Category: Cardiovascular Disease

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Algorithm for Paramedics Predicts Brain Damage Risk After Cardiac Arrest

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Researchers at King’s College London have shown that a widely used cardiac arrest risk score can be applied before patients reach hospital, enabling paramedics to assess the risk of brain injury at an earlier stage of care.

Results from the RAPID-MIRACLE trial have found, for the first time, that the widely used MIRACLE2 risk score can be applied outside a hospital setting to accurately predict brain injury following a cardiac arrest. This could inform the type of immediate care patients receive, helping to ensure they have the best treatment available while saving crucial resources.

An out of hospital cardiac arrest (OHCA) carries a high risk of death, with fewer than 10% of patients surviving. Even when a patient’s heart is successfully restarted through CPR and circulation is restored, known as return of spontaneous circulation (ROSC), clinicians often face uncertainty about the extent of brain injury.

Despite current UK and European guidelines recommending that patients who experience an out of hospital cardiac arrest are sent to a specialist cardiac centre, the majority of patients are still conveyed to local emergency departments. The MIRACLE2 score, when applied in the pre-hospital setting, may now open up the possibility of identifying patients earlier and enabling direct transfer to specialist centres, allowing faster access to expert care and advanced treatments for patients who might otherwise have been conveyed to a local hospital.

Created by Dr Nilesh Pareek, Adjunct Senior Lecturer and Consultant Interventional Cardiologist, the MIRACLE2 score accurately predicts the extent of brain damage after 30 days following an OHCA. Until now, it has only been applied once a patient reaches hospital.

Dr Pareek and his team worked with the London Ambulance Service and Heart Research UK to evaluate whether the score could be calculated immediately after ROSC in the community.

The study followed patients from paramedic care through to hospital treatment across multiple London sites, providing real-world evidence of how the score performs outside a hospital environment.

The researchers tested two new versions of the score – one which included a blood test and one which didn’t. While the version with the blood test was highly accurate, paramedics frequently found it impractical due to technical failures and time pressure. The version without the blood test, known as Pre-MIRACLE2, was almost identical in terms of accuracy.

While MIRACLE² has supported early in-hospital risk stratification following out-of-hospital cardiac arrest, RAPID-MIRACLE extends this work into the pre-hospital setting, enabling paramedics to assess risk earlier in a patient’s care pathway. By validating the model in the field, we have taken an important step towards integrating earlier risk assessment into routine emergency care.”Dr Nilesh Pareek, senior author of the study and Adjunct Senior Lecturer, King’s College London and Consultant Interventional Cardiologist, King’s College Hospital

Alongside the study, the MIRACLE² app, led by Dr Pareek, has been updated to incorporate the newly validated pre-hospital model. The app, developed by Ensono Digital, uses the MIRACLE2 algorithm and is designed as a practical tool to help clinicians calculate the score quickly and accurately, without needing to recall each variable from memory.

By entering patient information such as age, initial heart rhythm and other markers, paramedics and hospital clinicians can generate an immediate estimate of a patient’s risk of poor neurological outcome following out-of-hospital cardiac arrest.

The research team is now in discussion with emergency medical services regarding a potential service evaluation to explore how the updated tool could be implemented in routine practice.

Heart Research UK were delighted to fund the RAPID-MIRACLE trial with the aim of improving outcomes for this poorly served patient group. The promising results from the trial suggest that better outcomes can be delivered, and we hope the risk score can be adopted nationally for all patients.”Dr Kate Langton, Director of Research at Heart Research UK

The research findings were presented in Washington at the CRT 2026 conference and the full study was published in European Heart Journal – Acute Cardiovascular Care.

Source: King’s College London

Categories : Cardiovascular Disease Diet and NutritionTags :

Reducing Sodium in Everyday Foods may Yield Heart-health Benefits Across Populations

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Credit: Pixabay CC0

Lowering sodium in packaged and prepared foods could significantly improve cardiovascular health and prevent many cases of heart disease, stroke and deaths in the general population in France and the U.K., according to two new research studies published in Hypertension, an American Heart Association journal.

Consuming too much sodium is a major risk factor for hypertension, also known as high blood pressure, which can lead to health complications such as heart attack, stroke, chronic kidney disease, dementia and other forms of cardiovascular disease, according to the American Heart Association.

To address the global concern about excessive sodium consumption many countries have implemented salt-reduction strategies to improve public health and reduce health costs.

Two studies – one in France involving salt-reduction targets for baguettes and other bread products in 2025, and the other in the United Kingdom focusing on 2024 goals for takeaway and packaged foods – estimated the potential impact on the general population if those salt-reduction targets were met. The projections calculated in these two studies indicate that minor adjustments in sodium content to some of the most common prepared foods in each country would require no effort from people to change their eating habits, yet may produce significant public health benefits.

“This approach is particularly powerful because it does not rely on individual behaviour change, which is often difficult to achieve and sustain. Instead, it creates a healthier food environment by default,” said Clémence Grave, M.D., lead author of the study from France and epidemiologist and public health physician at the French National Public Health Agency, headquartered in Saint-Maurice near Paris.

The World Health Organization recommends adults should consume less than 2,000 milligrams (mg) of sodium per day, however, global intake is much higher. The American Heart Association recommends daily intake of no more than 2300mg of sodium a day – equal to about 1 teaspoon of table salt; but also says the ideal limit is no higher than 1500 mg per day for most adults, especially for those with high blood pressure.

Sodium reduction in bread (France)

In 2019, France set a national public health goal to reduce salt consumption by 30%. In 2022, a voluntary agreement was signed between the government and bread producers to lower salt content by 2025. Bread, especially the baguette, is a culturally and nutritionally central food in France, yet it can be high in salt– traditionally contain about 25% of total daily recommended intake of salt. By 2023, most breads made in France already met the new sodium standards.

To understand the potential impact of the agreement on public health, researchers used national data and a mathematical model to estimate how many cases of cardio-cerebrovascular disease (conditions and diseases that affect both the heart and the brain’s blood vessels), kidney disease and dementia could be prevented if the salt-reduction targets met full compliance.

The analysis found that with bread consumption remaining the same and sodium-reduction targets fully met, less salt in baguettes and bread would decrease daily intake by 0.35 g per person, leading to slightly lower blood pressure across the population.

“This salt-reduction measure went completely unnoticed by the French population – no one realised that bread contained less salt,” Grave said. “Our findings show that reformulating food products, even with small, invisible changes, can have a significant impact on public health.”

Sodium reduction in packaged foods and take-out meals (United Kingdom)

For the study in the U.K., researchers used national survey data to estimate the amount of salt people consumed from pre-prepared packaged and take-out meals. They then estimated daily sodium intake if all relevant food categories met the 2024 sodium-reduction targets.

Sales-weighted average and maximum salt content targets were set for 84 grocery food categories – including bread, cheeses, meats, and snacks – and, for the first time, 24 out-of-home categories such as burgers, curries, and pizza. The modelling also covered how these changes could affect heart disease, stroke, quality of life and health care costs.

The research found that fully meeting the sodium reduction goals could have reduced average salt intake from about 6.1 g to 4.9g per day – translating to an estimated average of 17.5% less salt consumed per person per day. Men would experience slightly larger reductions than women because they tend to consume more salt in general.

Even this small, daily reduction in salt would lower blood pressure modestly across the population, and the improvements could add up.

Source: American Heart Association

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Common Drug Class may Increase Cardiovascular Risk

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People who use drugs with anticholinergic effects, including certain antidepressants, drugs for urinary incontinence and common antihistamines, are at higher risk of developing cardiovascular disease. This is shown in a new study from Karolinska Institutet published in BMC Medicine.

Anticholinergic drugs reduce the effect of the neurotransmitter acetylcholine and are commonly prescribed to middle-aged and older people. This large group of drugs includes antihistamines used for allergic conditions, anxiety or insomnia, drugs for urinary incontinence, and certain antidepressants, where tricyclic antidepressants have a strong anticholinergic effect, whereas SSRIs have a weaker effect. A high cumulative use of these drugs, referred to as anticholinergic burden (see fact box), has previously been linked to impaired cognitive ability. 

May affect heart regulation 

The new study suggests that the drugs may also affect the parasympathetic nervous system and thereby the regulation of the cardiovascular system. The results show that it may be important to monitor the total drug burden in everyday clinical practice.

The study included more than 500 000 people in Stockholm who were 45 years of age or older and had no prior cardiovascular disease, except for hypertension, at the start of the study. The researchers followed the participants for up to 14 years and analysed how the use of anticholinergic drugs was associated with the development of cardiovascular disease.

“Many of these drugs are used by older people and by people with multiple medical conditions. We wanted to investigate whether the total exposure had any significance for the risk of developing cardiovascular disease over time,” says Nanbo Zhu, postdoctoral researcher at the Department of Neurobiology, Care Sciences and Society, Karolinska Institutet.

71 per cent higher cardiac risk

The study showed that the risk of cardiovascular disease increased in line with how much anticholinergic medication the participants used each year. Those with the highest exposure had a 71% higher risk of a cardiovascular event than people who did not use anticholinergic medication at all. The association was seen for all types of cardiovascular disease but was particularly clear for heart failure and various forms of arrhythmia.

“Our results indicate that the cumulative drug burden can affect heart regulation, not only in the short term but also over the long term. This does not mean that the drugs should always be avoided, but that exposure should be monitored carefully,” says Hong Xu, assistant professor at the Department of Neurobiology, Care Sciences and Society.

The researchers point out that the study is observational, meaning it cannot establish a causal relationship. Other factors, such as underlying diseases, may also influence the associations.

The work was carried out within the Stockholm CREAtinine Measurements project in collaboration between several research groups at Karolinska Institutet and Region Stockholm. The study was funded by the Swedish Research Council, the Center for Innovative Medicine Foundation, and other foundations.

Some researchers report assignments for the pharmaceutical industry, which are disclosed in the scientific publication.

Publication

“Anticholinergic drug burden and incident cardiovascular events: a population-based study”, Nanbo Zhu, Maria Eriksdotter, Bahira Shahim, Kristina Johnell, Sara Garcia-Ptacek, Juan-Jesus Carrero, Hong Xu, BMC Medicine, online 28 February 2026, doi: 10.1186/s12916-026-04751-w.

Facts about the drugs

Anticholinergic drugs in the study were identified based on the Anticholinergic Cognitive Burden (ACB) scale, a tool used in research and clinical contexts. The scale covers a wide range of different drugs that are scored between 1 and 3, depending on how much the drug blocks the neurotransmitter acetylcholine. The consumption of these drugs is added up to estimate a patient’s anticholinergic burden. The drugs included in ACB are listed in table S1 in the study’s supplementary information.

Source: Karolinska Institutet

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Ancient Mind-Body Practice Proven to Lower Blood Pressure in Clinical Trial

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Study shows traditional Chinese practice comparable to brisk walking and some medication trials at lowering BP

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A traditional Chinese mind-body practice that combines slow, structured movement, deep breathing and meditative focus lowered blood pressure as effectively as brisk walking in a large randomised clinical trial published in JACC, the flagship journal of the American College of Cardiology. Blood pressure reductions were seen after three months and sustained for one year.

High blood pressure is one of the leading preventable risk factors for heart disease. Clinical guidelines recommend regular physical activity, yet long-term adherence to exercise programmes is challenging for many people, particularly when routines require equipment, dedicated space, gym memberships or ongoing supervision.

Baduanjin is a widely practised, standardised eight-movement sequence that integrates aerobic, isometric, flexibility and mind–body components. Practised for centuries and commonly performed in community settings across China, the routine typically takes 10–15 minutes and requires no equipment and only minimal initial instruction, allowing it to be performed in a wide range of settings. Because it is low- to moderate-intensity, it is considered safe and accessible for many adults.

“Given its simplicity, safety and ease at which one can maintain long-term adherence, baduanjin can be implemented as an effective, accessible and scalable lifestyle intervention for individuals trying to reduce their blood pressure,” said Jing Li, MD, PhD, senior author of the study and Director, Department of Preventive Medicine, National Center for Cardiovascular Diseases in Beijing, China.

In the first large, multicentre randomised trial to look at the impact of baduanjin on blood pressure, researchers followed 216 participants across seven communities to determine changes in 24-hour systolic blood pressure from baseline to 12 and 52 weeks. Participants were 40 years old or older and had a systolic blood pressure of 130-139mmHg, which according to the ACC/AHA High Blood Pressure Guideline is considered stage 1 hypertension. They were randomly assigned to one of three arms: baduanjin, self-directed exercise alone, or brisk walking for the 52-week intervention.

Compared to self-directed exercise, practicing baduanjin five days a week reduced 24-hour systolic blood pressure approximately 3mmHg and office systolic blood pressure by 5mmHg at both three months and one year, which is comparable to reductions seen with some first-line medications. Baduanjin showed comparable results and safety profile to brisk walking at one year.

Notably, the benefits were sustained even without ongoing monitoring, a key challenge for many lifestyle interventions that struggle to maintain long-term adherence outside structured programs.

“Baduanjin has been practised in China for over 800 years, and this study demonstrates how ancient, accessible, low-cost approaches can be validated through high-quality randomised research,” said Harlan M. Krumholz, MD, FACC, Editor-in-Chief of JACC and the Harold H. Hines, Jr Professor at the Yale School of Medicine. “The blood pressure effect size is similar to that seen in landmark drug trials, but achieved without medication, cost or side effects. This makes it highly scalable for community-based prevention, including in resource-limited settings.”

Source: American College of Cardiology

Categories : Cardiovascular Disease GeneticsTags :

Study Identifies Risk Genes for Bicuspid Aortic Valve

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Source: CCO

Bicuspid aortic valve (BAV) is a common congenital heart defect where the aortic valve has two leaflets (cusps) instead of the usual three, resulting in abnormal blood flow and development of aortic valve diseases such as aortic stenosis and incompetence. In addition, the BAV is sometimes accompanied by development of an enlarged aorta – the main artery in the body.  Both the bicuspid aortic valve and an enlarged aorta often require cardiac surgery, usually after the age of 50 years. Despite this, only a limited number of genes have been associated with the disease and the molecular mechanisms remain unexplained in most cases.

In a new study aimed to further understand the genetic architecture of BAV, an international group of researchers led by Boston University Chobanian & Avedisian School of Medicine and Laval University in Quebec City, Canada, along with the Bicuspid Aortic Valve Consortium, the Genetic Aortic Network (a division of The Marfan Foundation) and participating Institutions, believe the condition is strongly influenced by the cumulative effect of variation in many different genes(polygenic contribution).

“We found that variation in 36 genetic regions increases the risk of a bicuspid aortic valve. These findings support the notion that bicuspid aortic valve disease is an inherited disease caused by a combination of many common genetic variants, not merely a single mutation in a single gene,” explains co-corresponding author Simon C. Body, MD, MPH, professor of anesthesiology at Boston University Chobanian & Avedisian School of Medicine.

From a group of 65 677 US, Canadian and European participants, the researchers performed a genome-wide association study (GWAS) meta-analysis on 9631 individuals with BAV. After identifying general genetic regions through GWAS, they used RNA sequencing to study gene activity (expression levels) in specific, relevant tissues.

They observed 36 regions with genetic variants associated with a bicuspid aortic valve, four of which had been previously identified. They prioritised 55 genes in these regions based upon expression in human aortic valve tissues from individuals who had surgery, then tested the effect of changing four selected genes, upon heart development in an experimental model, demonstrating that all four altered genes had effects on development of the valve. The researchers also looked at the effect of these genes in a statistical model finding a three-fold increase in risk for a BAV in individuals in the top 10% and association with aortic aneurysmal disease, a bulge in the aortic wall that can rupture. Some of these 36 genetic regions are also involved in aortic stenosis and aortic aneurysm development, which could lead to better prediction of these complications in people with BAV and point to biological mechanisms responsible for these joint effects.

According to the researchers, while these findings support the notion that BAV is an inherited disease, the findings do not currently support genetic testing, either prenatally or later in life, for predicting a bicuspid aortic valve.  “Echocardiography and other imaging modalities remain the gold standard for diagnosis.  In addition, the identified heritability supports performing screening echocardiography on first-degree relatives of a person with an identified bicuspid valve,” adds Body.

These findings appear online in the journal Circulation.

Source: University of Boston

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Statins do not Cause the Majority of Their Listed Side Effects

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Statins do not cause the majority of the conditions that have been listed in their package leaflets, including memory loss, depression, sleep disturbance, and erectile and sexual dysfunction, according to the most comprehensive review of possible side effects. The study was led by researchers at Oxford Population Health and published in The Lancet.

Cardiovascular disease results in around 20 million deaths worldwide and causes around a quarter of all deaths in the UK. Statins are highly effective drugs that lower LDL (‘bad’) cholesterol levels and have been repeatedly proven to reduce the risk of cardiovascular disease. However, there have been concerns about possible side effects.

The researchers gathered data from 23 large-scale randomised studies from the Cholesterol Treatment Trialists’ Collaboration: 123 940 participants in 19 large-scale clinical trials comparing the effects of statin therapies against a placebo, and 30 724 participants in four trials comparing more intensive versus less intensive statin therapy.

They found similar numbers of reports for those taking the statins and those taking the placebo for almost all the conditions listed in package leaflets as possible side effects. For example, each year, the number of reports of cognitive or memory impairment was 0.2% in those taking the statins, but also 0.2% in those taking the placebo. This means that while people may notice these problems whilst taking statins, there is no good evidence that they are caused by the statin.

Key findings:

  • There was no statistically significant excess risk from statin therapy for almost all the conditions listed in package leaflets as potential side effects.
  • Taking a statin did not cause any meaningful excess of memory loss or dementia, depression, sleep disturbance, erectile dysfunction, weight gain, nausea, fatigue or headache, and many other conditions.
  • There was a small increase in risk (about 0.1%) for liver blood test abnormalities. However, there was no increase in liver disease such as hepatitis or liver failure, indicating that the liver blood test changes do not typically lead to more serious liver problems.

Christina Reith, Associate Professor at Oxford Population Health and lead author of the study, said: ‘Statins are life-saving drugs used by hundreds of millions of people over the past 30 years. However, concerns about the safety of statins have deterred many people who are at risk of severe disability or death from a heart attack or stroke. Our study provides reassurance that, for most people, the risk of side effects is greatly outweighed by the benefits of statins.’

Previous work by the same researchers established that most muscle symptoms are not caused by statins; statin therapy caused muscle symptoms in only 1% of people during the first year of treatment with no excess thereafter. It has also shown that statins can cause a small increase in blood sugar levels, so people already at high risk may develop diabetes sooner.

Professor Bryan Williams, Chief Scientific and Medical Officer at the British Heart Foundation, said: ‘These findings are hugely important and provide authoritative, evidence-based reassurance for patients. Statins are lifesaving drugs, which have been proven to protect against heart attacks and strokes. Among the large number of patients assessed in this well-conducted analysis, only four side effects out of 66 were found to have any association with taking statins, and only in a very small proportion of patients.

‘This evidence is a much-needed counter to the misinformation around statins and should help prevent unnecessary deaths from cardiovascular disease. Recognising which side effects might genuinely be associated with statins is also important as it will help doctors make decisions about when to use alternative treatments.’

Professor Sir Rory Collins, Emeritus Professor of Medicine and Epidemiology at Oxford Population Health and senior author of the paper said: ‘Statin product labels list certain adverse health outcomes as potential treatment-related effects based mainly on information from non-randomised studies which may be subject to bias. We brought together all of the information from large randomised trials to assess the evidence reliably. Now that we know that statins do not cause the majority of side effects listed in package leaflets, statin information requires rapid revision to help patients and doctors make better-informed health decisions.’

All of the trials included in the analyses were large-scale (involving at least 1000 participants) and tracked patient outcomes for a median of nearly five years. The trials were double-blind, meaning that neither the trial participants nor those managing the participants or leading the study knew who was receiving which treatment, to avoid potential biases due to knowledge of treatment allocation. The list of possible side effects was compiled from those listed for the five most commonly prescribed statins.

The paper, ‘Assessment of adverse effects attributed to statin therapy in product labels: a meta-analysis of double-blind randomised controlled trials,’ is published in The Lancet.

Source: Oxford University

Categories : Cardiovascular Disease Respiratory DiseasesTags :

Scientists Uncover Link Between Influenza and Heart Disease

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Discovery could lead to mRNA therapeutic to reduce the risk of cardiac damage

Graphical Abstract summarising the key findings of the paper. The authors found that severe influenza damages the heart by exploiting a specific immune cells and engaging a type-I interferon response. The authors also show that therapeutic silencing of the response mitigates heart damage.

Researchers at Mount Sinai in the US have identified a cellular mechanism linking infections from influenza A viruses (IAVs) to cardiovascular disease, providing critical insights on how influenza can damage the heart and increase the risk of a heart attack or other major cardiovascular event.  

Through its work with mouse models and human data, the team also provided evidence that a cutting-edge modified mRNA treatment that dampens an interferon signalling pathway in the heart can significantly mitigate cardiac damage following viral infection while preserving the protective antiviral response of the immune system. The study was published in the February 9 issue of Immunity. 

“We have known for years that the frequency of heart attacks increases during flu season, yet outside of clinical intuition, scant evidence exists of the underlying mechanisms of that phenomenon,” says senior author Filip Swirski, PhD, Director of the Cardiovascular Research Institute at the Icahn School of Medicine at Mount Sinai.

“Studies like ours are now shedding valuable light on immune system pathways, like the antiviral cytokine type 1 interferon (IFN-1), that factor into damage to the heart following severe influenza infection. These findings offer great promise for the development of new therapies, which are desperately needed since there are currently no viable clinical options to prevent cardiac damage.” 

Influenza A viruses are responsible for an estimated 1 billion infections globally each year, ranging from seasonal flu outbreaks locally to pandemics globally. While most infections are mild and self-resolving, in some cases they can become severe or even fatal, particularly when the virus travels to the heart and triggers the death of cardiomyocytes, specialized muscle cells that are responsible for the rhythmic contraction and relaxation of the heart.   

The Mount Sinai team studied autopsies of 35 hospitalised patients who died of influenza and found that more than 85% had at least one significant cardiovascular comorbidity, such as hypertension, and that the majority had multiple comorbidities, including atherosclerosis and cardiac fibrosis, underscoring cardiovascular disease as a major driver of influenza mortality.  

The research team also uncovered the mechanism by which cardiac damage occurs. They learned, for example, that a novel subset of white blood cells, known as pro-dendritic cell 3, becomes infected in the lung and, after traveling to the heart, produces large amounts of type 1 interferon. This, instead of fulfilling its mission of clearing the virus from the heart, triggers the death of cardiomyocytes, impairing cardiac output.  

“We found that the pro-dendritic cell 3 acts as the ‘Trojan horse’ of the immune system during influenza infection, becoming infected in the lung, trafficking the virus to the heart, and disseminating it to cardiomyocytes. This process causes production of the damaging type 1 interferon that comes with considerable collateral damage to the heart,” explains Jeffrey Downey, PhD, a member of Dr Swirski’s laboratory who served as lead author of the study. “The hopeful news for patients is that by injecting a novel mod-RNA therapeutic that modulates the IFN-1 signaling pathway, we reduced levels of cardiac damage, as evidenced by lower troponin, and improved cardiac function, as measured by higher left ventricular ejection fraction.” 

As part of its ongoing research, Dr Swirski’s team is collaborating with Lior Zangi, PhD, Associate Professor of Medicine (Cardiology), and Genetics and Genomic Sciences, at the Icahn school of Medicine at Mount Sinai, to investigate the use of a safe and effective systemic delivery method of the mod-RNA therapeutic to the heart’s muscle cells, instead of the direct injection method used in its proof-of-concept study. Additional work is focused on the pro-dendritic cell 3 itself: why is it so susceptible to influenza and how could its protective capacity be fully harnessed to potentially minimize heart damage exacerbated by cardiovascular disease? 

“Pathogens are constantly emerging and evolving, which means our strategies to combat them must evolve as well,” says Dr Swirski. “Better understanding of influenza pathogenesis and immune pathways that are activated throughout the body will help fuel the next stage of advanced care.” 

Source: Mount Sinai

Categories : Cardiovascular DiseaseTags : 1 Comment

Why Heart Attacks in the Morning Have Worse Outcomes

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Human heart. Credit: Scientific Animations CC4.0

It has long been known that heart attacks occurring in the morning are typically more serious than those that happen at night. While daily variations in stress hormone levels and blood pressure affect cardiac health, these are only part of the picture. There is also the diurnal variation in immune response involved: neutrophils, the body’s ‘first responders’, cause more inflammatory damage in the morning, causing havoc even as they neutralise pathogens.

“They’re the first sentinel, but they come fully loaded,” said Douglas Mann, MD, professor at Washington University School of Medicine in St Louis. “They’re shooting at everything and dumping a lot of toxic granules on the environment. They are indiscriminate in terms of their ability to destroy, and they take out healthy cells in the process.”

But exactly why they are more damaging at night has been a mystery. Now, researchers have found the reason behind this diurnal difference in destructiveness, and also how to tweak the ‘internal clocks’ of these white blood cells so that they cause less damage during sterile inflammation while still protecting against pathogens. Their findings are reported in the Journal of Exploratory Medicine, and are summarised in JAMA news.

Finding the pattern

The researchers, from Spain and Yale University, discovered that the timing of heart attacks significantly affects their severity due to a ‘neutrophil clock’ controlled by circadian rhythms. Neutrophils are more active during the day (activated by the Bmal1 protein) and less active at night (inhibited by the CXCR4 receptor).

Analysing more than 2000 patients with ST-segment elevation myocardial infarction, the researchers found that those who had an MI in the morning suffered worse cardiac damage than those who had them at night. Mouse experiments confirmed this pattern and showed that genetically disabling the Bmal1 protein reduced daytime neutrophil activity, protecting against severe cardiac injury.

This suggests a treatment strategy of tricking neutrophils into remaining in their nighttime inactive state, allowing doctors to reduce inflammation and lessen heart attack damage during daytime hours without compromising the immune system’s ability to fight infections.

Reducing cardiac damage without compromising the immune system

Mice engineered to have high levels of CXCR4 were given a drug compound, ATI2341, which bound to CXCR4 receptors. When heart attacks were induced, the mice showed reduced tissue damage. To test the neutrophils’ pathogen-fighting ability, they were also infected with Staphylococcus aureus or Candida albicans, but the mice were able to overcome the infection – the treated mice even tolerated the Candida infection better than the controls.

Mann explained why controlling the neutrophils was a better option. “Prior trials have tried to neutralise neutrophils or reduce neutrophil numbers entirely,” Mann noted. “But when you get rid of neutrophils, you’re also handcuffing the immune system. Before, it was considered an inevitability that neutrophils killing off infection also meant damaging a lot of tissue.”

The crucial question is of course whether this research in mice can translate to humans.

Luigi Adamo, MD, PhD, director of cardiac immunology at Johns Hopkins University who was not involved in the study, said that the study, one of the first use immune circadian rhythms to modulate inflammation, “offers new insight into neutrophils and a new way to look at this cardiac damage that might even apply to other types of sterile inflammation.”

Adamo struck a note of caution: the extremely low success rate in animal-to-human translation in cardioimmunology. “Immune cells are not always the same when you go from mice to humans,” he said.

Treatment implementation is a major obstacle

Even if this neutrophil clock alteration could be applied to humans, it would be difficult to administer since heart attacks strike without warning.

“If everyone took one of these drugs in the morning when they woke up, maybe it would make heart attacks less severe, but ‘preventive’ means you’re giving it chronically, and I don’t know what would happen with long-term stimulation of that receptor and other cell types,” Mann said. “Their data support the acute application, but in the long term, that’s a whole different story.”

As systemic treatment, the off-target effects of ATI2341 would need to be explored. He also struggled to envision a potential therapeutic solution.

“Today, when you have a heart attack, in most places with hospitals and well-developed health care systems, the patient gets an angioplasty,” Mann said. “The only time this drug could be given would be at the time of reperfusion, when you’re blowing up the balloon and opening up the clot.” Typically, ideal reperfusion timing is within two hours – but neutrophils probably do their damage within a matter of 30 minutes, Mann explained. “It’s a race against time, and I’m curious if [the researchers] can demonstrate that.”

Source: JAMA

Categories : Cardiovascular Disease Diet and NutritionTags :

Mediterranean Diet Linked to Reduced Risk for All Stroke Types

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Following a Mediterranean diet is associated with a lower risk of all types of stroke among women, according to a study published on February 4, 2026, in Neurology® Open Access, an official journal of the American Academy of Neurology. The study does not prove that the Mediterranean diet is the cause of the lower risk of stroke; it only shows an association.

The diet was associated with a lower risk of stroke overall, as well as ischaemic stroke and haemorrhagic stroke. The Mediterranean diet includes a high intake of vegetables, legumes, fruits, fish and healthy fats such as olive oil, and a low intake of dairy products, meats and saturated fatty acids.

“Our findings support the mounting evidence that a healthy diet is critical to stroke prevention,” said study author Sophia S. Wang, PhD, of City of Hope Comprehensive Cancer Center in Duarte, California. “We were especially interested to see that this finding applies to haemorrhagic stroke, as few large studies have looked at this type of stroke.”

The study involved 105 614 women with an average age of 53 at the start of the study who had no history of stroke. The participants filled out a questionnaire at the start of the study about their diet. Participants were given a score of zero to nine based on how closely they followed the Mediterranean diet. People received one point if they consumed above the overall average in the population in these categories: whole grain cereals, fruits, vegetables, legumes, olive oil and fish, plus drinking a moderate amount of alcohol.

They also received one point if they consumed a below-average amount of red meat and dairy products. A total of 30% of participants had scores of six to nine – the highest group. And 13% had scores of zero to two, the lowest group.

The participants were followed for an average of 21 years. During that time, 4083 strokes occurred, with 3358 ischaemic strokes and 725 haemorrhagic strokes. For ischaemic strokes, there were 1058 among the 31 638 people in the highest group compared to 395 cases among the 13 204 people in the lowest group.

For haemorrhagic stroke, there were 211 strokes among those in the highest group, compared to 91 among the lowest group. When researchers adjusted for other factors that could affect stroke risk, such as smoking, physical activity and high blood pressure, they found that those in the highest group were 18% less likely to have a stroke than those in the lowest group. They were 16% less likely to have an ischaemic stroke and 25% less likely to have a haemorrhagic stroke.

“Stroke is a leading cause of death and disability, so it’s exciting to think that improving our diets could lessen our risk for this devastating disease,” said Wang. “Further studies are needed to confirm these findings and to help us understand the mechanisms behind them so we could identify new ways to prevent stroke.”

A limitation of the study is that people reported their own diet information, so they may not have remembered correctly.

Source: American Academy of Neurology

Categories : Cardiovascular DiseaseTags :

Gap in Onset of Cardiovascular Disease Still Persists Between Sexes

On By ModernMedia
Credit: American Heart Association

Historical data indicate that men develop coronary heart disease (CHD) 10 years before women. A recent study in the Journal of the American Heart Association indicates that this sex gap still remains.

Investigators analysed data from the Coronary Artery Risk Development in Young Adults (CARDIA) study, in which US adults aged 18–30 years enrolled in 1985–1986 and were followed through August 2020.

Among 5112 participants (54.5% female, 51.6% Black) with an average age of 24.8 years at enrolment and a median follow-up of 34.1 years, men had a significantly higher cumulative incidence of cardiovascular disease. They had higher cumulative incidence rates of the cardiovascular disease subtypes of CHD and heart failure compared with women, but no difference in stroke.

Men reached a 5% incidence of cardiovascular disease 7.0 years earlier than women (50.5 versus 57.5 years). CHD was the most frequent cardiovascular disease subtype, and men reached a 2% incidence 10.1 years earlier than women. There were no significant differences in the age at which men and women reached a 2% incidence for stroke (57.5 versus 56.9 years) or a 1% incidence for heart failure (48.7 versus 51.7 years)

Differences emerged in the fourth decade of life and were not explained after accounting for differences in cardiovascular health.

“Sex differences in cardiovascular disease risk are apparent by age 35, highlighting the importance of initiating risk assessment and prevention strategies in young adulthood,” said corresponding author Alexa Freedman, PhD, of the Northwestern University Feinberg School of Medicine.

Source: Wiley