6 levels are associated with an increase in AF burden and mortality.

    PFJ, on the other hand, has high levels of polyphenols, some of which have anti-inflammatory properties. Pomegranate juice can lower inflammatory indicators such as vascular cell adhesion molecule-1 (VCAM-1), E-selectin, and IL-6 due to its high concentration of hydrolyzable tannins.

    PFJ’s anti-inflammatory properties may lower angina incidence by blocking platelet aggregation and preventing coronary plaque development.

    Conclusions

    The study findings revealed a positive relationship between sugar-sweetened beverages and atrial fibrillation, whereas pure fruit juice had a negative link with angina.

    The findings should help us better understand the impact of long-term SSB/PFJ intake on cardiovascular disease (CVD) and recommend dietary choices for people who are at risk. Patients with AF should limit their SSB consumption to prevent potential pathogenic hazards, whereas individuals may incorporate PFJ into their diet as a protective factor against angina.

    However, further clinical and fundamental research is required to confirm these findings. Future research should concentrate on non-European ancestry groups and study data on various types of SSBs/PFJ and consumption rates to better understand their impact on CVD.

    Further research is needed to improve the understanding of their protective and pathogenic characteristics and assess their potential utility in clinical CVD prevention and therapy.

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  • Is spousal cardiovascular disease associated with an increased risk for depression?

    Is spousal cardiovascular disease associated with an increased risk for depression?

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    Cardiovascular disease (CVD) is among the leading causes of illness and death in the current age. While CVD has long been linked to the onset of depression, not much is known about whether the spouses of those affected are more likely to become depressed after such events.

    A study recently published in JAMA Network Open explored this topic, laying the foundation for future prospective studies in this field.

    Study: Depression Onset After a Spouse’s Cardiovascular Event. Image Credit: Chay_Tee/Shutterstock.comStudy: Depression Onset After a Spouse’s Cardiovascular Event. Image Credit: Chay_Tee/Shutterstock.com

    Depression and health

    Depression has become 65% more prevalent, and it stands as the predominant mental health disorder worldwide, not only diminishing quality of life but also adversely affecting overall health.

    Depression is associated with a higher risk of CVD, dementia, poor cognition, and death.

    How is CVD linked to depression?

    CVD and depression are both more common in people who are obese, and both share inflammation in the immune system. When someone suffers a CVD event such as a stroke or a heart attack, the family also suffers from mental stress, anxiety, and even depression.

    The current study was designed to explore the association between CVD and depression at the household level. The data came from a national database maintained by the Japan Health Insurance Association (JHIA).

    This included about 40% of the Japanese working-age population or 30 million individuals in this age group.

    What did the study show?

    The researchers found that among nearly 278,000 married couples matched for important characteristics, the vast majority (95%) reported a CVD-related event in the male partner. The mean age of the patients was 58 years.

    Those whose spouses had a CVD event were more likely to be diabetic, hypertensive, or depressed compared to the other group. The spousal group had an increased cumulative incidence of depression, between 4% to 5% for males and females, respectively.

    For spouses between 20 and 59 years, about 4% of spouses became depressed vs 3% of those aged 60 years or more.

    New-onset depression was observed in nearly 2% of individuals. Spousal risk for depression after a CVD was 13% higher than in the group without such an event.

    This did not show any change by age, sex, income, or a previous CVD history.

    However, depression risk was higher by 13% to 15% after spousal stroke or heart failure, but not after a heart attack.

    Other potentially confounding factors included smoking, drinking, exercise, or whether the index patient was using drugs to reduce blood pressure. None of these showed any impact on the risk of depression in the spouse, however.

    The researchers also checked for the possible interaction of these results with the spouse’s health status.

    They examined the body mass index (BMI), blood pressure, cholesterol levels, blood sugar concentrations, and kidney function. They found that the same increased risk was manifested after controlling for these factors.

    The study corroborates the depressive effect of a spousal CVD event, which could involve a need to be a caregiver for the sick spouse.

    This could mean inevitable lifestyle alterations, lack of other social interactions, sleep disruptions, and lack of exercise. All these are associated with chronic mental stress, which increases with the level and duration of caregiving.

    Financial problems due to the forced loss of employment to manage the spouse’s needs, with additional caregiving-related costs, are another source of stress.

    Finally, grief at the loss of a spouse or distress related to the stay of the loved one in the intensive care unit may trigger depression.

    Conclusions

    “These findings highlight the importance of preventive care for mental health disorders in individuals whose spouses experience incident CVD.”

    By paying attention to possible confounders such as a history of other diseases, individual practice of healthy habits, and physical health parameters, the study fills a knowledge gap and provides stronger evidence.

    Community-level and multidisciplinary clinical support systems should be studied as a possible intervention to reduce this risk for spouses of CVD patients through a wide-spectrum preventive care approach.

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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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  • Hypertensive disorders in pregnancy strongly associated with cardiovascular mortality after giving birth

    Hypertensive disorders in pregnancy strongly associated with cardiovascular mortality after giving birth

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    Rutgers Health researchers have found that hypertensive disorders in pregnancy are strongly associated with fatal cardiovascular disease for up to a year after birth.

    Among the hypertensive disorders that cause dangerously high blood pressure during pregnancy -; chronic hypertension, gestational hypertension, preeclampsia without severe features, preeclampsia with severe features, superimposed preeclampsia and eclampsia -; all but gestational diabetes were associated with a doubling in the risk of fatal cardiovascular disease compared to women with normal blood pressure.

    Eclampsia, a condition whereby hypertensive disorders cause seizures, was associated with a nearly 58-fold increase in fatal cardiovascular disease, according to a study published in Paediatric and Perinatal Epidemiology.

    “Maternal and postpartum mortality rates in the U.S. are higher than in other high-income countries and rising, but more than half of cardiovascular disease-related deaths are preventable,” said lead author Rachel Lee, a data analyst at Rutgers Robert Wood Johnson Medical School. “This study provides new information about how each hypertensive disorder is related to fatal cardiovascular disease, so healthcare providers can monitor patients with such complications more closely and develop strategies for keeping them healthy postpartum.”

    The researchers used the Nationwide Readmissions Database to examine pregnancy-related mortality rates for females 15 to 54 years old from 2010 to 2018. Data from more than 33 million delivery hospitalizations identified hypertensive disorders in 11 percent of patients, but that number increased with time. In 2010, 9.4 percent of patients in the study had hypertensive disorders of pregnancy. By 2018, that figure had risen by more than half to 14.4 percent.

    We’ve gotten better at predicting, diagnosing, and treating preeclampsia in this country, so the risk of death is falling for any individual patient with that condition.”


    Cande Ananth, Chief of the Division of Epidemiology and Biostatistics in the Department of Obstetrics, Gynecology, and Reproductive Sciences at Rutgers Robert Wood Johnson Medical School and senior author of the study

    Unfortunately, Ananth noted, the sharp increase in the number of patients who develop chronic hypertension has more than offset the improved ability to treat it.

    “Cases of chronic hypertension are rising sharply among people of childbearing age, but optimal treatment strategies remain uncertain,” he said. “While we’re treating more pregnant people with mild hypertension with antihypertensive medications, there remain many questions about the right definitions of hypertension in pregnant compared to non-pregnant individuals.”

    Pregnant people with hypertensive disorders, especially those with pre-existing hypertension, need high-quality care as heart disease and related cardiac symptoms can be confused with common symptoms of normal pregnancy. Delays in diagnosis are associated with an increased incidence of preventable complications, the study authors said. Early identification and optimal treatment of hypertensive disorders, especially preeclampsia-eclampsia, are crucial for the primary prevention of maternal stroke.

    Guidelines for ongoing care for up to one year after delivery are needed for each hypertensive disorder, the researchers conclude.

    Source:

    Journal reference:

    Lee, R., et al. (2024). Pregnancy‐associated mortality due to cardiovascular disease: Impact of hypertensive disorders of pregnancy. Paediatric and Perinatal Epidemiology. doi.org/10.1111/ppe.13055.

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  • Study aims to explore the underlying causes of excessive alcohol production in overweight people

    Study aims to explore the underlying causes of excessive alcohol production in overweight people

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    The microorganisms in the intestines of many overweight people produce alcohol to an increased extent, as Max Nieuwdorp, professor of Internal Medicine at Amsterdam UMC discovered a few years ago. Breaking down that excessive alcohol leads to fatty liver, which in turn increases the risk of serious diseases such as diabetes and cardiovascular disease. Nieuwdorp has now received an ERC Advanced grant of 2.5 million euros for a major study into the underlying causes of excessive alcohol production. Ultimately, he hopes to find a way to prevent excess alcohol produced in the intestines, and thus the related diseases. In 2022, Nieuwdorp and his team published a study in Nature Medicine on alcohol production in the intestines of overweight patients. “Our findings showed that the turnover of sugars in the intestines of these patients releases far too much alcohol, equivalent to almost half a litre of whisky of alcohol. This is because the composition of the microbiome in their small and large intestines is disrupted. It seems that a change in acidity plays a role in this,” Nieuwdorp explains. 

    Liver has to work hard

    For patients, large quantities of alcohol in the intestines can have major consequences. “The liver, as with alcohol from liquor, has to work hard to breakdown the alcohol, and that is done by storing it as fat. This causes people to develop a fatty liver disease that can eventually become inflamed and lead to serious conditions such as cirrhosis of the liver and cardiovascular disease,” says Nieuwdorp.  

    Almost 1 in 5 adults in the Netherlands are overweight and more than 80% of them have fatty liver. Nieuwdorp suspects that the high quantities of sugar in our modern diet can lead to increased alcohol production in the intestines. With the European money from the ERC Advanced grant, he will investigate this further, for example by analyzing the medical data and eating patterns of participants in the long-term HELIUS study.  

    Bacteria in the gut  

    Nieuwdorp hopes that the discovery of the increased alcohol production due to the disrupted microbiome in the intestines will create a new path in the search for a way to treat fatty liver disease and liver inflammation. For example, he wants to see if it is possible to control alcohol production in the intestines by equipping bacteria in the intestine with properties that allow them to breakdown more alcohol.

    But whether and how that actually works is still unknown. That’s what we’re going to investigate in this FATGAP-project.”

    Max Nieuwdorp, Professor of Internal Medicine at Amsterdam UMC

    Source:

    Amsterdam University Medical Center

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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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  • Eating Mediterranean-style during pregnancy linked to healthier moms and babies

    Eating Mediterranean-style during pregnancy linked to healthier moms and babies

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    The Mediterranean diet (MD) is universally recognized as a healthy and effective aid to managing body weight and overall health. A recent study published in Advances in Nutrition explores available evidence on how consuming the MD during pregnancy affects perinatal health.

    Study: Association between the maternal mediterranean diet and perinatal outcomes: a systematic review and meta-analysis. Image Credit: NDAB Creativity / Shutterstock.com Study: Association between the maternal Mediterranean diet and perinatal outcomes: a systematic review and meta-analysis. Image Credit: NDAB Creativity / Shutterstock.com

    The health benefits of MD

    The MD is associated with a high consumption of whole grains, vegetables, legumes, nuts, fish, olive oil, and fruits. Rich in antioxidants and anti-inflammatory compounds, the MD has been shown to prevent and treat cardiovascular disease (CVD), metabolic disease, autoimmune conditions, poor mental health, and cancers. The MD also reduces overall mortality rates and promotes a healthy aging pattern.

    The maternal diet can significantly impact the health of both the mother and fetus during pregnancy and thereafter. Thus, an adequate and high-quality maternal diet is essential for fetal growth and metabolic and physiological homeostasis.

    Many studies have investigated the importance of dietary and nutritional status during pregnancy, which can help prevent conditions like gestational diabetes mellitus (GDM), preterm delivery, and perinatal illness.

    Previous studies have indicated an improvement in metabolic health when following the MD; however, there is a lack of meta-analyses on this topic. Additionally, not all available randomized controlled trials (RCTs) have been included.

    The combined use of interventional, observational, prospective, and cross-sectional studies has increased concerns regarding the potential impact of recall bias and reverse causality. As a result, there is limited evidence on the association of the MD with metabolic health in pregnancy, which motivated the current study.

    Study findings

    In the current study, researchers reviewed 23 articles, including five RCTs and 18 cohort studies, in their systematic meta-analysis. These studies comprised 107,355 individuals from 10 different countries, including the United Kingdom, Spain, China, the United States, Greece, Norway, Denmark, Australia, and the Netherlands. Notably, almost every study relied on the food frequency questionnaire (FFQ) to obtain dietary intake information.

    The five RCTs reported a significantly reduced risk of GDM and small for gestational age (SGA) babies. Similar results were observed in the cohort studies, in which the MD was associated with a reduced risk of GDM, pregnancy-induced hypertension, pre-eclampsia, preterm delivery, low birth weight (LBW), and intrauterine growth restriction (IUGR) was observed, along with an increase in gestational age at delivery. A significant correlation was also observed between maternal MD and the incidence of preterm delivery.

    The greatest uniformity was observed for the association between MD adherence and pregnancy-linked hypertension, preterm delivery, and LBW. In two studies that accounted for confounding factors, the likelihood of pregnancy-linked hypertension was reduced by 30% among those on the MD. This was also observed in non-Mediterranean countries, but not when only Mediterranean countries were included.

    Similarly, the risk of preterm delivery among mothers who followed the MD was significantly reduced after considering potential confounding factors. However, the other parameters failed to show significant associations after such an adjustment.

    The pooled results demonstrate that following the MD during pregnancy reduces the risk of GDM and SGA in intervention studies. Cohort studies show that the MD produces positive effects in almost all outcomes, such as better metabolic health, reduced risk of pregnancy hypertension, increased birth weight, and higher gestational age at delivery.

    The underlying mechanisms responsible for the perinatal benefits of the MD may include the high antioxidant and anti-inflammatory content of this diet. Importantly, low-carbohydrate plant-based nutrition helps achieve satiety sooner, thereby supporting healthy weight management, particularly during pregnancy. By reducing systemic inflammation, this may help reduce the risk of preterm labor and high blood pressure during pregnancy, as well as of GDM.

    Conclusions

    Our meta-analysis solely focuses on robust evidence from RCTs and cohort studies, providing a comprehensive perspective on the potential associations between the maternal MD and both maternal and offspring outcomes.”

    Future studies need to include different types of evidence to determine the role of other confounding factors not considered in the studies included in the current meta-analysis. Larger study samples are also crucial to ensure the power to detect these effects and guide clinical recommendations for diet during pregnancy.

    Journal reference:

    • Xu, J., Wang, H., Bian, J., et al. (2024). Association between the maternal mediterranean diet and perinatal outcomes: a systematic review and meta-analysis. Advances in Nutrition 15(2). doi:10.1016/j.advnut.2023.100159.

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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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