Category: Cardiovascular Disease

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Maintaining Heart Health may Reduce Cerebral Small Vessel Disease

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Maintaining excellent cardiovascular health may lower the risk for abnormalities in the small vessels of the brain, a new study suggests.

Scientists aren’t sure what causes the condition, known as cerebral small vessel disease, or CSVD. Previous research shows CSVD contributes to about half of dementia cases, a quarter of clot-caused strokes and most bleeding strokes.

For the new study, researchers looked at data from 3067 older adults in Lishui, China. The study team ranked each person’s cardiovascular health as “poor,” “intermediate” or “ideal” based on three medical factors (blood pressure, cholesterol and blood sugar) and four modifiable behaviours (not smoking, maintaining a healthy weight, eating healthy and being physically active).

Next, they compared cardiovascular health to brain MRI scans that looked for signs of CSVD, such as cerebral microbleeds – remnants of blood that has leaked out of small vessels – and lesions called white matter hyperintensities.

The study found participants with ideal cardiovascular health had 26% lower odds of having CSVD than those with poor cardiovascular health. The research was published Wednesday in the journal Stroke.

“The findings were somewhat expected, since a healthy lifestyle can benefit both the arteries and the brain,” said study co-author Yuesong Pan, a researcher of neurological diseases at Capital Medical University’s Beijing Tiantan Hospital in China.

“This suggests that in clinical practice, the target is to attain an ideal (cardiovascular health) score, not just an intermediate score,” he said. “Patients can use a simple self-measuring scale to adjust their lifestyle, assess the risk of CSVD and reduce their CSVD burden.”

Researchers used the American Heart Association’s tool for scoring cardiovascular health that was recently updated to add sleep duration as an eighth factor for ideal heart and brain health. Pan suggested people use the tool, now known as Life’s Essential 8, to find out their risk for cardiovascular disease.

Dr. José Rafael Romero, a neurologist who wasn’t involved in the research, said CSVD is important because “it does not have a specific treatment and it is such a strong contributor to stroke and dementia, which are epidemic conditions around the world.”

In 2020, 7.1 million people worldwide died of stroke, according to AHA statistics. In the US, stroke ranks fifth among all causes of death, with more than 160 000 deaths in 2020, based on data from the Centers for Disease Control and Prevention.

Alzheimer’s disease – the main cause of dementia – is the seventh-leading cause of death in the US. An estimated 6.5 million people age 65 and older have the condition, according to the Alzheimer’s Association. That number is expected to reach 12.7 million by 2050.

“The study is important because it gives additional information on how to lower CSVD risk, which may have an enormous public health benefit,” said Romero, an associate professor of neurology at Boston University School of Medicine who wrote an editorial published alongside the new research.

“It shows that we shouldn’t stop halfway. We should aim for achieving all the goals and achieving ideal cardiovascular health.”

Pan said the study was limited by incomplete dietary data and because it didn’t follow participants over a period of time. He called for larger, long-term observational studies to learn more about the relationship between CSVD and cardiovascular disease risk factors.

Romero said randomised clinical studies are needed to see whether controlling cardiovascular disease risk does indeed lower small vessel disease risk. He also called for future studies to evaluate the usefulness of screening high-risk people for CSVD using brain MRI.

In general, he said, health care professionals and health organisations need to come up with a clearer plan on how to fight CSVD.

“Often, there is no dedicated effort to control risk factors and track this consistently, particularly in patients that have high risk,” Romero said. “We really need to develop programs for effective and sustained implementation of these guidelines for preventing cardiovascular disease.”

Source: American Heart Association

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Smartphone Video of Carotid Arteries Predicts Stroke Risk

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Credit: American Heart Association

Narrowed arteries in the neck – a major risk factor for stroke – may be detected by analysing smartphone video that picks up the motion of blood flowing just beneath the skin, a small study shows.

The research, published Wednesday in the Journal of the American Heart Association, may be useful in developing a non-invasive, early screening tool for detecting blockages in the carotid arteries that can lead to strokes.

“Between 2% and 5% of strokes each year occur in people with no symptoms, so better and earlier detection of stroke risk is needed,” study author Dr. Hsien-Li Kao said in a news release. He is an interventional cardiologist at National Taiwan University Hospital in Taipei.

“This was an exciting ‘eureka’ moment for us,” he said. “Existing diagnostic methods – ultrasound, CT and MRI – require screening with specialised medical imaging equipment and personnel. Analysis of video recorded on a smartphone is non-invasive and easy to perform, so it may provide an opportunity to increase screening.”

The carotid arteries, found in the neck, can become blocked by a buildup of fatty deposits known as plaque. That condition – carotid artery stenosis – restricts blood flow to the brain and may lead to an ischemic stroke. Nearly 87% of all strokes in the US are this type of stroke.

The carotid artery is just below the skin’s surface. When velocity and blood flow patterns change, those changes are reflected in the motion of the overlying skin, Kao said. However, those differences cannot be detected by the naked eye.

In the study, researchers used motion magnification and pixel analysis to detect subtle changes in pulse characteristics on the skin’s surface captured in 30-second smartphone video recordings. An older-generation smartphone was used to make video clips of the necks of 202 Taiwanese adults, who were an average 68 years old when the study took place between 2016 and 2019. While recordings were being made, participants lay on their backs with their heads tilted back in a custom-made box that restricted movement.

Among participants, 54% had previously been diagnosed with a blockage of 50% or more in the carotid artery. The phone videos were 87% accurate in predicting who had a blockage in the artery. Narrowing in the arteries was confirmed using a Doppler ultrasound test.

Kao said further research could determine whether it is possible to take recordings and perform the motion analysis remotely, in conjunction with a downloadable app.

“More research is needed to determine whether video recorded on smartphones is a promising approach to help expedite and increase stroke screening,” he said. “Carotid artery stenosis is silent until a stroke happens. With this method, clinicians may be able to record a video of the patient’s neck with a smartphone, upload the videos for analysis and receive a report within five minutes. The early detection of carotid artery stenosis may improve patient outcomes.”

Source: American Heart Association

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Falling Victim to Fraud Has a Lasting Impact on Men’s Blood Pressure

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A new study published in the Journal of the American Geriatrics Society suggests that experiencing financial exploitation, fraudulent schemes, and scams may raise a person’s blood pressure, especially in later life. A key difference in the findings was that fraud victimisation was linked with elevated blood pressure in men, but not in women.

Instead of focusing on subjective measures of health after fraud vicitimisation, this study included objective measures of physical health, specifically, systolic and diastolic blood pressure, pulse pressure, and mean arterial pressure. Chronic elevation of these measures are known to contribute to end organ damage including stroke, cardiovascular disease morbidity, and mortality. 

The study participants consisted of 1200 older adults from the Rush Memory and Aging Project. During up to 11 years of annual observations, participants were asked about fraud victimisation and underwent serial blood pressure measurements.

In men, blood pressure elevations were observed after they had been the victims of fraud. Those elevations, compounded over time, could indicate future poor health. The rise in blood pressure persisted for years after the fraud had taken place, especially in old age.

“These findings show that fraud victimisation has important public health consequences and underscore the need for efforts to prevent exploitation,” said lead author Melissa Lamar, PhD, of Rush University Medical Center.

Source: Wiley

Categories : Cardiovascular Disease Surgeries & ProceduresTags :

Aspirin and Antiplatelets after Coronary Artery Grafts are a Double-edged Sword

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A new analysis published in JAMA shows that a combination of aspirin and another antiplatelet agent can prevent clotting after coronary artery bypass grafts but also increases the risk of potentially dangerous bleeding. This double-edged finding from investigators suggests physicians should carefully weigh the use of these medications after this procedure.

A Weill Cornell Medicine and NewYork-Presbyterian team led by Dr Mario Gaudino, a coronary artery bypass surgeon, examined data from 1668 grafts in which surgeons use a saphenous vein graft to circumvent blocked coronary arteries. It is common for blood clots to form within the grafted vein, for which patients are typically given aspirin. Some evidence suggests that aspirin along with a prescription strength antiplatelet agent such as ticagrelor can more effectively prevent this clotting.

“We found that, yes, this dual therapy significantly reduces the risk that the grafts will fail. However, for the first time, we have shown that this approach also carries a significant risk of clinically important bleeding,” said Dr Gaudino. “So, the benefit comes at a price.”

Taken together, these results indicate physicians should base their decisions on patients’ individual circumstances and avoid using this approach for those with conditions that put them at risk of bleeding, he said.

In more than 90% of coronary artery bypass grafts, surgeons take a graft from one of the patient’s saphenous veins, which return blood up the leg. However, within a year, up to a quarter of these grafts become obstructed.

While studies have examined the benefit of aspirin and ticagrelor, known as dual antiplatelet therapy (DAPT), these studies were small and had conflicting conclusions. The team contacted researchers on four such trials to obtain access to their raw data. They aggregated the data and effectively created a much larger study capable of generating more robust conclusions.

They found a failure rate of approximately 11% in patients who received a combination of aspirin and ticagrelor, while blockages occurred in 20% of grafts when patients received only aspirin. However, compared to aspirin alone, DAPT brought on more bleeding events that, while generally not life threatening, required medical attention.

In these previous trials, patients received DAPT for a full year. However, most graft failure occurs in the first few months after surgery. Dr Gaudino plans a further test of aspirin and ticagrelor over one to three months to see if a shortened course offers the same benefit with less risk of bleeding.

Source: Weill Cornell Medicine

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Gout Flare-ups Linked to Increased MI and Stroke Risk

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The risk of myocardial infarction (MI) and strokes temporarily increases in the four months after a gout flare, suggests a study published in the journal JAMA.

The findings showed that gout patients who suffered from an MI or stroke were twice as likely to have had a gout flare in the 60 days prior to the event, and one and a half times more likely to have a gout flare in the 61-120 days prior.

Gout is a common form of arthritis that is caused by high levels of uric acid, a chemical produced by breakdown of body tissues and present in certain foods and drinks.

At high levels, uric acid is deposited in and around joints as needle shaped urate crystals. Once released from their deposits, these crystals cause severe inflammation that manifest as joint pain, swelling, redness, and tenderness that often lasts for 1–2 weeks. These episodes, called gout flares, often recur. Inflammation is also a risk factor for heart attack and stroke.

While gout patients tend to have more cardiovascular risk factors, there have been no previous studies about whether gout flares are linked with an increased risk of MI and stroke.

To address this, the team used data from 62 574 patients with gout treated in the NHS. Of these, 10 475 experienced heart attack or stroke after the diagnosis of gout, while matched controls did not experience such events. They evaluated the association between heart attacks or strokes and recent gout flares and adjusted these results for possible confounding factors. They found that gout patients who suffered an MI or stroke were twice as likely to have had a gout flare in the 60 days prior to the event, and one and a half times more likely to have a gout flare in the preceding 61–120 days.

They found a similar high rate of MI or stroke in the 0–60 and 61–120 days after gout flares compared with other time periods, when they used information from only patients who consulted for a gout flare and also experienced either MI or stroke. This further strengthened the finding that gout flares are associated with a transient increase in cardiovascular events following flares. The increased odds and rates persisted when people with pre-existing heart disease or stroke before their gout diagnosis were excluded, and when shorter exposure periods such as 0-15 and 16-30 days prior to MI or stroke, were considered.

Gout patients who died from a MI or stroke had over four times the odds of experiencing a gout flare in the preceding 0-60 days and over twice the odds of gout flare in the preceding 61-120 days.

The study’s lead author, Professor Abhishek at the University of Nottingham, said: “This is the first study of its kind to examine whether there is an association between recent gout flares and heart attacks and strokes.

“The results show that among patients with gout, patients who experienced a heart attack or stroke had significantly increased odds of a gout flare during the preceding 120-days compared with patients who did not experience such events. These findings suggest that gout flares are associated with a transient increase in cardiovascular events following flares.

“People with recurrent gout flares should be considered for long-term treatment with urate lowering treatments such as allopurinol. This is a reliable way of removing urate crystal deposits and providing freedom from gout flares. Patients should also be considered for concurrent treatment with anti-inflammatory medicines such as colchicine for the first few months because urate lowering treatments may trigger gout flares in the short term.

“People with gout should be encouraged to adopt a healthy lifestyle with appropriate treatment of conditions such as high blood pressure, high cholesterol, obesity and diabetes to minimise their background risk of heart attack and stroke.”

Source: University of Nottingham

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Gut Microbes Could Explain Some of Red Meat’s Added Cardiovascular Risk

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Part of the higher risk of cardiovascular disease associated with red meat consumption could be from metabolites produced by gut microbes, suggests new research published in Arteriosclerosis, Thrombosis, and Vascular Biology (ATVB).

“Most of the focus on red meat intake and health has been around dietary saturated fat and blood cholesterol levels,” said co-lead author of the study Meng Wang, PhD. “Based on our findings, novel interventions may be helpful to target the interactions between red meat and the gut microbiome to help us find ways to reduce cardiovascular risk.”

Previous research has found that certain metabolites are associated with a greater risk of cardiovascular disease. One of these is trimethylamine N-oxide (TMAO), which is produced by gut bacteria to digest red meat that contains high amounts of the chemical L-carnitine.

High blood levels of TMAO in humans may be linked to increased risks of CVD, chronic kidney disease and Type 2 diabetes. However, whether TMAO and L-carnitine-derived metabolites was linked to cardiovascular disease and to what extent, are still unknown.

To find out, the study researchers measured levels of the metabolites in blood samples. They also examined whether blood sugar, inflammation, blood pressure and blood cholesterol may account for the elevated cardiovascular risk associated with red meat consumption.

Study participants included nearly 4000 of the 5888 adults initially recruited from 1989 to 1990 for the Cardiovascular Health Study (CHS). The participants selected for the current study were free of clinical cardiovascular disease at time of enrolment in the CHS, an observational study of risk factors for cardiovascular disease in adults aged 65 or older. The CHS follows 5 888 participants, whose average age at enrolment was 73; nearly two-thirds were female and 88% of participants self-identified as white. The median follow-up time for participants was 12.5 years, and up to 26 years in some cases.  At follow-up appointment, participants’ medical history, lifestyle, health conditions and sociodemographic characteristics were assessed.

Several blood biomarkers were measured at the start of the study and again in 1996–1997. The fasting blood samples stored frozen at -80°C were tested for levels of several gut-microbiome linked to red meat consumption including TMAO, gamma-butyrobetaine and crotonobetaine.

Additionally, all study participants answered two validated food-frequency questionnaires about their usual dietary habits, including intake of red meat, processed meat, fish, poultry and eggs, at the start of the study and again from 1995 to 1996. For the first questionnaire, participants indicated how often, on average in the previous 12 months, they had eaten given amounts of various foods, ranging from “never” to “almost every day or at least five times per week,” based on medium portion sizes, which varied based on the food source. The second questionnaire used a ten-category frequency of average intake over the past 12 months, ranging from “never or less than once per month” to “six+ servings per day,” with defined standard portion sizes.

For the current analyses, the researchers compared the risk of cardiovascular disease among participants who ate different amounts of animal source foods (ie, red meat, processed meat, fish, chicken and eggs). They found that eating more meat, especially red meat and processed meat, was linked to a higher risk of atherosclerotic cardiovascular disease, an increased risk of 22% for 1.1 serving per day.

The increase in TMAO and related metabolites explained roughly one-tenth of this elevated risk, the authors said. They also noted that blood sugar and general inflammation pathways may help explain the links between red meat intake and cardiovascular disease. Blood sugar and inflammation also appear to be more important in linking red meat intake and cardiovascular disease than pathways related to blood cholesterol or blood pressure. Intake of fish, poultry and eggs were not significantly linked to higher risk of cardiovascular disease.

“Research efforts are needed to better understand the potential health effects of L-carnitine and other substances in red meat such as heme iron, which has been associated with Type 2 diabetes, rather than just focusing on saturated fat,” Dr Wang said. 

Source: American Heart Association

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Beta Blockers and Antiplatelet Drugs Tied to Heat-related MI Risk

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During hot weather events, people taking beta blockers and antiplatelet medications such as aspirin could be at increased risk of a myocardial infarction (MI), amplifying the risk already present from hot weather.

A new study published in Nature Cardiovascular Research found that, among people suffering non-fatal MI associated with hot weather, a greater portion are taking these heart drugs.

“Patients taking these two medications have higher risk,” said Assistant Professor Kai Chen, first author of the study. “During heat waves, they should really take precautions.”

External environmental factors like air pollution and cold weather can trigger MIs, and there is growing evidence to suggest that hot weather can do so, too. But epidemiologists are still working to identify which groups of people are most vulnerable to these environmental extremes.

The authors looked at 2494 cases sourced from a registry, in which individuals experienced a non-fatal MI in Augsburg, Germany during the hot-weather months (May–September) between 2001 and 2014.

In previous research, they had shown that exposure to either heat or cold made heart attacks more likely, and they calculated that heat-related MI rates would rise once the planet has warmed by 2–3°C.

The current study built on that research by examining patients’ medication use prior to their MI.

They analysed the data in a way that let patients serve as their own controls, by comparing heat exposure on the day of the MI versus the same days of the week within the same month. That is, if a person had an NI on the third Thursday in June, the authors compared their temperature exposure that day to their temperature exposure on other, “control” Thursdays in June.

It turned out that users of beta-blockers or antiplatelet medications were likelier to have an MI during the hottest days compared to control days. Antiplatelet medication use was associated with a 63% increase in risk and beta-blockers with a 65% increase. People taking both drugs had a 75% higher risk. Non-users of those medications were not more likely to have a heart attack on hot days.

When researchers compared younger patients (25–59 years) to older ones (60–74 years), they found, as expected, that the younger ones were a healthier group, with lower rates of coronary heart disease. Yet younger patients taking beta-blockers and antiplatelet medications were more susceptible to heat-related heart attack than older patients, despite the older ones having more heart disease.

Another clue that these two medication types may render people more vulnerable is that, other heart medications generally didn’t show a connection to heat-related heart attacks. An exception was statins, which taken by younger people, were associated with an over threefold risk of a heart attack on hot days.

“We hypothesise that some of the medications may make it hard to regulate body temperature,” Asst Prof Chen said. He plans to find out why in future studies.

The results suggest that as climate change progresses, heart attacks might become a greater hazard to some people with cardiovascular disease.

Source: Yale School of Public Health

Categories : Cardiovascular Disease Regenerative MedicineTags :

Novel Drug Shown to Repair Damage after Stroke

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MRI images of the brain
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A pioneering new study from the University of Cincinnati shows promise that a new drug may help repair damage caused by strokes. The preclinical study appears in the journal Cell Reports.

Currently, there are no FDA approved drugs to repair the damage caused by a stroke. The study found that the new drug, NVG-291-R, enables nervous system repair and significant functional recovery in an animal model of severe ischaemic stroke. Deleting the gene for the drug’s molecular target also shows similar effect on neural stem cells. The drug has also proven to be safe and well-tolerated in volunteers with multiple sclerosis.

“We are very excited about the data showing significant improvement in motor function, sensory function, spatial learning and memory,” said Agnes (Yu) Luo, PhD, associate professor UC and the study’s senior author.

Prof Luo said the drug would be a “substantial breakthrough” if the early results translate into clinical settings. Further study and validation of results from independent groups will be needed to determine if the drug is similarly effective to repair the damage of ischaemic strokes in human patients. Additional studies will be needed to research if NVG-291-R effectively repairs damage caused by haemorrhagic strokes in both animal models and human patients.

“Most therapies being researched today primarily focus on reducing the early damage from stroke,” Assoc Prof Luo said. “However, our group has focused on neurorepair as an alternative and now has shown that treatment with NVG-291-R not only results in neuroprotection to reduce neuronal death but also robust neuroreparative effects.”

The drug proved to be effective even when treatment began as late as seven days after the stroke’s onset.

“The only current FDA-approved drug for treatment of stroke does not repair damage and must be administered within 4.5 hours of stroke onset.” Luo said. “Most therapies being researched need to be applied within 24–48 hours of a stroke’s onset. A product that works to repair damage from stroke even a week after symptom onset would change the paradigm for stroke treatment.”

Jerry Silver, PhD, co-author of the study and professor of neurosciences at CWRU’s School of Medicine, said the study showed the drug repaired damage in at least two ways: creating new neuronal connections and enhancing migration of new neurons derived from neuronal stem cells to the damage site.

“NVG-291-R’s ability to enhance plasticity was demonstrated by using staining techniques that clearly showed an increase in axonal sprouting to the damaged part of the brain,” Prof Silver said. “This enhanced plasticity is an excellent validation of the same powerful mechanisms that we and other researchers were able to demonstrate using NVG-291-R in spinal cord injury.”

Source: University of Cincinnati

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Metastasis and Atherosclerosis Share an Underlying Mechanism

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Researchers have identified a key signalling molecule for cancer metastasis. one which is already known for its involvement in atherosclerosis, suggesting a possible treatment approach for both diseases simultaneously. The discovery was published in the International Journal of Cancer.

In order to become malignant, metastasising cancer, tumour cells undergo a series of transformations involving interactions with the immune system. Growing evidence exists that in tumour progression to metastasis, inflammation of blood vessel-lining endothelial cells is a key process.

A team of researchers led by Professor Kyoko Hida at Hokkaido University have discovered that, in malignant tumours, endothelial cells accumulate low-density lipoprotein (LDL) and neutrophils. Neutrophils are immune suppressor cells which are known to contribute to tumour progression.

Previous work by the team had revealed that blood vessels in malignant tumorus expressed a high level of proteoglycans, and it is known that cancerous tissue is inflamed – similar to what is seen in atherosclerosis.

The research team showed that metastasising tumors, in contrast to non-metastasising ones, accumulate proteoglycan molecules; these, in turn, attach to and accumulate LDL to the walls of blood vessels, where it becomes oxidised. There are also high levels of its receptor, LOX-1, in the blood vessel-lining endothelial cells of metastasising tumours. This, they found, causes these cells to produce inflammation signals that attract neutrophils. Using a mouse model, they proved that the suppression of LOX-1 can significantly reduce tumour malignancy, and also that LOX-1 overexpression caused an increase in signalling molecules attracting neutrophils.

This sequence of interactions observed in malignant tumours is not novel: it occurs in atherosclerosis. “Atherosclerosis and cancer appear to be completely different diseases, but they share several common pathophysiological features in the blood vessels,” said Prof Hida.

Though some questions remain, especially on the mechanism of how neutrophils contribute to cancer malignancy, this study is the first to explicitly prove the mechanistic commonalities between cardiovascular disease and cancer progression and trace the mechanism involving LDL accumulation and LOX-1 expression in in vivo tumour tissue.

“Our present study focused on the importance of LOX-1 in endothelial cells as a common factor between cancer and atherosclerosis,” Prof Hida explained. “The presence of neutrophils in tumours is a telltale sign of tumor progression.”

The study also points to a promising approach for treating and preventing malignant cancer (and cardiovascular disease) by targeting neutrophil recruitment to endothelial cells. Prof Hida concluded: “The number of patients with cancer who die not of cancer, but of cardiovascular events, is increasing. Targeting the LOX-1/oxidised LDL axis might be a promising strategy for the treatment of the two diseases concomitantly.”

Source: Hokkaido University

Categories : Cancer Cardiovascular DiseaseTags :

CVD Risk Greater Than Direct Risk from Hodgkin Lymphoma

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Although new treatments have improved the survival chances of patients with Hodgkin lymphoma (HL), these therapies can also increase the risk of cardiovascular disease (CVD). A recent study published in CANCER reveals that people with early-stage HL, which affects the lymphatic system, are now at higher risk of dying from CVD than from cancer.

The multicentre study included 15 889 children and adults in the United States who were diagnosed with HL between 1983 and 2015. “We conducted this study because cardiovascular disease may be the most common non-malignant long-term complication and a prevalent cause for non-malignant death following treatment in HL survivors,” said senior author Caiwen Ou, MD, PhD, of Southern Medical University in China.

Prof Ou and colleagues found that among patients with stage I and stage II classic HL, the proportion of CVD mortality exceeded the proportion of classic HL mortality after about 60 and 120 months of follow-up, respectively. The cumulative incidence of CVD mortality also exceeded that of HL and other cancers over time. In recent decades, the mortality risk from classic HL dropped sharply, but CVD mortality risk among patients with classic HL fell slowly or even remained unchanged among some groups.

The analysis also revealed that patients with stage I or stage II classic HL experienced a higher risk of CVD mortality than the general population at almost all follow-up intervals.

“Our results indicate that more effective measures are needed to reduce the risk of cardiovascular disease-related deaths in classic HL survivors,” said co-author Weijing Feng, MD, PhD.

Source: EurekAlert!