Tag: Heart Attack

Managing migraines and menopausal symptoms to reduce cardiovascular risks in middle-aged women

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For middle-aged women plagued by migraines, or hot flashes and night sweats, another worry may linger in the backs of their minds: whether these experiences have set them up for a heart attack, a stroke or another cardiovascular crisis.

After all, past research suggesting such a link during and after menopause has gotten a lot of attention.

But a pair of new studies in the journal Menopause suggest that most of them don’t need to worry as much, especially if they don’t have both migraines and long-term hot flashes and night sweats.

Instead, they should focus on tackling the other factors that can raise their cardiovascular risk by getting more sleep, exercise and healthy foods, quitting tobacco, and minding their blood pressure, blood sugar, cholesterol and weight.

For women who have experienced both migraines and hot flashes or night sweats over many years, one of the new studies does suggest an extra level of cardiovascular risk. That makes heart disease and stroke prevention even more important in this group, says study leader Catherine Kim, M.D., M.P.H., of the University of Michigan.

And for women currently in their 20s and 30s who experience migraines, the new research suggests that they might be heading for a higher risk of long-term menopause-related symptoms when they get older.

Long-term study yields important insights

Kim and her colleagues at Michigan Medicine, U-M’s academic medical center, published the new pair of studies based on an in-depth analysis of data from a long-term study of more than 1,900 women who volunteered to have regular physical exams and blood tests, and to take yearly health surveys, when they were in their late teens to early 30s.

Those women, now in their 50s and 60s, have provided researchers with a priceless view of what factors shape health in the years leading up to menopause and beyond, through their continued participation in the CARDIA study.

“The anxiety and dread that women with migraines and menopausal symptoms feel about cardiovascular risk is real – but these findings suggest that focusing on prevention, and correcting unhealthy habits and risk factors, could help most women,” said Kim, who is an associate professor of internal medicine at U-M and a primary care physician.

“For the subgroup with both migraines and early persistent hot flashes and night sweats, and for those currently experiencing migraines in their early adulthood, these findings point to an added need to control risks, and address symptoms early,” she adds.

Just over 30% of the middle-aged women in the study reported they had persistent hot flashes and night sweats, which together are called vasomotor symptoms or VMS because they relate to changes in the diameter of blood vessels.

Of them, 23% had reported also having migraines. This was the only group for whom Kim and her colleagues found extra risk of stroke, heart attack or other cardiovascular events that couldn’t be explained by other risk factors that have long been known to be linked to cardiovascular problems.

In addition to those with persistent vasomotor symptoms starting in their 40s or before, 43% of the women in the study had minimal levels of such symptoms in their 50s, and 27% experienced an increase in VMS over time into their 50s and early 60s.

The latter two groups had no excess cardiovascular risk once their other risk factors were taken into account, whether or not they had migraines. Use of hormone-based birth control and estrogen to address medical issues did not affect this risk.

Controlling destiny

In the study of data from the same women in their earlier stages of life, the researchers found that the biggest factors in predicting which ones would go on to have persistent hot flashes and night sweats were having migraines, having depression, and smoking cigarettes, as well as being Black or having less than a high school education.

These two studies, taken together, underscore that not all women have the same experiences as they grow older, and that many can control the risk factors that might raise their chances of heart disease and stroke later in life. In other words, women can do a lot to control their destiny when it comes to both menopause symptoms and cardiovascular diseases.”

Catherine Kim, M.D., M.P.H., University of Michigan

She notes that the American Heart Association calls these risk factors the “Essential 8” and offers guides for what women, men and even children and teens can do to address them.

Evolving knowledge and treatment

The long-term study that the two new findings come from was specifically designed to look at cardiovascular risks when it launched in the mid-1980s. CARDIA stands for Coronary Artery Risk Development in Young Adults.

Back in the 80s, knowledge about the biology of blood vessels, down to the cellular and molecular level, was nowhere near where it is today. Both vasomotor symptoms in menopause and migraines have to do with blood vessel contraction and dilation.

But decades of research has shown the microscopic impacts on blood vessels of years of smoking, poor sleep, poor eating habits and lack of activity, as well as a person’s genetic inheritance, life experiences and hormonal history.

Newer injectable migraine medications called calcitonin gene-related peptide (CGRP) antagonists have reached the market in recent years.

Using monoclonal antibodies, they target a key receptor on the surface of blood vessel cells to prevent migraines and cluster headaches. But they are expensive and not covered by insurance for all people with migraines.

While the new study is based on data from years before these medications became available, Kim said she recommends them to her patients with persistent migraines, as well as working with them to understand what triggers their migraines and how to use other medications including pain relievers and antiseizure medications to prevent them.

She also notes that the paper on future risk of persistent hot flashes and night sweats echoes the recent trend of using antidepressant medications to try to ease these menopause effects.

Kim also says that evidence has grown about the importance of healthy sleep habits for reducing hot flashes, as well the short-term use of estradiol-based hormone therapy patches, which have not been shown to have a link to cardiovascular risk. And, she notes that research has not shown any over-the-counter supplement or herbal remedy to be effective, and that these are far less regulated than medications.

Additional authors:

Kim and Deborah Levine, M.D., M.P.H., senior author of the paper on cardiovascular risk, are both on the faculty in the Division of General Medicine, and members of the U-M Institute for Healthcare Policy and Innovation. Levine heads the Cognitive Health Services Research Program or COG-HSR. Other authors on this paper are Pamela J. Schreiner, Ph.D., of the University of Minnesota, Zhe Yin, M.S., formerly of IHPI, Rachael Whitney, Ph.D., lead statistician at COG-HSR; Stephen Sidney, MD, MPH, of Kaiser Permanente Northern California and Imo Ebong, M.D. of the University of California, Davis.

Schreiner is the senior author of the paper on later persistent VMS risk in younger women. Other authors on that paper are U-M’s Abbi Lane, Ph.D.; Zhe Yin, M.S.; Hui Jiang, Ph.D. and Richard Auchus, M.D., Ph.D.; as well as Thanh-Huyen Vu M.D., Ph.D. of Northwestern University and Cora Lewis, M.D.of the University of Alabama.

The study was funded by the National Heart, Lung and Blood Institute (HL169167), which also sponsors the CARDIA study.

Source:

Michigan Medicine – University of Michigan

Journal reference:

Kim, C., et al. (2024) Migraines, vasomotor symptoms, and cardiovascular disease in the Coronary Artery Risk Development in Young Adults study. Menopause. doi.org/10.1097/GME.0000000000002311.

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February 14, 2024
Bariatric surgery more effective in controlling hypertension rates in obese patients

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Bariatric surgery is more effective in controlling hypertension rates, or high blood pressure, in people with obesity and uncontrolled high blood pressure compared to blood pressure medication alone, according to a study published today in the Journal of the American College of Cardiology. People who underwent bariatric surgery had lower BMI and were on fewer medications after five years while maintaining normal blood pressure levels than those who only used antihypertensive medications.

According to the CDC, the U.S. obesity and hypertension rates in adults are 41.9% and 45.4%, respectively. Obesity is a known risk factor for cardiovascular disease and a major contributor to high blood pressure, which can make a person more susceptible to heart attack, stroke and heart failure, among other risks.

In clinical practice, obesity is an overlooked condition. As a consequence, there is a frequent failure in approaching obesity as a crucial step for mitigating the risk of important cardiovascular risk factors including hypertension.”

Carlos Aurelio Schiavon, MD, FACS, lead author of the study and a surgeon specializing in bariatric surgery at Heart Hospital (hcor) and BP Hospital in Sao Paulo

Researchers in this study looked at the impact of treating obesity to lower high blood pressure. While there are new medications to treat obesity, long-term adherence to medication can be challenging. This study looks at bariatric surgery as a better long-term solution to control obesity and, as a result, high blood pressure.

The GATEWAY trial included 100 people (76% of which were female) who had a body mass index (BMI) of around 36.9Kg/m². All participants had hypertension and were using at least two medications. People with previous cardiovascular events and poorly controlled Type 2 diabetes were excluded. Subjects were assigned to either Roux-en-Y gastric bypass with medical therapy or medial therapy alone and the primary outcome was reduction of at least 30% antihypertensive medications while maintaining blood pressure levels less than 140/90 mmHg at five years.

At five years, BMI was 28.01 Kg/m²for those who received bariatric surgery and 36.40 Kg/m²for those on medical therapy alone. People who had bariatric surgery had an 80.7% reduction in the number of medications they were taking compared to a 13.7% reduction in those only using medical therapy. Hypertension remission, defined as controlled blood pressure without medications, was 46.9% in those who underwent bariatric surgery compared to 2.4% in those on medical therapy alone.

“Our results underscore the importance of approaching obesity in reducing hypertension rates,” Schiavon said.

Limitations of the study include that it was a single-center, open-label study with a small sample size and there was loss of follow up in some patients.

In an accompanying editorial comment, Michael Hall, MD, MSc, professor and chair of the Department of Medicine at the University of Mississippi Medical Center, said the study provides important long-term data on the benefits of gastric bypass on weight loss and blood pressure control, but questions remain.

“Further studies assessing the threshold for bariatric surgery in people with obesity, optimal timing of bariatric surgery in obese people with cardiometabolic diseases, type of bariatric surgery and comparative studies of obesity pharmacotherapies and bariatric surgery are needed to clarify the optimal treatment pathways for this common and growing disease,” he said.

Source:

American College of Cardiology

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February 6, 2024
UVA scientists develop new approach to machine learning for identifying heart drug

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University of Virginia scientists have developed a new approach to machine learning – a form of artificial intelligence – to identify drugs that help minimize harmful scarring after a heart attack or other injuries.

Jeff Saucerman, PhD. Image Credit: University of Virginia

The new machine-learning tool has already found a promising candidate to help prevent harmful heart scarring in a way distinct from previous drugs. The UVA researchers say their cutting-edge computer model has the potential to predict and explain the effects of drugs for other diseases as well.

“Many common diseases such as heart disease, metabolic disease and cancer are complex and hard to treat,” said researcher Anders R. Nelson, PhD, a computational biologist and former student in the lab of UVA’s Jeffrey J. Saucerman, PhD. “Machine learning helps us reduce this complexity, identify the most important factors that contribute to disease and better understand how drugs can modify diseased cells.”

On its own, machine learning helps us to identify cell signatures produced by drugs. Bridging machine learning with human learning helped us not only predict drugs against fibrosis [scarring] but also explain how they work. This knowledge is needed to design clinical trials and identify potential side effects.”

Jeffrey J. Saucerman, PhD., UVA’s Department of Biomedical Engineering, a joint program of the School of Medicine and School of Engineering

The power of combining human learning and machine learning

Saucerman and his team combined a computer model based on decades of human knowledge with machine learning to better understand how drugs affect cells called fibroblasts. These cells help repair the heart after injury by producing collagen and contract the wound. But they can also cause harmful scarring, called fibrosis, as part of the repair process. Saucerman and his team wanted to see if a selection of promising drugs would give doctors more ability to prevent scarring and, ultimately, improve patient outcomes.

Previous attempts to identify drugs targeting fibroblasts have focused only on selected aspects of fibroblast behavior, and how these drugs work often remains unclear. This knowledge gap has been a major challenge in developing targeted treatments for heart fibrosis. So Saucerman and his colleagues developed a new approach called “logic-based mechanistic machine learning” that not only predicts drugs but also predicts how they affect fibroblast behaviors.

They began by looking at the effect of 13 promising drugs on human fibroblasts, then used that data to train the machine learning model to predict the drugs’ effects on the cells and how they behave. The model was able to predict a new explanation of how the drug pirfenidone, already approved by the federal Food and Drug Administration for idiopathic pulmonary fibrosis, suppresses contractile fibers inside the fibroblast that stiffen the heart. The model also predicted how another type of contractile fiber could be targeted by the experimental Src inhibitor WH4023, which they experimentally validated with human cardiac fibroblasts.

Additional research is needed to verify the drugs work as intended in animal models and human patients, but the UVA researchers say their research suggests mechanistic machine learning represents a powerful tool for scientists seeking to discover biological cause-and-effect. The new findings, they say, speak to the great potential the technology holds to advance the development of new treatments – not just for heart injury but for many diseases.

“We’re looking forward to testing whether pirfenidone and WH4023 also suppress the fibroblast contraction of scars in preclinical animal models,” Saucerman said. “We hope this provides an example of how machine learning and human learning can work together to not only discover but also understand how new drugs work.”

Findings published

The researchers have published their findings in the scientific journal PNAS, the Proceedings of the National Academy of Sciences. The research team consisted of Nelson, Steven L. Christiansen, Kristen M. Naegle and Saucerman. The scientists have no financial interests in the work.

The research was supported by the National Institutes of Health, grants HL137755, HL007284, HL160665, HL162925 and 1S10OD021723-01A1.

Source:

University of Virginia Health System

Journal reference:

Nelson, A. R., et al. (2024). Logic-based mechanistic machine learning on high-content images reveals how drugs differentially regulate cardiac fibroblasts. Proceedings of the National Academy of Sciences. doi.org/10.1073/pnas.2303513121.

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February 5, 2024
Stroke and neck artery tear increase heart attack risk in the first year
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Heart attack risk almost doubles in the first year after a stroke or when combined with a tear in a neck artery wall, however, a tear without a stroke does not seem to raise heart attack risk, according to preliminary research to be presented at the American Stroke Association’s International Stroke Conference 2024. The meeting will be held in Phoenix, Feb. 7-9, and is a world premier meeting for researchers and clinicians dedicated to the science of stroke and brain health.

Our findings may aid physicians in assessing and managing cardiovascular risk after these events.”

Liqi Shu, M.D., clinical fellow in neurology, Warren Alpert Medical School of Brown University in Providence, Rhode Island

Aortic dissection is a tear in the wall of the aorta, the large artery that receives blood directly from the heart, and is known to increase heart attack risk. Tears in the walls of the carotid or vertebral arteries, which extend out from the aorta and carry blood through the neck to the brain, are called carotid or vertebral artery dissections. These dissections can result in stroke, and stroke is known to be associated with heart attack. It was unclear whether carotid or vertebral artery dissection itself increases heart attack risk prior to this study.

The researchers analyzed health information for more than 800,000 adults (average age of 63 years; 62% women) hospitalized in New York (between 2011 and 2017) or Florida (between 2011-2019). The patients with no history of recent major head or neck trauma were separated into four groups based on diagnoses: acute ischemic stroke; cervical artery dissection; both; or a reference group of patients with transient ischemic attack known as a “warning stroke,” temporary loss of short-term memory (transient global amnesia) or migraine.

After adjusting for heart attack risk factors, the study found:
- Patients who had carotid or vertebral artery dissection without stroke had the same risk of having a heart attack within a year as those in the reference group.
- Patients with stroke, either with or without carotid or vertebral artery dissection, were almost twice as likely to have a heart attack within a year, in comparison to patients in the reference group.
“Before, it was just a guess, but now we know that carotid or vertebral artery dissection not causing a stroke does not raise the risk of a heart attack, and it makes sense that clinicians should focus predominantly on stroke prevention in this subgroup of patients,” Shu said.

Study background:
- Participants with a recent history of major head or neck trauma were excluded. Head or neck trauma may lead to traumatic carotid dissection, which is different from this study’s focus on spontaneous dissection.
- The analysis controlled for several heart attack risk factors, including age, Type 1 or Type 2 diabetes, heart failure, coronary artery disease, high cholesterol and high blood pressure.
- Almost 20,000 of the participants experienced a heart attack within one year of their initial hospitalization, and the risk of heart attack was compared among the diagnostic groups.
- Among the study group of 823,634 participants, 65.4% were white, 16.2% were Black or African American, and 12.2% were Hispanic or Latino adults.
While this study is based on hospitalization data only in New York and Florida, it’s important to note that these states collectively represent a substantial portion of the U.S. population, accounting for over 10% of the total. These two states also provide a good representation of diverse demographic groups, adding strength to the findings. However, caution should still be exercised when generalizing these results to people living in other geographic areas. In addition, this retrospective analysis (looks back in time to analyze data) might not have accounted for all factors influencing heart attack risk such as medication usage, which was not included in the databases.

According to the American Heart Association’s Heart Disease and Stroke Statistics 2024 Update, stroke accounted for approximately 1 of every 21 deaths in the United States in 2021.

Source:

American Heart Association
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February 1, 2024
Dementia risk can be the highest in the first year after stroke
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Having a stroke may significantly increase the risk of developing dementia. The risk of dementia was the highest in the first year after a stroke and remained elevated over a period of twenty years, according to preliminary research to be presented at the American Stroke Association’s International Stroke Conference 2024. The meeting will be held in Phoenix, Feb. 7-9, and is a world premier meeting for researchers and clinicians dedicated to the science of stroke and brain health.

Our findings show that stroke survivors are uniquely susceptible to dementia, and the risk can be up to 3 times higher in the first year after a stroke. While the risk decreases over time, it remains elevated over the long-term.”

Raed Joundi, M.D., D.Phil., lead study author, assistant professor at McMaster University in Hamilton, Ontario, Canada, and investigator at the Population Health Research Institute, a joint institute of McMaster University and Hamilton Health Sciences

To evaluate dementia risk after stroke, the researchers used databases at the Institute for Clinical Evaluative Sciences (University of Toronto, Canada), which includes more than 15 million people in the Canadian province of Ontario. They identified 180,940 people who had suffered a recent stroke -; either an ischemic stroke (clot-caused) or intracerebral hemorrhage (bleeding within the brain) -; and matched those stroke survivors to two control groups -; people in the general population (who had not had a heart attack or stroke) and those who had had a heart attack and not a stroke. Researchers evaluated the rate of new cases of dementia starting at 90 days after stroke over an average follow-up of 5.5 years. In addition, they analyzed the risk of developing dementia in the first year after the stroke and over time, up to 20 years.

The study found:
- The risk of dementia was highest in the first year after stroke, with a nearly 3-fold increased risk, then decreasing to a 1.5-fold increased risk by the 5-year mark and remaining elevated 20 years later.
- Dementia occurred in nearly 19% of stroke survivors over an average follow-up of 5.5 years.
- The risk of dementia was 80% higher in stroke survivors than in the matched group from the general population. The risk of dementia was also nearly 80% higher in stroke survivors than in the matched control group who had experienced a heart attack.
- The risk of dementia in people who had an intracerebral hemorrhage (bleeding in the brain) was nearly 150% higher than those in the general population.
“We found that the rate of post-stroke dementia was higher than the rate of recurrent stroke over the same time period,” Joundi said. “Stroke injures the brain including areas critical for cognitive function, which can impact day-to-day functioning. Some people go on to have a recurrent stroke, which increases the risk of dementia even further, and others may experience a progressive cognitive decline similar to a neurodegenerative condition.”

Each year, about 795,000 people experience a new or recurrent stroke. Approximately 610,000 of these are first attacks, and 185,000 are recurrent attacks, according to the American Heart Association’s Heart Disease and Stroke Statistics 2024 Update. According to the CDC, of those at least 65 years of age, there is an estimated 7 million adults with dementia in 2014 and projected to be nearly 14 million by 2060.

“Our study shows there is a large burden of dementia after acute stroke in Canada and identifies it is a common problem that needs to be addressed. Our findings reinforce the importance of monitoring people with stroke for cognitive decline, instituting appropriate treatments to address vascular risk factors and prevent recurrent stroke, and encouraging lifestyle changes, such as smoking cessation and increased physical activity, which have many benefits and may reduce the risk of dementia,” Joundi said. “More research is needed to clarify why some people who have a stroke develop dementia and others do not.”

A 2023 American Heart Association scientific statement, Cognitive Impairment After Ischemic and Hemorrhagic Stroke suggests post-stroke screenings and comprehensive interdisciplinary care to support stroke survivors with cognitive impairment.

A limitation of the study is that administrative data, hospital records and medication dispensary data were used for the analysis. Researchers were not able to perform cognitive assessments or neuroimaging (noninvasive images of the brain) on stroke survivors, therefore, there is no way to confirm the dementia diagnosis or type of dementia. However, the dementia definition was previously validated and shown to be accurate when compared to medical charts.

Study background and details:
- The study examined data from 2002 to 2022 on a total population of 15 million adults in Ontario, Canada.
- Data was mined from all hospital admissions, pharmacies prescribing medications for dementia and emergency departments across the province of Ontario.
- The analysis included 180,940 stroke survivors (mean age of 69, and 45% women) who had either an ischemic stroke or intracerebral hemorrhage and survived without dementia for at least 90 days.
- The study population was matched 1 to 1 on age, sex, rural residence, neighborhood marginalization, hypertension, diabetes (including Type 1 and Type 2 together), high cholesterol, atrial fibrillation, heart failure and peripheral artery disease -; factors known to increase the risk of dementia.
Source:

American Heart Association
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February 1, 2024