Category: Cardiovascular Disease

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Statin Use May Improve Survival in Patients for Some Blood Cancers

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Patients with chronic lymphocytic leukaemia (CLL) or small lymphocytic lymphoma (SLL) who were taking cholesterol-lowering statin medications at the start of their cancer treatment had a 61% lower risk of dying from their cancer compared to similar patients who were not taking statins, according to a study published today in the journal Blood Advances.

“This is the first systematic evaluation of the association of statin use with survival outcomes in patients with CLL or SLL who have been treated with contemporary targeted agents such as ibrutinib,” said the study’s principal investigator, Ahmad Abuhelwa, PhD, an assistant professor of pharmacy practice and pharmacotherapeutics at the University of Sharjah in the United Arab Emirates. “Our results highlight a strong link between statin use and improved survival in this patient population.”

CLL is a slow-growing cancer that starts in the blood-forming cells of the bone marrow and is the most common form of leukaemia in adults in the United States. SLL, also a slow-growing cancer, affects the same type of cells as CLL but starts in lymphoid tissues such as the spleen instead of in the blood-forming cells.

Statins are among the most widely prescribed medications. It’s estimated that over 90 million adults in the United States take a statin drug to reduce their cholesterol levels and lower their risk for heart disease, which can lead to heart attacks or strokes. Previous studies have linked statin use to reduced death rates from several cancers, including CLL, said Dr Abuhelwa. However, those studies did not evaluate the effects of statin use in patients who were treated with newer cancer therapies such as the targeted drug ibrutinib, he said.

In the current study, Dr Abuhelwa and his colleagues analysed data from 1467 patients with CLL or SLL who participated in four international clinical trials conducted between 2012 and 2019. In these trials, patients were randomly assigned to treatment with ibrutinib either alone or in combination with other anti-cancer drugs, or to a drug regimen that did not include ibrutinib. A total of 424 patients (29%) were taking a statin at the time they started treatment across the four clinical trials. The median patient age was 65, and 66% were men; 92% had CLL, which was either newly diagnosed, had come back, or had not responded to prior treatment.

The study’s primary endpoints were cancer-specific survival (how long patients lived after starting treatment before dying specifically from their cancer), overall survival (how long patients lived after starting treatment, regardless of the cause of death), and progression-free survival (how long patients lived after starting treatment before their cancer worsened or they died from any cause). The secondary endpoint was the proportion of patients who experienced severe or life-threatening adverse events. The median follow-up time for all patients enrolled in the four trials was five years for overall survival and 22 months for progression-free survival.

To account for potential confounding factors, the investigators adjusted their analysis for variables including each patient’s diagnosis, age, sex, weight, physical functioning (as assessed by doctors), disease severity, length of time since their diagnosis, number of co-existing illnesses, use of other medications for heart conditions or high blood pressure, and the specific anti-cancer treatment regimen received.

Results showed that, regardless of any of these factors, patients who took a statin had, on average, a 61% reduced risk of dying from their cancer, a 38% reduced risk of death from any cause, and a 26% reduced risk of disease progression. Importantly, statin use did not increase the likelihood of severe or life-threatening adverse events.

“These findings don’t allow us to say for certain that statins directly improve cancer outcomes,” said Dr. Abuhelwa. “However, the fact that this association remained strong even after accounting for multiple factors makes it an important area for future research.” As next steps, he recommended conducting laboratory studies to better understand how statins may influence cancer biology, as well as prospective clinical trials in which patients with CLL or SLL are randomly assigned to take a statin or not.

The study has several limitations given its observational nature. For example, patients enrolled in clinical trials tend to be monitored more closely than those who receive treatment outside of a clinical trial, so the study findings may not be generalizable to patients treated in non-clinical trial settings. Additionally, because patients used various statins at different doses, the study could not determine the effects of specific statin types, doses, or duration of use on patients’ survival.

“While our results are very promising, we can’t recommend starting statins for CLL/SLL treatment based on this study alone,” Dr Abuhelwa said. “Future clinical trials are needed to determine definitively whether statins have a direct benefit on cancer survival.”

Source: American Society of Hematology

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Urinary Incontinence may Be Associated with Cardiovascular Disease

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A University of Iowa-led research team has found that urinary incontinence may be associated with a greater risk for cardiovascular disease in women.

Urinary incontinence is a common condition, especially in older adults. Previous studies have stated that it can affect between 38% and 60% of women. The researchers aimed to find out whether urinary incontinence was linked to a decline in physical activity, which can lead to a host of health issues, including greater risk for cardiovascular disease.

The findings were published in Preventive Medicine.

In the study, the researchers – led by Lisa VanWiel, assistant professor at the University of Wisconsin-La Crosse who in April earned her doctorate in health and human physiology from Iowa – analysed medical records over two years from more than 20 000 female patients in the Hartford Healthcare system in Connecticut. Of those patients, 5.4% reported through a questionnaire to have urinary incontinence. All patients were asked to rate their level of physical activity in the questionnaire.

The researchers found that the respondents with urinary incontinence did not report engaging in less physical activity than those who did not have the condition. But the team did find an association between patients with urinary incontinence and cardiovascular disease risk factors or events, such as dyslipidemia, type 2 diabetes, and stroke.

“There is an association between incontinence and cardiovascular disease (CVD) risk,” the study authors write. “Women should be screened for incontinence regularly as it may contribute to CVD risk, and women with CVD risk factors should be screened for undiagnosed incontinence.” 

Source: University of Iowa

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Preventing Onset and Development of Heart Failure with Preserved Ejection Fraction

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Right side heart failure. Credit: Scientific Animations CC4.0

There is a natural mechanism that protects the heart from heart failure with preserved ejection fraction (HFpEF), according to findings published in Circulation. An international team of researchers at the University of Manchester, Baylor College of Medicine and collaborating institutions discovered that when the cardioprotective mechanism fails, it promotes the development of HFpEF. Restoring the mechanism prevents progression, and presents a promising therapeutic target to prevent and treat this life-threatening disease.

“HFpEF is a complex, multifactorial disease associated with metabolic stress. One of the factors involved is the toxic accumulation of lipids in heart cells,” said co-author Dr Tamer M. A. Mohamed, associate professor of surgery and director of the Laboratory for Cardiac Regeneration Baylor.

The team began by assessing gene changes in hearts from people diagnosed with metabolic stress along with various cardiovascular complications and found alterations in the expression of 488 genes. “We found particularly relevant the simultaneous reduction of the expression of genes XBP1 and EDEM2 in human HFpEF hearts,” Mohamed said.

The link between EDEM2 and other conditions has been studied, but its role in the heart remains unexplored.

“We discovered that the XBP1 protein regulates the Edem2 gene in animal models and that EDEM2 was downregulated in hearts from individuals with metabolic disorders and in mouse models,” Mohamed said. “Further evidence supported the involvement of EDEM2 and XBP1 in cardiovascular diseases and lipid regulation.”

To investigate whether XBP1 and EDEM2 were directly involved in lipid toxicity and HFpEF, the researchers removed the Xbp1 or the Edem2 gene in mice. Consequently, these mice became more vulnerable to metabolic stress-induced heart lipid toxicity and cardiac dysfunction. “It was exciting to see that restoring Xbp1 or Edem2 alleviated lipid overload in the heart and reversed HFpEF,” Mohamed said.

This comprehensive study uncovered that XBP1 and EDEM2 work together to maintain a healthy lipid balance in heart cells.

“Our findings support further study of the XBP1s and EDEM2 pathway as a promising therapeutic target for mitigating cardiac lipotoxicity and progression of HFpEF,” Mohamed said.

Source: Baylor College of Medicine

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Daytime-only Meals Could Protect People from the Heart Risks of Shift Work

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A new study from Mass General Brigham suggests that eating only during the daytime could help people avoid the health risks associated with shift work. Results are published in Nature Communications.

“Our prior research has shown that circadian misalignment – the mistiming of our behavioral cycle relative to our internal body clock – increases cardiovascular risk factors,” said senior author Frank A.J.L. Scheer, PhD, a professor of Medicine at Brigham and Women’s Hospital. “We wanted to understand what can be done to lower this risk, and our new research suggests food timing could be that target.”

Animal studies have shown that aligning food timing with the internal body clock could mitigate the health risks of staying awake during the typical rest time, which prompted Scheer and his colleagues to test this concept in humans.

For the study, researchers enlisted 20 healthy young participants to a two-week in-patient study at the Brigham and Women’s Center for Clinical Investigation. They had no access to windows, watches, or electronics that would clue their body clocks into the time. The effect of circadian misalignment could be determined by comparing how their body functions changed from before to after simulated night work.

Study participants followed a “constant routine protocol,” a controlled laboratory setup that can tease apart the effects of circadian rhythms from those of the environment and behaviours (eg, sleep/wake, light/dark patterns). During this protocol, participants stayed awake for 32 hours in a dimly lit environment, maintaining constant body posture and eating identical snacks every hour. After that, they participated in simulated night work and were assigned to either eating during the nighttime (as most night workers do) or only during the daytime. Finally, participants followed another constant routine protocol to test the aftereffects of the simulated night work. Importantly, both groups had an identical schedule of naps, and, thus, any differences between the groups were not due to differences in sleep schedule.

The investigators examined the aftereffects of the food timing on participants’ cardiovascular risk factors and how these changed after the simulated night work. Researchers measured various cardiovascular risk factors, including autonomic nervous system markers, plasminogen activator inhibitor-1 (which increases the risk of blood clots), and blood pressure.

Remarkably, these cardiovascular risk factors increased after simulated night work compared to the baseline in the participants who were scheduled to eat during the day and night. However, the risk factors stayed the same in the study participants who only ate during the daytime, even though how much and what they ate was not different between the groups—only when they ate.

Limitations of the study include that the sample size was small, although of a typical size for such highly controlled and intensive randomised controlled trials. Moreover, because the study lasted two weeks, it may not reflect the chronic risks of nighttime versus daytime eating.

A strength is that the study participants’ sleep, eating, light exposure, body posture, and activity schedule were so tightly controlled.

“Our study controlled for every factor that you could imagine that could affect the results, so we can say that it’s the food timing effect that is driving these changes in the cardiovascular risk factors,” said Sarah Chellappa, MD, MPH, PhD, an associate professor at the University of Southampton, and lead author for the paper.

While further research is necessary to show the long-term health effects of daytime versus nighttime eating, Scheer and Chellappa said the results are “promising” and suggest that people could improve their health by adjusting food timing. They add that avoiding or limiting eating during nighttime hours may benefit night workers, those who experience insomnia or sleep-wake disorders, individuals with variable sleep/wake cycles, and people who travel frequently across time zones.

Source: Mass General Brigham

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Add-on for Statins Greatly Reduces Recurrence of Heart Attacks

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Photo by Mikhail Nilov: https://www.pexels.com/photo/paramedics-using-a-defibrillator-on-a-patient-8942635/

Patients who receive an add-on medication soon after a heart attack have a significantly better prognosis than those who receive it later, or not at all. These are the findings of a new study from researchers at Lund University in Sweden and Imperial College London.

Their analysis suggests that treating patients earlier with a combination of statins and the cholesterol-lowering drug ezetimibe could prevent thousands of new heart attacks in the UK over a decade.

Cardiovascular disease is by far the most common cause of death worldwide, with heart attack (‘myocardial infarction’) being the most common acute event.

For those who survive a heart attack, the risk of a new heart attack is greatest in the first year after the initial event because the blood vessels are more sensitive, making it easier for blood clots to develop.

Our findings suggest that a simple change in treatment guidelines could have a huge impact on patients and reduce the demand on the NHS.

Professor Kausik Ray, School of Public Health

Reducing LDL or “bad” cholesterol in the blood can stabilise changes in the vessels, decreasing the risk for new events.

The current treatment guidelines for patients are high-potency statins immediately after a heart attack, to lower their cholesterol levels.

However, the majority of patients do not reach recommended cholesterol levels using only statins, and so need an add-on treatment, such as ezetimibe.

“Today’s guidelines recommend stepwise addition of lipid-lowering treatment. But it’s often the case that this escalation takes too long, it’s ineffective and patients are lost to follow-up,” says Margrét Leósdóttir, Associate Professor at Lund University and senior cardiology consultant at Skåne University Hospital in Malmö, Sweden. “By giving patients a combination treatment earlier, we could help to prevent many more heart attacks.”

Co-investigator Professor Kausik Ray, from Imperial College London’s School of Public Health, said: “This study shows that we could save lives and reduce further heart attacks by giving patients a combination of two low-cost drugs.

“But at the moment patients across the world aren’t receiving these drugs together. That’s causing unnecessary and avoidable heart attacks and deaths – and also places unnecessary costs on healthcare systems.

“Our study shows the way forward; care pathways must now change for patients after this type of heart event.”

Reducing heart attacks

In the latest study, the international team examined outcomes for heart attack patients if they received a combination of statins with the add-on therapy ezetimibe (within 12 weeks after a heart attack), statins with ezetimibe added later (between 13 weeks and 16 months), or just statins with no ezetimibe at all.

Based on Swedish registry data from 36 000 patients who had a heart attack between 2015 and 2022, the researchers used advanced statistical models to emulate a clinical trial.

The results show that patients who received a combination treatment of statins and ezetimibe within 12 weeks of a heart attack and were able to lower cholesterol to the target level early, had a better prognosis and less risk of new cardiovascular events and death than those who received the add-on treatment later, or not at all.

From the analysis, the researchers believe many new heart attacks, strokes and deaths could be prevented every year internationally if the treatment strategy were to be changed.

Under a scenario in which 100% of patients would receive ezetimibe early, they estimate 133 heart attacks could be avoided in a population of 10 000 patients in 3 years.

The researchers suggest that in the UK, which records an estimated 100 000 hospital admissions from heart attacks a year,[1] this would equate to an estimated 5000 heart attacks being prevented over a ten year period.[2]

Improving guidance

Dr Leósdóttir said: “Combination therapy is not applied up-front for two main reasons. General recommendations are not included in today’s guidelines and a precautionary principle is applied to avoid side effects and overmedication.

However, there are positive effects from applying both medicines as soon after the infarction as possible. Not doing this entails an increased risk. In addition, the drug we have examined in the study causes few side effects and is readily available and inexpensive in many countries.”

Margrét Leósdóttir hopes that the research results will in time provide support for changes in the recommendations. A treatment algorithm has already been introduced at her hospital in Sweden to help doctors to prescribe appropriate lipid-lowering treatment for patients who have had a myocardial infarction.

It has been noted that patients achieve their treatment goals earlier and two months after the infarction twice as many patients have reduced their bad cholesterol to the target level, compared with previously.

“Several other hospitals in Sweden have also adopted the algorithm and there are similar examples from other countries that have produced as good results. My hope is that even more will review their procedures, so that more patients will get the right treatment in time, and we can thereby prevent unnecessary suffering and save lives.”

Source: Imperial College London

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CVD and Obesity: When Protective Lipids Decline, Health Risks Increase

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The mesenteric arteries from obese and lean mice, pictured above, supply oxygen and nutrients to the intestines. Immunofluorescence staining revealed that the NOGO-B protein increases in the vascular walls of mice fed a high fat diet compared to mice fed a standard diet. As a result, ceramides decrease in the mesenteric arteries of the obese mice, damaging endothelial cells lining blood vessels. Credit: Annarita Di Lorenzo/Weill Cornell Medicine

New research from Weill Cornell Medicine has uncovered a surprising culprit underlying cardiovascular diseases in obesity and diabetes—not the presence of certain fats, but their suppression. The study, published in Nature Communications, challenges the conventional belief that a type of fat called ceramides accumulates in blood vessels causing inflammation and health risks. Instead, their findings reveal that when ceramides decrease in endothelial cells lining blood vessels, it can be damaging and cause chronic illnesses. Ironically, the findings could ultimately lead to therapies that maintain high levels of these protective lipids in patients with obesity.

Ceramides are found throughout the body and in the endothelium, the thin lining inside blood vessels. These waxy lipids regulate blood vessel tone, dilating or contracting vessels to modulate blood pressure. They also help prevent blood clots, keeping blood flowing easily through the body’s extensive highway of arteries and veins.

“The common assumption in the field was that high levels of ceramides in the endothelium of blood vessels contributed to cardiovascular disease, but this conclusion was extrapolated from in vitro data in cells,” said Dr Annarita Di Lorenzo, professor of pathology and laboratory medicine at Weill Cornell Medicine. “Ours is the first in vivo study that measures the levels of the lipids in the endothelial cells of an animal model. In obese mice fed a high-fat diet, ceramides do not build up—they decrease compared to lean mice.” Also working on this research are co-first authors Dr Onorina L. Manzo, postdoctoral associate and Luisa Rubinelli, both in Dr Di Lorenzo’s lab.

Ceramide to the Rescue

Dr Di Lorenzo and her team discovered the importance of ceramides in blood vessels two years ago. Together with Dr Giuseppe Faraco, assistant professor of neuroscience at Weill Cornell Medicine, they found that decreased levels of ceramides in otherwise healthy mice causes severe blood vessel inflammation in the brain, clot formation and death. Last year, the team reported that ceramide production increases as a protective response in a mouse model of coronary artery disease. Ultimately, when ceramide is broken down by the body it produces a compound called sphingosine-1-phosphate (S1P), which builds up and protects mice against cardiovascular disease. But when this process doesn’t work the mice are left vulnerable.

The researchers also found that two proteins, Nogo-B and ORMDL, decreased the production of ceramides and S1P in obesity. This decrease leads to increased blood pressure, impaired vascular regulation and higher glucose levels—all of which contribute to cardiometabolic conditions that affect the heart (cardiovascular system) and energy processing (metabolism), like diabetes like diabetes, hypertension, coronary artery disease and stroke.

Maintaining Balance

To understand how these different molecules interact, the researchers tested what happens in animal models. Mice with obesity fed a high-fat diet had low levels of ceramides and S1P, but high levels of Nogo-B. These mice showed signs of inflammation, diabetes and high blood pressure.

But what happens if the Nogo-B inhibitor wasn’t present? The researchers knocked out Nogo-B only in the endothelium of blood vessels in a mouse model to find out. “These mice have the same body weight and diabetes as controls, but their blood vessel health is much better,” said Dr. Di Lorenzo. “By knocking out this inhibitor, we preserved vascular health. This also showed that the regulation of ceramide metabolism causes vascular dysfunction and inflammation in obesity.”

The paper suggests that targeting this metabolic pathway could have multiple beneficial effects in the treatment of cardiometabolic diseases related to obesity. “Nogo suppresses biosynthesis of ceramides, so if we can identify a drug that can block Nogo-B, we could restore ceramide levels to a healthy balance and this would fight not only obesity and diabetes, but would directly keep blood vessels functioning properly,” she said.

Source: Weill Cornell Medicine

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New Study Investigates Effects of ADHD Medications on the Heart

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A new study led by the University of Southampton has found that medications for ADHD have overall small effects on blood pressure and heart rate after weeks or a few months of use.

There have been concerns about the side effects of ADHD medications but the new findings, coupled with other studies, suggest that the benefits of taking these medications outweigh the risks, while highlighting the need for careful monitoring.

The study, published in The Lancet Psychiatry, conducted the largest and most comprehensive analysis of the cardiovascular effects of ADHD medications based on the results of randomised controlled trials – the most rigorous type of clinical study to assess medication effects.

Professor Samuele Cortese, senior lead author of the study from the University of Southampton said: “When it comes to taking any medication, risks and benefits should always be assessed together. We found an overall small increase in blood pressure and pulse for the majority of children taking ADHD medications.

“Other studies show clear benefits in terms of reductions in mortality risk and improvement in academic functions, as well as a small increased risk of hypertension, but not other cardiovascular diseases. Overall, the risk-benefit ratio is reassuring for people taking ADHD medications.”

The study was funded by the National Institute for Health and Care Research (NIHR), within the framework of the NIHR Research Professorships scheme to Professor Samuele Cortese, with Dr Luis Farhat (University of São Paulo, Brazil) as first author and Professor Alexis Revet (University of Toulouse, France) as co-senior author.

It is estimated that attention-deficit/hyperactivity disorder (ADHD) affects around 4 per cent of children in the UK. Of these, around 45 per cent are treated with medication.

The international team of investigators analysed data from 102 randomized controlled trials, including a total of 22,702 participants with ADHD. They used an advanced statistical approach – network meta-analysis – that allowed them to compare the effects of several medications, even when the medications were not directly compared in the trials included in the analysis.

They found that all ADHD medications were generally associated with overall small effects on blood pressure, heart rate, and ECG parameters. With the exception of guanfacine (which leads to decreased blood pressure and heart rate), other medications led to increases in the values of these parameters.

No significant differences were found between stimulants (including methylphenidate and amphetamine) and non-stimulants (atomoxetine and viloxazine) with regard to their effects on blood pressure and heart rate.

“Our findings should inform future clinical guidelines, stressing the need to systematically monitor blood pressure and heart rate, both for stimulants and non-stimulants. This should be particularly relevant for practitioners who might assume that only stimulants have a negative effect on the cardiovascular system,” said Dr Farhat.

The researchers say that those with existing heart conditions should discuss the side effects of ADHD medications with a specialist cardiologist before starting treatment.

Professor Revet added: “Our findings, based on randomised controlled trials that tend to be of short duration due to ethical issues, should be complemented by results from real-world, longer-term studies.”

The research team will now look to see if some groups might be more vulnerable to cardiovascular side effects than others.

NIHR Research Professor Cortese concluded: “While our findings are informative at the group level, that is, on average, we cannot exclude that a subgroup of individuals may have a higher risk of more substantial cardiovascular alterations.

“While it is currently not possible to identify those individuals at higher risk, efforts based on precision medicine approaches will hopefully provide important insights in the future.”

Source: University of Southampton

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A Nearly Five-fold Increase in Hospitalisations for Common Cause of Stroke

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Ischaemic and haemorrhagic stroke. Credit: Scientific Animations CC4.0

Cervical artery dissection is a tear in an artery in the carotid or vertebral artery, and can result in blood clots that cause stroke. A new study has found almost a five-fold increase in the number of U.S. hospitalisations for cervical artery dissection over a 15-year period. The study is published on April 2, 2025, online in Neurology®, the medical journal of the American Academy of Neurology (AAN).

A dissection in the artery wall is most often caused by trauma due to motor vehicle accidents but can also occur with smaller injuries. Heavy lifting has also been shown to cause dissection in some people.

“Cervical artery dissection is an important cause of stroke, especially in people under 50, so it is crucial to detect it right away,” said Shadi Yaghi, MD, of Brown University in Providence, Rhode Island. “Strokes that are not fatal can lead to long-term disability, poor mental health and reduced quality of life. Our research found a dramatic increase in the number of hospitalisations for cervical artery dissection with rates rising steadily year over year.”

For the study, researchers reviewed 15 years of U.S. health data to identify 125 102 people hospitalised for cervical artery dissection. Participants had an average age of 51, and just over half had a stroke at the same time as dissection. Of all participants, 65% were white, 10% were Black, 8% were Hispanic, 3% were Asian or Pacific Islander, and 14% were of other racial groups. Researchers compared the number of hospitalisations to U.S. Census data to determine the annual rate of cervical artery dissections. They then calculated the average annual percentage change in those rates.

Researchers found the number of dissections increased from 11 cases per one million people in 2005 to 46 cases per one million people in 2019, with an average annual increase of 10%. Results were similar for both female and male participants. The average annual increase for Hispanic participants was 16%; for Black participants it was 13%, Asian participants, 12% and white participants, 8%.

Researchers also found a greater average annual increase among people 65 and older at 12% compared to 8% for people under 65.

“Possible reasons for this nearly five-fold increase over 15 years include greater awareness of cervical artery dissection by health care professionals, better access to imaging to help identify it and an overall increase in this condition for which a cause has yet to be determined,” said Yaghi. “Given the rising incidence of cervical artery dissection, our study underscores the importance of finding prevention strategies as well as new treatments to reduce the risk of stroke.” A limitation of the study was that the hospital admission data does not include undiagnosed or untreated cases, so the number of cases may be even higher.

Source: American Academy of Neurology

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Preventable Cardiac Deaths during Marathons are Down

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While more people than ever are running marathons in the U.S., the risk of dying from a heart attack during a run has fallen dramatically in recent years. That’s a key conclusion from a new study by Jonathan Kim, associate professor in the Emory School of Medicine. Kim’s research is a follow-up to a study he published in 2012 — the first investigation into unexpected cardiac arrests during long distance running events.

The new findings, published in JAMA, indicate that, while the rate of marathon runners who suffer cardiac arrests remained unchanged, their chance for survival is twice what it was in the past. Far fewer marathon runners who suffer cardiac arrest are now dying of it.

“We continue to see media reports about unfortunate cases of cardiac arrest during long distance running events,” Kim says. “But, has the incidence of these events changed? Have there been changes in the most common causes of cardiac arrest? What are the factors associated with death and survival? It was a novel question to ask 13 years after our first analysis, and an important one because recreational running continues to increase in popularity.”

The challenge of finding data

More than 29 million people completed marathons in the U.S. between 2010 and 2023, triple the number of the previous decade, which Kim examined in his first study. There’s no central registry of race-related cardiac events, so for both studies, his team had to find their data through a range of sources, starting by contacting individual race directors.

“We leveraged a few sources including a comprehensive review of media reports,” Kim says. “We also had contact information for all race directors and were able to reach approximately 70% of them who helped and told us the number of events during this specific timeline, including if the individual died and the sex of the participant.”

The researchers used extensive public internet searches to identify and reach out to runners who survived cardiac arrests or next-of-kin to construct detailed profiles of as many cases as possible. “The vast majority of cases were identifiable by public search engines. And all of the deaths were as well,” he says.

Analyzing this extensive database, Kim found that while the rate of cardiac arrests was about the same during the two periods — .60 per 100 000 participants now versus .54 per 100 000 participants in the earlier period — the rate of deaths from these cases, however, fell by half: from .39 per 100 000 to .19 per 100 000. That’s about a 50% decline in the death rate since 2000–2009. As before, cardiac arrests remained far more common among men than among women and more common in marathons than half marathons.

The sport’s growing awareness of cardiac death risk

What led to the dramatic change in death rates? Kim thinks the whole sport has become more aware of the risks and of the need to have emergency services available to runners, a conclusion he reached after interviewing as many survivors as he could find. “What we found was that every one of those people got hands-on cardiopulmonary resuscitation, but the vast majority also had immediate access to an automated external defibrillator. That’s the difference,” he says.

That survival rate is comparable to the cardiac arrest survival rate in other public places that now make defibrillators routinely available such as airport and casinos, which have seen similar declines in deaths.

Kim says his findings offer additional evidence of how important it is to make CPR training available to race participants and to strategically place defibrillators along the racecourse. It’s also important, he says, to better identify the most vulnerable in a population before they run a race.

“These are more often potentially preventable events,” he says. “Being able to identify people, more commonly older individuals with unrecognized cardiovascular risk factors, doesn’t mean they can’t run a race. Rather, it affords the opportunity to improve primary preventive cardiovascular care and potentially further reduce the risk of cardiac arrest during these events. The incidence of sudden cardiac arrest during long-distance races hasn’t changed in over twenty years. I think this is an important arena of future research.”

Source: Emory Health Sciences

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Possible Link Between Medication and Unexpected Blood Clots

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Thrombophilia. Credit: Scientific Animations CC4.0.

Why do medications that are supposed to help patients with chronic inflammatory diseases sometimes lead to blood clots? This is one of the questions that a team of researchers from Aarhus University has sought to answer in a study that has just been published in the journal Inflammopharmacology.

The study suggests that disturbances in the JAK-STAT signalling pathway, an important communication pathway in the body, may contribute to this side effect.

“In the study, we uncover the potential links between components of the JAK-STAK signalling pathway, blood markers in patients with blood clots, and the genetic factors that contribute to the risk of blood clots in patients. This helps improve our understanding of why we see an increased risk of blood clots when using JAK inhibitors,” explains Stine Rabech Haysen, former medical student at the Department of Biomedicine at Aarhus University, who is the first author of the publication. 

The potential of the study

In the study, researchers used publicly available data from a number of published studies about patients with blood clots and compared them with a healthy control group.

They found no direct genetic explanation, but they did find a statistically significant enrichment of genes that are subject to regulatory control of the JAK-STAT signalling pathway among genes whose expression is altered in patients with blood clots.

“Although we cannot draw definitive conclusions about the mechanistic link between the use of JAK inhibitors and the risk of blood clots, our study demonstrates the potential of using data mining to identify and shed light on possible mechanisms of drug side effects,” says one of the study’s senior authors, associate professor at the Department of Biomedicine Per Qvist.

What does this mean for patients?

Although JAK inhibitors rarely lead to blood clots, it’s important to understand the mechanism behind them so that the risk can be reduced.

“For the average person, our study means that we’re getting closer to understanding why some drugs can have dangerous side effects like blood clots. And going forward, our method could help identify and prevent serious side effects, potentially making drug treatment safer,” explains the other senior author of the study, associate professor at the Department of Biomedicine Tue Wenzel Kragstrup.

The researchers will now test the method on other types of medication to see if it can be used to detect side effects more widely.

Source: Aarhus University