A new study has found that hypertension may double an adult’s risk of developing epilepsy, according to a new study published in Epilepsia.
The study recruited 2986 US participants with an average age of 58 years, 55 new cases of epilepsy were identified during an average follow-up of 19 years. Hypertension, defined as presence of elevated blood pressure or use of antihypertensive medications, was linked to a nearly 2-fold higher risk of epilepsy. After excluding participants with normal blood pressure who were taking antihypertensive medications, hypertension was linked to a 2.44-times higher risk of epilepsy.
“Our study shows that hypertension, a common, modifiable, vascular risk factor, is an independent predictor of epilepsy in older age,” said co–lead author Maria Stefanidou, MD, MSc, of Boston University School of Medicine. “Even though epidemiological studies can only show association and not causation, this observation may help identify subgroups of patients who will benefit from targeted, aggressive hypertension management and encourage performance of dedicated clinical studies that will focus on early interventions to reduce the burden of epilepsy in older age.”
In a new study, penicillin significantly reduces the risk of underlying rheumatic heart disease progression in children and adolescents.
The research also showed that early screening was critical for preventing serious rheumatic heart disease progression and death in young children. Rheumatic heart disease affects 40.5 million people globally, causing 306 000 or more deaths every year. The chronic disease results from damage to the valves of the heart after a case of Strep throat. It’s considered a disease of poverty and disadvantage.
Associate Professor Andrea Beaton of Cincinnati Children’s Hospital Medical Center said that prior to this study, it was unknown if antibiotics were effective at preventing the progression of latent rheumatic heart disease.
“The trial is the first contemporary randomised controlled trial in rheumatic heart disease. The results are incredibly important on their own, but also demonstrate that high-quality clinical trials are feasible to address this neglected cardiovascular disease,” she said.
The trial involved 818 Ugandan children aged 5 to 17 years with latent rheumatic heart disease, who received either four-weekly injections of penicillin for two years or no treatment. All underwent echocardiography screening at the beginning and end of the trial.
The findings from the screenings, published in theNew England Journal of Medicine, reported just three (0.8%) participants who received penicillin experienced latent rheumatic heart disease progression, compared to 33 (8.3%) who didn’t receive the treatment.
Dr Daniel Engelman of Murdoch Children’s Research Institute (MCRI) said the results showed a significant and greater than expected reduction in disease development.
MCRI Professor Andrew Steer said screening for latent rheumatic heart disease was critical to stop progression because heart valve damage was largely untreatable.
“Children with latent rheumatic heart disease have no symptoms and we cannot detect the mild heart valve changes clinically,” he said.
“Currently, most patients are diagnosed when the disease is advanced, and complications have already developed. This late diagnosis is associated with a high death rate at a young age, in part due to the missed opportunity to benefit from preventative antibiotic treatment. If patients can be identified early, there is an opportunity for intervention and improved health outcomes.”
Uganda Heart Institute Dr Emmy Okello said the Ugandan government should strengthen programs that promote screening of rheumatic heart disease and the availability of penicillin.
“Our study found a cheap and easily available penicillin can prevent progression of latent rheumatic heart disease into more severe, irreversible valve damage that is commonly seen in our hospitals with little or no access to valve surgery,” Dr Okello said.
Percutaneous coronary intervention (PCI) is often performed after a heart attack, or to alleviate symptoms of chest pressure, but a new study published in Naturequestions the efficacy of the current guidelines.
Current American Heart Association guidelines recommend that patients who undergo PCI, a minimally invasive procedure to open clogged arteries, be prescribed dual antiplatelet therapy (DAPT) to prevent blood clots, and that they continue using the combination of aspirin and a second antiplatelet medication for at least one year after the procedure with continuation of DAPT beyond one year for patients with acceptable bleeding risk.
The current guidelines are based on previous research, including the DAPT Study, a large clinical trial 10 years ago of patients undergoing PCI with a stent, that found using DAPT beyond one year after PCI decreased ischaemic events but posed a higher risk of bleeding. Since then, questions have arisen as to whether the evidence is representative of real-world populations and changing practice patterns.
To better understand whether the results of prior trials of DAPT duration are applicable today, researchers at Beth Israel Deaconess Medical Center (BIDMC) developed new analytic methods to update a previously conducted trial to better reflect contemporary practice. The findings, published in Circulation, suggest that because of improvements in stent technology and changes in the types of patients receiving stents, the risks of DAPT may now outweigh the benefits for the average patient.
“Clinical research can become outdated as practices and technologies evolve,” said corresponding author Robert W. Yeh, MD, MSc, an interventional cardiologist at BIDMC. “By extrapolating what an older trial might have shown had it been conducted today, we found that many patients who’ve received stents and are currently on combination antiplatelet therapy may actually benefit from stopping one of those antiplatelet drugs – adding to growing evidence that aspirin and drugs like it may be less useful than previously thought.”
Yeh and colleagues extrapolated the results of 5743 DAPT Study participants to national data from 568 540 patients undergoing PCI with a stent. Using new analytic methods, the team estimated a contemporary “real-world” treatment effect of 30 months versus 12 months of DAPT after coronary stent procedures. Compared to the previous trial population, contemporary registry patients had more comorbidities and were more likely to present with heart attack and receive second generation drug-eluting stents. After adjustment to represent the registry population, the researchers no longer saw a significant effect of prolonged DAPT on reducing stent thrombosis or heart attack, but increased risk of bleeding persisted.
Additionally, the team used their previously developed risk tool called the DAPT Score to stratify subgroups of patients who may or may not benefit from prolonged DAPT. They found that the projected ischemic benefits of prolonged DAPT in the subgroup of patients with DAPT score less than two disappeared, while the bleeding risk persisted. In contrast, in the subgroup of patients with DAPT score of two or greater, ischemic benefits of prolonged DAPT persisted, though were slightly attenuated, with negligible increase in bleeding.
“While patients at highest risk of ischaemic event, [a] small group of patients should likely remain on these medications, longer duration DAPT may have more limited benefits and greater harms for most,” said lead author Neel M. Butala, MD, MBA, a research fellow in the Smith Center. “These results illustrate the importance of a nuanced interpretation of clinical trials to guide clinical decision-making. The methods may be applicable across various cardiovascular conditions to help ensure that evidence is up-to-date and appropriate for real world populations.”
Altered function of the red blood cells leads to vascular damage in type 2 diabetes, and new research shows that this effect is caused by low levels of an important red blood cell molecule.
Patients with type 2 diabetes have an increased risk of cardiovascular disease, and type 2 diabetes may over time damage blood vessels, raising the risk for heart attack and stroke. However, the disease mechanisms underlying cardiovascular injury in type 2 diabetes are largely unknown and treatments to prevent such injuries are lacking.
Research has shown that red blood cells become dysfunctional in type 2 diabetes and can act as mediators of vascular complications. In this study, published in Diabetes, researchers examined cells from patients with type 2 diabetes and mice to see if molecular changes in the red blood cells could explain these harmful effects in type 2 diabetes.
The researchers found that levels of the small molecule microRNA-210 were markedly reduced in red blood cells from 36 patients with type 2 diabetes compared to healthy controls. Micro-RNAs belong to a group of molecules that serve as regulators of vascular function in diabetes and other conditions. The reduction in microRNA-210 caused alterations in specific vascular protein levels, and impaired blood vessel endothelial cell function. In laboratory experiments, restoration of microRNA-210 levels in red blood cells prevented the development of vascular injury via specific molecular changes.
“The findings demonstrate a previously unrecognised cause of vascular injury in type 2 diabetes,” said Zhichao Zhou, researcher at the Department of Medicine, Solna, Karolinska Institutet. “We hope that the results will pave the way for new therapies that increase red blood cell microRNA-210 levels and thereby prevent vascular injury in patients with type 2 diabetes.”
Earlier adrenaline treatment during a cardiac arrest is linked to better recovery compared to later treatment, according to preliminary research to be presented at the American Heart Association’s Resuscitation Science Symposium (ReSS) 2021.
“Our study’s findings should guide emergency medical services professionals towards earlier administration of epinephrine [adrenaline] during out-of-hospital cardiac arrest management,” said lead study author Shengyuan Luo, MD, MHS, an internal medicine resident physician at Rush University Medical Center in Chicago.
Previous research found that only about 1 in 5 people survive a cardiac arrest outside of the hospital and those who do survive often have long-term impairment in the ability to perform daily living tasks.
During a cardiac arrest, immediate CPR (cardiopulmonary resuscitation) is critical. For some types of cardiac arrest, an AED (automated external defibrillator) also is used to deliver an electric shock through the chest to the heart to restore a heartbeat. For these ‘shockable’ cardiac arrests, adrenalineis injected to help restore blood flow. Previous research indicated that adrenaline should be given after three unsuccessful electric shocks with an AED, however, it was unclear whether it should be given even earlier – such as after the first electric shock.
To compare the effects of earlier versus later administration of adrenaline, the researchers examined medical records to compare epinephrine timing to patient recovery. Study subjects included 6416 multi-ethnic adults across North America who had an out of hospital cardiac arrest with shockable initial rhythm from 2011-2015. They were an average age of 64 years, and most were men.
Overall, adrenaline administration within four minutes after the first shock from an AED was associated with greater chances of recovery, while administration after four minutes was associated with reduced chances. Specifically, people who received adrenaline after four minutes were nearly half as likely to have heartbeat and blood flow restored before hospital admittance and half as likely to survive to hospital discharge or be able to perform daily tasks, as measured by a standard test, at discharge. Additionally, the risks of later adrenaline treatment rose with each minute of delayed treatment.
“It is crucial that whenever a cardiac arrest event is suspected, the emergency medical system be notified and activated immediately, so that people with cardiac arrest receive timely, life-saving medical care,” Dr Luo said.
These findings support the latest American Heart Association CPR and Emergency Cardiovascular Care Guidelines, which were released in October 2020. The guidelines indicate adrenaline should be administered as early as possible to maximise good resuscitation outcome chances. The guideline recommendation was based on previous observational data that suggest better outcomes when adrenaline is given sooner.
When the emergency alarm sounds, blood pressure (BP) among firefighters often soars, according to preliminary research presented at the American Heart Association’s Scientific Sessions 2021.
“All emergency and first responders should be aware of their health. They should know what their typical blood pressure level is and be aware of how it fluctuates. Most important, if they have high blood pressure, they should make sure it is well-controlled,” said senio author Deborah Feairheller, PhD.
The study recruited 37 male and 4 female volunteer and municipal firefighters who wore ambulatory BP monitors during an on-call work shift lasting at least 12 consecutive hours. In addition to the automatic BP readings from the monitor, study participants were instructed to prompt the monitor to take a BP reading whenever a pager or emergency call sounded and whenever they felt they entered a stressful situation. Participants also logged activities and call types for each measurement. The firefighters’ average age was 41.2 years. Average body mass index (BMI) of all participants was 30.3, with BMI ≥ 25 defined as overweight, while BMI ≥ 30 is defined as obesity. The firefighters all had high blood pressure, defined as systolic BP as 130 mm Hg or higher, or a diastolic BP of 80 mm Hg or higher, as defined by the American Heart Association’s most recent guideline.
The findings were that:
Average BP and heart rate (HR) were 131/79.3 mmHg and 75.7 beats per minute (bpm) respectively.
Compared with the reading immediately preceding the call, systolic BPsurged an average of 19.2 mm Hg with fire calls and 18.7 mm Hg with medical calls.
Meanwhile, diastolic BP surged 10.5 mm Hg with fire calls and 16.5 mm Hg with medical calls.
Compared with the average BP during the entire 12-hour shift, systolic BP was 9% higher during fire calls, and diastolic BP was 9% higher during medical calls.
Average HR also increased during both types of calls: 10bpm with fire calls, and 15bpm for medical calls.
There were no significant differences in BP, HR or BP surge levels when comparing responses among fire calls, medical calls, riding an emergency vehicle or false alarms.
Surprising findings “The public knows the value that emergency responders provide to communities. We hope to increase awareness that many firefighters have hypertension and that their blood pressure can increase to very dangerous levels when responding to emergency calls,” said Dr Feairheller.
“The current data show that almost 75% of firefighters have hypertension, and less than 25% have their blood pressure under control. I hope that our research can help identify occupational factors that affect blood pressure and increase awareness among this population,” Dr Feairheller added.
They were also surprised at the findings on diastolic BP increases. “We anticipated systolic blood pressure surges because that reading is usually more responsive to stimuli; however, the extent of the diastolic blood pressure surge was unexpected,” said Dr Feairheller.
The investigators are currently exploring whether diet and exercise regimens could help to lower the BP surge that firefighters experience during emergency calls.
Though small studies have suggested that statins, which lower low-density lipoprotein (LDL), may also reduce COVID severity or mortality, findings from a large study suggest that it has no effect and may even worsen the disease.
In the effort to fight COVID, researchers have attempted to find existing medications that might have an effect on the outcome of the disease, and statins were one readily available candidate that appeared to have some effect. However, a new study published in the journal PLOS ONE suggests they may not be suitable.
“Despite the apparent beneficial effect of statins on the outcomes of various infectious diseases, our study revealed that their specific use to treat COVID is probably not merited,” said senior study author Petros Karakousis, MD, professor of medicine at the Johns Hopkins University School of Medicine. “Compared with earlier research, we looked at a larger and more widely varied inpatient population, and had better criteria for defining disease severity, thereby enabling our results to be more relevant for predicting the impact of statins on COVID outcomes in hospitalised patients.”
In the study, researchers reviewed the records of 4447 hospitalised patients, ages 18 years or older, who had been diagnosed with SARS-CoV-2 infection between March 1 and June 30, 2020. Of these, 594 (13%) were receiving statins at admission, with most statin users being men (57%) and older (ages 52–78 compared with ages 29–62) than the non-statin users. The highest percentage of statin users were black (47%), had hypertension (74%) or diabetes (53%), and were more likely to take medications for lowering blood pressure – along with statins to reduce their LDL cholesterol.
After accounting for confounding factors, statin use was found to have no significant effect on COVID mortality. However, they did find that patients hospitalised with COVID and taking statins had an 18% increased risk for having a more severe form of the disease.
“One plausible explanation for this finding is that statins increase cellular production of angiotensin-converting enzyme 2 [ACE2], the receptor on a cell’s surface through which SARS-CoV-2 gains entry,” said Prof Karakousis. “Therefore, statins may lower a cell’s resistance to infection and in turn, increase the odds that the patient will have a more severe case of COVID.”
Prof Karakousis said future studies should attempt to better define the relationship between statin use and COVID, noting that all previous ones were retrospective and had factors that could not be eliminated, such as many statin users being overweight.
The only way to definitively determine if statins have any benefit for patients with COVID is to conduct a randomised, placebo-controlled clinical trial.
In a distinct on previous advice, new draft recommendations posted by the U.S. Preventive Services Task Force (USPSTF) advise against adults 60 and older to begin taking aspirin to lower their risk of a first heart attack or stroke.
They further advise that people aged 40 to 59 at higher risk for cardiovascular disease, but without a history of it, should talk to a health care provider before starting an aspirin regimen.
The proposed guidance is based on new evidence that suggests the potential harms of taking aspirin can outweigh the benefits. While daily aspirin use reduces the odds of a first heart attack or stroke, it increases the risks of gastrointestinal and intracerebral bleeding, which progressively increase with age.
“The latest evidence is clear: starting a daily aspirin regimen in people who are 60 or older to prevent a first heart attack or stroke is not recommended,” UPTSTF member Chien-Wen Tseng, MD, a professor at the University of Hawaii John A. Burns School of Medicine, said in a statement. “However, this Task Force recommendation is not for people already taking aspirin for a previous heart attack or stroke; they should continue to do so unless told otherwise by their clinician.”
The new guidance will be finalised after public comments close in November. It pivots from previous recommendations issued in 2016, which suggest that people ages 50 to 59 with a risk of cardiovascular disease ≥ 10% in the next decade and a low risk for bleeding take a daily low-dose aspirin (≤ 100mg/day) to reduce the likelihood of suffering a heart attack or stroke. According to the 2016 recommendations, the decision to start taking aspirin for preventive reasons should be “an individual one” for adults ages 60 to 69 who are at risk for cardiovascular disease
At present, neither the American Heart Association nor the American College of Cardiology recommend aspirin use for the prevention of heart attack and stroke in the general population; this only applies for some people between the ages of 40 and 70 who have never had a heart attack or stroke but have an increased risk for cardiovascular disease and a low risk for bleeding. The groups recommend that adults 70 and up should not take aspirin for first stroke or heart attack prevention.
Still, aspirin use for cardiovascular risk prevention is widespread in the US, “and is often self-initiated rather than recommended by a physician,” the latest USPSTF report states. A 2017 National Health Interview Survey (NHIS) found that 23.4 percent of adults age 40 or older and without cardiovascular disease took aspirin for primary prevention; among adults 60-69 years, 34.7 percent reported aspirin use. Tomas Ayala, MD, a cardiologist at Mercy Personal Physicians, said that this pivot had been anticipated by doctors.
“It is not that aspirin is less effective at reducing heart attacks or strokes than it once was,” he told Health. “Rather, it is that we have other therapies at our disposal that have reduced the overall population risk of these conditions, so the relative benefit of aspirin is less, and in many cases, is outweighed by the risks.”
A new study published in Neurology shows that women are underrepresented in stroke clinical trials compared to the proportion who have strokes in the general population.
“Making sure there are enough women in clinical studies to accurately reflect the proportion of women who have strokes may have implications for future treatment recommendations for women affected by this serious condition,” said study author Cheryl Carcel, MD, of The George Institute for Global Health in Sydney, Australia. “When one sex is underrepresented in clinical trials, it limits the way you can apply the results to the general public and can possibly limit access to new therapies.”
The study analysed 281 stroke trials conducted between 1990 and 2020, with a total of 588 887 participants. Of these, only 37.4 % were women. The average prevalence of stroke in women across the countries included was 48%.
Results were calculated in participation-to-prevalence ratio, a relative measure that weights the percentage of women in a trial compared to their proportion in the total population with that disease. A ratio of one indicates that the percentage of women in the study is the same as the percentage of women with the disease in the general population. An acceptable range for an ideal ratio of female participation is between 0.8 and 1.2.
Overall, women were found to be underrepresented relative to their prevalence in the underlying population, with a consistent ratio of 0.84 over time. They found the greatest differences in trials of intracerebral haemorrhage, with a ratio of 0.73; trials with average participant age under 70, with a ratio of 0.81; non-acute interventions, with a ratio of 0.80; and rehabilitation trials, with a ratio 0.77.
“Our findings have implications for how women with stroke may be treated in the future, as women typically have worse functional outcomes after stroke and require more supportive care,” Dr Carcel said. “We will only achieve more equitable representation of women in clinical trials when researchers look at the barriers that are keeping women from enrolling in studies and actively recruit more women. People who fund the research also need to demand more reliable, sex-balanced evidence.”
In a surprise finding, Monash University researchers have reported that proportional carbohydrate intake and not saturated fat was significantly associated with cardiovascular disease benefit in Australian women.
Cardiovascular disease (CVD) is the leading cause of death in women. Poor diet is recognised as both an independent CVD risk factor and a contributor to other CVD risk factors, such as obesity, diabetes mellitus (DM), hypertension, and dyslipidaemia.
In middle-aged Australian women, it was found that increasing the percentage of carbohydrate intake was linked to reduced risks of CVD, hypertension, diabetes mellitus, and obesity.
Furthermore, a moderate carbohydrate intake between 41.0–44.3% of total energy intake was associated with the lowest risk of CVD, compared to women who consumed less than 37% energy as carbohydrates. However, no significant relationship was demonstrated between proportional carbohydrate intake and all-cause mortality.
Furthermore, increasing proportional saturated fat intake was not associated with cardiovascular disease or mortality in women; rather, increasing saturated fat intake correlated with lower odds of developing diabetes mellitus, hypertension, and obesity.
The results contradict much of the historical epidemiological research that supported a link between saturated fat and CVD. Instead, the results mirror contemporary meta-analysis of prospective cohort studies where saturated fat was found to have no significant relationship with total mortality or CVD.
Historical studies neglected to adjust for fibre, which is known to help prevent plaque from forming in the arteries, which may explain this discrepancy with older literature.
“Controversy still exists surrounding the best diet to prevent CVD,” said Sarah Zaman, an associate professor at the University of Sydney.
“A low-fat diet has historically been the mainstay of primary prevention guidelines, but the major issue within our dietary guidelines is that many dietary trials have predominately involved male participants or lacked sex-specific analyses.”
She added: “Further research is needed to tailor our dietary guidelines according to sex.”
First author Sarah Gribbin, a Doctor of Medicine and BMedSc (Hons) student, said: “As an observational study, our findings only show association and not causation. Our research is purely hypothesis-generating. We are hoping that our findings will spark future research into sex-specific dietary research.”
