Tag: Cardiovascular Disease

Study finds elevated sodium consumption in heart disease patients

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Individuals with heart disease stand to gain the most from a low-sodium diet but, on average, consume over twice the recommended daily sodium intake, according to a study being presented at the American College of Cardiology’s Annual Scientific Session.

Sodium is an essential nutrient, but consuming too much can raise blood pressure, which damages blood vessels and forces the heart to work harder. Excess sodium can also cause the body to retain fluid, exacerbating conditions like heart failure. The current U.S. Dietary Guidelines put out by the U.S. Department of Agriculture recommends most adults limit their sodium intake to less than 2,300 mg/day, which is equivalent to about 1 teaspoon of table salt. For individuals with cardiovascular diseases, the limit is even lower at 1,500 mg/day, according to guideline recommendations from the ACC and the American Heart Association.

This new study found that among a sample of more than 3,100 people with heart disease, 89% consumed more than the recommended daily maximum of 1,500 mg of sodium and, on average, study participants consumed more than twice this amount. Limiting sodium intake is a fundamental lifestyle modification shown to reduce the likelihood of subsequent major adverse cardiovascular events, researchers said. Their findings underscore the challenges many people face in keeping within recommended sodium limits, regardless of other factors such as socioeconomic status.

Estimating sodium quantities in a meal can be challenging. Food labels aid in dietary sodium estimation by providing sodium quantities in packaged food. Yet, adhering to a low sodium diet remains challenging even for individuals with cardiovascular disease who have a strong incentive to adhere.”

Elsie Kodjoe, MD, MPH, internal medicine resident at Piedmont Athens Regional Hospital in Athens, Georgia, and study’s lead author

The study used data from patients diagnosed with a heart attack, stroke, heart failure, coronary artery disease or angina who participated in the National Health and Nutrition Examination Survey (NHANES) between 2009–2018.

Researchers estimated sodium intake based on questionnaires in which participants were asked to report everything they had consumed in 24 hours. According to the results, study participants with cardiovascular disease consumed an average of 3,096 mg of sodium per day, which is slightly lower than the national average of 3,400 mg/day reported by the U.S. Centers for Disease Control and Prevention.

“The relatively small difference in sodium intake suggests that people with cardiovascular disease are not limiting their intake very much compared with the general population and are also consuming more than double what is recommended,” Kodjoe said. “To make it easier for patients to adhere to dietary guidelines, we need to find more practical ways for the general public to estimate dietary sodium levels or perhaps consider a reduction in the sodium content of the food we consume right from the source.”

The researchers also compared sodium intake among people in different socioeconomic groups, but they did not find any significant differences between wealthier and less affluent participants after accounting for age, sex, race and educational attainment.

Individuals can take proactive measures to lower their sodium intake, Kodjoe said. This includes preparing more meals at home where they have greater control over the sodium content and paying close attention to food labels, particularly targeting foods with sodium levels of 140 mg or less per serving. Researchers suggested that better education around the benefits of limiting sodium could also help motivate more people to follow the recommendations.

“Cardiovascular disease is real, and it is the number one cause of morbidity and mortality worldwide according to the World Health Organization,” Kodjoe said. “Adhering to sodium guidelines is one of the easier strategies individuals could readily adopt to reduce hospitalizations, health care costs, morbidity and mortality associated with cardiovascular disease.”

One limitation of the study is that sodium intake was estimated based on food recall questionnaires, rather than 24-hour urine sodium measurements, which is considered the gold standard method. NHANES has included 24-hour urine sodium measurements in its data gathering methods in recent survey cycles, so future studies using this data could provide a more accurate assessment of sodium intake among people with cardiovascular disease.

Source:

American College of Cardiology

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April 2, 2024
Heavy drinkers who cut back see major heart health benefits, study finds

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In a recent study published in JAMA Network Open, a group of researchers explored the link between lowering alcohol intake and the occurrence of major adverse cardiovascular events (MACEs) in heavy drinkers, focusing on different subtypes of cardiovascular disease (CVD).

Study: Reduced Alcohol Consumption and Major Adverse Cardiovascular Events Among Individuals With Previously High Alcohol Consumption. Image Credit: Vaclav Mach / Shutterstock

Background

Alcohol consumption significantly influences both individual and public health, with research showing its complex relationship with CVD. While light to moderate drinking is believed to offer some protection against CVD, this effect varies by the type of CVD, and the relationship between alcohol intake and heart health is not linear. Previous studies have typically measured alcohol consumption at a single point in time and compared drinkers to non-drinkers without considering changes in drinking habits over time. Further research is essential to understand the mechanisms underlying the cardiovascular benefits of reduced alcohol consumption and to establish tailored guidelines for different populations and CVD subtypes.

About the study

In the present study, researchers utilized data from the Korean National Health Insurance Service–Health Screening (NHIS-HEALS) database to examine a representative sample of Korean adults aged 40 to 79. Approved by Chungbuk National University Hospital’s institutional review board (IRB) and adhering to the Declaration of Helsinki and Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines, the study utilized the National Health Screening Program’s (NHSP’s) broad coverage to analyze information on demographics, medical histories, and lifestyle factors, including alcohol consumption. This careful documentation provided a foundation for a detailed investigation into the effects of alcohol on health.

Participant selection was methodical, excluding non-drinkers in the latter period to avoid confounding factors like the sick-quitter effect. The study’s rigor extended to defining heavy drinking based on established criteria and dividing participants into groups based on their drinking habits over time.

Confounding variables were identified with precision, including a range of demographic, health, and lifestyle factors. The study’s outcomes centered on MACEs, with detailed coding and procedures to ensure accuracy. Statistical analyses were conducted with sophisticated tools and methods, including propensity score matching (PSM) and multivariate Cox proportional hazards regression models, to draw reliable conclusions about the relationship between alcohol consumption and cardiovascular health.

Study results

In the comprehensive study analyzing 21,011 participants with initially high alcohol consumption levels, 14,220 maintained their heavy drinking habits, while 6,791 reduced their intake to mild or moderate levels. Predominantly male (90.3%) and averaging 56 years of age, this cohort provided a detailed snapshot of baseline health and lifestyle characteristics. Initially, the heavy drinkers were younger on average and had a higher proportion of males compared to those who reduced their alcohol consumption.

Clinical indicators such as body mass index (BMI), blood pressure, and various biochemical markers showed differences between the groups, with the sustained heavy drinkers generally presenting poorer health metrics. Interestingly, despite the health disparities, after PSM, these groups were closely aligned on most variables, allowing for a more accurate comparison of outcomes.

Over the course of the study, the incidence of MACEs was notably higher in the group that continued heavy drinking compared to those who reduced their intake, with a significant divergence in outcomes over time. Specifically, reduced drinking was associated with a 23% lower risk of experiencing a MACE. When examining specific CVDs, reductions in alcohol consumption significantly lowered the risk of coronary artery disease (CAD), angina, any stroke, ischemic stroke, and all-cause mortality, while no benefits were observed for nonfatal myocardial infarction (MI) or hemorrhagic stroke.

Subgroup analyses highlighted the cardiovascular advantages of reducing alcohol intake across various demographics and health statuses, including age, gender, BMI, smoking status, and levels of physical activity. Notably, these benefits were evident regardless of pre-existing conditions like atrial fibrillation and chronic kidney disease and were consistent across different socioeconomic statuses and comorbidities.

Further sensitivity analyses, which excluded variables potentially modifiable by alcohol consumption changes, reaffirmed the cardiovascular benefits of reducing alcohol intake.

Conclusions

To summarize, in the study, heavy drinkers who reduced their alcohol intake demonstrated a significantly lower risk of cardiovascular events over a decade, with notable health improvements visible three years post-reduction. This reduction in alcohol consumption correlated with a broad array of cardiovascular benefits, especially in lowering the risk of ischemic stroke and angina-related interventions. The study clarifies the complex biological mechanisms through which moderate alcohol consumption may confer cardiovascular protection, highlighting improvements in lipid regulation, endothelial function, and reduced inflammation. Importantly, it revealed specific reductions in CAD and ischemic stroke risk among heavy drinkers, underlining the potential health benefits of moderating alcohol intake.

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April 1, 2024
Research identifies optimal body weight to reduce cardiovascular risk in diabetes patients

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New research being presented at this year’s European Congress on Obesity (ECO) in Venice, Italy (12-15 May), identifies the optimum body weight range for adults with type 2 diabetes to minimize their risk of dying from any cardiovascular disease, including heart failure, heart disease, stroke, and chronic kidney disease.

The findings, based on health data from the UK Biobank, indicate that for adults aged 65 years or younger, maintaining a body mass index (BMI) within the normal range of 23–25 kg/m² was associated with the lowest risk of dying from cardiovascular disease. But for those over 65 years old, being moderately overweight with a BMI of 26–28 kg/m², had the lowest risk.

Maintaining a healthy weight is crucial for reducing the risk of cardiovascular diseases, particularly for people with type 2 diabetes who are predisposed to cardiovascular disease and death. However, it’s not clear whether the optimal BMI range for people with type 2 diabetes varies by age.

To plug these knowledge gaps, researchers explored the age differences in the association between BMI and risk of cardiovascular death in 22,874 UK Biobank participants with a previous diagnosis of type 2 diabetes at the time they enrolled between 2006 and 2010. Patients with prior cardiovascular diseases were not excluded.

The average age of all the participants was 59 years, and around 59% were women. Their cardiovascular health was tracked, using linked health records, for nearly 13 years during which time 891 participants died from cardiovascular diseases.

Researchers analyzed data in two age groups-;the elderly (over 65 years) and the middle-aged (age 65 years or younger)-;and assessed the relationship between variables such as BMI, waist circumference, and waist-to-height ratio and the risk of cardiovascular death.

The optimal BMI cut-off point was also calculated in different age groups and the findings were adjusted for traditional cardiometabolic risk factors and other factors associated with adverse cardiovascular outcomes including age, sex, smoking history, alcohol consumption, level of physical exercise, and history of cardiovascular diseases.

The analyses found that in the middle-aged group, having a BMI in the overweight range range (25 kg/m² to 29.9 kg/m²) was associated with a 13% greater risk of dying from cardiovascular disease than those with a BMI in the normal range (less than 25.0 kg/m²).

However, in the elderly group, having a BMI in the overweight range (25 kg/m² to 29.9 kg/m²) was associated with an 18% lower risk of dying compared to having a BMI in the normal range (less than 25.0 kg/m²).

The relationship between BMI and cardiovascular death risk exhibited a U-shaped pattern, even after stratification by age, so the optimal BMI cut-off point was different in the elderly and middle-aged groups. For the middle-aged group, the optimal BMI cut-off was 24 kg/m², whereas for the elderly group, it was 27 kg/m². Consequently, personalized treatment plans can be developed in clinical settings by tailoring recommendations to different age groups.

The researchers also found a positive relationship between both waist circumference and waist-to-height ratio and the risk of cardiovascular death. As waist circumference increased, the risk of cardiovascular death also showed a corresponding rise. When the study population was divided into older and middle-aged categories, this upward trend remained consistent. Similar patterns were observed for the waist-to-height ratio. However, no significant BMI cut-off point was identified.

Importantly, we demonstrate that optimal BMI for people with type 2 diabetes varies by age, independent of traditional cardiometabolic risk factors. Our findings suggest that for older individuals who are moderately overweight but not obese, maintaining rather than losing weight may be a more practical way of reducing their risk of dying from cardiovascular disease.”

Dr Shaoyong Xu, lead author from Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China

He adds, “Our findings also indicate that adiposity may offer some protection against fatal diseases to some extent. The possible biological mechanisms that explain this ‘obesity survival paradox’ in elderly people may be associated with a lower rate of bone mass loss, which reduces the effects of fall and trauma episodes, and greater nutritional reserves to accommodate periods of acute stress.”

The authors say that in the future, measures of central obesity, such as waist circumference, would be used to further refine the risk.

This is an observational study, and as such, can’t establish cause. And the researchers acknowledge various limitations to their findings, including small numbers of cardiovascular deaths and no information on type of cardiovascular disease or specific treatments. They also note that most of the UK Biobank study participants are White, so the findings might not apply to people of other ethnic backgrounds. Also, the nature of the cohort study may create potential classification errors that could partially affect the conclusions, because anthropometric measurements were only assessed at the start of the study, and body weight may change during the follow-up period.

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March 30, 2024
Trial shows blood pressure drops with less sitting

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In a recent study published in JAMA Network Open, researchers investigated whether reducing sitting time could effectively improve blood pressure (BP) among older adults.

Study: Sitting Time Reduction and Blood Pressure in Older Adults. Image Credit: insta_photos/Shutterstock.com

Background

Sedentary behavior is associated with adverse health outcomes such as cardiovascular disease, type 2 diabetes, low physical function, and death. Moderate to moderate activity can benefit older adults’ cognitive, physical, functional, and emotional health; however, their compliance with physical activity is poor, with most of them sitting for much of the day.

Identifying modifiable variables is critical to improving cardiometabolic fitness in older individuals. Short-term experimental investigations demonstrate that lowering sitting duration reduces blood pressure, particularly in hypertensive individuals.

About the study

In the present randomized controlled trial, researchers evaluated the impact of sitting time reduction on BP readings in the geriatric population.

The team conducted the Healthy Aging Resources to Thrive (HART) trial primarily remotely at the state level during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic between January 2019 and November 2022.

Participants included adult Kaiser Permanente Washington (KPWA) care recipients, enrolled for at least a year, aged between 60 and 89 years, sitting for ≥6.0 hours daily, and a body mass index (BMI) ranging between 30 and 50 kg/m2.

The researchers excluded palliative, long-term, or hospice care recipients, those with cancer, deafness or considerable hearing impairment, degenerative disorders such as dementia, or adverse mental health conditions in the previous two years, diagnosed using the International Statistical Classification of Diseases and Related Health Problems, tenth revision (ICD-10) codes.

The team randomized the participants in a 1:1 ratio to the sedentary behavior reduction intervention (I-STAND) or healthy living control conditions for six months.

The intervention group received ten health enhancement contacts, sedentary time reduction targets, and a fitness tracker. The controls received ten health training contacts to establish broad healthy living objectives that excluded physical activity and sedentary behavior.

The primary study outcome was sitting duration recorded at study initiation, three months, and six months, using accelerometers for a week at every time point. The researchers monitored systolic BP (SBP) and diastolic BP (DBP) at study initiation and after six months.

The exploratory outcomes included changes in accelerometer standing and walking time, daily step count, number of sitting bouts of ≥30 minutes, mean sitting bouts’ duration, time to perform five chair stands from the Short Physical Performance Battery, and changes in hypertension medication classes.

The researchers performed linear regression modeling for analysis, with study covariates such as age, sex, race, ethnicity, residence county, physical function, retirement status, diabetes, and hypertension.

They also performed a sensitivity analysis, separately analyzing data obtained before and during coronavirus disease 2019 (COVID-19).

Results

The researchers randomized 283 individuals to the I-STAND intervention (n=140) and control (n=143) groups. The mean participant age was 69 years, 186 (66%) were female, and the mean BMI was 35 kg/m2.

At study initiation, 52% (n=147) suffered from hypertension, and 69% (n=97) consumed one or more antihypertensive medications. Accelerometer awake time was nearly 16 hours daily over a week of wear in the study groups.

The team noted sedentary time reduction in favor of the I-STAND intervention, with an average difference of 31 minutes per day at three months and 32 minutes per day at six months.

The intervention group had a considerably higher mean drop in SBP (3.5 mm Hg) after six months. However, DBP changes were not significantly different across the study groups (0.3 mm Hg).

The sensitivity analysis showed similar results. The study found six major adverse events in both the I-STAND intervention group (two cancer diagnoses, one emergency department admission, two hospitalizations, and one fall) and the control group.

However, there were no adverse events associated with the trial. They found no significant intergroup variations in BMI, waist circumference, or body weight.

The study found that standing time rose while sitting bouts’ duration and extended sitting bouts were reduced after six months, favoring the intervention group. Changes in antihypertensive drug classes in both groups were not significant.

Women had significantly lower diastolic blood pressure than men, but the impact was minor. Participants in suburban and rural locations demonstrated minor improvements in diastolic blood pressure, supporting the research intervention.

Conclusion

The study findings revealed that lowering sitting time may be successfully provided remotely, resulting in considerable blood pressure decreases. The intervention, which involved 283 older individuals, decreased sitting duration by >30 minutes per day and SBP by about 3.5 mm Hg.

The findings indicate that sitting time reduction by standing more and taking more frequent breaks may be a unique lifestyle option for decreasing blood pressure that is simpler for older individuals with chronic diseases to implement into their everyday lives.

Possible physiological causes for SBP decreases include frequent interruptions to the bent arterial posture, which may enhance blood flow and vascular shear stress.

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March 29, 2024
Statins linked to slight diabetes risk but benefits outweigh the concerns
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In a recent study published in The Lancet Diabetes & Endocrinology, a large collaborative team of researchers investigated the factors associated with the increased risk of diabetes due to statin use, such as the types of individuals or populations that are at greater diabetes risk due to statin therapy, at what point after beginning statin therapy does the risk increase, and whether the use of statins has an impact on the glycemic control of known diabetes patients.

Study: Effects of statin therapy on diagnoses of new-onset diabetes and worsening glycaemia in large-scale randomised blinded statin trials: an individual participant data meta-analysis. Image Credit: Fahroni / Shutterstock

Background

One of the leading causes of mortality across the world is cardiovascular disease, with low-density-lipoprotein (LDL) cholesterol being the major risk factor for atherosclerotic cardiovascular disease. The risk of atherosclerosis also increases significantly in diabetic patients. Treatment with statins such as 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitor is believed to decrease the incidence of ischemic stroke and myocardial infarction by one-fourth for a reduction of 1 mmol/L LDL cholesterol reduction.

However, findings from recent meta-analyses have indicated that standard regimens of statin therapy are linked to a 10% increase in new-onset diabetes risk, as compared to usual care for hypercholesteremia or placebo. The risk of new-onset diabetes was also found to be higher with more intense regimens of statin therapy. However, aspects of this association between statin use and diabetes risk, such as the populations at greater risk and the impact of statin use on individuals already diagnosed with diabetes, remain unclear.

About the study

In the present study, the researchers obtained information on adverse events related to diabetes, diabetes treatments, and records of glycemia measurements from participants registered in the Cholesterol Treatment Trialists’ Collaboration, which consisted of double-blinded, long-term, randomized controlled trials evaluating statin therapy.

This study included statin therapy trials if they had a minimum of a thousand participants with a mean follow-up period of two years. Furthermore, the only differences mandated in the protocol of these trials had to be in the administration of statin therapy or placebo or the intensity of statin therapy. The individual participant data, which also included information on comorbidities, anthropometric measurements, and laboratory results for blood glucose tests, was used for a meta-analysis.

The adverse events related to diabetes that were considered in the analysis included a diagnosis of diabetes, complications related to diabetes, such as glucose control and ketosis, or any other complications specific to diabetes. The medications for lowering glucose levels were identified from the prescription information using a standard drug dictionary, and fasting status was used to categorize the glucose concentrations.

A history of diabetes, the occurrence of any diabetes-related adverse event, fasting blood glucose levels of 7 mmol/L or above, or the use of medications to lower blood glucose before the registration or assignment of the participant to the trial was used to define baseline diabetes. In those without baseline diabetes, the occurrence of any adverse event related to diabetes, a higher than the standard cut-off of blood glucose, or the use of any medication to lower blood glucose levels after the commencement of the trial were considered as new-onset diabetes diagnoses.

Results

The study found that statin use was indeed linked to an increase in new-onset diabetes, although the association was moderate and dose-dependent. Furthermore, while a slight increase in glycemia was observed after statin treatment, most of the diagnoses for new-onset diabetes were in individuals whose baseline glycemic markers were already quite close to the threshold for diagnosing diabetes.

The potential increase in cardiovascular disease risk that could occur due to the marginal increase in glycemia was accounted for in the significant decrease in cardiovascular risk brought about by lowering LDL cholesterol due to statin therapy. Additionally, the impact of statin therapy on glycemic control in individuals with diabetes was not dissimilar from that observed in cases of new-onset diabetes.

The results also suggested that the incidence rates of new-onset diabetes were significantly higher for the trials involving high-intensity statin regimens in both the intervention and placebo groups, as compared to trials evaluating moderate or low-intensity statin regimens. The researchers believe this significant difference in event rates could be because the trials evaluating the high-intensity regimens had a higher follow-up frequency, including more frequent blood glucose tests.

Conclusions

Overall, the findings suggested that while statin therapy was associated with an increase in the rate of new-onset diabetes diagnoses, the association was moderate and dose-dependent. Furthermore, the risk of new-onset diabetes was higher in individuals whose glycemic markers were already quite close to the threshold for diagnosing diabetes. Any potential increase in cardiovascular disease risk due to the hyperglycemic effect of statins was mitigated by the overall reduction in cardiovascular risk due to statin therapy.
Journal reference:

Reith, C., Preiss, D., Blackwell, L., Emberson, J., Spata, E., Davies, K., … Marschner, I. (n.d.). Effects of statin therapy on diagnoses of new-onset diabetes and worsening glycaemia in largescale randomised blinded statin trials: an individual participant data meta-analysis. The Lancet Diabetes & Endocrinology. DOI: 10.1016/S22138587(24)000408, https://www.thelancet.com/journals/landia/article/PIIS2213-8587(24)00040-8/fulltext
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March 29, 2024
Google Street View predicts heart disease risk based on neighborhood features

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Researchers have used Google Street View to study hundreds of elements of the built environment, including buildings, green spaces, pavements and roads, and how these elements relate to each other and influence coronary artery disease in people living in these neighborhoods.

Their findings, published in the European Heart Journal today (Thursday), show that these factors can predict 63% of the variation in the risk of coronary heart disease from one area to another.

Coronary heart disease, where a build-up of fatty substances in the coronary arteries interrupts the blood supply to the heart, is one of the most common forms of cardiovascular disease.

Researchers say that using Google Street View can help provide an overview of physical environmental risk factors in the built and natural environments that could help not only in understanding risk factors in these environments, but ultimately help towards building or adapting towns and cities to make them healthier places to live.

The study was led by Prof. Sadeer Al-Kindi and Prof. Sanjay Rajagopalan from University Hospitals Harrington Heart & Vascular Institute and Case Western Reserve University, Ohio, USA, and Dr. Zhuo Chen, a post-doctoral fellow in Prof. Rajagopalan’s laboratory.

We have always been interested in how the environment, both the built and natural environment, influences cardiovascular disease. Here in America, they say that the zip code is a better predictor of heart disease than even personal measures of health. However, to investigate how the environment influences large populations in multiple cities is no mean task. Hence, we used machine vision-based approaches to assess the links between the built environment and coronary heart disease prevalence in US cities.”

Prof. Sanjay Rajagopalan from University Hospitals Harrington Heart & Vascular Institute and Case Western Reserve University, Ohio, USA

The study included more than half a million Google Street View images of Detroit, Michigan; Kansas City, Missouri; Cleveland, Ohio; Brownsville, Texas; Fremont, California; Bellevue, Washington State; and Denver, Colorado. Researchers also collected data on rates of coronary heart disease according to ‘census tracts’. These are areas smaller than a US zip code that are home to an average of 4,000 people. The researchers used an approach called a convolutional neural network; a type of artificial intelligence that can recognize and analyze patterns in images to make predictions.

The research revealed that features of the built environment visible on Google Street View images could predict 63% of the variation in coronary heart disease between these small regions of US cities.

Prof. Al-Kindi added: “We also used an approach called attention mapping, which highlights some of the important regions in the image, to provide a semi-qualitative interpretation of some of the thousands of features that may be important in coronary heart disease. For instance, features like green space and walkable roads were associated with lower risk, while other features, such as poorly paved roads, were associated with higher risk. However, these findings need further investigation.

“We’ve shown that we can use computer vision approaches to help identify environmental factors influencing cardiovascular risk and this could play a role in guiding heart-healthy urban planning. The fact that we can do this at scale is something that is absolutely unique and important for urban planning.”

“With upcoming challenges including climate change and a shifting demographic, where close to 70% of the world’s population will live in urban environments, there is a compelling need to understand urban environments at scale, using computer vision approaches that can provide exquisite detail at an unparalleled level,” said Prof. Rajagopalan.

In an accompanying editorial, Dr. Rohan Khera from Yale University School of Medicine, USA said: “The association of residential location with outcomes often supersedes that of known biological risk factors. This is often summarised with the expression that a person’s postal code is a bigger determinant of their health than their genetic code. However, our ability to appropriately classify environmental risk factors has relied on population surveys that track wealth, pollution, and community resources.

“The study by Chen and colleagues presents a novel and more comprehensive evaluation of the built environment. This work creatively leverages Google’s panoramic street-view imagery that supplements its widely used map application.

“… an AI-enhanced approach to studying the physical environment and its association with cardiovascular health highlights that across our communities, measures of cardiovascular health are strongly encoded in merely the visual appearance of our neighborhoods. It is critical to use this information wisely, both in defining strategic priorities for identifying vulnerable communities and in redoubling efforts to improve cardiovascular health in communities that need it most.”

Source:

European Society of Cardiology

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March 28, 2024
Exercise could be the cure to your insomnia
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In a recent study published in the journal BMJ Open, an international team of researchers conducted a longitudinal study over 10 years to understand the association between physical activity and sleep duration, daytime sleepiness, and current insomnia symptoms in adults.

Study: Association between physical activity over a 10-year period and current insomnia symptoms, sleep duration and daytime sleepiness: a European population-based study. Image Credit: Ground Picture/Shutterstock.com

Background

Adequate sleep is one of the major aspects of life and health that has suffered due to the fast-paced nature of modern lives and an increase in the use of electronic devices such as mobile phones.

Sleep disturbance and insomnia have a direct impact on overall health, can increase the risk of metabolic dysfunction, cardiovascular disease, and psychiatric disorders, and impact the quality of life.

Physical activity or exercise is known to improve sleep quality, reduce symptoms of insomnia, and benefit overall health. Exercise has been associated with reduced daytime sleepiness, and low levels of physical activity are believed to increase daytime sleepiness.

However, factors such as age, gender, body mass index (BMI), general state of health, fitness levels, and type of physical activity can moderate the association between exercise and sleep quality through numerous psychological and physiological pathways.

Furthermore, there is a dearth of long-term data from studies involving large cohorts, making it difficult to decipher whether the positive impact on sleep outcomes is due to higher physical activity levels, or inadequate physical activity is due to disturbed sleep.

About the study

In the present study, the researchers aimed to assess whether the frequency, intensity, and duration of physical activity were interrelated with daytime sleepiness, disturbed sleep, and symptoms of insomnia.

The study was conducted across nine countries, twice over a span of 10 years, among adults between the ages of 39 and 67 years.

The data for this study was obtained from two follow-ups of the European Community Respiratory Health Survey. Assessments of physical activity levels were conducted using participant responses to questionnaires.

The queries aimed at determining how often the participants exercised, and the number of hours per week they needed to exercise to get to a stage where they were sweaty or out of breath.

A minimum of one hour of physical activity a week or an exercise frequency of twice a week or more was considered physically active.

Based on the change in physical activity levels between the two follow-ups, the participants were grouped into four categories — those who remained non-active, those who went from active to inactive, those who became more active, and those who maintained their physical activity levels over the 10 years of follow-up.

The Basic Nordic Sleep Questionnaire was used to evaluate the symptoms related to disturbed sleep and insomnia. These questions addressed the occurrence and frequency of symptoms such as difficulty initiating or maintaining sleep, as well as awakening too early in the morning.

The Epworth Sleepiness Scale was used to assess daytime sleepiness. Additionally, the average sleep duration was used to classify the participants into short, normal, and long sleepers based on more than six hours, between six and nine hours, and more than nine hours of sleep, respectively.

Results

The results showed that adequate physical activity was associated with a lower incidence of either short or long sleep durations and decreased risk of some symptoms of insomnia.

Individuals who maintained adequate physical activity levels through the 10 years of follow-up were found to be less likely to report symptoms of insomnia during the follow-up.

Furthermore, persistently active individuals also reported achieving the recommended six to nine hours of sleep, and these associations were found to be significant even after adjusting for confounders such as age, sex, BMI, and smoking behavior.

On average, individuals who were persistently active over the 10 years of follow-up had lower BMI, were younger, and were male. They were also less likely to be smokers and more likely to be currently employed.

Although daytime sleepiness or symptoms such as difficulty maintaining sleep were not found to be linked to physical activity levels, smoking behavior was found to have independent associations with daytime sleepiness.

Conclusions

Overall, the findings suggested that consistent, long-term physical activity can decrease the risk of various insomnia symptoms and help achieve adequate sleep.

Furthermore, although physical activity levels did not seem to impact the occurrence of daytime sleepiness, lifestyle factors such as smoking behavior were associated with daytime sleepiness.
Journal reference:

Bjornsdottir E., Thorarinsdottir E.H., Lindberg E., et al. (2024). Association between physical activity over a 10-year period and current insomnia symptoms, sleep duration and daytime sleepiness: a European population-based study. BMJ Open. doi:https://doi.org/10.1136/bmjopen-2022-067197.
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March 27, 2024
Environmental and social adversities double heart disease risk
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People who live in areas with social and environmental adversities may have up to twice the increased risk for developing heart disease and stroke, according to new research published today in the Journal of the American Heart Association, an open access, peer-reviewed journal of the American Heart Association.

In this study, environmental adversities included air and water pollution, potentially hazardous or toxic sites, few recreational parks, and high traffic roads, railways or airports. Social vulnerabilities were defined as racial and ethnic minority status; socioeconomic factors such as income, education and employment levels; housing status; and access to internet and health care.

“Our study is one of the first to examine the impact of both social and environmental factors in combination and looked at the complex interplay between them,” said the study’s senior author Sarju Ganatra, M.D., a cardiologist and vice chair in the department of medicine for research and director of the Cardio-Oncology Program and South Asian Cardio-Metabolic Program at Lahey Hospital and Medical Center in Burlington, Massachusetts.

This study used the Environmental Justice Index -; developed with data from the U.S. Census Bureau, the U.S. Environmental Protection Agency, U.S. Mine Safety and Health Administration and the U.S. Centers for Disease Control and Prevention -; to rate environmental disadvantages across all U.S. census tracts.

The analysis found:
- People living in the most environmentally vulnerable neighborhoods had 1.6 times the rate of blocked arteries and more than twice the rate of stroke compared to people living in the least environmentally vulnerable neighborhoods.
- Cardiovascular disease risk factors were higher in the most vulnerable areas with twice the rate of Type 2 diabetes, 1.8 times higher rates of chronic kidney disease, and 1.5 times higher incidence of high blood pressure and obesity.
- About 30% of all U.S. residents aged 18-44, 21% of Black adults and most Hispanic adults resided in places with alarmingly high environmental burdens.
“I was amazed to see the tight links and complex interplay between social and environmental factors on health outcomes. We were able to demonstrate their ‘dual hit’ on health outcomes. And beyond that, we were more amazed by the fact that even after adjusting for socioeconomic factors, environmental factors played a crucial and independent role in determining various heart disease and other related health outcomes,” Ganatra said.

According to researchers, reversing the impact of social and environmental disadvantages will require a multi-pronged approach with interventions to reduce pollution exposure and policies that address the causes of poverty, urban revitalization, high quality public education, job creation programs and affordable housing, along with steps to ensure universal access to quality health care.

Our aim is to empower the health care community to better inform patients about environmental factors they encounter daily. Patients, in turn, gain the ability to reduce their exposure to harmful environmental conditions, such as exposure to harmful chemicals and air pollutants to minimize health hazards and mitigate health risks.”

Sarju Ganatra, M.D., cardiologist and vice chair in the department of medicine for research and director of the Cardio-Oncology Program and South Asian Cardio-Metabolic Program at Lahey Hospital and Medical Center in Burlington, Massachusetts

A March 2024 American Heart Association Policy Statement, Adapting cities for heart-healthy, sustainable living requires integrated public policies, addresses the impact of urban provisioning systems – those that provide energy, mobility, housing, green infrastructure, water and waste management – on the cardiovascular and metabolic health of people who live in urban communities nationwide.

Study background and details:
- The study used the 2022 Environmental Justice Index, socio-environmental justice index, and an environmental burden module to rank census tracts from least vulnerable to most vulnerable to determine the cumulative impact of environmental injustice for more than 71,000 census tracts in the U.S.
- Age-adjusted rate ratios of blocked arteries, strokes and various health measures reported in the Prevention Population-Level Analysis and Community Estimates (PLACES) data were compared between the index and module rankings. The population estimates were taken from the 2015-2019 American community survey.
Study limitations include that it cannot prove cause and effect due to the nature of the database. However, the study’s findings show strong associations.

Source:

American Heart Association

Journal reference:

Khadke, S., et al. (2024) Association of Environmental Injustice and Cardiovascular Diseases and Risk Factors in the United States. Journal of the American Heart Association. doi.org/10.1161/JAHA.123.033428.
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March 27, 2024
Inflammatory responses fuel cardiovascular complications

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In a recent study published in the journal Circulation, researchers investigate the inflammatory response to acute respiratory distress syndrome (ARDS) within the heart.

Study: Virus-Induced Acute Respiratory Distress Syndrome Causes Cardiomyopathy Through Eliciting Inflammatory Responses in the Heart. Image Credit: Kateryna Kon / Shutterstock

The link between respiratory viral infections and CVD

Seasonal viral infections can range in severity from mild flu-like symptoms to potentially lethal ARDS. For example, despite being primarily a respiratory tract infection, coronavirus disease of 2019 (COVID-19) can lead to ARDS and other severe cardiovascular disease outcomes with high mortality rates.

Circulating immune cells may respond to COVID-19 by upregulating cytokine release, which can lead to myocardial injury. Cardiac macrophages, immune cells responsible for the myocardial inflammatory response, are increasingly being investigated for their role in ARDS. Recent evidence indicates that macrophage expansion, which can be accompanied by changes in the population size and relative abundances of various cardiac macrophages, is a characteristic feature of ARDS.

The main two types of cardiac macrophages include C-C chemokine receptor type 2 negative (CCR2^–) and CCR2⁺ macrophages. Further research is needed to determine the viral-induced contributions of these macrophages to adverse cardiac outcomes.

These data would allow clinicians to make informed intervention decisions and elucidate whether these outcomes are COVID-19-induced or if observed inflammation is a systemic immune response to viral infection. Furthermore, this information could support the development of future therapies to prevent cardiovascular disease (CVD) following recovery from COVID-19.

About the study

In the present study, researchers investigate the role of viral- and non-viral-induced ARDS-associated immune signals in altering cardiac macrophage populations, thereby impacting CVD parameters, including systemic inflammation.

This study was conducted at Massachusetts General Hospital and involved 33 control samples obtained from patients who died between September and December 2019, prior to the onset of COVID-19, as well as 21 samples obtained between May and July 2020 from patients who died from COVID-19-associated complications. Samples consisted of autopsy tissue excised from the left ventricular or septal region.

Simultaneously, in vivo studies involved a daily intratracheal administration of an ARDS cocktail of immunostimulatory agents to mice, which included resiquimod, imiquimod, lipopolysaccharide (LPS), and angiotensin-converting enzyme 2 (ACE2) inhibitor MLN-4760. This model allowed the researchers to reproduce clinical ARDS features in mice without the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

Patient data included results obtained from electrocardiogram (ECG), echocardiography, lung computed tomography (CT) scan, blood gas analyses, body temperature evaluation, bronchoalveolar lavage fluid (BALF) characterization, blood pressure measurements, and flow cytometry. Both human and murine autopsy samples were processed using ribonucleic acid (RNA) isolation, real-time polymerase chain reaction (PCR) assay, and enzyme-linked immunosorbent assays (ELISAs) for protein and gene expression determinations.

Similar immune responses in non-viral- and SARS-CoV-2-associated ARDS

In the absence of viral infection, mice treated with the ARDS cocktail exhibited significant weight loss over the five-day cocktail treatment period. This was accompanied by hypothermia, a common feature of both ARDS and septic shock, as well as a mortality rate of over 40% by day five.

Mice with ARDS exhibited bilateral opacities and immune cell infiltrations within their lungs, as well as reduced blood oxygenation. Furthermore, increased D-dimer, neutrophil, and monocyte levels were observed, as well as reduced blood pressure and lower heart rates in ARDS mice. Other inflammatory pathways that were activated in ARDS mice included increased levels of interleukin 6 (IL-6), IL-1ß, tumor-necrosis factor α (TNF-α), and interferon y (IFN-y), all of which are also associated with SARS-CoV-2 infection.

In both non-infected ARDS and SARS-CoV-2-infected mice, an increased infiltration of interstitial macrophages and reduced levels of alveolar macrophages were observed. Although both mouse models exhibited increased levels of cardiac macrophages, this immune response was more pronounced in infected mice. Nevertheless, both models’ subsets of cardiac macrophages were altered to similar levels.

Upon comparison of control and COVID-19 patient myocardium samples, SARS-CoV-2 infection recruited a more significant number of CCR2+ CD68+ macrophages, thus indicating that a robust immune response is elicited after severe infection compared to other life-threatening diseases.

“Our findings indicate that systemic and myocardial inflammatory signals elicited by virally induced ARDS may contribute to the cardiovascular complications and high mortality rates of this condition. In addition, our study confirms previous reports that SARS-CoV-2 infection increases overall macrophage numbers in hearts.”

The cardiac benefits of TNF-α immune therapy

TNF-α neutralizing antibodies were also administered to mice to evaluate their effects on immune activation during ARDS. To this end, TNF-α immune therapy reduced weight loss, improved body temperature, increased blood oxygenation, and led to better survival rates. Histological analysis indicated that ARDS mice receiving anti-TNF-α therapy exhibited reduced macrophages, Cxcl2, IL-1ß, and IL-6 expression within the lungs.

TNF-α therapy also improved systolic dysfunction, cardiomyocyte apoptosis, and monocyte infiltration in ARDS mice. Total cardiac macrophage counts and reduced expression of IL-1ß, IL-6, and TNF-α within the myocardium were also observed, thus demonstrating the anti-inflammatory benefits associated with TNF-α immune therapy in the lungs and hearts of mice with ARDS.

Conclusions

The study findings demonstrate that SARS-CoV-2 infection leads to significant alterations in cardiac macrophage subset levels, particularly increased levels of CCR2+ macrophages, in both mice and humans. Even in the absence of SARS-CoV-2 or another virus, the immune response to ARDS-like injury is capable of inducing significant alterations in heart macrophage levels, which may increase the risk of cardiovascular complications and mortality associated with ARDS.

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March 24, 2024
Study evaluates the use of tirzepatide in overweight/obese adults with type 1 diabetes

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A new study in the peer-reviewed journal Diabetes Technology & Therapeutics (DTT) evaluated the use of tirzepatide in overweight/obese adults with type 1 diabetes.

Tirzepatide is approved for managing type 2 diabetes. It improves glucose control, facilitates weight loss, and improves cardiovascular disease outcomes.

Satish Garg, MD, from the University of Colorado Denver, and coauthors, compared a group of adults with type 1 diabetes who were prescribed tirzepatide (off-label) to a control group of adults with type 1 diabetes who were not using any weight-loss medication. The investigators reported significantly larger declines in body mass index (BMI) and weight in the treated group compared to controls. HbA1c decreased in the treated group as early as three months and was sustained through a one-year follow-up. Insulin dose decreased at 3 months in the treated group and throughout the study period.

“We conclude that tirzepatide facilitated an average 18.5% weight loss (>46 pounds) and improved glucose control in patients with T1D at one year,” stated the investigators.

“Most of the patients with diabetes, both type 1 diabetes (T1D) and T2D are either overweight or obese in the United States and Western Europe,” state Satish Garg, MD, and coauthors of an accompanying Editorial. The newer therapies for diabetes, which are known to not only improve glucose control but also cause significant weight loss and improve cardiovascular disease and diabetic kidney disease are currently not approved in the U.S. for use in type 1 diabetes. “Using GLP analogs in patients with T1D poses many challenges, but with close follow-up both patients and the healthcare provider may see many benefits such as significant weight loss and reduction of insulin dose, increased time-in-range on continuous glucose monitoring, and improve HbA1c levels,” state the authors. Long -term side-effects like gastroparesis, GERD, Cholelithiasis etc. from use of GLP analogs in patients with diabetes are not known. The authors recommend proper randomized control trials especially in patients with T1D.

Source:

Journal reference:

Garg, S. K., et al. (2024). Efficacy and Safety of Tirzepatide in Overweight and Obese Adult Patients with Type 1 Diabetes. Diabetes Technology & Therapeutics. doi.org/10.1089/dia.2024.0050.

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March 23, 2024