Category: Cardiovascular Disease

Categories : Cardiovascular Disease GenderTags :

Heart Attack Deaths are Increasing in Young Women

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Fatal heart attacks are increasing among young women in the US, a study has found.

The increase has reversed a trend from 1999 to 2010 of falling heart disease deaths in young women. Cancer deaths meanwhile have been consistently falling over the period 2010 to 2018. 

“Young women in the US are becoming less healthy, which is now reversing prior improvements in heart disease deaths,” said senior author Dr Erin Michos, Johns Hopkins University School of Medicine. “With worsening epidemics of diabetes and obesity across developed countries, our findings are a warning sign that we need to pay more attention to the health of young women.”

“Women frequently put others’ health and needs before their own, often caring for children and parents and working full-time,” continued Dr Michos. “But if they have a fatal heart attack, they won’t be there for loved ones. Women must prioritise their own health, especially since heart disease is largely preventable.”

From 1999 to 2018, the respective age-adjusted mortality rates for cancer and heart disease were 52.6 and 24.0 per 100 000. Ischaemic heart disease (56%) was the most common cause of heart disease death. Respiratory tract/lung cancer (23%) was the leading cause of cancer death.

Across the 19 year study period, age-adjusted mortality rates decreased for both cancer and heart disease. However, while cancer death rates experienced a consistent decline, heart disease death rates initially fell and then increased between 2010 and 2018. This resulted in the absolute mortality gap between cancer and heart disease significantly decreasing from 32.7 to 23.0 per 100 000 per year.

The authors urged “extreme public health measures” should be taken, stressing that most heart disease was preventable, and urgent action was needed to reverse this upward trend.
“There is a misconception that women are not at risk for heart disease before the menopause, yet one-third of their cardiovascular problems occur before 65,” said Dr Michos. “Studies of young heart attack patients show that compared to men, women were less likely than to have been told they were at risk for heart disease before the attack and less often received stents and medications.”

“Most heart disease can be avoided with a healthy balanced diet, physical activity, not smoking, and maintaining healthy blood pressure, blood glucose, cholesterol level, and body weight. Just because a woman is before menopause does not mean she is not at risk. Unfortunately, the first attack can be fatal, so we need to do better with prevention,” she concluded.

Source: Medical-News.Net

Journal information: Khan, S. U., et al. (2021) A comparative analysis of premature heart disease- and cancer-related mortality in women in the USA, 1999–2018. European Heart Journal – Quality of Care and Clinical Outcomes. doi.org/10.1093/ehjqcco/qcaa099.

Categories : Ageing Cardiovascular DiseaseTags :

Cannabis can Lower Hypertension in Older Adults

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Adding to a growing body of evidence as to its health benefits, medical cannabis may lower blood pressure in older adults, according to research from Ben-Gurion University of the Negev (BGU) and its affiliated Soroka University Medical Center.

This is the first such study to investigate cannabis’  effect on blood pressure, heart rate and metabolic parameters in hypertensive adults 60 and older.

“Older adults are the fastest growing group of medical cannabis users, yet evidence on cardiovascular safety for this population is scarce. This study is part of our ongoing effort to provide clinical research on the actual physiological effects of cannabis over time,” said Dr Ran Abuhasira, BGU Faculty of Health Sciences and BGU-Soroka Cannabis Clinical Research Institute

Before and three months after beginning medical cannabis therapy, patients in the study were evaluated using 24-hour ambulatory blood pressure monitoring, ECG, blood tests, and body measurements. Patients ingested cannabis either orally in the form of oil extracts or by smoking.

The findings included a significant drop in 24-hour systolic and diastolic blood pressure values, with the lowest point occurring three hours after ingesting cannabis. Both daytime and nighttime reductions in blood pressure were observed, with more greater changes at night. Higher nighttime than daytime blood pressure may also raise the risk of Alzheimer’s disease, so lowering it at night may offer that benefit.

The pain relief from taking cannabis, often a reason for prescriptions, may also have resulted in a reduction of blood pressure, the BGU researchers postulated.

“Cannabis research is in its early stages and BGU is at the forefront of evaluating clinical use based on scientific studies,” said Doug Seserman, chief executive officer of American Associates, BGU. “This new study is one of several that has been published recently by BGU on the medicinal benefits of cannabis.”

Source: News-Medical.Net

Journal information: Abuhasira, R., et al. (2021) Cannabis is associated with blood pressure reduction in older adults – A 24-hours ambulatory blood pressure monitoring study. European Journal of Internal Medicine.doi.org/10.1016/j.ejim.2021.01.005.

Categories : Cancer Cardiovascular DiseaseTags :

Simvastatin Treatment Hope for Subtype of Ovarian Cancer

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Researchers have found that simvastatin has anti-proliferative potential against ovarian clear cell carcinoma, a highly lethal gynaecological cancer.

Dr Ingrid Hedenfalk from The Lund University explained: “Ovarian clear cell carcinoma (OCCC) is a subtype of epithelial ovarian cancer (EOC) accounting for 5–10% of cases diagnosed in Europe and America, while the incidence in Asia is reported to be higher (10–20%).”

GTPases are a range of enzymes that hydrolyse guanosine triphosphate (GTP) to guanosine diphosphate (GDP). They are also involved in cells as switches and timers. Rho GTPases have been studied for their role in cancers. However, it is difficult to target Rho GTPases directly, so research has involved indirect strategies.

The researchers tested three cell lines of OCCC and one line of high-grade serous ovarian carcinoma (HGSOC) with simvastatin, which is a Rho GTPase interfering drug, and another GTPase interfering drug, CID-1067700, as a control. CID-1067700 is a pan-GTPase, which makes it useful as a comparator.

The research was motivated by a study which found deregulated expression of both Rho GTPases and cytoskeletal pathways in primary human OCCC tumours. The OCCC cell lines treated with simvastatin showed reduced c-Myc protein expression and signs of cell death, as well as curbing proliferation and migration.

Simvastatin could act through Rho GTPase interference as simvastatin affects the cytoskeletal integrity of OCCC cells at clinically relevant levels. However, the mechanism involved is different from Rho GTPase inhibition by CID-1067700.

However, caution is warranted with simvastatin as combination with chemotherapy may yield an antagonistic response. Further research is warranted to develop simvastatin as a potential drug candidate for the treatment of OCCC. 

Source: Oncotarget

Journal information: Arildsen N, Hedenfalk I. Simvastatin is a potential candidate drug in ovarian clear cell carcinomas. Oncotarget. 2020;11(40):3660-3674. doi:10.18632/oncotarget.27747

Categories : Cardiovascular Disease GenderTags :

Women are Less Likely to Undergo Critical Heart Surgery

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A scientific presentation at the 57th Annual Meeting of The Society of Thoracic Surgeons revealed that women are less likely to have a coronary artery bypass grafting (CABG) using guideline-recommended approaches, possibly resulting in worse post-surgery outcomes.

CABG is a major surgical operation involves bypassing atheromatous blockages in a patient’s coronary arteries with venous or arterial conduits harvested from elsewhere in the patient’s body.

Dr Oliver Jawitz and colleagues from Duke and The Johns Hopkins University School of Medicine used the STS Adult Cardiac Surgery Database (containing records of nearly all CABG procedures done in the US), and identified adult patients from 2011 to 2019 who underwent first-time isolated CABG, along with detailed demographic, clinical and procedural data.

The association between female sex and three different CABG surgical techniques from US and European guidelines was investigated. Grafting of the left internal mammary artery to the left anterior descending artery, complete revascularisation, and multiarterial grafting have been linked to better short and/or long-term outcomes. Despite this, the results indicated that women were 14%-22% less likely than men to undergo CABG procedures with these revascularisation strategies.

“With these findings, we did in fact see less aggressive treatment strategies with women,” said Dr Jawitz. “It is clear that sex disparities exist in all aspects of care for patients with coronary artery disease (CAD), including diagnosis, referral for treatment, and now, in surgical approaches to CABG. We must ensure that female patients undergoing CABG are receiving evidence-based, guideline-concordant techniques.”

The results are in accordance with an overall neglect of heart disease treatment in women. Women are much more likely than men to have non-typical symptoms of heart disease which are also subtler, such as abdominal pain and fatigue, as well as having their own particular set of risk of factors. This is compounded by women being underrepresented in cardiac disease study cohorts.

Women’s health historically focused on mother and child, and breast cancer. As such, the period from symptom onset to diagnosis and treatment is longer, allowing the disease to progress and worsen outcomes. This is also reflected by fewer women being referred for beneficial treatments such as CABG. 


“Delayed diagnosis of CAD in women leads to late initiation of key behavioral and pharmacologic interventions for minimizing heart disease risk, as well as delayed referral for invasive diagnostic and therapeutic procedures, including surgical revascularisation with CABG,” said Dr Jawitz. “This often means that by the time female patients undergo these procedures, they have more severe disease than males, as well as a greater number of comorbidities, which leads to worse outcomes.

“Now that we have identified specific differences in surgical approaches to CABG between females and males, we must further elucidate how these differences result in disparate outcomes such as increased mortality, readmissions, and complications,” he concluded. “These findings will help inform the development of sex-specific guidelines for the diagnosis and management of cardiovascular disease.”

Source: News-Medical.Net

Categories : Cardiovascular DiseaseTags :

Moderate Alcohol Has an Immediate Effect on the Heart

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One or two drinks a day may make for a healthy heart, but people with atrial fibrillation (AFib) may experience immediate impacts, as a new study reveals.

University of California, San Francisco (UCSF) researchers found that alcohol immediately changed the electrical properties driving heart muscle contraction in patients undergoing a treatment for AFib. These subjects were randomised to receive an infusion of alcohol maintained at the lower limit of legal intoxication, An equal number of control subjects who instead received a placebo infusion did not have this occur. The work was published January 27, 2021 in the Journal of the American College of Cardiology: Clinical Electrophysiology,

Senior study author Gregory Marcus, MD, professor of medicine in the Division of Cardiology at UCSF explained: “The acute impact of exposure to alcohol is a reduction in the time needed for certain heart muscle cells in the left atrium to recover after being electrically activated and to be ready to activated again, particularly in the pulmonary veins that empty into the left atrium.”    

AFib is the most common cardiac rhythm disorder, affecting some 1% of the world’s population, and is characterised by tachyarrhythmia. It is caused by abnormal electrical activity in the atria of the heart, making them fibrillate. This causes the atria to pump blood inefficiently, leading to feelings of the heart pounding, fluttering or skipping a beat. Due to turbulence caused by the irregular rhythm, a clot could form which could lead to a stroke. This results in some 158 000 deaths in the US annually. Other negative impacts include fatigue, weakness, dizzy lightheadedness, difficulty breathing and chest pain.

The study patients were undergoing a catheter ablation procedure. This is commonly used to suppress AFib by severing the electrical connection between the pulmonary veins and the left atrium. This areas was also the area noted to be affected by alcohol in the study.

Preparation for the ablation therapy required installation of catheters and electrodes in the heart chambers to monitor and pace the heart, and destroy selected tissue. The study measured refractory time before cells could again transmit electrical signals, and conduction speeds, as well as a stimulus inducing more AFib events. Electrical conduction speed and induced AFib events did not vary, but a 12 millisecond delay was seen in tissue around the pulmonary vein in the alcohol infusion group.

“Although epidemiological studies have found an association between self-reported alcohol consumption and the development of an atrial fibrillation diagnosis, ours is the first study to point to a mechanism through which a lifestyle factor can acutely change the electrical properties of the heart to increase the chance of an arrhythmia,” Marcus said. The same changes caused by alcohol infusion in the study have earlier been associated with episodes of AFib in previous computer models and animal studies, he said.
“Patients should be aware that alcohol can have immediate effects that are expected to increase risk for arrhythmias,” Marcus concluded.

However, in a separate study, injecting ethanol into the vein of Marshall when performing a catheter ablation seemed to increase the odds of treatment success compared to catheter ablation alone.

Source: MedicalXpress

Categories : Cardiovascular Disease ExerciseTags :

Large Study Casts Doubt on “Fat but Fit”

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New Spanish research casts doubt on the “fat but fit” paradox, where it is thought that physical fitness is enough to eliminate cardiovascular disease (CVD) risk.

Overweight and obesity is a worldwide problem that is greatly contributing to the burden of noncommunicable diseases, including CVD. A high body mass index (BMI) is strongly associated with CVD risk factors, such as hypercholesterolaemia, hypertension and diabetes. The cardiovascular complications arising from overweight and obesity are driven by processes such as inflammation, insulin resistance, endothelial dysfunction, coronary calcification. Some evidence suggested that physical activity was cardioprotective, partly or completely eliminating the CVD risk from disease – the “fat but fit” paradox.

A recent meta-analysis showed that cardiovascular fitness was a better predictor of cardiovascular disease over overweight/obesity, suggesting that perhaps public health programmes should emphasise fitness over control of body weight. To this end, the researchers sought to confirm if the “fat but fit” paradox was real.

The researchers gathered data from workers’ health insurance, with participants aged 18-64 grouped into normal weight, overweight and obesity by BMI, and into regularly active ( >150 min moderate physical activity or equivalent per week), insufficiently active (less than regularly active) and inactive (no physical activity at all). They were further separated by age, sex, smoking status and residential address.

Approximately 42%, 41%, and 18% of participants had normal weight, overweight, or obesity, respectively; 63.5%, 12.3%, and 24.2% were inactive, insufficiently active, and regularly active; and 30%, 15%, and 3% had hypercholesterolaemia, hypertension, and diabetes.

However, the protective effect of physical activity was far less than the excess risk from overweight/obesity. So much so that even regularly active obese participants had two to five-fold risk increases over their inactive but normal weight peers in the risk factors.

The protective effect of physical activity in overweight/obesity remains controversial. Shortcomings of the study were that they did not control for diet, and only accounted for self-reported leisure time activities. However, the large study size, with over 500 000 participants, should put paid to the theory that a physically active lifestyle can completely eliminate the deleterious effects of overweight/obesity.

The researchers concluded that, “weight loss per se should remain a primary target for health policies aimed at reducing CVD risk in people with overweight/obesity.”

Journal article source: European Journal of Protective Cardiology

Journal information: Pedro L Valenzuela, et al., Joint association of physical activity and body mass index with cardiovascular risk: a nationwide population-based cross-sectional study, European Journal of Preventive Cardiology, 2021;, zwaa151, https://doi.org/10.1093/eurjpc/zwaa151

Categories : Ageing Cardiovascular DiseaseTags :

New Study Has Good and Bad News on TIAs

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There is both good and news on transient ischaemic attacks (TIAs) from a more than six-decade long study: TIAs are indeed harbingers of strokes, but also the incidence of post-TIA strokes has been falling over the decades.

A TIA is defined as a passing episode of neurologic dysfunction due to the focal brain, spinal cord, or retinal ischaemia, without acute infarction or tissue injury. The results were derived from the Framingham Heart Study had 14 059 participants and ran for over six decades, allowing for a more-complete picture of strokes that happen after a TIA. Of the participants, 435 had a TIA; these were compared against a second group of 2175 participants who did not have a TIA.

Even after accounting for other risk factors such as hypertension or diabetes, people who had experienced a TIA had a 4.5 to five times greater chance of a stroke. Study lead author Vasileios-Arsenios Lioutas, MD, said that the results show a need for intensive follow-up of TIA : “According to our findings, people continue to have a high risk of stroke for a sustained time after they’ve had a TIA. Therefore, one shouldn’t think that the high-risk period is just in the first 90 days after the attack and then one can relax. It seems these patients should be followed closely over time, keeping in mind that they are at risk for stroke and paying close attention to controlling their cardiovascular risk factors.”

The 66 years of study data was broken into three epochs. One- and five-year risks of post-TIA stroke in the 2000-2017 epoch were 7.6% and 16.1%, compared to 23.9% and 35.5% during the earliest epoch, from 1948 to 1985.

Sudha Seshadri, MD, professor of neurology at The University of Texas Health Science Center at San Antonio, said: “We examined 66 years of follow-up from Framingham participants, which allowed us to study trends over time. We can see that starting in the very early years of the Framingham study, the 1950s, moving on to the most recent times, the risk of subsequent stroke went down a lot.”

Source: News-Medical.Net

Journal information: Lioutas, V-A., et al. (2021) Incidence of Transient Ischemic Attack and Association With Long-term Risk of Stroke. JAMA.doi.org/10.1001/jama.2020.25071.

Categories : Cardiovascular DiseaseTags :

Blood Vessels Self-Reinforce After Aneurysms

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Immediately following an aneurysm, blood vessels reinforce themselves by adapting collagen fibres to spread out the load, a study has found. 

An aneurysm is an abnormal bulge in the artery wall that can form in brain arteries. Brain aneurysms that rupture are fatal in nearly 50% of cases. In a rabbit model, the researchers used cutting-edge high-resolution microscopes to observe changes within the aneurysm, and observed that new collagen fibres laid down to deal with the strain and existing ones were re-oriented. Blood vessels had already been known to be able to reform and restructure over time, but this kind of primary restructuring is the first time that it has been observed, happening immediately after an event.  Instead of forming along the same direction, the blood vessels adapt to the different directions the new loads are in. 

Professor Anne Robertson at the University of Pittsburgh’s Swanson School of Engineering explained: “Imagine stretching a rubber tube in a single direction so that it only needs to be reinforced for loads in that direction. However, in an aneurysm, the forces change to be more like those in a spherical balloon, with forces pulling in multiple directions, making it more vulnerable to bursting. Our study found that blood vessels are capable of adapting after an aneurysm forms. They can restructure their collagen fibers in multiple directions instead of just one, making it better able to handle the new loads without rupturing.

“The first restructuring phase involves putting down a layer collagen fibres in two directions to deal with the new load, and the second phase involves re-orienting existing layers to adjust to these two directions, explained Chao Sang, who was a primary investigator on this research as part of his doctoral dissertation.

“The long-term restructuring is akin to a scar forming after a cut has healed, while this first phase that we observed can be thought of as having a role similar to clotting immediately after the cut–the body’s first response to protect itself,” added Robertson, who has a secondary appointment in the Swanson School’s Department of Bioengineering. “Now that we know about this first phase, we can begin to investigate how to promote it in patients with aneurysms, and how factors like age and preexisting conditions affect this ability and may place a patient at higher risk for aneurysm rupture

Source: News-Medical.Net

Journal information: Sang, C., et al. (2020) Adaptive Remodeling in the Elastase-Induced Rabbit Aneurysms. Experimental Mechanics. doi.org/10.1007/s11340-020-00671-9.

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Religiosity-based Stress Linked to Cardiovascular Risk in South Asians

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In a new study, the Study on Stress, Spirituality and Health (SSSH) linked proteomics from religiosity-based stress to cardiovascular disease (CVD) risk markers. This study marks the first investigation of protein levels associated with religion and spirituality in any group.

South Asians have an elevated CVD risk compared to other racial/ethnic groups, with the biological risk factors attributable to type 2 diabetes risk factors, and the rest stemming from traditional risk factors which show no enhancements as compared to other racial/ethnic groups.

“Before we can develop the best interventions to reduce CVD disparities, we need to understand the biological pathways through which health disparities are produced,” said principal investigator and co-senior author Alexandra Shields, PhD, associate professor of Medicine at Harvard Medical School (HMS). “As this study shows, psychosocial factors—and religious or spiritual struggles in particular—can affect biological processes that lead to CVD in this high-risk population. Spirituality can also serve as a resource for resilience and have a protective effect. Given that many of the minority communities that experience higher levels of CVD also report higher levels of religiosity and spirituality, studies such as the SSSH may help identify new leverage points, such as spiritually focused psychotherapy for those in spiritual distress, that could reduce risk of CVD for such individuals.”

The study had 100 South Asian participants, 50 diagnosed with CVD and 50 without. The participants were drawn from the Mediators of Atherosclerosis in South Asians Living in America (MASALA) Study, which is following 1164 South Asian participants to investigate the factors that lead to heart disease among this racial/ethnic group. Three proteins were found to be involved in CVD risk after adjustment for diabetes (Contactin-5 [CNTN5], Low affinity immunoglobulin gamma Fc region receptor II-a [FCGR2A], and Complement factor B [CFB]), and of these, the expression of two (Contactin-5 and Complement factor B) were slightly modified by religious struggles interacting with adverse life events.

The results indicate that there may be unique protein expressions associated with CVD among individuals of South Asian descent, and these associations may be affected by religious struggles, such as feeling abandoned by God. “Understanding the pathways of this mechanism at the molecular level using proteomics technology is crucial to developing potential interventions that can help reduce CVD incidence in this population,” says Long H. Ngo, PhD., lead author and co-director of Biostatistics in the Division of General Medicine at BIDMC and associate professor of Medicine at HMS.

Co-senior author Towia Libermann, PhD, at Beth Israel Deaconess Medical Center, added: “The kinds of blood-based protein biomarkers used in this study are particularly effective in assessing CVD risk because they carry clinical information about risk of disease and are the most commonly used molecules for diagnostic applications.

Source: Medical Xpress

Journal information: Long H. Ngo et al, Plasma protein expression profiles, cardiovascular disease, and religious struggles among South Asians in the MASALA study, Scientific Reports (2021). DOI: 10.1038/s41598-020-79429-1

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Omega-3 Carboxylic Acid Does not Prevent Recurrence of Heart Attacks

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Omega-3 carboxylic acid (CA) is often prescribed by healthcare professionals to patients following a heart attack to lower the risk of a recurrence. However, new evidence from the STRENGTH trial shows that it has no effect in this regard.

Phase III of the STRENGTH trial involved 13 078 adult participants at 675 centres across 22 countries. They were randomised to either receive a 4gm of omega-3 CA medication or a maize oil placebo. All of the patients were being treated with statins and were at increased risk due to factors such as diabetes, or had experienced arterial blockages.

The participants were all monitored for rates of cardiovascular death, heart attack, stroke, need for coronary revascularisation or hospitalisation for unstable angina, starting in 2014 and concluding in 2020.

The trial was stopped slightly early due to the low likelihood of a benefit emerging from continuing to take omega-3 CA; furthermore, there was evidence of increased rates of atrial fibrillation among participants taking omega-3 CA.

Source: Science Daily