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Tag: Heart Attack

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

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

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

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

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


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

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

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

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

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

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

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

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

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

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

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

    Source:

    American College of Cardiology

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  • Impella CP pump shows survival benefit in cardiogenic shock

    Impella CP pump shows survival benefit in cardiogenic shock

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

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

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

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

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

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

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


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

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

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

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

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

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

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

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

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

    Source:

    American College of Cardiology

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  • Novel cholesterol removal strategy shows potential benefits post-heart attack

    Novel cholesterol removal strategy shows potential benefits post-heart attack

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    The first trial of a novel strategy for removing cholesterol from patients’ arteries did not reduce the risk of death, heart attack or stroke within three months of a prior heart attack, according to research presented at the American College of Cardiology’s Annual Scientific Session. However, the findings suggest that the strategy may be beneficial with longer follow-up.

    We did not see a statistically significant reduction in the primary endpoint of risk for death, a heart attack or a stroke at 90 days, or a reduction in risk for stroke at any time.”


    C. Michael Gibson, MD, professor of medicine at Harvard Medical School and study’s lead author

    However, in an exploratory analysis of outcomes, treated patients had fewer heart attacks and heart-attack deaths than patients in the control group at six months, he said.

    “Although we missed our primary endpoint, our data support the hypothesis that HDL cholesterol plays a role in reducing subsequent coronary plaque disruption events like heart attack via enhanced cholesterol efflux attacks,” Gibson said.

    People who have had a heart attack are at high risk for another one, especially during the next 90 days, Gibson said. This study was the first in which patients received an infusion of ApoA-I, a component of HDL (“good”) cholesterol, shortly after a heart attack, with the aim of stabilizing coronary plaque and reducing adverse cardiovascular events. The investigational drug CSL112 used in the study is a form of ApoA-I that’s extracted from human plasma, the liquid component of blood.

    High levels of LDL cholesterol create a build-up of plaque in the arteries that carry blood to the heart, increasing risk for an arterial blockage that causes a heart attack. HDL cholesterol removes cholesterol from the arteries and carries it to the liver, which then excretes it. ApoA-I, the main component of HDL cholesterol, helps initiate the process of removing cholesterol from the body. A previous study showed that a single infusion of CSL112 reduced the amount of LDL cholesterol in arterial plaque by as much as 50%.

    Other studies have shown that high levels of HDL cholesterol are associated with reduced heart attack risk. Recent research, however, suggests that the level of HDL cholesterol number may be less important for reducing heart attack risk than how well it performs at removing cholesterol, Gibson said.

    “We know that in the setting of a heart attack, when the HDL cholesterol is good at getting a lot of cholesterol out of the arteries, that results in better outcomes for patients,” he said.

    Gibson and his colleagues hypothesized that infusions of CSL112 given shortly after a heart attack might—by boosting the body’s ability to dispose of cholesterol—reduce patients’ risk for a repeat heart attack during the next crucial 90 days. The international AEGIS-II trial, conducted in 49 countries, was designed to test this hypothesis.

    The study enrolled 18,219 patients (median age 65.5 years, 74% men and 84.5% White) who had been hospitalized for a heart attack and had multiple blockages in arteries carrying blood to the heart that elevated their risk for another heart attack. They also had other risk factors, including having had a previous heart attack, receiving drug treatment for diabetes or being 65 or older. Patients were randomly assigned to receive infusions of either CSL112 or a placebo for four weeks, with the first infusion given within five days of hospitalization.

    The study’s primary endpoint was the time to the first occurrence of a major adverse cardiovascular event (MACE; i.e., heart attack, stroke or death due to heart disease or a stroke) at 90 days. Secondary endpoints included the time to the first occurrence of a MACE within six months and one year and of each specific event within 90 days, six months and one year.

    At 90 days, patients treated with CSL112 had a 4.8% reduction in risk for death, heart attack or stroke compared with 5.2% for those treated with a placebo, a difference that was not statistically significant. In an exploratory analysis, however, patients treated with CSL112 were 14% less likely to have or die from a heart attack at 180 days. In addition, patients treated with CSL112 were 32% less likely to have a heart attack caused by a blood clot in a stent (a tiny mesh tube inserted into an artery to prevent it from becoming blocked) at 90 days and 29% less likely at 180 days.

    Another potentially important finding, Gibson said, is that patients whose LDL cholesterol level was 100 mg/dL or higher at study entry experienced a 30% decrease in the primary endpoint, a statistically significant finding, whereas patients whose LDL cholesterol at study entry was less than 100 mg/dL saw no decrease in the primary endpoint.

    “Baseline LDL modulated the treatment effect,” Gibson said.

    “Overall, our findings are consistent with ApoA-I having a role in stabilizing heart blockages and reducing the risk of a blockage that ruptures and causing a heart attack further out than 90 days,” Gibson said. “It’s plausible that by giving ApoA-1 to clear the cholesterol out of the body and then treating the patient with cholesterol-lowering medications to keep LDL cholesterol levels low, we could see reductions in deaths and heart attacks that continue over time.”

    Future research will focus on identifying high-risk patients who might benefit from this approach, he said.

    An antiplatelet effect of CSL112 or a reduction of cholesterol in the arteries resulting from treatment with CSL112 could also explain the significant reduction in the number of heart attacks caused by a blood clot in a stent, he said. The reason strokes were not reduced may be that strokes can be caused by mechanisms other than the rupture of arterial blockages, he said.

    A limitation of the study is that women, Black people and people of Asian heritage were underrepresented, which could reduce the findings’ generalizability, Gibson said.

    The study was funded by CSL Behring, the manufacturer of CSL112.

    This study was simultaneously published online in the New England Journal of Medicine at the time of presentation. The findings of the exploratory analysis were/will be published in the Journal of the American College of Cardiology.

    Gibson will be available to the media in a press conference on Saturday, April 6, 2024, at 10:45 a.m. ET / 14:45 UTC in Room B203.

    Gibson will present the study, “Patients With Acute Myocardial Infarction (ApoA-I Event Reducing In Ischemic Syndromes II (AEGIS-II) Trial): Primary Trial Results,” on Saturday, April 6, 2024, at 9:30 a.m. ET / 13:30 UTC in the Hall B-1 Main Tent.

    Source:

    American College of Cardiology

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  • Empagliflozin shows mixed results in heart attack patients

    Empagliflozin shows mixed results in heart attack patients

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    Use of the sodium glucose cotransporter-2 (SGLT-2) inhibitor empagliflozin following a heart attack did not show a significant benefit in reducing overall heart failure hospitalizations or death from any cause, according to a study presented at the American College of Cardiology’s Annual Scientific Session. However, researchers said the drug may be helpful in reducing heart failure risks, including hospitalization, following a heart attack.

    Despite falling short of its primary endpoint, results from the EMPACT-MI trial found that people who took empagliflozin had a significantly lower risk of certain outcomes directly related to heart failure, including first hospitalization for heart failure, total hospitalization for heart failure and a composite of heart failure hospitalization and death from heart failure, without any increased risk of adverse events.

    We found that empagliflozin did not reduce mortality after a heart attack but did reduce the risk of heart failure after heart attack. To have a 25% to 30% reduction in heart failure hospitalizations is pretty clinically meaningful, but if you put it together with all-cause mortality, it was not a positive study for our primary endpoint.”


    Javed Butler, MD, president of the Baylor Scott and White Research Institute in Dallas, distinguished professor of medicine at the University of Mississippi in Jackson, Mississippi, and study’s lead author

    SGLT-2 inhibitors were initially approved to treat Type 2 diabetes by lowering blood sugar. As evidence has mounted pointing to their benefits in reducing heart failure and other forms of heart disease, researchers have sought to determine whether these drugs could help to prevent heart failure even in people without diabetes or chronic kidney disease.

    A heart attack can damage the heart muscle in ways that sometimes lead to heart failure, a condition in which the heart becomes too weak or too stiff to effectively pump blood throughout the body. The EMPACT-MI trial was designed to determine whether SGLT-2 inhibitors could safely help to prevent heart failure and reduce mortality in people with a high risk of heart failure following a heart attack.

    The study enrolled 6,522 people treated for acute myocardial infarction at 451 centers in 22 countries. Participants had no history of heart failure but had at least one heart failure risk factor in addition to signs of potential heart dysfunction as indicated by a newly lowered left ventricle ejection fraction to below 45% and/or signs or symptoms of congestion requiring treatment. About 32% had Type 2 diabetes. On average, participants were 64 years old and approximately 25% were women and 84% were White.

    Within 14 days of being admitted to the hospital for a heart attack, half of the participants were randomly assigned to receive empagliflozin at a dose of 10 mg daily, while the other half received a placebo. Researchers tracked outcomes for a median of just under 18 months.

    The study’s primary composite endpoint occurred in 8.2% of those who received empagliflozin and 9.1% of those receiving a placebo, a difference that was not statistically significant. There was also no difference in the rate of death from any cause, which occurred in 5.2% of those receiving empagliflozin and 5.5% of the control group.

    All secondary endpoints related specifically to heart failure outcomes were significantly reduced among patients who received empagliflozin. For example, those receiving empagliflozin were 23% less likely to experience a first heart failure hospitalization and 33% less likely to experience any heart failure hospitalization—including recurrent hospitalizations—compared with those taking a placebo. The composite rate of total heart failure hospitalizations and death from heart failure was also 31% lower among those receiving empagliflozin.

    Among patients who were not taking common heart failure therapies such as diuretics, angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor/neprilysin inhibitor (ARNI) at the time of their initial hospital discharge, those taking empagliflozin were significantly less likely to start such therapies within six months compared with those taking a placebo.

    “In terms of heart failure outcomes, the data is not only strong, but it’s consistent with what we’ve found over the past 10 years in yet another population,” Butler said. “This finding is completely consistent in both direction and magnitude with other studies of SGLT-2 inhibitors in populations with diabetes and chronic kidney disease.”

    While as a pragmatic trial design to simplify trial procedures and make it easier on both the participants and the sites, the study had limitations that may have influenced the findings, researchers said. For example, because outcomes were not adjudicated by independent reviewers, outpatient heart failure events were not formally captured as part of the primary endpoint. However, researchers said data on outpatient heart failure visits were collected as part of the study protocols for assessing adverse events. An analysis of these events showed outpatient visits for heart failure were substantially lower in participants who received empagliflozin compared with placebo.

    Another limitation was the use of all-cause mortality as part of the primary endpoint, which meant that deaths unrelated to heart failure were included in the endpoint even though the study drug was unlikely to influence them. There were also some unusual circumstances that may have influenced rates of both hospitalization and death, including the COVID-19 pandemic and conflicts involving Russia, Ukraine and Israel, all countries that participated in the trial.

    Finally, researchers said that the follow-up period may have been too short to fully capture any difference in mortality related to heart failure. Since people who developed heart failure following their heart attack typically did not begin to show heart failure symptoms until a few months later, any reductions in mortality would not be expected to emerge until after that.

    “We just did not have long enough follow-up to see whether that heart failure prevention would lead to a benefit in mortality, but it’s a reasonable clinical thing to say that if you’re preventing heart failure, it’s a good thing,” Butler said.

    The study was funded by Boehringer Ingelheim and Eli Lilly.

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

    Butler will be available to the media in a press conference on Saturday, April 6, 2024, at 10:45 a.m. ET / 14:45 UTC in Room B203.

    Butler will present the study, “Empagliflozin After Acute Myocardial Infarction: Results of the EMPACT-MI Trial,” on Saturday, April 6, 2024, at 9:30 a.m. ET / 13:30 UTC in the Hall B-1 Main Tent.

    Source:

    American College of Cardiology

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  • SARS-CoV-2-associated ARDS can damage the heart without direct infection

    SARS-CoV-2-associated ARDS can damage the heart without direct infection

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    SARS-CoV-2, the virus that causes COVID-19, can damage the heart even without directly infecting the heart tissue, a National Institutes of Health-supported study has found. The research, published in the journal Circulation, specifically looked at damage to the hearts of people with SARS-CoV2-associated acute respiratory distress syndrome (ARDS), a serious lung condition that can be fatal. But researchers said the findings could have relevance to organs beyond the heart and also to viruses other than SARS-CoV-2.

    Scientists have long known that COVID-19 increases the risk of heart attack, stroke, and Long COVID, and prior imaging research has shown that over 50% of people who get COVID-19 experience some inflammation or damage to the heart. What scientists did not know is whether the damage occurs because the virus infects the heart tissue itself, or because of systemic inflammation triggered by the body’s well-known immune response to the virus.

    This was a critical question and finding the answer opens up a whole new understanding of the link between this serious lung injury and the kind of inflammation that can lead to cardiovascular complications. The research also suggests that suppressing the inflammation through treatments might help minimize these complications.”


    Michelle Olive, Ph.D., Associate Director, Basic and Early Translational Research Program at the National Heart, Lung, and Blood Institute (NHLBI)

    To reach their findings, the researchers focused on immune cells known as cardiac macrophages, which normally perform a critical role in keeping the tissue healthy but can turn inflammatory in response to injury such as heart attack or heart failure. The researchers analyzed heart tissue specimens from 21 patients who died from SARS-CoV-2-associated ARDS and compared them with specimens from 33 patients who died from non-COVID-19 causes. They also infected mice with SARS-CoV-2 to follow what happened to the macrophages after infection.

    In both humans and mice, they found the SARS-CoV-2 infection increased the total number of cardiac macrophages and also caused them to shift from their normal routine and become inflammatory.

    When macrophages are no longer doing their normal jobs, which includes sustaining the metabolism of the heart and clearing out harmful bacteria or other foreign agents, they weaken the heart and the rest of the body, said Matthias Nahrendorf, M.D., Ph.D., professor of Radiology at Harvard Medical School and senior author on the study.

    The researchers then designed a study in mice to test whether the response they observed happened because SARS-CoV-2 was infecting the heart directly, or because the SARS-CoV-2 infection in the lungs was severe enough to render the heart macrophages more inflammatory. This study mimicked the lung inflammation signals, but without the presence of the actual virus. The result: even in the absence of a virus, the mice showed immune responses strong enough to produce the same heart macrophage shift the researchers observed both in the patients who died of COVID-19 and the mice infected with SARS-CoV-2 infection.

    “What this study shows is that after a COVID infection, the immune system can inflict remote damage on other organs by triggering serious inflammation throughout the body – and this is in addition to damage the virus itself has directly inflicted on the lung tissue,” said Nahrendorf. “These findings can also be applied more generally, as our results suggest that any severe infection can send shockwaves through the whole body.”

    The research team also found that blocking the immune response with a neutralizing antibody in the mice stopped the flow of inflammatory cardiac macrophages and preserved cardiac function. While they have yet to test this in humans, Nahrendorf said a treatment like this could be used as a preventive measure to help COVID-19 patients with pre-existing conditions, or people who are likely to have more severe outcomes from SARS-CoV-2 associated ARDS.

    Source:

    NIH/National Heart, Lung and Blood Institute

    Journal reference:

    Grune, J., et al. (2024) Virus-induced ARDS causes cardiomyopathy through eliciting inflammatory responses in the heart. Circulation. doi.org/10.1161/CIRCULATIONAHA.123.066433.

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  • Childhood ‘lazy eye’ linked to increased health risks in adulthood

    Childhood ‘lazy eye’ linked to increased health risks in adulthood

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    Adults who had amblyopia (‘lazy eye’) in childhood are more likely to experience hypertension, obesity, and metabolic syndrome in adulthood, as well as an increased risk of heart attack, finds a new study led by UCL researchers.

    In publishing the study in eClinicalMedicine, the authors stress that while they have identified a correlation, their research does not show a causal relationship between amblyopia and ill health in adulthood.

    The researchers analyzed data from more than 126,000 participants aged 40 to 69 years old from the UK Biobank cohort, who had undergone ocular examination.

    Participants had been asked during recruitment whether they were treated for amblyopia in childhood and whether they still had the condition in adulthood. They were also asked if they had a medical diagnosis of diabetes, high blood pressure, or cardio/cerebrovascular disease (ie. angina, heart attack, stroke).

    Meanwhile, their BMI (body mass index), blood glucose, and cholesterol levels were also measured and mortality was tracked.

    The researchers confirmed that from 3,238 participants who reported having a ‘lazy eye’ as a child, 82.2% had persistent reduced vision in one eye as an adult.

    The findings showed that participants with amblyopia as a child had 29% higher odds of developing diabetes, 25% higher odds of having hypertension and 16% higher odds of having obesity. They were also at increased risk of heart attack – even when other risk factors for these conditions (e.g. other disease, ethnicity and social class) were taken into account.

    This increased risk of health problems was found not only among those whose vision problems persisted, but also to some extent in participants who had had amblyopia as a child and 20/20 vision as an adult, although the correlation was not as strong.

    Corresponding author, Professor Jugnoo Rahi (UCL Great Ormond Street Institute for Child Health, UCL Institute of Ophthalmology and Great Ormond Street Hospital), said: “Amblyopia is an eye condition affecting up to four in 100 children. In the UK, all children are supposed to have vision screening before the age of five, to ensure a prompt diagnosis and relevant ophthalmic treatment.

    “It is rare to have a ‘marker’ in childhood that is associated with increased risk of serious disease in adult life, and also one that is measured and known for every child – because of population screening.

    “The large numbers of affected children and their families, may want to think of our findings as an extra incentive for trying to achieve healthy lifestyles from childhood.”

    Amblyopia is when the vision in one eye does not develop properly and can be triggered by a squint or being long-sighted.

    It is a neurodevelopmental condition that develops when there’s a breakdown in how the brain and the eye work together and the brain can’t process properly the visual signal from the affected eye. As it usually causes reduced vision in one eye only, many children don’t notice anything wrong with their sight and are only diagnosed through the vision test done at four to five years of age.

    A recent report from the Academy of Medical Sciences involving some researchers from the UCL Great Ormond Street Institute for Child Health, called on policymakers to address the declining physical and mental health of children under five in the UK and prioritize child health.

    The team hopes that their new research will help reinforce this message and highlight how child health lays the foundations for adult health.

    Vision and the eyes are sentinels for overall health – whether heart disease or metabolic dysfunction, they are intimately linked with other organ systems. This is one of the reasons why we screen for good vision in both eyes.


    We emphasize that our research does not show a causal relationship between amblyopia and ill health in adulthood. Our research means that the ‘average’ adult who had amblyopia as a child is more likely to develop these disorders than the ‘average’ adult who did not have amblyopia. The findings don’t mean that every child with amblyopia will inevitably develop cardiometabolic disorders in adult life.”


    Dr Siegfried Wagner, First Author, UCL Institute of Ophthalmology and Moorfields Eye Hospital

    The research was carried out in collaboration with the University of the Aegean, University of Leicester, King’s College London, the National Institute for Health and Care Research (NIHR) Biomedical Research Centre (BRC) at Moorfields Eye Hospital and UCL Institute of Ophthalmology and the NIHR BRC at UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital.

    The work was funded by the Medical Research Council, the NIHR and the Ulverscroft Foundation.

    Source:

    University College London

    Journal reference:

    Wagner, S. K., et al. (2024) Associations between unilateral amblyopia in childhood and cardiometabolic disorders in adult life: a cross-sectional and longitudinal analysis of the UK Biobank. eClinicalMedicine. doi.org/10.1016/j.eclinm.2024.102493.

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  • New blood biomarkers identified to predict cardiovascular risk in rheumatoid arthritis patients

    New blood biomarkers identified to predict cardiovascular risk in rheumatoid arthritis patients

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    Rheumatoid arthritis impacts approximately 2 million people in the United States and is associated with increased risk of cardiovascular disease. However, assessing cardiovascular risk is difficult in patients with rheumatoid arthritis because standard clinical assessments based on factors like age, cholesterol, and smoking status tend to underestimate cardiovascular risk in individuals with rheumatoid arthritis. 

    In a new study published in the Journal of the American Heart Association, a research team led by physicians at Mass General Brigham with expertise in rheumatology and cardiovascular disease identified six blood biomarkers that are associated with cardiovascular risk in patients with rheumatoid arthritis and whose measurements improved the researchers’ ability to predict a future increase in arterial inflammation. The biomarkers hold the potential to clinically assess an individual patient’s risk of cardiovascular disease, but more research is needed to determine whether they are associated with cardiovascular events such as heart attack or stroke.

    We think these biomarkers might improve our ability to predict risk and intervene early to help our patients. The idea is that if we measure biomarkers that are specific to rheumatoid arthritis, we might be able to better identify those at highest risk of cardiovascular events.”


    Daniel H. Solomon, MD, MPH, first author, chief of the Section of Clinical Sciences in the Division of Rheumatology and Matthew H. Liang Distinguished Chair at Brigham and Women’s Hospital, founding member of the Mass General Brigham healthcare system

    To identify rheumatoid arthritis-specific biomarkers of cardiovascular risk, the researchers assembled a panel of 24 candidate biomarkers that had been previously shown to be associated with rheumatoid arthritis and systemic inflammation. Then, they measured the concentration of these biomarkers in 109 patients with rheumatoid arthritis who were taking part in a randomized clinical trial (the TARGET Trial) to compare the efficacy of two different treatments for rheumatoid arthritis at preventing cardiovascular disease. The researchers measured the biomarkers at the beginning of the study and six months later, imaging the patients’ arteries at each time to assess their arterial inflammation-;an indicator of cardiovascular risk.

    “Arterial inflammation can predict future cardiovascular disease risk,” said cardiologist and co-author Ahmed Tawakol, MD, the director of Nuclear Cardiology and co-director of the Cardiovascular Imaging Research Center at Massachusetts General Hospital, a founding member of the Mass General Brigham healthcare system. “If you take a snapshot of a person’s blood vessels, the more inflammation that is measured there, the greater the likelihood the person will have progression of their disease, and the greater likelihood that they will have a stroke or a myocardial infarction.”

    Six of the 24 biomarkers were associated with increased cardiovascular risk and using them in predictive models improved the researchers’ ability to predict increases in arterial inflammation compared to standard clinical indices such as the Framingham Risk Score, which is based on factors such as age, sex, cholesterol, blood pressure, diabetes, and smoking.

    “This is an important step towards using blood samples to measure changes in cardiovascular risk with the treatment of rheumatoid arthritis,” said Solomon.

    The study showcases the strength of ongoing collaborations between Brigham and Women’s Hospital and Massachusetts General Hospital, said Solomon and Tawakol, who trained together as residents at the Brigham around 30 years ago. “Having two really great institutions collaborating in the same organization meant we could leverage the strengths of the respective institutions and teams,” said Solomon.

    Now, the team is working to test these biomarkers in a larger and more long-term cohort of rheumatoid arthritis patients, the Brigham and Women’s Rheumatoid Arthritis Sequential Study (BRASS), which has been following over 1,000 patients with rheumatoid arthritis since 2003. This follow-up study will allow the researchers to not only test associations between the biomarkers and arterial inflammation, but also assess whether the biomarkers can predict future cardiovascular events such as heart attack or stroke.

    Source:

    Journal reference:

    Solomon, D. H., et al. (2024) Biomarkers of Cardiovascular Risk in Patients with Rheumatoid Arthritis: Results from the TARGET Trial. Journal of the American Heart Association. DOI: 10.1161/JAHA.123.032095.

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  • Women reap greater health benefits from exercise than men

    Women reap greater health benefits from exercise than men

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    Women who exercise regularly have a significantly lower risk of an early death or fatal cardiovascular event than men who exercise regularly, even when women put in less effort, according to a National Institutes of Health-supported study. The findings, published in the Journal of the American College of Cardiology, are based on a prospective analysis of data from more than 400,000 U.S. adults ages 27-61 which showed that over two decades, women were 24% less likely than those who do not exercise to experience death from any cause, while men were 15% less likely. Women also had a 36% reduced risk for a fatal heart attack, stroke, or other cardiovascular event, while men had a 14% reduced risk. 

    We hope this study will help everyone, especially women, understand they are poised to gain tremendous benefits from exercise. It is an incredibly powerful way to live healthier and longer. Women on average tend to exercise less than men and hopefully these findings inspire more women to add extra movement to their lives.” 


    Susan Cheng, M.D., cardiologist and the Erika J. Glazer Chair in Women’s Cardiovascular Health and Population Science in the Smidt Heart Institute at Cedars-Sinai, Los Angeles

    The researchers found a link between women experiencing greater reduced risks for death compared to men among all types of exercise. This included moderate aerobic activity, such as brisk walking; vigorous exercise, such as taking a spinning class or jumping rope; and strength training, which could include body-weight exercises.

    Scientists found that for moderate aerobic physical activity, the reduced risk for death plateaued for both men and women at 300 minutes, or five hours, per week. At this level of activity, women and men reduced their risk of premature death by 24% and 18% respectively. Similar trends were seen with 110 minutes of weekly vigorous aerobic exercise, which correlated with a 24% reduced risk of death for women and a 19% reduced risk for men.

    Women also achieved the same benefits as men but in shorter amounts of time. For moderate aerobic exercise, they met the 18% reduced risk mark in half the time needed for men: 140 minutes, or under 2.5 hours, per week, compared to 300 minutes for men. With vigorous aerobic exercise, women met the 19% reduced risk mark with just 57 minutes a week, compared to 110 minutes needed by men.

    This benefit applied to weekly strength training exercises, too. Women and men who participated in strength-based exercises had a 19% and 11% reduced risk for death, respectively, compared to those who did not participate in these exercises. Women who did strength training saw an even greater reduced risk of cardiovascular-related deaths – a 30% reduced risk, compared to 11% for men. 

    For all the health benefits of exercise for both groups, however, only 33% of women and 43% of men in the study met the standard for weekly aerobic exercise, while 20% of women and 28% of men completed a weekly strength training session.

    “Even a limited amount of regular exercise can provide a major benefit, and it turns out this is especially true for women,” said Cheng. “Taking some regular time out for exercise, even if it’s just 20-30 minutes of vigorous exercise a few times each week, can offer a lot more gain than they may realize.”

    “This study emphasizes that there is no singular approach for exercise,” said Eric J. Shiroma, Sc.D., a program director in the Clinical Applications and Prevention branch at the National Heart, Lung, and Blood Institute (NHLBI). “A person’s physical activity needs and goals may change based on their age, health status, and schedule – but the value of any type of exercise is irrefutable.”

    The authors said multiple factors, including variations in anatomy and physiology, may account for the differences in outcomes between the sexes. For example, men often have increased lung capacity, larger hearts, more lean-body mass, and a greater proportion of fast-twitch muscle fibers compared to women. As a result, women may use added respiratory, metabolic, and strength demands to conduct the same movement and in turn reap greater health rewards.

    The Physical Activity Guidelines for Americans recommend adults get at least 2.5-5 hours of moderate-intensity exercise or 1.25-2.5 hours of vigorous exercise each week, or a combination of both, and participate in two or more days a week of strength-based activities.

    Source:

    NIH/National Heart, Lung and Blood Institute

    Journal reference:

    Ji, H., et al. (2024) Sex Differences in Association of Physical Activity With All-Cause and Cardiovascular Mortality. Journal of the American College of Cardiology. doi.org/10.1016/j.jacc.2023.12.019.

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  • Study links finger length ratio to oxygen metabolism efficiency in athletes

    Study links finger length ratio to oxygen metabolism efficiency in athletes

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    The efficiency of oxygen supply to tissues is a factor in the severity of important diseases such as Covid-19 and heart conditions.

    Scientists already know that the relationship between the length of a person’s index and ring fingers, known as the 2D:4D ratio is correlated with performance in distance running, age at heart attack and severity of Covid-19.

    Now Swansea University digit ratio expert Professor John Manning has been working with colleagues to look more closely at the subject.

    Their findings have just been published by the prestigious American Journal of Human Biology.

    The research analyzed 133 professional football players as they underwent a series of body measurements which included measuring digit lengths from hand scans. They also completed an incremental cardiopulmonary test to exhaustion on a treadmill.

    With our partners from the Cyprus campus of the University of Central Lancashire, we have clarified the relationship between 2D:4D and oxygen metabolism in a sample of well-trained athletes.


    The players with long ring digits (4D) relative to their index digits (2D) have efficient oxygen metabolism such that they reach very high maximal oxygen consumption in an incremental cardiopulmonary test to exhaustion on a treadmill.”


    Professor Manning, of the Applied Sports, Technology, Exercise and Medicine (A-STEM) research team

    Long ring digits relative to index digits are thought to be a marker of high testosterone levels in the womb. Testosterone has effects on oxygen metabolism through its influence on the energy producers (mitochondria) within cells.

    He added: “Our findings are consistent with those from distance running, where long 4D is related to high performance, and heart disease and Covid-19 where long 4D is linked to low severity of disease.

    “Overall, our study illustrates the value of using healthy well-trained athletes to clarify metabolic processes that are important in disease outcomes.”

    The team say further work is now necessary to quantify these associations in women.

    Professor Manning’s previous research has examined how the difference in finger length between a person’s left and right hand may provide vital information concerning outcomes from contracting Covid-19.

    Source:

    Journal reference:

    Parpa, K., et al. (2024). The associations between digit ratio (2D:4D and right – left 2D:4D), maximal oxygen consumption and ventilatory thresholds in professional male football players. American Journal of Human Biology. doi.org/10.1002/ajhb.24047.

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  • Groundbreaking study sheds light on the potential of the heart to achieve self-repair and regeneration

    Groundbreaking study sheds light on the potential of the heart to achieve self-repair and regeneration

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    A groundbreaking scientific study published in Nature Cardiovascular Research has unveiled a remarkable discovery that may have far-reaching implications for the treatment of heart disease.

    The intensive investigations utilizing single-cell genomics and genetic experiments were conducted by a team of renowned scientists in the Cardiomyocyte Renewal Laboratory and McGill Gene Editing Laboratory at The Texas Heart Institute, including James F. Martin Vivian L. Smith Chair in Regenerative Medicine and Vice Chairman and Professor of Molecular Physiology and Biophysics at Baylor College of Medicine, and co-first authors Xiao Li, PhD, and Rich Gang Li, PhD. Titled “YAP Induces a Neonatal Like Pro-Renewal Niche in the Adult Heart,” this research sheds light on the potential of the human heart to achieve self-repair and regeneration.

    Heart disease remains a leading cause of death worldwide, with myocardial infarction, also known as a heart attack, causing irreparable damage to cardiac muscle cells. While current treatments focus on alleviating symptoms and improving blood flow, they fall short in addressing the crucial issue of lost cardiomyocytes (CMs), leading to further complications such as heart failure. However, this groundbreaking study offers hope for a paradigm shift in regenerative medicine.

    Heart disease remains a leading cause of death worldwide, with myocardial infarction, also known as a heart attack, causing irreparable damage to cardiac muscle cells. While current treatments focus on alleviating symptoms and improving blood flow, they fall short of addressing the crucial issue of lost cardiomyocytes (CMs), leading to further complications such as heart failure. However, this groundbreaking study offers hope for a paradigm shift in regenerative medicine.

    Contrary to longstanding beliefs, the study reveals that regeneration of CMs requires a complex microenvironment, where a dynamic synergy between CMs, resident immune cells, and cardiac fibroblasts is the driving force behind cardiac renewal. Through intricate signaling mechanisms, these cell types coordinately instruct and support each other, facilitating CM proliferation and effectively repairing damaged heart tissue.

    “Understanding heart regeneration on a molecular level is an important step towards developing innovative therapeutics that can facilitate CM regeneration,” said the team in their lay summary. “Our study challenges the existing paradigm, suggesting that targeting the microenvironment rather than a specific cell type is instrumental in healing the injured heart.”

    The implications of this groundbreaking discovery are immense, offering glimpses of a future where heart disease may no longer be an irreversible condition but a challenge that can be overcome through medical intervention. The potential for developing novel therapies that leverage the body’s innate regenerative capacity holds great promise for millions of individuals affected by heart disease worldwide.

    “YAP Induces a Neonatal Like Pro-Renewal Niche in the Adult Heart” is a milestone in cardiac research. It unlocks a new avenue for scientific exploration and fosters hope for a future where damaged hearts can mend themselves. This remarkable study, published in a prestigious journal like Nature Cardiovascular Research, confirms the significance and impact of these findings.

    Source:

    Journal reference:

    Li, R. G., et al. (2024). YAP induces a neonatal-like pro-renewal niche in the adult heart. Nature Cardiovascular Research. doi.org/10.1038/s44161-024-00428-w.

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