Tag: Heart

Good sleep patterns cut heart disease risk, study finds
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A recent study published in JAMA Network Open reveals that persistently favorable sleep patterns may reduce the risk of cardiovascular disease (CVD), even in individuals with higher genetic susceptibility.

Study: Changes in Sleep Patterns, Genetic Susceptibility, and Incident Cardiovascular Disease in China. Image Credit: aslysun / Shutterstock.com

How does sleep affect CVD?

CVD is a leading cause of morbidity and mortality worldwide, with about 33% of all deaths in 2019 attributed to CVD throughout the world. Similarly, the estimated mortality rate due to CVD in China currently exceeds 40%. Thus, the global burden of CVD emphasizes the importance of identifying modifiable risk factors that can be implemented to prevent CVD.

Growing evidence indicates that an unhealthy lifestyle, including impaired sleep patterns, can potentially increase the risk of CVD. Despite these studies, a single sleep measurement was often used to define sleep patterns, which may not adequately reflect sleep with CVD, as sleep habits can evolve. Furthermore, there remains a lack of data on how different sleep patterns in retired and older populations affect their risk of CVD.

Study design

The current study was conducted between 2008 and 2018 in China and included 15,306 middle-aged and older individuals without diagnosed cardiovascular complications. Self-reported sleep information was collected at baseline between 2008 and 2010 and at the first follow-up visit in 2013.

Sleep patterns of the study participants were defined as “favorable” and “unfavorable” based on bedtime, sleep duration, sleep quality, and midday napping. Study participants were categorized into four groups: persistent unfavorable, favorable-unfavorable (transitioning from favorable to unfavorable), unfavorable-favorable (transitioning from unfavorable to favorable), and persistent favorable.

Polygenic risk scores for coronary heart disease and stroke were calculated to determine the genetic susceptibility of the study participants to these diseases. Additionally, an expert panel of physicians was appointed to assess incident CVD, defined as a composite outcome of incident coronary heart disease and incident stroke, until the end of 2018.

Important observations

A total of 3,669 incident CVD cases, including 2,986 coronary heart disease cases and 683 stroke cases, were documented during the five-year study period from 2013 to 2018.

The assessment of five-year changes in sleep patterns found that 35.8% of participants practiced persistent unfavorable sleep patterns, whereas 25.8% had persistent favorable sleep patterns. Young age, female gender, and higher educational background were associated with persistent favorable sleep patterns.

Study participants with persistent unfavorable sleep patterns were at a greater risk of CVD than those with persistent favorable, favorable-unfavorable, or unfavorable-favorable sleep patterns. More specifically, a 16% and 34% reduced risk of coronary heart disease and stroke were observed among participants with persistent favorable sleep patterns. A subgroup analysis conducted after adjusting for participant’s age and sex revealed similar associations between changes in sleep patterns and CVD risk.

Genetic risk factors were not found to significantly influence the association between sleep pattern changes and cardiovascular disease risk. However, a combination of sleep pattern changes and polygenic risk scores was associated with cardiovascular risk in a dose-dependent manner.

To this end, individuals with persistent favorable sleep patterns and an intermediate genetic risk had a 36% reduced risk of stroke. In contrast, those with persistent favorable sleep patterns and a high genetic risk had a 45% reduced risk of stroke. Further analysis revealed that participants with persistent favorable sleep patterns and low genetic risk had a 35% reduced risk of coronary heart disease and a 52% lower risk of stroke compared to those with persistently unfavorable sleep patterns and high genetic risk.

Conclusions

The current study found that individuals with persistent favorable sleep patterns were at the lowest risk of incident CVD, coronary heart disease, and stroke during the subsequent five years. The benefits of persistent favorable sleep patterns remain unchanged for those with high genetic susceptibility to cardiovascular complications, thus demonstrating that individuals with higher genetic risk may benefit from persistent favorable sleep patterns.

Importantly, the study population included middle-aged and older Chinese retirees, which may restrict the generalizability of these findings. Furthermore, the current study does not include any information about participants’ sleep disorders and depression levels, which may have confounded the observed associations.
Journal reference:

Diao, T., Liu, K., Lyu, J., et al. (2024). Changes in Sleep Patterns, Genetic Susceptibility, and Incident Cardiovascular Disease in China. JAMA Network Open. doi:10.1001/jamanetworkopen.2024.7974
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April 26, 2024
Research reveals undertreatment of women with heart disease

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Women with heart disease are less often treated with cholesterol-lowering drugs than men, according to research presented today at ESC Preventive Cardiology 2024, a scientific congress of the European Society of Cardiology (ESC).

Cholesterol-lowering drugs save lives and prevent heart attacks, and should be prescribed to all patients with coronary artery disease. Unfortunately, our study shows that women are missing out on these essential medications.”

Dr. Nina Johnston, study author of Uppsala University, Sweden

Patients with coronary artery disease, also called chronic coronary syndrome, require medication to alleviate symptoms and prevent heart attacks and death. ESC guidelines recommend statins for all patients to lower cholesterol levels in the blood. If levels are not sufficiently lowered with the maximum tolerated dose of statin, then patients should receive a statin plus another cholesterol-lowering drug called ezetimibe. The recommendations are the same for women and men.

Despite having the same recommendations for treatment and for target levels of low-density lipoprotein (LDL; “bad”) cholesterol, previous studies have shown that women are less likely to meet target levels than men. This study examined whether women and men receive the same treatments.

This was a retrospective observational study that included 1,037 men and 415 women with a chronic coronary syndrome diagnosed between 2012 and 2020, and who had never had a heart attack. The median age was 68 years in men and 70 years in women. Electronic health records were used to obtain data on cholesterol levels. Information on dispensed medications was obtained from the Swedish National Prescribed Drug Registry.

Participants were followed up for three years following their diagnosis. The researchers found that at the end of the third year of follow-up, just 54% of women were treated with cholesterol-lowering drugs compared with 74% of men. Additionally, 5% of women were treated with statin plus ezetimibe compared with 8% of men. Factors which may explain the observed sex differences are under further investigation by the research group.

The researchers also examined treatments and cholesterol levels of women and men diagnosed with a chronic coronary syndrome at different ages (less than 60, 60 to 69.9, 70-79.9, 80 years or older). In all age groups, prescription of cholesterol-lowering treatment was highest at diagnosis and declined over the following three years. This decline in treatment over time was steeper in women compared with men. For example, in patients under 60 years of age, 65% of women and 79% of men were treated with cholesterol-lowering treatment the week after diagnosis, compared with 52% of women and 78% of men three years later. Achievement of LDL cholesterol targets was also lower in women than men.

Dr. Johnston said: “Our findings should be a wake-up call about the undertreatment of women with heart disease. Equal prescribing practices are needed so that women receive all recommended therapies and are protected from adverse outcomes.”

Contrary to common belief, cardiovascular disease kills more women than men, accounting for 45% of all deaths in women which is more than all cancers combined in the 57 ESC member countries.

Source:

European Society of Cardiology

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April 25, 2024
PhRMA Foundation awards grants to fight health disparities with digital health tools

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The PhRMA Foundation (PhF) awarded $500,000 grants to David G. Armstrong, DPM, MD, PhD, of the University of Southern California and Nino Isakadze, MD, MHS, of Johns Hopkins University to conduct research using digital health technologies (DHTs) to improve health equity and health outcomes for patients.

Armstrong and Isakadze were selected out of a group of seven researchers awarded $25,000 planning grants in 2023 by the Foundation to develop comprehensive research proposals to study the use of DHTs for advancing patient health, especially in underserved populations.

Digital health technologies have great potential to improve health care broadly, but they could be especially impactful for underserved communities if we design and test them with equity in mind. These studies will engage diverse populations to develop digital health solutions targeting treatment challenges for patients with diabetes and heart arrhythmia.”

Amy M. Miller, PhD, President of the PhRMA Foundation

Armstrong, a professor of surgery and neurological surgery at Keck School of Medicine of USC, will lead a project that aims to improve treatment for diabetic foot ulcers (DFU) using special smart boots that relieve pressure from specific areas of the foot. DFUs affect 15% of patients with diabetes -; more than 1 million people annually -; and if inadequately treated, can lead to amputation. Individuals from racial and ethnic minority groups are more likely to develop DFUs, receive amputations, and experience complications, leading to a lower survival rate.

While pressure offloading boots are considered the gold standard of care for DFU, patients struggle with using them because of discomfort, aesthetics, and mobility restrictions. Armstrong’s team seeks to improve patient outcomes with a new smart boot design that allows for remote monitoring of patient activity and adherence to the treatment.

“This grant from the PhRMA Foundation empowers us to enhance our smart offloading boots, tailoring them to fit the unique cultural and behavioral aspects of minority populations who are most at risk for hospitalization and amputation,” Armstrong said. “Our project is a step forward in making state-of-the-art health care accessible and equitable for all, particularly those in underserved communities.”

Isakadze, a clinical cardiac electrophysiology fellow and incoming faculty at Hopkins’ School of Medicine, will lead a project to test a digital health intervention for the management of atrial fibrillation (Afib), the most common type of heart arrhythmia. Afib is associated with poor quality of life and increased risk of stroke, heart attack, and death. Evidence shows that modifying risk factors such as weight, physical activity, and tobacco and alcohol use can reduce Afib burden.

Isakadze’s team is working with diverse patients, clinicians, and key stakeholders to design and test an Afib care management program that integrates 1) an Apple watch to track heart health data 2) a mobile app to educate and empower patients in tracking their health and setting health goals, 3) a clinician dashboard with patient data from the mobile app and smartwatch, and 4) individualized weekly health coaching to promote adherence to the virtual program.

“Receiving the PhRMA Foundation grant will allow us to generate robust evidence to support the use of digital health technologies to enable risk factor modification for diverse patients with Afib and bridge the critical gap in Afib management,” Isakadze said. “I am confident that digital health tools have tremendous potential to reach people where they are and transform health care delivery.”

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April 25, 2024
Researchers identify a ‘gene module’ involved in both depression and cardiovascular disease

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Depression and cardiovascular disease (CVD) are serious concerns for public health. Approximately 280 million people worldwide have depression, while 620 million people have CVD. It has been known since the 1990s that the two diseases are somehow related. For example, people with depression run a greater risk of CVD, while effective early treatment for depression cuts the risk of subsequently developing CVD by half. Conversely, people with CVD tend to have depression as well. For these reasons, the American Heart Association (AHA) advises to monitor teenagers with depression for CVD.

What wasn’t yet known is what causes this apparent relatedness between the two diseases. Part of the answer probably lies in lifestyle factors common in patients with depression and which increase the risk of CVD, such as smoking, alcohol abuse, lack of exercise, and a poor diet. But it’s also possible that both diseases might be related at a deeper level, through shared developmental pathways.

Now, scientists have shown that depression and CVD do indeed share part of their developmental programs, having at least one functional ‘gene module’ in common. This result, published in Frontiers in Psychiatry, provides new markers for depression and CVD, and could ultimately help to find drugs to target both diseases.

“We looked at gene expression profile in the blood of people with depression and CVD and found 256 genes in a single gene module whose expression at levels higher or lower than average puts people at greater risk of both diseases,” said first author Dr Binisha H Mishra, a postdoctoral researcher at Tampere University in Finland.

The authors define a gene module as a group of genes with similar expression patterns across different conditions and hence likely to be functionally related.

Young Finns study

Mishra and colleagues studied gene expression data in the blood of 899 women and men between 34 and 49 years old who were participants in the Young Finns study, one of largest studies of cardiovascular risk factors from childhood to adulthood to date. The Young Finns study began in 1980 with a cohort of almost 4,000 children and adolescents, then between three and 18 years old, randomly selected from five cities in Finland. The health of these participants has been followed ever since.

Finland has the highest estimated incidence of mental disorders in the EU, and is the ninth-highest ranking country in the world for the prevalence of depression. In contrast, the country has a relatively low prevalence of CVD, ranking in the bottom 20% worldwide for this class of diseases.

In 2011, the researchers running the Young Finns study tested the participants for symptoms of depression with a tried-and-tested questionnaire: Beck’s depression inventory (BDI-II), whose score increases with more severe symptoms. They also tested them for the risk of developing CVD through AHA’s ‘ideal cardiovascular health’ score, on a scale from zero (highest risk) to seven (lowest risk). Mishra et al. further analyzed these data for the present study.

It’s all in the blood

In 2011, whole blood had also been taken from each participant, and Mishra and colleagues here analyzed these samples with state-of-the-art gene expression methods.

They used advanced statistics to identify 22 distinct gene modules, of which just one was associated with both a high score for depressive symptoms and a low score for cardiovascular health.

The top three genes from this gene module are known to be associated with neurodegenerative diseases, bipolar disorder, and depression. Now we have shown that they are associated with poor cardiovascular health as well.”

Dr Binisha H Mishra, Postdoctoral Researcher, Tampere University in Finland

These genes are involved in biological processes such as inflammation that are involved in pathogenesis of both depression and cardiovascular disease. This helps to explain why both diseases often occur together.

Other genes in the shared module have been shown to be involved in brain diseases such as Alzheimer’s, Parkinson’s, and Huntington’s disease.

“We can use the genes in this module as biomarkers for depression and cardiovascular disease. Ultimately, these biomarkers may facilitate the development of dual-purpose preventative strategies for both the diseases,” said Mishra.

Source:

Journal reference:

Mishra, B. H., et al. (2024) Identification of gene networks jointly associated with depressive symptoms and cardiovascular health metrics using whole blood transcriptome in the Young Finns Study. Frontiers in Psychiatry. doi.org/10.3389/fpsyt.2024.1345159.

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April 25, 2024
Better cardiovascular health among middle-aged Black women linked to less decline in cognition
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Better heart health was linked to less decline in mental processing speed and cognition among middle-aged Black women, although not among middle-aged white women, according to new research published today in the Journal of the American Heart Association, an open access, peer-reviewed journal of the American Heart Association.

Take care of your heart, and it will benefit your brain. Better cardiovascular health in women in their 40s is important to prevent later-life Alzheimer’s disease, dementia and to maintain independent living.”

Imke Janssen, Ph.D., study lead author, professor of family and preventive medicine at Rush University Medical Center in Chicago

Previous research has linked heart health to a lower risk of cognitive decline. This decline may begin years before the onset of dementia, Janssen explained. Questions that need to be answered include understanding when the cognitive benefits of heart health begin, whether they occur among people of different races and whether they affect different types of brain function including reasoning.

In this study, researchers compared key heart health metrics, known as the American Heart Associations’ Life’s Essential 8, among middle-aged Black and white women to cognitive testing conducted on the women every one to two years over a 20-year period.

Life’s Essential 8^TM includes objectively measured weight, blood pressure, glucose, and cholesterol, as well as self-reported health behaviors such as eating healthy foods, being physically active, not smoking and getting enough sleep.

The cognitive tests assessed processing speed and working memory. Processing speed is the pace at which the brain has accurate recognition of visual and verbal information and is necessary for daily activities such as driving. In this study, cognitive processing speed was assessed as quickly and accurately recognizing sets of numbers, objects, pictures or patterns. Working memory is the ability to remember and use small pieces of information for daily tasks, including remembering names and doing math.

The study found differences in cognitive decline by race only in processing speed, not in working memory. Specifically:
- Black women with lower heart health, based on the Life’s Essential 8 metrics, had a 10% decrease in processing speed over 20 years. Their scores were worse for all eight risk factors for heart disease, especially blood pressure and smoking.
- In contrast, Black women with good heart health showed little decline in mental processing during the 20-year study.
- Among white women with poorer heart health, processing speed did not decline.
- Heart health did not affect working memory for Black or white women.
“We were surprised that we did not find results like those of past studies, which showed cognitive decline in Black and white men and women, and found cardiovascular health to be more important for white adults rather than people in Black subgroups,” Janssen said. “We think these differences are due to the younger age of our participants, who began cognitive testing in their mid-40s, whereas previous studies started with adults about 10 to 20 years older. The next step is a clinical trial to confirm whether optimizing heart health in Black women at midlife may slow cognitive aging, maximize independence and reduce racial inequities in dementia risk.”

Several limitations may have affected the study’s results. The study included women from a single study site and relied on self-reported measures of heart health, which may have been inaccurate. In addition, the study did not include measures that may account for racial differences in access to health care or the potential impact of structural racism on Black participants.

Study background and details:
- The study included 363 Black and 402 white women from the Chicago site of the Study of Women’s Health Across the Nation (SWAN).
- The Chicago SWAN group started cognitive testing in 1997, when the women were between 42 and 52 years old. Cognitive testing continued every one to two years through 2017.
- The analytic sample consisted of 765 women who provided 5,079 cognitive processing speed and 4,933 working memory assessments over the 20-year period.
- Heart health based on Life’s Essential 8 was assessed at time of enrollment only.
Source:

American Heart Association
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April 24, 2024
Younger adults with atrial fibrillation face higher rates of heart failure and stroke

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In a recent study published in the Circulation: Arrhythmia and Electrophysiology, a group of researchers investigated the risk factor (RF) burden, clinical outcomes, and long-term survival among patients with atrial fibrillation (AF) under 65 years of age.

Study: Mortality, Hospitalization, and Cardiac Interventions in Patients With Atrial Fibrillation Aged <65 Years. Image Credit: Nakharin T/Shutterstock.com

Background

AF, the most prevalent heart rhythm disorder in the United States (U.S.), affected an estimated 5.2 million people in 2010, with projections rising to 12.1 million by 2030.

While AF is typically seen in older adults, a growing number of patients are under 65 at diagnosis, representing 10%-15% of cases. This age group faces increasing rates of RFs, such as hypertension, diabetes, and obesity.

Despite their prevalence, the impact of AF on mortality and major clinical events in younger patients remains poorly defined. Further research is needed to clarify the unique clinical outcomes and effective management strategies for younger patients with AF.

About the study

The present study was a retrospective observational cohort analysis at the University of Pittsburgh Medical Center involving patients over 18 years diagnosed with AF.

The diagnosis was confirmed using the International Classification of Diseases (ICD), Ninth and Tenth Revision codes. Patients evaluated between January 2010 and December 2019, were included if they had at least two outpatient visits in internal medicine, family medicine, or cardiology.

Data were extracted from an extensive electronic health record system combined with administrative and other data sources.

This study assessed a range of cardiovascular risk factors and comorbidities, including obesity, smoking history, hypertension, diabetes, and various heart conditions. Detailed information on patient characteristics such as age, gender, and race was gathered, along with data on previous cardiovascular interventions and medication usage at baseline.

The primary outcome measured was all-cause mortality, verified through the Social Security Death Index and supplemented by electronic health record data. The study also looked at secondary outcomes like hospitalizations for cardiovascular events and cardiac interventions that occurred during follow-up.

Statistical analyses involved various tests to compare continuous and categorical variables and utilized Kaplan-Meier survival analysis and Cox proportional hazards models to explore the impact of AF on mortality in patients under 65, adjusting for multiple confounders.

Sensitivity analyses were conducted to consider the effects of various exclusions on the study results.

Study results

The study included 67,221 patients diagnosed with AF, reflecting an average CHA₂DS₂-VASc score of 3.1±1.6. The cohort’s average age was 72.4±12.3 years, with 45% female and 95% white participants. Notably, a significant portion, 26%, were under 65 years at their initial evaluation.

Within the subgroup of patients younger than 65, males were more prevalent, especially in those under 50 (73%) and those between 50 to 65 years (66.3%). This group displayed substantial cardiovascular RFs, including hypertension (55%), diabetes (21%), heart failure (HF) (21%), and dyslipidemia (47%).

Lifestyle RFs such as obesity (over 20% affected) and current smoking (16%) were also significant. Among these younger patients, 4% had a history of stroke, and peripheral vascular disease was present in 1.35%.

Cardiac interventions were common: 3% had an implantable cardioverter-defibrillator, 2% had a pacemaker, 5.5% underwent percutaneous coronary intervention, and 2.5% had prior mitral valve surgery.

Additional comorbidities included obstructive sleep apnea (18%), chronic obstructive pulmonary disease (11%), and chronic kidney disease (1.3%).

At baseline, over half of the patients under 65 were taking anticoagulants, with similar rates for aspirin and significant use of class 1 (6%) and class 3 (17%) antiarrhythmic drugs.

Mortality and hospitalization rates varied by age, with the younger cohort experiencing notably lower mortality rates compared to their older counterparts. In the under-50 age group, the 5-year and 10-year mortality rates were 5.6% and 10.3%, respectively, which approximately doubled in the 50 to 65 age group to 11.5% and 20.8%.

Hospitalization for AF, HF, and myocardial infarction was reported in 31%, 12%, and 2.7% of those under 50, while those figures increased to 38%, 19%, and 4.7% in the 50 to 65 group.

Further analysis revealed multiple cardiovascular RFs and comorbidities independently associated with all-cause mortality among those under 65. HF, peripheral vascular disease, diabetes, coronary artery disease, smoking, and obesity significantly impacted mortality rates.

Notably, chronic kidney disease and chronic obstructive pulmonary disease were also linked to poorer outcomes. Interaction analyses indicated a significant correlation between age and the impact of hypertension and HF on mortality rates.

Comparing the AF cohort with national mortality estimates highlighted a considerably higher all-cause mortality rate among the AF patients, particularly notable in younger males and females. Furthermore, adjusting for cardiac and noncardiac risk factors, AF significantly increased the mortality hazard in patients under 65 compared to a control group without AF.

This population also showed a heightened risk of hospitalization for myocardial infarction, HF, and stroke, underscoring the severe impact of AF in younger patients.

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April 24, 2024
American Heart Association launches initiative to engage pharmacists in atrial fibrillation care
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Atrial fibrillation, or AFib, is the most common type of irregular heartbeat, estimated to affect about 12.1 million U.S. adults by 2030. The abnormal firing of electrical impulses causes part of the heart to quiver, or fibrillate, often leading to complications and up to a fivefold increased risk of stroke. To help ensure all patients with AFib receive the most appropriate care, the American Heart Association is launching a new effort to educate and engage pharmacists, an important but underrepresented voice in AFib care.

This new effort, being conducted through June 2025, is the latest phase of the Association’s Four Fs of Atrial Fibrillation initiative, supported by Bristol Myers Squibb-Pfizer Alliance. The Four Fs are patient health concerns impeding guideline-directed anticoagulant therapy, including:
- fear of falling,
- fear of bleeding,
- forgetfulness, or cognitive dysfunction and
- frailty.
Pharmacists are often not consulted in the decision-making conversations for Afib patients during the patient care journey. During this next phase of the initiative, the Association will convene pharmacists in a roundtable event to identify gaps and opportunities related to AFib in this field. The Association then will share resources and insights nationally across thousands of hospitals and outpatient clinics.

Pharmacists are an integral part of the multidisciplinary team to optimize care for individuals with atrial fibrillation. The insight of pharmacists in evaluating the medical complexity and use of multiple medications is essential in facilitating safe and effective anticoagulation and ultimately preventing life-altering medical consequences of AFib.”

Cody Parsons, APh, PharmD, BCCCP, manager of clinical operations for Stanford Health Care’s cardiovascular health service line

AFib is often only detectable during physical examination, although some affected people may experience fatigue, rapid and irregular heartbeat or other discomfort. The use of anticoagulant therapy to reduce stroke risk is supported by science, but many patients remain untreated or undertreated.

This is the latest in ongoing efforts by the American Heart Association, the world’s leading voluntary organization focused on heart and brain health and this year celebrating 100 years of lifesaving service, to advance health and hope for everyone, everywhere.

Source:

American Heart Association
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April 23, 2024
Simple sore throat can lead to serious damage to the heart valves

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A simple sore throat from a bacterial streptococcal infection can lead to serious damage to the heart valves, a condition known as RHD. It mainly affects children and young adults with poor living conditions and limited access to health care. In Namibia, which was studied for the thesis, it is estimated that about 1% of the population lives with RHD.

In our research, we have reviewed health records from the Ministry of Health and Social Affairs and the Department of Cardiology for the years 2010 to 2020. We also interviewed patients with RHD at the cardiology clinic between 2019 and 2020 to understand how RHD affects them. Furthermore, we have reviewed international studies to assess the effectiveness of different prevention strategies that have been evaluated.”

Panduleni Penipawa Shimanda, dissertation author, Department of Epidemiology and Global Health

Main findings of the study suggest that there is poor documentation and detection of people with RHD in Namibia.

“From a survey of patients, we could see that treatment of RHD means that people can live a good life. Another observation is that there are few preventive interventions that have been evaluated worldwide. Our findings also suggest that school-based screening to detect early symptoms such as sore throat and RHD at an early stage is likely to be cost-effective”.

Overall, RHD was observed in children and young adults in Namibia’s northern regions, possibly due to living conditions and access to medical care.

To improve the situation in Namibia and other countries, ministries of health and health organizations need to work together for better data collection practices, raise awareness of RHD among families and health professionals, and ensure early detection and treatment. Incorporating RHD services into existing health care programs, such as for maternal and child health care, can save resources.

“This is important in countries like Namibia, where RHD prevention is limited. Prevention of RHD can save young lives, and for this we need to find efficient and effective strategies,” says Panduleni Penipawa Shimanda.

The dissertation will take place on 26 April 2024, 09.00. Thesis title: Rheumatic heart disease in Namibia: Evaluation of the burden and cost-effectiveness of a prevention strategy. Opponent Phillip Moons, KU Leuven, Belgium.

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April 23, 2024
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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April 23, 2024
Replacing dinner calcium with breakfast intake could reduce heart disease risk, study finds

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In a recent study published in BMC Public Health, researchers investigated whether the quantity of calcium consumed at breakfast and dinner was associated with cardiovascular disease (CVD) in the general population.

Study: Association of dietary calcium intake at dinner versus breakfast with cardiovascular disease in U.S. adults: the national health and nutrition examination survey, 2003–2018. Image Credit: Goskova Tatiana/Shutterstock.com

Background

Cardiovascular disease is the primary cause of mortality globally and the most prevalent chronic illness among individuals living in the United States.

Calcium, a crucial dietary element, helps prevent and manage CVD by regulating blood vessels, muscular contraction, nerve transmission, hormone production, fat mass, blood pressure, and blood lipids. Circadian clocks in animals govern circadian rhythms, which are biological rhythmic patterns that last 24 hours.

Diet is a significant external element that influences the synchronization of circadian clocks. Recent research indicates that calcium intake can influence physiological variations in circadian pacemaker-type neuronal cells and alter the expression of the biological clock genes.

However, the relationship between calcium consumption at various times of the day and cardiovascular disease is unclear.

About the study

The present study examined the relationship between dietary calcium consumption at dinner and breakfast and CVD.

The study comprised 36,164 United States individuals (17,456 males, 18,708 females, and 4,040 cardiovascular disease patients) from the 2013–2018 National Health and Nutrition Examination Surveys. They stratified the participants into five groups based on their calcium intakes from night and early morning meals.

The study focused on the fraction of calcium consumption in night and morning meals (Δ=calcium intake from dinner /calcium intake from breakfast).

The study’s endpoint was cardiovascular disease, based on a self-reported history of angina, heart failure, stroke, coronary artery disease, or heart attack.

Potential confounders included age, sex, educational attainment, smoking status, physical activity, marital status, annual income, alcohol consumption, body mass index (BMI), high-density lipoprotein (HDL), uric acid (UA), total cholesterol (TC), hypertension, and type 2 diabetes (T2DM).

Following confounder adjustment, the researchers used logistic regression to calculate the odds ratios (OR) for the relationship between the calcium intake percentage at night and morning and cardiovascular disease.

They used dietary replacement models to investigate changes in cardiovascular disease risk by replacing 5.0% calcium from dinner with calcium consumption in the morning.

The team conducted home interviews with individuals and collected data at a mobile testing facility. They excluded individuals under 20 years, pregnant women, those with incomplete data, those consuming more than 4,500 kcal per day, and those using calcium supplements.

They assessed dietary consumption using a 24-hour diet recall completed on two non-consecutive days. They assessed nutrient intake using the Food and Nutrient Database for Dietary Studies recommendations by the United States Department of Agriculture. They performed sensitivity studies to investigate the validity of the study findings.

Results and discussion

Individuals in the uppermost quartile showed a higher likelihood of having cardiovascular disease than those in the lowermost quintile, with adjusted OR values of cardiovascular disease of 1.2.

While keeping total calcium consumption constant, substituting a 5.0% calcium consumption from dinner meals with calcium consumption at breakfast reduced CVD risk by 6.0%.

Breakfast meals with morning snacks or dinner meals with evening snacks reduced CVD risk by 6% (OR, 0.9). Compared to the lowermost quintile, having breakfast and morning snacks as breakfast or dinner and evening snacks as dinner in the uppermost Δ quintile significantly reduced CVD risk, with adjusted ORs of 1.1 and 1.1, respectively.

Consuming dinner with evening snacks and breakfast with morning snacks yielded an adjusted OR of 1.1. Among overweight and obese individuals, the adjusted odds ratio of cardiovascular disease in the uppermost Δ quintile was 1.2 after adjusting for various confounding variables.

The circadian clock governs several cardiovascular processes, including endothelial function, thrombus development, blood pressure, and heart rate. Basic helix-loop-helix ARNT-like protein 1 (Bmal1), a primary clock gene, regulates calcium absorption and metabolism.

Sleep periods improve calcium retention capability. Circadian rhythm influences the inflammatory nuclear factor kappa B (NFκB) pathway, metabolism, and immune system adaptability.

The study found that those in the top percentile of calcium consumption at dinner and breakfast are more likely to develop cardiovascular disease. The findings imply that allocating calcium intake to both meals is critical.

The study demonstrated a positive correlation between the Δ value and cardiovascular disease risk. Replacing 5.0% of calcium consumption from dinner meals with the same amount at breakfast reduced CVD risk by 6.0%. However, further research is required to corroborate these findings across races and nations.

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April 23, 2024