Tag: Heart

US study links extended sitting and lack of coffee to higher death rates

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The researchers of a recent study published in BMC Public Health examined the independent and combined effects of daily sedentary times and coffee consumption on cardiovascular disease (CVD)-related and any-cause mortality in the United States.

Study: Association of daily sitting time and coffee consumption with the risk of all-cause and cardiovascular disease mortality among US adults. Image Credit: ViDI Studio/Shutterstock.com

Background

Sedentary behavior and coffee drinking are associated with chronic illnesses, but their combined links with mortality are poorly understood.

Prolonged sitting raises the risk of all-cause and heart disease-related mortality, particularly in individuals who do not meet the recommended physical activity levels. According to studies, death rates are increasing for all causes, including cancer.

Coffee consumption varies depending on lifestyle and demographics, with age playing a primary role. Its antioxidant qualities can lower chronic disease morbidity and mortality.

However, further study is required to discover the best coffee intake technique and dose. The growing incidence of sedentary behavior and coffee drinking raises concerns about their relationship.

About the study

In the present prospective cohort study, researchers investigated the combination effects of daily sedentary times and coffee consumption on death from all causes and CVDs.

The researchers examined data from the National Health and Nutrition Examination Surveys (NHANES) conducted between 2007 and 2018, including 10,639 participants.

They excluded individuals with missing data on exposure factors, outcome variables, and covariates and those with inconsistent daily energy intake. They gathered mortality data from interviews and physical examinations until 31 December 2019 and assessed self-reported daily sedentary time data.

All participants had offline interviews, physical examinations, and laboratory investigations at testing sites. They collected coffee beverage data from one-day food recall questionnaires and used the Global Physical Activity Questionnaire (GPAQ) to assess sedentary time.

The primary study outcomes were cardiovascular disease and all-cause death, established using ICD-10 numbers.

The team used Cox proportional hazard regressions to calculate hazard ratios (HR) values adjusted for sociodemographic variables, lifestyle factors, and medical history covariates. Sociodemographic variables included sex, ethnicity, race, educational attainment, marital status, poverty income ratio, body mass index (BMI), and waist circumference].

Lifestyle factors included smoking habits, alcohol intake, the Healthy Eating Index (HEI) 2015 values, and physical activity. Medical history included hypertension, diabetes, hypercholesterolemia, cancer, and medications.

Results

Individuals being sedentary for six hours or more daily showed a higher likelihood of being white, non-Hispanic, and educated beyond high school. They also exhibited a larger waist circumference, abdominal obesity, and a higher BMI.

Coffee users showed higher odds of being non-Hispanic, Caucasian, older, and educated beyond high school. Only 52% of US people drink coffee, and over half report sitting for at least six hours daily. Twenty-three percent of Americans stated they sat for six hours or more daily and did not drink coffee.

Over a 13-year follow-up, 945 fatalities occurred among research participants, with 284 of these being due to CVD.

Sedentary times of >8.0 hours daily were linked to increased death rates from all causes (HR, 1.5) and CVD-related (HR, 1.8) compared to sitting times of <4.0 hours daily, according to multivariate analysis. Individuals in the uppermost quartile for coffee consumption had decreased odds of any-cause deaths (HR, 0.7) and CVD-related fatalities (HR, 0.5) compared to non-coffee users.

Joint analyses revealed that coffee non-drinkers sitting for at least six hours per day had a 1.6-fold higher likelihood of any-cause mortalities than coffee consumers who sat for <6.0 hours daily.

The findings indicate that the relationship between sitting time and increased death risk was exclusive for adult non-consumers of coffee, not among coffee drinkers.

Any-cause death risk was considerably greater in those aged >65 years inactive for >8.0 hours daily (HR, 1.7). Individuals aged >65 years, females, those with truncal obesity, former alcohol consumers, former cigarette smokers, and insufficient physical activity had higher HR values for all-cause death risk as their daily sedentary time increased, and the trend showed statistical significance.

Subgroup analyses stratified by coffee intake showed that the relationship between coffee drinking and all-cause death risk was considerably more robust among black and non-Hispanic individuals consuming coffee (HR 0.6).

Conclusions

The study showed sedentary behavior associated with increased any-cause and heart disease-related mortality. However, any-cause fatalities were lower in the highest percentile of coffee consumption, and the lower risk was strongly associated with any amount of coffee consumed.

The relationship was exclusively to individuals who did not drink coffee. Over a 13-year follow-up, the researchers found a statistically significant link between individuals sitting for more than eight hours per day and an elevated risk of any cause and cardiovascular death.

Prolonged and unbroken sitting tends to decrease glucose metabolism and exacerbate inflammation. Coffee consumption reduces the risk of metabolic syndrome, which promotes inflammation.

Prospective cohort studies are needed to analyze the influence of coffee intake on health benefits in sedentary populations, and further research, especially multicenter studies, is required to investigate the effects of individual coffee types on mortality and causal linkages.

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April 23, 2024
Delving into burning issues about heart disease and much more
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The hottest science in the prevention of heart disease awaits at ESC Preventive Cardiology 2024, a scientific congress of the European Society of Cardiology (ESC). The annual congress of the European Association of Preventive Cardiology (EAPC), a branch of the ESC, takes place 25 to 27 April at the Megaron – Athens International Conference Centre, Greece. Explore the scientific programme.

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

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

Dr. Nicolle Kränkel, Congress Programme Committee Chair

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

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

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

Heart health and the young:
- How do energy drinks affect the hearts of adolescents?
- Is doping dangerous for the heart? Find out in a session dedicated to stimulants and their effects on the heart.
- What is the impact of e-cigarettes on young hearts?
Lifestyle issues:
- Weight loss update: different approaches to weight loss are needed from childhood to old age – hear how one size does not fit all. And it’s not only about losing fat: learn about personalising exercise in obese patients.
- What’s new in smoking cessation, including digital tools?
- Can heart healthy diets be affordable? And the latest evidence on demographic and socio-economic disparities in nutrition. Check out nutrition for a better heart.
And finally, could a vaccine prevent heart disease? Get up-to-the-minute scientific evidence on immunity and cardiovascular risk and what’s on the horizon.

Source:

European Society of Cardiology (ESC)
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April 22, 2024
Climate change predicted to spike cardiovascular deaths in China
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A new study published in the journal eBioMedicine aims to predict the extent to which climate change may impact the risk of cardiovascular disease (CVD) mortality in China.

Study: Projecting heat-related cardiovascular mortality burden attributable to human-induced climate change in China. Image Credit: Piyaset / Shutterstock.com

Climate change and CVD

Current estimates indicate that about 19 million people die each year due to CVD, five million of whom reside in China. Furthermore, CVD causes over 390 million disability-adjusted life years (DALYs) globally.

Due to climate change, the global temperature at the earth’s surface has risen by 1.15 °C above that in the pre-industrial era. Previous studies have reported an adverse impact of climate change on overall mortality that is dependent on age, sex, and cause of death, as well as deaths due to CVD.

Heat affects the cardiovascular system in multiple ways, including the excretion of salt and water as sweat, higher cholesterol levels, and hemodynamic strain. Moreover, climate change-related heat can increase the risk of atherosclerotic thrombosis of the heart and brain vessels and, as a result, the rate of strokes and heart attacks.

About the study

The present study attempted to predict CVD mortality associated with climate change in a Chinese setting. Current temperatures were measured at 161 disease surveillance points (DSPs).

These projections were based on the Coupled Model Intercomparison Project Phase 6 (CMIP6), which is under the World Climate Research Programme (WCRP). WCRP examines natural climate change and the combined scenario with both natural and anthropogenic impacts on the climate.

A total of 22 General Climate Models (GCMs) were used to determine projected temperatures from 2010 to 2100 in both human-induced and natural scenarios. Human-induced scenarios were calculated based on the difference between the combined and natural impacts.

Recognizing that economic and social change is closely related to climate change, the Intergovernmental Panel on Climate Change (IPCC) has presented a series of integrated scenarios that combine both shared socioeconomic pathways (SSPs) and climate representative concentration pathways (RCPs).

Study findings

The mean annual temperature at the DSPs varied from 12.6 to 28.4 °C, during which time about 330,000 CVD deaths occurred.

Under natural conditions, the summer temperatures in China would not significantly change. Similarly, in this scenario, the proportion of CVD deaths related to heat would decline by 0.5% in the 2090s as compared to 2010 death rates due to CVD.

Conversely, summer temperatures increased by 5-6 °C with the combined scenarios, depending on the region. The predicted CVD mortality fraction in the 2090s rose from 10% to 30%, depending on the modeled scenario.

The death rate among CVD patients followed a J-shaped curve beyond a critical minimum temperature. The most significant increase relative to baseline temperature was in the South and East of China.

The proportion of heat-related deaths due to CVD with human-induced climate change continued to rise during each decade from about 31% in the 2010s to an estimated 70-90% in the 2090s under different scenarios.

Individuals who were considered to be most vulnerable to heat-related CVD mortality included those living in rural areas, those with lower education levels, stroke patients, females, older adults, and those residing in Southern and Eastern China. Importantly, individuals with lower levels of education are more likely to work outdoor jobs, have unequal access to healthcare, and be diagnosed with chronic diseases.

Conclusions

“This study provides evidence that human activities will amplify future heat-related cardiovascular mortality burden.”

Anthropogenic climate change resulting in CVD deaths could account for as much as 90% of excess mortality due to excessive heat by 2090. Simultaneously, the CVD burden associated with natural climate change may not change significantly. Nevertheless, the study findings emphasize the importance of limiting carbon emissions to prevent further global warming ultimately.

“Active adaptation and mitigation measures towards future warming could yield substantial health benefits for the patients with CVD.”

Future studies are needed to identify populations and groups at the greatest risk of climate-related health effects and the different types of risk that may be associated with global climate change. These data will assist in implementing integrated and sensitive public health policies to ultimately reach environmental targets.
Journal reference:

Zhu, Q., Zhou, M., Sakhvidi, M. J. Z., et al. (2024). Projecting heat-related cardiovascular mortality burden attributable to human-induced climate change in China. eBioMedicine. doi:10.1016/j.ebiom.2024.105119.
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April 22, 2024
Rising trend in atrial fibrillation risk over 20 years heightens concern for related heart and stroke complications
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In a recent Danish population-based cohort study published in the British Medical Journal, researchers analyzed the changes in lifetime risks of atrial fibrillation (AF) and complications. They compared the data between two periods, 2000-2010 and 2011-2022. They found that the lifetime risk of AF increased over the study period, and individuals with AF showed significant risks of heart failure (HF) and stroke over their lifetime.

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

Background

AF poses a growing health concern globally, with a substantial projected increase in affected populations. While improvements in mortality rates have been observed, AF remains linked to increased risks of stroke, HF, and myocardial infarction (MI). Understanding and effectively assessing AF risk, including its long-term complications, are crucial for prevention efforts. Residual lifetime risk, a measure capturing cumulative disease risk over the remaining lifespan, offers valuable insights for public health initiatives and patient education. Despite previous studies on AF lifetime risk, data on temporal trends and comprehensive complication risks are lacking. Monitoring changes in AF burden is vital for evaluating management strategies and prevention efforts, especially amid evolving stroke prevention therapies. In the present investigation involving the Danish population, researchers aimed to assess the lifetime risk of AF and its associated complications and to analyze their temporal trends spanning from 2000 to 2022.

About the study

Data were gathered from national registries, including the Danish National Patient Registry for hospital stays and outpatient contacts, the Civil Registration System for demographics and vital status, and the Danish National Prescription Registry for medication information. The study included 3,574,903 Danish individuals without AF at or after the age of 45 between 2000 and 2022. About 51.7% of the participants were women. Those aged 95 years or older were excluded. Follow-up ended at incident AF, death, age 95 years, emigration, or period end. Primary analysis used 45 years as the index age, with secondary analyses for ages 55, 65, and 75 or older. Incident AF was identified from hospital diagnoses.

A total of 362,721 individuals were followed up upon newly diagnosed AF (46.4% females). Complications, including HF, stroke, MI, or systemic embolism, were recorded post-diagnosis. Exclusions comprised pre-existing complications and events within seven days of diagnosis. The diagnosis followed strict International Classification of Diseases 10 (ICD-10) criteria with high predictive values. Analyses were conducted for index ages 45, 55, 65, and 75 years.

Study populations were characterized by assessing medical history along with family income and educational attainment. The statistical methods included the use of the Aalen-Johansen estimator for cumulative incidence, pseudo-value regression, propensity score adjustment using logistic regression, stabilized inverse propensity weighting, and subgroup analyses with interaction testing.

Results and discussion

Age distributions were found to remain consistent across the periods, while hypertension, dyslipidemia, and diabetes prevalence rose over time, whereas HF and MI prevalence reduced.

The lifetime risk of AF at the age of 45 between 2000-2022 was 27.7%, with higher risk observed among men, those with a history of certain cardiovascular conditions, and individuals with higher socioeconomic status. From 2000-2010 to 2011-2022, there was an absolute increase in lifetime risk from 24.2% to 30.9%. This trend persisted across all subgroups, with slightly higher increases among men, individuals with HF or stroke history, and those without dyslipidemia. At ages 55, 65, and 75, the lifetime risk also showed an upward trajectory, with absolute increases between the two periods.

Among individuals diagnosed with AF, HF was the most common complication, with a lifetime risk of 41.2%, followed by stroke (21.4%), MI (11.5%), and diagnosed systemic embolism (1.8%). Men generally faced higher risks of HF and MI compared to women, while women had a higher risk of stroke post-AF. History of certain cardiovascular conditions significantly increased the risk of HF post-AF. Over time, a slight decrease in the lifetime risks of stroke (-2.5%) and MI (-3.9%) was observed.

The study reports the temporal patterns in lifetime risks associated with AF and its subsequent complications for the first time. However, the study is limited by its potential underestimation of incident events due to a lack of differentiation between AF and atrial flutter and the absence of data on lifestyle factors and causes of death, among others.

Conclusion

The present Denmark-wide study reveals a concerning trend: the lifetime risk of AF has increased from one in four to one in three over the past two decades. HF emerged as the most common complication following AF, with a lifetime risk twice that of stroke. While there were slight improvements in the lifetime risks of stroke, ischemic stroke, and MI after AF, the rates remained high. These findings highlight the urgent need for effective strategies to prevent HF and stroke in patients with AF.
Journal reference:

Temporal trends in lifetime risks of atrial fibrillation and its complications between 2000 and 2022: Danish, nationwide, population-based cohort study. Vinter N. et al., British Medical Journal, 385:e077209 (2024), DOI: doi:10.1136/bmj-2023-077209, https://www.bmj.com/content/385/bmj-2023-077209
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April 22, 2024
Study shows antipsychotic drugs increase health risks in dementia patients
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In a recent British Medical Journal study, researchers assess the adverse effects associated with the use of antipsychotic drugs in people with dementia.

Study: Multiple adverse outcomes associated with antipsychotic use in people with dementia: population based matched cohort study. Image Credit: Fahroni / Shutterstock.com

The role of antipsychotics in dementia management

Individuals diagnosed with dementia undergo functional disability and progressive cognitive decline. Some common psychological and behavioral symptoms of dementia include anxiety, depression, apathy, aggression, delirium, irritability, and psychosis.

To manage psychological and behavioral symptoms of dementia, patients are commonly treated with antipsychotics. The United Kingdom National Institute for Health and Care Excellence currently recommends the use of antipsychotics only when non-drug interventions are ineffective in alleviating behavioral and psychological symptoms of dementia. However, there has been an increase in antipsychotic use during the recent coronavirus disease 2019 (COVID-19) pandemic, which has been attributed to lockdown measures and the unavailability of non-pharmaceutical treatments.

In the U.K., risperidone and haloperidol are the only antipsychotics that have received approval for the treatment of behavioral or psychological symptoms of dementia. In 2003, the United States Food and Drug Administration (FDA) highlighted the risks, such as stroke, transient ischaemic attack, and mortality, associated with the use of risperidone in older adults with dementia.

Based on multiple study reports, regulatory guidelines have been formulated in the U.K., U.S., and Europe to reduce inappropriate prescriptions of antipsychotic drugs for the treatment of behavioral and psychological symptoms of dementia. To date, few studies have provided evidence of the association between antipsychotic drug prescriptions in older adults with dementia and risks of multiple diseases, such as myocardial infarction, venous thromboembolism, ventricular arrhythmia, and acute kidney injury.

About the study

The current study investigated the risk of adverse outcomes associated with antipsychotics in a large cohort of adults with dementia. Some adverse outcomes considered in this study were venous thromboembolism, stroke, heart failure, ventricular arrhythmia, fracture, myocardial infarction, pneumonia, and acute kidney injury.

Over 98% of the U.K. population is registered with National Health Service (NHS) primary care general practice. All relevant data were collected from the electronic health records held at the Clinical Practice Research Datalink (CPRD), which is associated with over 2,000 general practices. CPRD comprises the Aurum and GOLD databases, which can be considered as broadly representative of the U.K. population.

Individuals above 50 years of age and diagnosed with dementia were recruited. Importantly, none of the study participants were under antipsychotic intervention one year before their diagnosis.

The researchers utilized a matched cohort design, in which each patient who used antipsychotics after their initial dementia diagnosis was matched using the incidence density sampling method. This method considered up to 15 randomly selected patients who were diagnosed with dementia on the same date but were not prescribed antipsychotic drugs.

Antipsychotics increase the risk of adverse effects in dementia patients

Across the two cohorts, the mean age of the participants was 82.1 years. A total of 35,339 participants were prescribed an antipsychotic during the study period.

The mean number of days between the first diagnosis of dementia and the date of a first antipsychotic prescription was 693.8 and 576.6 days for Aurum and GOLD, respectively. The most commonly prescribed antipsychotics were risperidone, haloperidol, olanzapine, and quetiapine.

The current population-based study revealed that adults with dementia prescribed antipsychotics are at a greater risk of venous thromboembolism, myocardial infarction, stroke, heart failure, pneumonia, fracture, and acute kidney injury than non-users. This observation was based on analyzing 173,910 adults with dementia selected from both databases.

The increased risk of adverse outcomes was most prevalent among current and recent users of antipsychotic drugs. After 90 days of antipsychotic use, the risk of venous thromboembolism, pneumonia, acute kidney injury, and stroke was higher than non-users. However, antipsychotic drugs did not impact the risk of ventricular arrhythmia, appendicitis, and cholecystitis.

As compared to the use of risperidone, haloperidol was significantly associated with an increased risk of pneumonia, fracture, and acute kidney injury. Although the adverse effects of haloperidol were higher than quetiapine, no significant differences were observed between risperidone and quetiapine for the risk of fracture, heart failure, and myocardial infarction. The risk of pneumonia, stroke, acute kidney injury, and venous thromboembolism was lower for quetiapine as compared to risperidone.

Conclusions

The current study highlights how antipsychotic drugs affect older adults with dementia. The use of these drugs was associated with many serious adverse outcomes, such as stroke, acute kidney injury, pneumonia, venous thromboembolism, heart failure, and myocardial infarction.

In the future, these risks must be considered, along with cerebrovascular events and mortality, while making regulatory decisions about the use of antipsychotic drugs for the treatment of dementia in older adults.
Journal reference:

Mok, L. H. P., Carr, M. J., Guthrie, B., et al. (2024) Multiple adverse outcomes associated with antipsychotic use in people with dementia: population based matched cohort study. BMJ. doi:10.1136/bmj.2023.076268
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April 19, 2024
Discovery of new vascular cell type may pave way for novel strategies to treat cardiovascular diseases

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

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

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

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

Pioneer cells move inside the vessel walls

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

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

Molecular cocktail encodes the time and place of blood vessel formation

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

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

Foundations for new therapeutic approaches

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

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

Professor Ferdinand le Noble

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

Source:

Karlsruhe Institute of Technology

Journal reference:

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

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April 18, 2024
Study reveals long-term consequences of atrial fibrillation

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Source:

Journal reference:

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

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April 18, 2024
Global disease burden study highlights COVID-19 impact and health inequities

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Rates of early death and poor health caused by HIV/AIDS and diarrhea have been cut in half since 2010, and the rate of disease burden caused by injuries has dropped by a quarter in the same time period, after accounting for differences in age and population size across countries, based on a new study published in The Lancet. The study measures the burden of disease in years lost to early death and poor health. The findings indicate that total rates of global disease burden dropped by 14.2% between 2010 and 2019. However, the researchers found that the COVID-19 pandemic interrupted these downward trends: rates of disease burden increased overall since 2019 by 4.1% in 2020 and by 7.2% in 2021. This is the first study to measure premature death and disability due to the COVID-19 pandemic globally and compare it to other diseases and injuries.

The study reveals how healthy life expectancy, which is the number of years a person can expect to live in good health, rose from 61.3 years in 2010 to 62.2 years in 2021. Pinpointing the factors driving these trends, the researchers point to rapid improvements within the three different categories of disease burden: communicable, maternal, neonatal, and nutritional diseases; non-communicable diseases; and injuries. Among communicable, maternal, neonatal, and nutritional diseases, the burden of disease declined for neonatal disorders (diseases and injuries that appear uniquely in the first month of life), lower respiratory infections, diarrhea, malaria, tuberculosis, and HIV/AIDS between 2010 and 2021, ranging from reductions of 17.1% for neonatal disorders to 47.8% for HIV/AIDS. In the category of non-communicable diseases, disease burden from stroke dropped by 16.9%, while disease burden from ischemic heart disease fell by 12.0% during this period.

For injuries, the years of healthy life lost due to road injuries was slashed by nearly a quarter (22.9%), while disease burden from falls was reduced by 6.9%. Progress in reducing disease burden varied by countries’ Socio-demographic Index – a measure of income, fertility, and education – underscoring inequities. For example, the burden of disease due to stroke dropped by 9.6% from 2010 to 2021 in countries with the lowest Socio-demographic Index, but it declined faster – by 24.9% – among countries with higher Socio-demographic Index.

Our study illuminates both the world’s successes and failures. It demonstrates how the world made huge strides in expanding treatment for HIV/AIDS and combatting vaccine-preventable diseases and deaths among children under 5. At the same time, it shows how COVID-19 exacerbated inequities, causing the greatest disease burden in countries with the fewest resources, where health systems were strained and vaccines were difficult to secure. Governments should prioritize equitable pandemic preparedness planning and work to preserve the momentum that we’ve seen in improving children’s health.”

Dr. Alize Ferrari, Affiliate Associate Professor at the Institute for Health Metrics and Evaluation (IHME) at the University of Washington, Honorary Associate Professor at the School of Public Health at the University of Queensland, and co-first author of the study

The research presents updated estimates from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021. The GBD 2021 study analyzes incidence, prevalence, years lived with disability (years lived in less-than-ideal health), and disability-adjusted life years (lost years of healthy life) at global, regional, national, and subnational levels. It presents estimates of health and health loss in age-adjusted rates and total rates per 100,000 people. The study provides globally comparable measures of healthy life expectancy and is the first study to fully evaluate burden of disease amid the first two years of the COVID-19 pandemic. COVID-19 was the single leading cause of disease burden worldwide in 2021, accounting for 7.4% of total disease burden globally.

The study also examined how the COVID-19 pandemic affected males and females differently. The researchers found that males were more likely than females to die of COVID-19; the age-standardized disease burden rate for COVID-19 among males was nearly twice that of females. However, the secondary effects of the COVID-19 pandemic, including long COVID and mental disorders, hit females hardest. For example, females were twice as likely as males to develop long COVID. Depression, which increased sharply during the pandemic, was most likely to affect females between ages 15 and 65. Looking at differences between age groups, COVID-19 caused the most disease burden in older adults. For COVID-19, adults 70 years and older had more than double the levels of disease burden compared to adults between the ages of 50 and 69.

The study highlights not only the diseases and injuries that cut life short and cause poor health, and how the burden of disease from different causes has changed over time, but also examines how these patterns differ across countries and regions. “In essence,” the authors write, the study “provides a comprehensive toolkit to inform and enhance decision-making processes across various levels of governance and practice.”

GBD 2021 shines a light on the different causes of disease burden, showing which ones have improved and which are stagnating or worsening. It also tallies the number of years that people are living healthy lives. Healthy life expectancy rose significantly in 59 countries and territories between 2010 and 2021, with the greatest improvements in countries ranking lowest on the Socio-demographic Index, jumping from 52.2 years in 2010 to 54.4 years in 2021. In contrast, healthy life expectancy showed minimal change among countries in the highest levels of the Socio-demographic Index, decreasing slightly from 68.9 years in 2010 to 68.5 years in 2021. The findings on healthy life expectancy demonstrate that even though people are living longer lives all over the world, they aren’t spending all those years in good health. The researchers found that the main causes of poor health were low back pain, depressive disorders, and headache disorders.

“With low back pain, the leading cause of poor health globally, we see that the existing treatments aren’t working well to address it,” said Dr. Damian Santomauro, Affiliate Assistant Professor of Health Metrics Sciences at IHME; Stream Lead at Queensland Centre for Mental Health Research; Adjunct Fellow at the School of Public Health at the University of Queensland; and co-first author of the study. “We need better tools to manage this major cause of global disease burden.”

“In contrast, for depressive disorders, we know what can work: therapy, medication, or both in combination for an adequate period of time. However, most people in the world have little or no access to treatment, unfortunately,” he said. “Considering how depression increased dramatically during the COVID-19 pandemic, it’s urgent to ensure that everyone with this disorder can get treatment.”

Another way to understand what is making people ill is by looking at which diseases are growing fastest. GBD 2021 reveals that diabetes experienced the most rapid growth among the different causes of poor health, what the researchers call years lived with disability. Age-adjusted years lived with disability due to diabetes rose by 25.9% between 2010 and 2021. Poor health from diabetes increased in every country and territory that the researchers studied.

“Diabetes is a major contributor to stroke and ischemic heart disease, which are among the top three causes of disease burden worldwide,” said Dr. Theo Vos, Professor Emeritus at IHME and one of the study’s senior authors. “Without intervention, more than 1.3 billion people in the world will be living with diabetes by 2050. To counter the threat of diabetes, we must ensure that people in all countries can access preventive care and treatment, including to anti-obesity medications, which can lower a person’s risk of developing diabetes.”

Source:

Institute for Health Metrics and Evaluation

Journal reference:

GBD 2021 Diseases and Injuries Collaborators., (2024) Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021. The Lancet. doi.org/10.1016/S0140-6736(24)00757-8.

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April 18, 2024
Bidirectional Mendelian randomization uncovers link between plasma metabolites and heart attack risk

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

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

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

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

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

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

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

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

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

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

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

Source:

Tsinghua University Press

Journal reference:

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

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April 17, 2024
Lifetime risk of atrial fibrillation rises to nearly 31% in recent decade
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Atrial fibrillation (AF) is a common arrhythmia or cardiac rhythm disorder. It is associated with significant mortality risk and also a higher risk of multiple complications. As such, understanding the risk of AF in the population is necessary.

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

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

AF risk and complications

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

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

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

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

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

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

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

About the study cohort

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

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

AF risk

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

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

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

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

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

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

AF complications

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

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

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

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

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

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

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

Conclusions

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

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

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

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

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

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

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

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

Vinter, N., Cordsen, P., Johnsen, S. P., et al. (2024) Temporal trends in lifetime risks of atrial fibrillation and its complications between 2000 and 2022: Danish, nationwide, population based cohort study. BMJ. doi: http://dx.doi.org/10.1136/bmj-2023-077209.
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April 17, 2024