Category: Cardiovascular Disease

Categories : Cardiovascular Disease COVIDTags :

Long COVID Associated with Increased Risk of Cardiovascular Disease

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People with long COVID are at increased risk of developing cardiovascular disease, according to a new study from Karolinska Institutet published in eClinicalMedicine. The results show that the risk of conditions such as cardiac arrhythmias and coronary artery disease is higher even among those who were not hospitalised during the acute infection.

Long COVID has become an increasingly significant health problem worldwide, and a growing number of studies suggest that the condition can lead to secondary cardiovascular diseases. To date, research has mainly focused on people who were hospitalised, whilst the risks for those who stayed at home or were treated at a GP are less well known. In the current study, the researchers investigated how often major cardiovascular events occur in these individuals compared with those without the diagnosis.

Of the just over 1.2 million people aged between 18 and 65 included in the study, around 9,000 had been diagnosed with long COVID, corresponding to 0.7 per cent. Two-thirds of them were women. People who had previously had cardiovascular disease or been hospitalised for COVID-19 were excluded from this group.

During the follow-up period of around four years, people with long COVID were more likely to suffer from cardiovascular disease: 18.2 per cent of women and 20.6 per cent of men experienced some form of cardiovascular event, compared with 8.4 per cent of women and 11.1 per cent of men in the group without long COVID.

When the researchers then adjusted the results for factors such as age, socio-economic status and other known risk factors, the differences remained. Women with long COVID had just over twice the risk of receiving a cardiovascular diagnosis compared with women without long COVID. Men had approximately a third higher risk.

“We found that cardiac arrhythmias and coronary artery disease were more common among both women and men with long COVID. In women, there was also an increased risk of heart failure and peripheral vascular disease. However, no clear association was found between long COVID and stroke,” says lead author Pia Lindberg, a nurse and PhD student at the Department of Medicine, Solna, Karolinska Institutet.

Need to be monitored more systematically

As many people with long COVID never required hospitalisation during their acute infection, there is a risk that secondary conditions may be missed, says Pia Lindberg, pointing out that the results suggest these patients may need to be monitored more systematically.

”Our results show that long COVID can be a risk factor for cardiovascular disease, even in younger people who were previously healthy. This underlines the need for structured follow-up that takes gender differences into account, particularly as cardiovascular disease in women often presents with more diffuse symptoms that can make diagnosis more difficult”, concludes Pia Lindberg.

Source: Karolinska Institutet

Categories : Cardiovascular DiseaseTags :

Stopping Beta-Blockers After Heart Attack is Safe for Low-Risk Patients

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Findings suggest lifelong beta-blockers may be unnecessary in some patients

Human heart. Credit: Scientific Animations CC4.0

Among stable, relatively low-risk patients who had previously suffered a heart attack, discontinuing beta-blockers after at least one year was found to be non-inferior, or comparable, to continuing beta-blockers in terms of death, another heart attack or hospitalisation for heart failure, according to a study presented at the American College of Cardiology’s Annual Scientific Session (ACC.26).

Beta-blockers, which lower heart rate and blood pressure by inhibiting adrenaline and other hormones, have long been a mainstay of treatment to reduce the likelihood of subsequent cardiac events following a heart attack. However, many studies confirming their benefits were conducted decades ago, when procedures and medications for secondary prevention were more limited than they are today. More recent studies suggest the benefits of beta-blockers may vary depending on the overall health of a patient’s heart.

“In appropriately selected patients who survived a heart attack and do not have heart failure or left ventricular systolic dysfunction, routine continuation of beta-blockers indefinitely may not be necessary,” said Joo-Yong Hahn, MD, a cardiologist at Samsung Medical Center in Seoul, South Korea, and the study’s senior author. “In practice, for stable patients who are several years out from a heart attack, discontinuation can be considered through shared decision-making and with monitoring of blood pressure and heart rate. For patients with beta-blocker-related side effects – fatigue, dizziness, bradycardia, hypotension – the case for discontinuation is even stronger.”

The study evaluated 2,540 patients at 26 sites in South Korea between 2021 and 2024 who had no subsequent cardiac events after taking beta-blockers for at least one year following a heart attack. Participants’ average age was 63 years and 87% were men. At a median of 3.5 years following randomisation, the primary endpoint – a composite of all-cause death, recurrent heart attack or heart failure hospitalisation – occurred in 7.2% of those who discontinued beta-blockers and 9% of those who continued taking the medication. The results met the threshold for non-inferiority because of a lower rate of this composite endpoint in the group that stopped taking beta-blockers.

Discontinuation of beta-blockers was also found to be similar for secondary endpoints, including each of the components of the primary composite endpoint, new-onset atrial fibrillation, unfavourable changes in left ventricular function, changes in quality of life and serious adverse events.

“In current practice – where revascularisation rates are high and secondary prevention is strong – we expected that the incremental benefit of continuing beta-blockers indefinitely in stable patients might be small,” Hahn said. “We found that discontinuation did not worsen major outcomes, cardiac function or quality of life in this selected stable population.”

Since most study participants had been taking beta-blockers for several years before discontinuing, Hahn said that the results may not apply to patients who have been taking beta-blockers for a shorter amount of time. The study also does not definitively establish the earliest timepoint at which it is safe to stop taking beta-blockers.

The results were generally consistent across prespecified subgroups. However, women and patients with mildly reduced left ventricular ejection fraction made up a small proportion of the trial population, limiting the interpretation of results for these subgroups. In addition, the study was conducted only in South Korea, potentially limiting its generalisability to other areas of the world.

Hahn said future studies could help to clarify whether and when it is safe to discontinue beta-blockers among higher-risk groups, women and those with mildly reduced left ventricular ejection fraction and to better define the optimal timing of discontinuation. Pooled analyses across contemporary randomised trials could provide additional insights and help guide practice decisions. The researchers also plan to conduct further analyses to assess potential differences in health care costs.

The study was funded by the Patient-Centered Clinical Research Coordinating Center in the Ministry of Health and Welfare of the Republic of Korea.

This study was simultaneously published online in the New England Journal of Medicine at the time of presentation.

Source: American College of Cardiology

Categories : Cardiovascular DiseaseTags :

Lipid Lowering: Why 70mg/dL May Not Be Low Enough

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Image by Scientific Animations, CC4.0

Current clinical guidelines stress that lower LDL cholesterol levels significantly reduce the risk of major cardiac events. Essential strategies for treatment include heart-healthy lifestyle changes and pharmacological interventions using statins, ezetimibe, and PCSK9 inhibitors. Early intervention is vital, as the cumulative exposure to high cholesterol over time – often termed “LDL years” – determines the onset of vascular disease. But a major question has remained as to whether more aggressive lip-lowering targets is worth the potential side effects such as kidney damage.

Now, a new clinical trial published in NEJM provides evidence that an intensive target of less than 55mg/dL is superior for preventing secondary complications. In the Ez-PAVE trial, researchers in South Korea investigated whether this more intensive provided better protection than the conventional goal of less than 70mg/dL. The study found that patients in the intensive group experienced a significant reduction in cardiovascular events over a three-year period. The researchers conclude that their findings support stricter lipid-lowering guidelines, which can safely and effectively improve long-term patient outcomes.

Categories : Cardiovascular DiseaseTags :

Are Heart Failure and Atrial Fibrillation the Same Disease?

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

New research published in Nature Cardiovascular Research reveals that heart failure and atrial fibrillation share underlying genetic and molecular mechanisms, suggesting that the two cardiovascular conditions may be less distinct than previously thought.

Two serious heart conditions that often coexist

Heart failure occurs when the heart muscle is damaged and unable to pump enough nutrient-rich blood to meet the body’s needs for oxygen. Heart failure is usually evaluated in the heart’s lower chambers, called ventricles, which provide most of the pumping power.

Atrial fibrillation is an arrhythmia that originates in the heart’s upper chambers, known as the atria. During atrial fibrillation, the heart beats too fast, resulting in a lower blood flow to the body and a higher risk for clots or stroke.

Epidemiologists have observed that these two conditions aren’t independent of one another: People with heart failure are much more likely to have atrial fibrillation, and vice versa. Patients’ outcomes also tend to be worse when they have both conditions.

“This intersection between two very common, very important diseases – both of which cause a lot of morbidity and mortality and billions of dollars in annual healthcare costs – has been called an ‘epidemic in cardiology,’ yet our understanding has remained very limited,” said senior author Ivan Moskowitz, MD, PhD, a paediatric cardiologist and pathologist at the University of Chicago Medicine.

Uncovering TBX5 as a key genetic regulator

This new study was guided by previous research Moskowitz and his collaborators published in 2024, which kick-started when a former lab member created a mouse model by “turning up” a gene linked to human heart failure in the mouse heart.

“We expected to get a heart failure mouse model, but instead we got an atrial fibrillation model,” Moskowitz said. “That observation put us on the right path.”

This focused attention on a gene called TBX5. TBX5 is a transcriptional regulator: a protein in the cell nucleus that controls which genes are turned on or off at a given time. When TBX5 levels are decreased in the atrium, it disrupts the normal gene expression needed to maintain a stable heart rhythm.

Zeroing in on transcriptional responses, the researchers compared different mouse models of heart failure and atrial fibrillation, finding that an atrial fibrillation model created by removing TBX5 from the atria actually creates gene expression changes almost identical to those seen in heart failure.

“That made us think that diminished TBX5 may be important in heart failure,” Moskowitz said. “So, we looked at human gene expression data, and lo and behold, TBX5 was very downregulated in the atria of patients with heart failure, but not the ventricles.”

This finding suggested a mechanistic link: reduced TBX5 in the atrium may contribute to the development of atrial fibrillation in the context of heart failure.

Coordinated genetic response across cell types

Further analysis revealed that over 100 other transcription factors – proteins that regulate gene expression – were altered in both the heart failure and TBX5-deficient atrial fibrillation models. Almost all the key transcription factors changed in the same direction in both conditions.

“Seeing these correlations emerge effectively indicates that from the atrium’s perspective, what’s happening in the two conditions is the same,” Moskowitz said.

Using single-cell analysis, the team identified which human cell types in the atrium were involved in the disease mechanism. Cardiomyocytes and fibroblasts both showed disease-related gene changes, suggesting that the pathological response involves multiple cell types communicating with one another.

Rethinking atrial fibrillation as atrial heart failure

Strikingly, the authors argue that the results should prompt a fundamental shift in how atrial fibrillation is understood. The rhythm disorder seen in atrial fibrillation may be a symptom of underlying atrial muscle dysfunction similar to the ventricular dysfunction in heart failure.

“The coordinated change in transcription factors lead us to conclude that atrial fibrillation is not really a different disease than heart failure; it is just what we might call ‘atrial heart failure,’ a manifestation of which is atrial fibrillation,” Moskowitz said. “Instead of a rhythm disorder in the atria, we can understand it more like an atrial myopathy that is mimicking what’s happening in ventricle cells in heart failure.”

Unlocking future treatment avenues

This new perspective could have important implications for cardiovascular disease treatment. Currently, therapies for atrial fibrillation focus on controlling the heart’s electrical rhythm, often by targeting ion channels that regulate electrical signals. Moskowitz suggests a broader approach: “We may be able to go higher upstream. Rather than trying to drug the channels directly, we could think more about the response of the atrium to pressure, much like we do the ventricles in heart failure. Approaching atrial fibrillation like heart failure may be a different avenue.”

In ongoing work, the UChicago Medicine researchers are continuing to analyse these genetic and molecular pathways. They’ve already identified multiple signalling genes expressed in cardiomyocytes that are disrupted when TBX5 is “turned down,” and are working to investigate whether replenishing those signals can prevent atrial fibrillation from occurring. This combination of insight and fundamental biology is the driving force behind translational advancement.

“This intersection is a fertile ground for insight into atrial fibrillation and how it may be treated,” Moskowitz said. “We’re excited because this study provides many candidates for future investigation. We hope our work can be applied to new thinking and interventions toward a cure.”

Source: University Chicago Medicine

Categories : Cardiovascular Disease NeurologyTags :

Algorithm for Paramedics Predicts Brain Damage Risk After Cardiac Arrest

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Photo by Ian Taylor in Unsplash

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

Categories : Cardiovascular DiseaseTags :

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

Categories : Cardiovascular DiseaseTags :

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

Categories : Cardiovascular DiseaseTags :

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