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Tag: Heart Attack

  • Immune dysfunction mechanism discovered in stroke and heart attack patients

    Immune dysfunction mechanism discovered in stroke and heart attack patients

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    Every year, between 250,000 and 300,000 people in Germany suffer from a stroke or heart attack. These patients suffer immune disturbances and are very frequently susceptible to life-threatening bacterial infections. Until now, little was known about the underlying mechanisms of this immune dysfunction. Research teams from the Faculty of Medicine at the University Hospital of the UDE and the Leibniz Institute for Analytical Sciences in Dortmund have now uncovered a previously unknown cause – and a therapeutic approach. These findings are published in the May 2024 issue of the Journal Nature Cardiovascular Research.

    The study was led by Prof. Matthias Gunzer, Director of the Institute of Experimental Immunology and Imaging (IEIB) at the UDE and Head of the Biospectroscopy Department at the Leibniz Institute for Analytical Sciences (ISAS), and Dr. Vikramjeet Singh, Head of the Stroke Immunology Unit at the IEIB. They found that in patients one to three days after a stroke or heart attack, the amount of IgA antibodies in the blood decreases drastically – these are essential for defense against infections. Antibodies come in several subtypes, collectively known as immunoglobulins (Ig), which are produced by specialized plasma cells.

    To track down the mechanism behind the loss of antibodies – and to improve the treatment of patients with these findings – the researchers used disease mouse models. Mice also experienced a loss of IgA in their blood and stool after a stroke or heart attack. The researchers discovered that specialized DNA fibers released in blood are a factor in the loss of immune defense. These DNA fibers, known as neutrophil extracellular traps (NETs), originate from the nuclei of another type of immune cell, neutrophils. NETs are released into the blood in large quantities by highly activated neutrophils after a stroke or heart attack and can directly kill plasma cells in the intestine. Probably an even more important effect of NETs is the formation of hundreds of small clots in the blood vessels that supply energy to plasma cells in the intestine. This results in a lack of nutrient and oxygen supply and the Ig-forming cells die off in large numbers.

    The immunologists and their teams not only succeeded in proving a causal link between stroke, heart attack and immunodeficiency, but they were also able to demonstrate a new treatment approach: If the NETs were destroyed with the enzyme DNase or their release was prevented by a substance with a novel mode of action, the immune defense remained intact. The researchers were able to demonstrate this both in the mouse model and – in the case of DNase – in later clinical studies.

    Until now, no therapeutic approaches could be developed because the cause of the immune deficiency was unclear. A treatment that breaks down the NETs or even prevents them from forming in the first place could be a promising new approach to maintaining the immune defense in patients after a stroke or heart attack. It may be possible to prevent serious secondary infectious diseases or even death.”


    Prof. Matthias Gunzer, Director of the Institute of Experimental Immunology and Imaging (IEIB) at the UDE and Head of the Biospectroscopy Department at the Leibniz Institute for Analytical Sciences (ISAS)

    Source:

    Universität Duisburg-Essen

    Journal reference:

    Tuz, A. A., et al. (2024). Stroke and myocardial infarction induce neutrophil extracellular trap release disrupting lymphoid organ structure and immunoglobulin secretion. Nature Cardiovascular Research. doi.org/10.1038/s44161-024-00462-8.

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  • Delving into burning issues about heart disease and much more

    Delving into burning issues about heart disease and much more

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

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

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

    Dr. Nicolle Kränkel, Congress Programme Committee Chair

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

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

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

    Heart health and the young:

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

    Lifestyle issues:

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

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

    Source:

    European Society of Cardiology (ESC)

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  • Discovery of new vascular cell type may pave way for novel strategies to treat cardiovascular diseases

    Discovery of new vascular cell type may pave way for novel strategies to treat cardiovascular diseases

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    Cardiovascular diseases, including stroke and myocardial infarction, are the world’s leading causes of mortality, accounting for over 18 million deaths a year. A team of KIT researchers has now identified a new cell type in blood vessels responsible for vascular growth. This discovery may allow for novel therapeutic strategies to treat ischemic cardiovascular diseases, i.e. diseases that are caused by reduced or absent blood flow. Nature Communications (DOI: 10.1038/s41467-024-47434-x)

    In our body, a large network of blood vessels distributes blood across our organs and thereby ensures that the active cells are supplied with sufficient oxygen and nutrients to function and to maintain heart beat and brain activities for example. Occlusion of blood vessels and compromising oxygen delivery may cause neuronal or cardiac cell death culminating in stroke or heart attack. Revascularization , i. e. restoring vascular perfusion and promoting tissue regeneration, requires functional blood vessels, but how to effectively revascularize organs still is an unsolved clinical question.

    Since each organ fulfills a different physiological function, vascular branching patterns differ across organs. It has long been a mystery how such unique, so-called organo-typical vascular structures develop.

    From a therapeutic point of view, it is believed that understanding the organ-specific molecular control of vascular growth and patterning could open the doors for developing personalized medicine strategies to combat cardiovascular and neurodegenerative diseases and cancer.

    Pioneer cells move inside the vessel walls

    Scientists of the KIT led by Professor Ferdinand le Noble, Head of the Department of Cell and Developmental Biology and Director of the Zoological Institute of KIT, now discovered that one crucial element contributing to organ-dependent variability in vascular branching involves the activation of a novel vascular cell type they coined endothelial L-tip cell or pioneer cell. Pioneer cells reside inside the inner layer that lines the blood vasculature, the so-called endothelium.

    Using high-end imaging techniques, the scientists found that pioneer cells move inside the vessel wall. Once they come into contact with specific signals produced by cells in the surrounding organ, pioneer cells start to make new blood vessels. To elucidate which cells produce such signals and how these signals are sensed to promote pioneer cell differentiation, the scientists used a recently developed technique called single cell sequencing.

    Molecular cocktail encodes the time and place of blood vessel formation

    Dr. Laetitia Preau, first author of the paper, explains: “Single cell sequencing combines detailed RNA sequencing of individual cells with bio-informatic analyses and allows precise identification of cell subtypes and the molecules these cells produce for cell-to-cell communication. Using this technique, we discovered that the vascular patterning is encoded by a distinct set of molecules that can only be sensed by a subset of endothelial cells to promote vessel growth.”

    The cells in the tissue produce an organ-specific set of molecules that encode the instruction how to make a new blood vessel at that particular place and time. Once the prospective pioneer cell senses and unravels this specific tissue-derived molecular code, it will initiate the vascular growth process.

    Foundations for new therapeutic approaches

    It turned out that several organ-specific vascular growth code molecules are drug-targetable, i.e. react to externally added chemicals.

    To explore the therapeutic avenues, we are collaborating with chemists, tissue engineers, and artificial intelligence (AI) specialists at the 3ROCKIT platform of the Health Technologies Center established recently at Karlsruhe Institute of Technology (KITHealthTech). We hope to identify novel smart molecules to target the vascular growth process that may benefit patients suffering from ischemic cardiovascular diseases, such myocardial infarction and stroke, as well as from certain forms of cancer.”


    Professor Ferdinand le Noble

    The study was financed by the German Research Foundation (DFG) and carried out by KIT in cooperation with the German Center for Cardiovascular Research (DZHK) at its partners sites in Heidelberg and Munich and the Max Planck Institute for Molecular Biomedicine in Münster.

    Source:

    Karlsruhe Institute of Technology

    Journal reference:

    Préau, L., et al. (2024). Parenchymal cues define Vegfa-driven venous angiogenesis by activating a sprouting competent venous endothelial subtype. Nature Communications. doi.org/10.1038/s41467-024-47434-x.

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  • Study reveals long-term consequences of atrial fibrillation

    Study reveals long-term consequences of atrial fibrillation

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    The lifetime risk of atrial fibrillation (a heart condition that causes an irregular and often abnormally fast heart rate) has increased from one in four to one in three over the past two decades, finds a study from Denmark in The BMJ today.

    And among those with the condition, two in five are likely to develop heart failure over their remaining lifetime and one in five encounter a stroke, with little or no improvement in risk evident over the 20 year study period.

    As such, the researchers say stroke and heart failure prevention strategies are needed for people with atrial fibrillation.

    Atrial fibrillation is estimated to affect 18 million people in Europe by 2060 and 16 million people in the US by 2050. In the English NHS alone, more new cases of atrial fibrillation are diagnosed each year than the four most common causes of cancer combined, and direct expenditure on atrial fibrillation has reached £2.5 billion.

    Once atrial fibrillation develops, patient care has primarily focused on the risk of stroke, but other complications such as heart failure and heart attack have yet to be fully explored.

    To address this knowledge gap, researchers analysed national data for 3.5 million Danish adults with no history of atrial fibrillation at age 45 or older to see whether they developed atrial fibrillation over a 23 year period (2000-22).

    All 362,721 individuals with a new diagnosis of atrial fibrillation during this time (46% women and 54% men) but with no complications, were subsequently followed until a diagnosis of heart failure, stroke or heart attack.

    Potentially influential factors such as history of high blood pressure, diabetes, high cholesterol, heart failure, chronic lung and kidney disease, family income and educational attainment, were also taken into account.

    The results show that the lifetime risk of atrial fibrillation increased from 24% in 2000-10 to 31% in 2011-22. The increase was larger among men and individuals with a history of heart failure, heart attack, stroke, diabetes, and chronic kidney disease. 

    Among those with atrial fibrillation, the most common complication was heart failure (lifetime risk 41%). This was twice as large as the lifetime risk of any stroke (21%) and four times greater than the lifetime risk of heart attack (12%).

    Men showed a higher lifetime risk of complications after atrial fibrillation compared with women for heart failure (44% vs 33%) and heart attack (12% vs 10%), while the lifetime risk of stroke after atrial fibrillation was slightly lower in men than women (21% vs 23%).

    Over the 23-year study period, there was virtually no improvement in the lifetime risk of heart failure after atrial fibrillation (43% in 2000-10 vs 42% in 2011-22) and only slight (4-5%) decreases in the lifetime risks of any stroke, ischaemic stroke, and heart attack after atrial fibrillation, which were similar among men and women. 

    This is an observational study, so no firm conclusions can be drawn about cause and effect, and the authors acknowledge that they may have missed patients with undiagnosed atrial fibrillation. Nor did they have information on ethnicity or lifestyle factors, and say results may not apply to other countries or settings.

    But despite these caveats, they conclude: “Our novel quantification of the long term downstream consequences of atrial fibrillation highlights the critical need for treatments to further decrease stroke risk as well as for heart failure prevention strategies among patients with atrial fibrillation.”

    Interventions to prevent stroke have dominated atrial fibrillation research and guidelines during this study period, but no evidence suggests that these interventions can prevent incident heart failure, say UK researchers in a linked editorial.

    They call for alignment of both randomized clinical trials and guidelines “to better reflect the needs of the real-world population with atrial fibrillation” and say this robust observational research “provides novel information that challenges research priorities and guideline design, and raises critical questions for the research and clinical communities about how the growing burden of atrial fibrillation can be stopped.”

    Source:

    Journal reference:

    Vinter, N., et al. (2024). Temporal trends in lifetime risks of atrial fibrillation and its complications between 2000 and 2022: Danish, nationwide, population based cohort study. BMJ. doi.org/10.1136/bmj-2023-077209.

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

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

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

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

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


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

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

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

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

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

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

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

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

    Source:

    Tsinghua University Press

    Journal reference:

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

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  • Lifetime risk of atrial fibrillation rises to nearly 31% in recent decade

    Lifetime risk of atrial fibrillation rises to nearly 31% in recent decade

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    Atrial fibrillation (AF) is a common arrhythmia or cardiac rhythm disorder. It is associated with significant mortality risk and also a higher risk of multiple complications. As such, understanding the risk of AF in the population is necessary.

    A new study published online in the BMJ explores the risk of both AF and its complications in a Danish national cohort, beginning from the age of 45 years. The results underline the risk for preventive strategies to reduce the burden of AF on public health. 

    Study: Temporal trends in lifetime risks of atrial fibrillation and its complications between 2000 and 2022: Danish, nationwide, population based cohort study. Image Credit: Orawan Pattarawimonchai/Shutterstock.comStudy: Temporal trends in lifetime risks of atrial fibrillation and its complications between 2000 and 2022: Danish, nationwide, population based cohort study. Image Credit: Orawan Pattarawimonchai/Shutterstock.com

    AF risk and complications

    About 16 million and 18 million people are predicted to develop AF by 2050 in the USA and Europe, respectively. In this condition, the atria, or heart chambers that receive the venous blood, begin to show irregular twitches rather than a coordinated pumping contraction.

    This prevents the efficient movement of blood through the atria into the ventricles, the main pumping chambers.

    The complications of AF include stroke, heart failure, and heart attacks, though the overall and specific AF-related mortality risk has gone down over time. Primary and secondary prevention is, therefore, essential in protecting AF patients.

    This motivated the present study, which seeks to establish the lifetime risk of AF in a large Danish cohort. Two periods were chosen to capture any change in risk over time.

    Residual lifetime risk of a disease is the measure of the total risk that a given individual who does not have the disease at a specified age will develop it during the rest of the lifespan.

    It helps educate the public about health risks and encourages compliance with healthy lifestyle recommendations. Not much is known about the long-term risk of several complications.

    Though patients with AF are typically warned about their risk for stroke, all the long-term sequelae require more study, especially to identify how these risks have changed since the introduction of new stroke-prevention protocols for AF.

    About the study cohort

    The cohort included all Danes aged at least 45 years but less than 95 years who had never had an episode of AF. Those who developed AF from that point onwards were followed up for five complications arising from the diagnosis.

    These included heart failure, any stroke, ischaemic stroke, myocardial infarction, and systemic embolism.

    AF risk

    There were over 3.5 million individuals without a history of AF at the age of 45 years or above. In this group, there was a rising prevalence of hypertension, diabetes, dyslipidemia, and stroke over the study periods among both the baseline population and those who developed AF after the study began.

    AF was newly diagnosed in over 360,000 individuals with a similar age spectrum at the time of diagnosis in both periods. The lifetime risk of AF at 45 years was ~28% over the two decades of the study.

    The same pattern was observed at the later index ages, viz., 55, 65, and 75 years. The risk at each age was 28%, 27%, and 24%, respectively.

    Risk factors for AF included male sex, a history of hypertension, heart failure, heart attacks, other heart conditions, and dyslipidemia. Those with higher educational status and household income were also at greater risk.

    Patients with stroke, chronic obstructive pulmonary disease (COPD), and chronic kidney disease (CKD) were more likely to die early compared to others, thus accounting for a significantly lower risk of AF over their lifespan.

    Comparing the first decade to the second, they observed a 6.7% increased lifetime risk of AF from 45 years onwards, from 24% to 31%. This was unchanged after compensating for confounding factors. Similar increases were observed, by  6.5%, 6.3%, and 5.6%, at the later ages, respectively.

    AF complications

    The study shows a high lifetime risk of post-AF complications. While heart failure was the most common, affecting 41% of AF patients over their lifespan, stroke occurred in 21% of the patients. Heart attacks affected 12% of the patients.

    Men had a higher risk, with 44% of them likely to develop AF complications, vs 35% of women with AF. The post-AF stroke risk was somewhat lower in men, affecting 21% of them vs 22.6% of women.

    The risk of all AF complications except for all strokes was higher among hypertensive individuals.

    Heart failure was much more likely among those who had a history of heart attacks, cardiomyopathy, or valvular heart disease, with the difference being as large as 22% to 45% compared to those without such conditions.

    However, the lifetime risk of heart failure did not change over the study periods. Marginal decreases were observed in the risk of stroke (by 2.5%), ischemic stroke (~5%), and heart attacks (~4%).

    When stratified by health condition, patients with hypertension or dyslipidemia had a reduced risk of post-AF heart failure over this period by 10% and 5%, respectively.

    The heart attack risk among those with dyslipidemia went down by 11% vs 4% for those with normal lipid levels. These findings may be attributable to better medical care for such conditions. The risk of such complications decreases with age.

    Conclusions

    The study shows an increased lifetime risk for new AF over time, from one in four to one in three, over the two study periods. The most frequent complication was heart failure, affecting two out of five patients over the lifespan.

    People with hypertension or dyslipidemia showed reduced lifetime risk of heart failure, however, compared with the general cohort, which showed no change in risk.

    This is twice as high as the risk of post-AF stroke and four times greater than the risk of heart attack. This underlines the need for secondary prevention of heart failure in this group.

    The results corroborate previous studies on the incidence of AF at various ages. The study demonstrates, for the first time, a rising risk of AF.

    This may be due to better diagnostic methods and a lower threshold of suspicion, with improved clinical practice coupled with higher life expectancy. However, the increasing prevalence of risk factors like hypertension and diabetes must also be kept in mind.

    By providing estimates of the lifetime risk of AF and its complications, the study could be important in helping to develop more efficient preventive strategies and policies.

    For instance, stroke risk is managed by anticoagulants in Denmark, with compliance above 85%. The persistently high risk of stroke indicates the need for additional steps.

    “As atrial fibrillation is a common arrhythmia, a lower incidence of complications may reduce the future economic costs in healthcare.”

    Journal reference:

    • Vinter, N., Cordsen, P., Johnsen, S. P., et al. (2024) Temporal trends in lifetime risks of atrial fibrillation and its complications between 2000 and 2022: Danish, nationwide, population based cohort study. BMJ. doi: http://dx.doi.org/10.1136/bmj-2023-077209.

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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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  • Heart transplant recipient’s journey: From patient to advocate

    Heart transplant recipient’s journey: From patient to advocate

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    Glen Kelley’s journey as a heart transplant recipient came full circle today in Prague, as he addressed attendees of the Annual Meeting and Scientific Sessions of the International Society for Heart and Lung Transplantation (ISHLT), including members of his own care teams.

    As a high school senior outside of Peoria, Illinois, Kelley was diagnosed with stage-4 Hodgkin’s lymphoma and underwent eight months of chemotherapy and radiation. After 10 months in remission, the cancer returned, and he received a bone marrow transplant. With his cancer once again in remission, he finished college and went on to enjoy an extremely active life for the next 17 years, skiing, cycling, climbing mountains, and even running marathons.

    Then out of nowhere, Kelley suffered a heart attack at 36. Doctors found his right coronary artery nearly completely blocked and placed three stents to prop it open. Over the next decade, his ailing heart would require more stents, valve replacements, and not one but two coronary artery bypasses at the University of Minnesota Medical Center in Minneapolis. By 2015, Kelley was in heart failure -; most likely the result of the radiation he received in his teens.

    He was placed on the transplant list and eventually transferred to Baylor University Medical Center in Dallas, where he received a new heart in 2016. An unusually long and rough recovery period followed, during which he suffered kidney failure, a fungal infection, and two bouts of organ rejection. In 2019, he received his second organ transplant, a kidney indirectly donated from his youngest son.

    I had support along the way from my physicians and healthcare providers to volunteers at the support group Second Chance for Life. I don’t think my outcomes would have been nearly as successful without the support I received throughout my journey.”


    Glen Kelley, heart transplant recipient

    Despite all his health problems, Kelley led a successful career in IT and marketing, including 17 years at IBM. But it was through his experiences as a patient that he realized his true calling.

    “My metrics changed from how well I did at my day job to how many patients I could help,” he said. “Patients became my currency.”

    Kelley dedicated himself to supporting patients dealing with advanced heart disease through in-person and phone visitation and support groups, ultimately serving as president of Second Chance for Life for four years. During his tenure, the group created an alliance with the international group Mending Hearts, the world’s the largest peer-to-peer heart patient support organization with 115,000+ members.

    With Mended Hearts, Kelley had an opportunity to continue working in patient education and support -; and to become more involved in advocacy and legislation at the state and federal levels. Today, he serves as the group’s Patient Voice and Advocacy Leader.

    “Working in advocacy allowed me to help not one but thousands of patients at a time,” he said.

    Today, Kelley fills his days with phone calls to patients, in-person visits, and advising. In his new role as Patient Advocate Trustee on ISHLT Foundation Board of Trustees, Kelley will help to ensure the Foundation agenda addresses issues that matter most to patients with advanced heart and lung disease.

    His highest calling yet may be serving the United States’ new Organ Procurement and Transplantation Network (OPTN). Created last fall by a bipartisan law, OPTN is charged with revamping the country’s organ transplant system. Kelley was elected thoracic patient representative to OPTN’s Board of Directors.

    “Patients always need support, whether they know it or not, at some point in their journey,” said Kelley. “This motivates me to do the work I do. I want to empower patients through support and education and teach them how to self-advocate.”

    Source:

    International Society for Heart and Lung Transplantation

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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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  • Beta-blockers show no benefit for heart attack patients with normal heart function

    Beta-blockers show no benefit for heart attack patients with normal heart function

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    In a recent study published in The New England Journal of Medicine, researchers conducted the Randomized Evaluation of Decreased Usage of Beta-Blockers after Acute Myocardial Infarction (REDUCE-AMI) trial to determine whether long-term oral beta-blocker therapy could reduce the risk of any cause or incident MI-related mortality among individuals with acute myocardial infarction but preserved left ventricular ejection fraction compared to no beta-blocker treatment.

    Study: Beta-Blockers after Myocardial Infarction and Preserved Ejection Fraction. Image Credit: aipicte / ShutterstockStudy: Beta-Blockers after Myocardial Infarction and Preserved Ejection Fraction. Image Credit: aipicte / Shutterstock

    Background

    Beta-blockers are beneficial in treating heart failure patients and those with reducing ejection fractions; however, these findings are from 1980s trials of patients with massive myocardial infarctions and systolic dysfunction in the left ventricle. Meta-analytical research indicated that beta-blockers do not appear to lower mortality in contemporary reperfusion techniques.

    There is a lack of data from recent randomized clinical studies on the efficacy of long-term use of beta-blockers among acute myocardial infarction patients with intact ejection fraction. Previous Cochrane reviews underscore the need for novel research studies in this target population. Despite the absence of convincing scientific evidence of medication benefit, current recommendations strongly advocate beta-blocker therapy following a myocardial infarction.

    About the study

    In the present open-label, prospective, parallel-group trial, researchers evaluated the impact of beta-blocker therapy on reducing mortality among acute MI patients.

    The team conducted the registry-based trial between September 2017 and May 2023 at 45 sites across New Zealand, Sweden, and Estonia. They randomized participants with prior acute MI who underwent coronary angiographies and had ≥50% ejection fraction from the left ventricle to receive 1:1 long-term therapy with beta-blockers such as ≥100 mg/day of metoprolol or ≥5 mg/day of bisoprolol (intervention group) or no such therapy.

    All participants had obstructive coronary heart disease, as determined from coronary angiographies (i.e., ≥50% stenosis, ≤0.8 fractional flow reserves, or ≤0.9 instant wave-free segment ratios) before randomization. The primary outcome was the composite measure of all-cause or incident MI-related mortality. Secondary outcomes included cardiovascular disease-related mortality and hospital admission for atrial fibrillations or heart failure.

    Safety outcomes included hospital admission for hypotension, second and third-degree atrioventricular blocks, bradycardia, syncope, or pacemaker implantation, and hospital admission due to chronic obstructive pulmonary disease (COPD), asthma, or stroke. Other endpoints included dyspnea [diagnosed using the New York Heart Association (NYHA) recommendations] and angina pectoris (diagnosed using the Canadian Cardiovascular Society guidelines) six to 10.0 weeks or 11.0 to 13.0 months after treatment. The team used Cox proportional-hazards regressions to determine the hazard ratios (HR) for analysis. They performed sensitivity analyses, adjusting for age, country, diabetes, and prior myocardial infarction. The Swedish population registry provided data on death or emigration, and the Swedish Web System for Enhancement and Development of Evidence-based Care in Heart Disease Evaluated According to Recommended Therapies (SWEDEHEART) register collected data on incident myocardial infarctions. The national cause-of-death registry provided cardiovascular-related mortality data, while the national patient registry provided data on atrial fibrillation, heart failure, and safety outcomes.

    Results

    The researchers enrolled 5,020 MI patients (95% from Sweden) who followed up for a median of 3.50 years until November 16, 2023. The median participant age was 65.0 years, 23% were female, and 35% had myocardial infarction with an elevation in the ST segment. Among the participants, 46% were hypertensive, 14% were diabetic, and 7.1% had a prior myocardial infarction. Of 2,508 beta-blocker recipients, 1,560 (62%) and 948 (38%) received metoprolol and bisoprolol, respectively.

    Coronary angiography showed one-vessel involvement among 55% of MI patients, two vessels involved among 27%, and three vessels involved among 17% of patients. The team performed percutaneous coronary interventions in 96% of patients, with coronary artery bypass grafting (CABG) among 3.9%. At hospital discharge, 97% received aspirin, P2Y12 receptor blockers, angiotensin-converting enzyme (ACE) inhibitors, and statins.

    The researchers observed the primary endpoint among 7.9% (199 out of 2,508) of beta-blocker recipients and 8.3% (208 out of 2,512) of non-recipients (HR, 0.96). Beta-blockers did not lower the cumulative incidence rates of secondary endpoints (all-cause mortality, 3.90% and 4.10% among beta-blocker recipients and non-recipients, respectively); cardiovascular disease-related mortality, 1.50% and 1.30%, respectively; myocardial infarctions, 4.50% and 4.70%; hospital admission due to atrial fibrillations, 1.10% and 1.40%; and hospital admission due to heart failures, 0.80% and 0.90%).

    Concerning safety endpoints, the researchers observed hospital admission due to atrioventricular blocks, bradycardia, syncope, hypotension, or pacemaker implantation among 3.40% of beta-blocker recipients and 3.20% of non-recipients; hospital admission due to COPD or asthma in 0.60% and 0.60%, respectively, and hospital admission due to stroke among 1.40% and 1.80% of beta-blocker recipients and non-recipients, respectively. Subgroup analyses yielded similar results.

    Overall, the study findings showed that long-term use of beta-blockers did not reduce the risk of all-cause or incident myocardial infarction-related mortality in patients with an acute MI who underwent coronary angiography but retained ≥50% ejection fraction from the left ventricle compared to no treatment with beta-blockers.

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