Tag: cardiovascular disease

Categories : Neurology PaediatricsTags :

Boy’s Brain Rewires After Stroke as a Newborn

On By ModernMedia
Photo by cottonbro from Pexels

Researchers have reported the case of a boy whose brain was able to rewire after a severe stroke that damaged much of his brain.

In the seventh grade, 13-year old Daniel Carr amazed his baseball coach with his ability to throw with his left hand, saying that it was the fastest he’d ever seen. However, he was unable to properly catch with his right hand.

Hearing this from the coach, Kellie Carr, Daniel’s mother, realised that his son had a number of quirks, such as favouring his left side when he was an infant, and his left-handedness emerged well before the normal age of two or three. However, she was unable to get any explanation for this until she met Nico Dosenbach, MD, PhD, who informed her that her son had had a stroke when he was a newborn.

MRI scans revealed large, bilateral voids in Daniel’s brain, but incredibly, he had no cognitive, behavioural or motor problems other than a lack of strength and dexterity in his right arm.
“The extent of Daniel’s injuries may be on the edge of what’s compatible with life,” Dosenbach said.

Dainel’s remarkable recovery can be explained by his young age at the time the stroke.

“The brain can compensate more quickly and completely for strokes sustained in early childhood,” he said. “By contrast, large strokes in adults often cause death or severe functional impairment with little chance of recovery. However, the mechanics behind this are only beginning to be understood.”

More MRI scans were done on Daniel’s brain to determine its structure and pathology. Dosenbach and Laumann conducted high-resolution functional MRI scans to understand how Daniel’s brain had reorganised itself.
With his mother’s consent, Daniel was further tested over a period of six years, including batteries of neurological tests, and more scans done. Timothy Laumann, MD, PhD, now a fourth-year psychiatry resident at Barnes-Jewish Hospital, had the expertise to analyse the data.

Looking at his medical records, the physician-scientists noted that he had an infection as a newborn, and was hospitalised with an IV drip. However, none of the physicians had suspected a stroke, which happens to one in every 4000 newborns. Daniel was sent home after a week, the doctors having suspected a viral infection.

“The risk of having a pediatric stroke greatly increases with a medical problem, especially an infection during the newborn period,” Dosenbach said. “However, usually there are more obvious signs that a stroke occurred. I can understand how no one suspected it.”

The researchers compared the images of Daniel’s brain to others of young adults, as well as Dosenbach’s own brain, which he had imaged and studied extensively.

“Part of Daniel’s brain structure is gone,” Laumann explained, referring to their analysis of the MRI data. “He’s missing almost a quarter of his cortex.”

The dead tissue was replaced by pockets of cerebrospinal fluid, which acts as a shock absorber, as well as delivering nutrients and removing waste. The surviving neurons formed interconnected islands that restored cognitive and motor functions, and neighbourhoods of healthy tissue were again reconnected.

“Our findings illustrate the brain’s tenacity at reorganizing and recovering functions damaged by a massive stroke affecting both sides of his brain,” Dosenbach said. “Future studies of functional remapping relative to tissue loss may provide additional insights. Our results raise the possibility that variability in outcomes may depend on specific features unique to an individual’s brain.”

Despite the extensive damage, Daniel completed tertiary education and now works as a diesel mechanic.

“His stroke still shocks me,” Kellie Carr said. “How could I have not known? But looking back, maybe it was better that way. I might have babied Daniel and been afraid to let him be a regular kid. Maybe the best thing for him was living normally.”

Daniel agreed: “I think about my right hand daily because I have to constantly think five steps ahead to figure out how to compensate for not being able to use it properly, like I did with the baseball glove. But the last thing I want is for people to act like something is wrong with me. I’m fine.”

Source: Medical Xpress

Journal information: Timothy O Laumann et al. Brain network reorganisation in an adolescent after bilateral perinatal strokes, The Lancet Neurology (2021). DOI: 10.1016/S1474-4422(21)00062-4

Categories : Cardiovascular DiseaseTags :

Patients Might Benefit From Thrombectomy in Basilar Strokes

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Despite the disappointing results of the BEST and BASICS trials for basilar artery occlusion strokes, in some cases, patients might benefit from endovascular therapy (EVT) after all, according to a closer look at the data.

Raul Nogueira, MD, of Grady Memorial Hospital and Emory University School of Medicine in Atlanta, and colleagues in the VERITAS group, presented their findings at the American Stroke Association virtual International Stroke Conference.

On adjusted intention-to-treat analysis, among the 351 stroke patients with baseline NIH Stroke Scale (NIHSS) scores of ≥ 10, having EVT showed a 38.7% chance of zero-to-moderate disability modified Rankin Scale [mRS] 0-3) at 90 days compared to 26.5% with best medical management (adjusted OR 1.94).

EVT also offered a mortality reduction benefit over controls (40.3% vs 48.2%), although at the risk of increased risk of symptomatic intracranial hemorrhage (5.0% vs 0.6%). Subgroup analysis suggested that older patients tended to have especially good outcomes with EVT.

Based on the study’s results, it does appear “that some patients with basilar artery occlusion strokes benefit from mechanical thrombectomy,” commented Steven Hetts, MD, of UCSF Mission Bay Hospitals in San Francisco.

“The trends do appear to be toward favoring EVT in selected patients, which is consistent with our earlier experience in anterior circulation large vessel occlusion [LVO] strokes,” he noted.

Given how rare they are, posterior circulation LVO strokes are challenging to study, and are also characterised by complex symptoms and severity.

Nogueira noted that the BEST and BASICS were underpowered as they had suffered from poor recruitment, crossovers, and selection issues. Additionally, the BASICS trial had undergone a protocol modification to allow recruitment of people with milder strokes (NIHSS <10), which had potentially diluted the treatment effect. An important point which had been missed was that underlying atrial fibrillation was more prevalent at baseline among the EVT arm than controls.

This implies “that their basilar occlusions may more likely have been from embolization of a clot from the heart to an otherwise normal basilar artery,” according to Dr Hetts. “I would expect that those patients would do better clinically than patients with underlying atherosclerotic disease in the basilar artery itself that leads to basilar artery occlusion.”

Source: MedPage Today

Presentation information: Nogueira RG, et al “Vertebrobasilar occlusion randomization to endovascular reperfusion versus intravenous thrombolysis or medical treatment alone systematic evaluation (VERITAS) collaboration” ISC 2021; Abstract LB 11.

Categories : Implants and Prostheses PaediatricsTags :

Lab-made Heart Valves That Can Grow With The Recipient

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In a new study, lab-made heart valves were shown to grow along with their recipient when implanted into lambs for a year, making a new alternative possible for thousands of paediatric patients who need replacement heart valves. 

Researchers from the University of Minnesota Twin Cities’ College of Science and Engineering and the Medical School published the results in Science Translational Medicine. The production procedure for the valves has also been patented and licensed to the University of Minnesota startup company Vascudyne, Inc.

Compared to currently used animal-derived valves, these new valves also showed reduced calcification and improved blood flow when tested in the same growing lamb model. Current solutions for children involve prosthetic valves, but these calcify over time and cannot grow with the patient. This requires up to five open-heart surgeries to replace them as the children grow towards adulthood, involving considerable risk and expense, as well as demanding lifelong anticoagulation therapy.

“This is a huge step forward in paediatric heart research,” commented senior researcher Robert Tranquillo, a University of Minnesota professor in the Departments of Biomedical Engineering and the Department of Chemical Engineering and Materials Science. “This is the first demonstration that a valve implanted into a large animal model, in our case a lamb, can grow with the animal into adulthood. We have a way to go yet, but this puts us much farther down the path to future clinical trials in children. We are excited and optimistic about the possibility of this actually becoming a reality in years to come.”

Using a combination of tissue engineering and regenerative medicine, they were able to grow the heart valves. Implementing a tissue engineering technique they had previously developed, they grew tube-like structures out of skin cells. This involved combining the skin cells in fibrin, and providing nutrients in a bioreactor. After washing the skin cells out with detergent, the researchers were left with a collageneous matrix which would not provoke an immune response when implanted. They then sewed and trimmed three of these tubes together to make a 19mm diameter heart valve-like structure.

“After these initial steps, it looked like a heart valve, but the question then became if it could work like a heart valve and if it could grow,” Tranquillo said. “Our findings confirmed both.”

The valves grew from 19mm to 25mm over a year, and showed little of the calcification or clotting associated with prosthetic valves, while performing better than animal-derived valves.”We knew from previous studies that the engineered tubes have the capacity to regenerate and grow in a growing lamb model, but the biggest challenge was how to maintain leaflet function in a growing valved conduit that goes through 40 million cycles in a year,” said lead researcher Zeeshan Syedain, a University of Minnesota senior research associate in Tranquillo’s lab. “When we saw how well the valves functioned for an entire year from young lamb to adult sheep, it was very exciting.”

The next steps are to implant the valve into the right ventricle of the heart to see how it performs, and apply for FDA approval to proceed to human trials. 

Source: Medical Xpress

Journal information: Zeeshan H. Syedain et al, Pediatric tri-tube valved conduits made from fibroblast-produced extracellular matrix evaluated over 52 weeks in growing lambs, Science Translational Medicine (2021). DOI: 10.1126/scitranslmed.abb7225

Categories : Lab Tests and ImagingTags :

Retinal Images Could Provide Stroke and Dementia Warning

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In the future, images of the retina could warn of a person’s increased risk of stroke and dementia, making it possible to take preventive measures.

These findings come from preliminary research to be presented at the American Stroke Association’s International Stroke Conference 2021.

Retinopathy is damage to the retina from injury or disease, commonly associated with diabetes. People with severe retinopathy are more likely to have a diseased-looking brain on magnetic resonance imaging (MRI). Retinal tissue has the highest consumption of oxygen in the body, and is the most vulnerable to oxidative stress. Most causes of retinopathy involve damage to the retinal and choroidal circulatory systems.

Study Lead Author Michelle P  Lin, MD., MPH, Neurologist at Mayo Clinic explained:”The retina is a window to the brain. A retinal photo that shows a magnified look at the back of the eye, including the retina and optic nerve, is cheaper and faster to perform than an MRI, so we’re wondering if it might be a good screening tool to see who could benefit from a referral to a neurologist for a brain MRI.”

In addition to the ophthalmologist’s office, retinal photos could be taken by a smartphone camera or via a smartphone adapter, Lin said.

Researchers explored the association of retinopathy with stroke, dementia, and the risk of death in 5543 adults who had participated in the annual US National Health and Nutrition Examination Surveys (NHANES) from 2005 to 2008. Interviews were conducted with the participants on a number of aspects of their medical history and health behaviours. Additionally, they received a retinal scan photo to look for signs of retinopathy.

Compared with participants not diagnosed with retinopathy, those with retinopathy were more than twice as likely to have had a stroke. They were also  nearly 70% more likely to have dementia; and more likely to die within the next 10 years, with increasing severity of retinopathy conferring a higher risk of death. The odds were calculated after adjusting for risk factors such as age, hypertension, diabetes and smoking.

“If you have retinopathy, work closely with your primary care doctor to alter your vascular risk factors and ask to be screened for cognitive impairment. You may be referred to a neurologist for evaluation and possibly a brain MRI,” said Dr Lin, who is also an assistant professor of neurology at the Mayo Clinic College of Medicine.

Source: News-Medical.Net

Categories : Cardiovascular Disease Medical Research & TechnologyTags :

New Smart Speakers That Can Remotely Monitor Heartbeat

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Smart speaker services like Amazon’s Alexa have shown that they can be adapted to monitor the breathing of babies, and recent development has enabled them to detect heartbeats without contacting the skin.

“Heart rhythm disorders are actually more common than some other well-known heart conditions. Cardiac arrhythmias can cause major morbidities such as strokes, but can be highly unpredictable in occurrence, and thus difficult to diagnose,” explained co-senior author Dr Arun Sridhar, assistant professor of cardiology at the UW School of Medicine. “Availability of a low-cost test that can be performed frequently and at the convenience of home can be a game-changer for certain patients in terms of early diagnosis and management.”

Instead of listening to the heartbeat, the smart speaker emits a continuous sound which bounces off the patient’s body. Changes in the received sound are associated with motions in the body from a heartbeat.
“The motion from someone’s breathing is orders of magnitude larger on the chest wall than the motion from heartbeats, so that poses a pretty big challenge,” said lead author Anran Wang, a doctoral student in the Allen School. “And the breathing signal is not regular so it’s hard to simply filter it out. Using the fact that smart speakers have multiple microphones, we designed a new beam-forming algorithm to help the speakers find heartbeats.”

Beam-forming is a technology where an array of emitters or receivers can change the direction in which a signal is emitted or received. Applications of such technology include directing sound only in one direction, such as a person watching TV while another wants quiet while they read,
Much in the way AI systems sort out sounds to identify human speech, the algorithm developed by the team can pick up heartbeats. As this does not produce the usual peaks seen in heartbeat monitors, this also requires processing the heartbeat further to extract the inter-beat interval.
“With this method, we are not getting the electric signal of the heart contracting. Instead we’re seeing the vibrations on the skin when the heart beats,” Mr Wang said.

The researchers tested their prototype smart speaker system on 26 healthy participants and 24 patients with hospitalised with a variety of cardiac conditions. The team compared the smart speaker’s inter-beat interval with one from a standard heartbeat monitor. Of the nearly  2,300 heartbeats measured for the healthy participants, the smart speaker’s median inter-beat interval was within 28 milliseconds of the standard monitor. With cardiac patients, the median inter-beat interval measured by the smart speaker was within 30 milliseconds of the standard.

The technology is currently set up for spot checks; a person concerned about their heart rhythm could sit in front of a smart speaker for a reading. In the future, the researchers hope that the system could be set up to monitor heartbeats for long periods, such as when they are sleeping, helping to diagnose conditions like sleep apnoea.

Source: Medical Xpress

Categories : Cardiovascular DiseaseTags :

Central Retinal Artery Occlusion Needs to be Treated as A Stroke

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The American Heart Association published a new scientific statement, “Management of Central Retinal Artery Occlusion,” which laid out the best methods to treat what is effectively a small stroke in the eye.

A central retinal artery occlusion (CRAO) is a rare (1 in 100 000 people) form of acute ischaemic stroke arising from a blockage of blood flow to the main artery of the eye. It causes painless, immediate vision loss in the impacted eye from which less than 20% of people will recover from.

“Central retinal artery occlusion is a cardiovascular problem disguised as an eye problem. It is less common than stroke affecting the brain but is a critical sign of ill health and requires immediate medical attention,” said the chair of the statement writing committee Brian C Mac Grory, MBBCh, BAO, MRCP, an assistant professor of neurology and staff neurologist at the Duke Comprehensive Stroke Center at Duke University School of Medicine. “Unfortunately, a CRAO is a warning sign of other vascular issues, so ongoing follow-up is critical to prevent a future stroke or heart attack.”

In a comprehensive review of the literature, committee members from a variety of specialties summarised the state of the science in this condition. They noted that a lack of clinical trials results in physicians not recognising the problem, including that it is a type of stroke, resulting in inaction and differing methods of diagnosis and treatment.

“We know acute CRAO is a medical emergency requiring early recognition and triage to emergency medical treatment,” said Dr Mac Grory. “There is a narrow time window for effective treatment of CRAO and a high rate of serious related illness. So, if a person is diagnosed in a doctor’s office or another outpatient clinic, they should be immediately sent to a hospital emergency department for further evaluation and treatment.”

CRAOs can be caused by problems with carotid arteries, the blood vessels in the neck, but there is also evidence CRAOs could be caused by heart problems such as atrial fibrillation.

CRAO risk factors include age and the presence of cardiovascular risk factors such as type 2 diabetes, smoking, and obesity. 

Currently, the literature suggests that intravenous tissue plasminogen activator (tPA) treatment, a “clot buster” also used for brain strokes, could be effective. However, to be effective and safe tPA must be administered within 4.5 hours of the onset of symptoms

Hyperbaric oxygen and intra-arterial alteplase, were also noted as showing potential but requiring further study. Hyperbaric oxygen can result in an improvement if done within 24 hours of the CRAO event. Other possible treatments needing further research icnclude breaking up clots with novel thrombolytics and using novel neuroprotectants (substances capable of preserving brain function and structure) in concert with other treatments to restore blood flow in the blocked artery.

Since there is potential for future strokes or even heart attacks, patients should undergo screening and treatment of vascular risk factors as a matter of urgency. CRAOs are complex to treat and manage, requiring the joint effort of a team of specialists.

Secondary prevention (including monitoring for complications) must be a collaborative effort between neurologists, ophthalmologists, cardiologists and primary care clinicians. Risk factor modification includes lifestyle and pharmacological interventions.

Source: News-Medical.Net

Journal information: Grory, B. M., et al. (2021) Management of Central Retinal Artery Occlusion: A Scientific Statement From the American Heart Association. Stroke. doi.org/10.1161/STR.0000000000000366.

Categories : Cardiovascular Disease COVIDTags :

Study Shows That COVID Causes Heart Damage

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Heart problems in COVID are caused by the virus invading heart cells and causing damage, according to a new study.

Heart problems such as arrhythmia and lack of pumping ability were associated with COVID even at the start of the pandemic. However, it was not clear whether these effects were caused by the virus, or whether it was due to the body’s inflammatory response in mounting a defence against the virus. 

“Early on in the pandemic, we had evidence that this coronavirus can cause heart failure or cardiac injury in generally healthy people, which was alarming to the cardiology community,” said senior author Kory J Lavine, MD, PhD, an associate professor of medicine. “Even some college athletes who had been cleared to go back to competitive athletics after COVID-19 infection later showed scarring in the heart. There has been debate over whether this is due to direct infection of the heart or due to a systemic inflammatory response that occurs because of the lung infection.”

Dr Lavine, along with other researchers from the Washington University School of Medicine, engineered stem-cell derived tissue as a model for how human heart tissue contracts. Studying these heart tissue models, they came to the conclusion that the viral infection kills muscle cells as well as the muscle fibre units involved in heart muscle contraction. This cell death and muscle fibre destruction happened even without inflammation.

“Our study is unique because it definitively shows that, in patients with COVID-19 who developed heart failure, the virus infects the heart, specifically heart muscle cells,”  Dr Lavine said. “Inflammation can be a second hit on top of the damage caused by the virus, but the inflammation itself is not the initial cause of the heart injury.”

While other viral infections have been linked to heart damage, SARS-CoV-2 is unique in that monocytes and dendritic cells dominate the immune response, while other viruses that damage the heart attract T and B cells.

“COVID-19 is causing a different immune response in the heart compared with other viruses, and we don’t know what that means yet,” Dr Lavine said. “In general, the immune cells seen responding to other viruses tend to be associated with a relatively short disease that resolves with supportive care. But the immune cells we see in COVID-19 heart patients tend to be associated with a chronic condition that can have long-term consequences. These are associations, so we will need more research to understand what is happening.”

Source: News-Medical.Net

Journal information: Bailey, A. L., et al. (2021) SARS-CoV-2 Infects Human Engineered Heart Tissues and Models COVID-19 Myocarditis. JACC: Basic to Translational Science. doi.org/10.1016/j.jacbts.2021.01.002.

Categories : Cardiovascular DiseaseTags :

Only Smaller ‘Good’ Cholesterol Particles Reduce Heart Risk

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New research on cholesterol shows that ‘good cholesterol’ is not all good for the heart – only smaller particles reduce heart risk.

Higher levels of ‘good cholesterol’ or high-density lipoprotein cholesterol (HDL-c ) have been associated with better cardiovascular outcomes. In contrast, ‘bad cholesterol’ or low-density lipoprotein cholesterol (LDL-c ), deposits cholesterol on artery walls, increasing the risk of cardiovascular disease.

Medications that lowers LDL-c  also reduce cardiovascular risk, but medication that increases HDL-c does not decrease cardiovascular risk. This paradox calls into question the assumption that HDL-c is protective against cardiovascular risk.

Researchers analysed the size of HDL-c particles, which is determined by genetic characteristics, and compared this to the risk of myocardial infarction. The results showed that genetic characteristics for having large HDL-c particles were associated with increased heart attack risk. Characteristics for smaller HDL-c particles were linked to reduced heart attack risk.

“There is a positive causal relationship between the size of HDL cholesterol particles and the risk of heart attack, so although we have to increase the levels of good cholesterol in the blood, they must always be small particles,” explains the study’s principal investigator, Dr Robert Elosua, a researcher at the Hospital del Mar-IMIM, CIBERCV, and the University of Vic-Central University of Catalonia.

The HDL-c particles are more effective in transferring cholesterol to the liver for subsequent elimination. “If we need to do something in relation to HDL, it is to increase the number of small particles, which are those that adequately perform the function of eliminating cholesterol, those that really move it to the liver for removal, and do not allow it to accumulate in the arteries and cause cardiovascular disease,” said Dr Álvaro Hernáez.
There are currently no drugs that increase HDL-c and also reduce cardiovascular risk. “This study highlights new and potential therapeutic targets in the field of cardiovascular diseases, including several genes related to the qualitative aspects of HDL particles, which may contribute to cardiovascular prevention,” concluded first author Dr Albert Prats.

Source: Medical Xpress

Journal information: Albert Prats-Uribe et al, High-density lipoprotein characteristics and coronary artery disease: a Mendelian randomization study, Metabolism (2020). DOI: 10.1016/j.metabol.2020.154351

Categories : Cardiovascular Disease Diet and NutritionTags :

High GI Carbohydrates Raise CVD Risk Across Countries

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A multinational study has shown that high consumption of high glycaemic index foods increases the risk of cardiovascular disease (CVD) events such as stroke or heart disease, regardless of pre-existing CVD.

The study examined low-, middle- and high-income countries, beginning in 2006, with a median follow-up of 9.5 years. Data was used from nearly 120 000 participants.

The glycaemic index was first introduced in the 1970s to compare the rise of blood glucose from a given carbohydrate food in a patient in comparison to their blood glucose curve from the same patient ingesting glucose. This ranges from 20 for fructose to 100 for barley. In comparison to individuals eating low glycaemic index foods, those eating high glycaemic index foods had a greater risk of CVD events (51%) if there was pre-existing CVD, and even without CVD (21%). 

The highest glycaemic index foods were eaten in China, followed by Africa and Southeast Asia. The highest glycaemic loads were seen in Southeast Asia, followed by Africa and China. Glycaemic load is a better measure of a food’s effect on blood sugar taking into account how quickly it enters the bloodstream and how much glucose can be delivered.

There was less of an effect seen with glycaemic load only those with preexisting CVD showed an association between high glycaemic load diets and patient outcomes.

The participants were given a questionnaire, breaking foods down into seven categories based on glycaemic load and frequency, with a number of options each.

The broad geographic and economic scope of this study enabled the investigation of glycaemic index and load across a wide range of diets that would not be possible if it were restricted to sampling only Western-style diets.

“As expected, a higher glycaemic index was associated with an increased risk of adverse effects among the participants with a higher BMI, as reported previously,” the researchers wrote. “Although the glycaemic index of foods is independent of glucose-tolerance status, the overall postprandial glycaemic response to diet increases as the BMI increases.”

The authors acknowledge that economic development may have altered the mix of diets sampled over time, leading to an overestimation of glycaemic foods in China, for example. The findings nonetheless have important implications for primary and secondary prevention of CVD.

Source: MedPage Today

Journal information: Jenkins DJA, et al “Glycemic index, glycemic load, and cardiovascular disease and mortality” N Engl J Med 2021; DOI: 10.1056/NEJMoa2007123.

Categories : Ageing Cardiovascular Disease Substance UseTags :

Recreational Substances Including Cannabis Linked to Heart Disease

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Alcohol, tobacco and cannabis are among recreational drugs that contribute to early-onset atherosclerotic cardiovascular disease (ASCVD) in young people, a study has found.

The study drew on data of more than a million people receiving primary care services throughout the VA Healthcare System in 2014 or 2015, of whom there were 135 703 with premature ASCVD.

A number of independent predictors for first-event ASCVD for men (from age 55) and women (from 65) were picked up. Tobacco (adjusted odds ratio [OR] 1.97) and alcohol use (OR 1.50)  conferred significant additional risk, but the greatest risk increase of generally legal substances was cannabis use (OR 2.65). Cocaine use (OR 2.44), amphetamine use (OR 2.74) and other drug use (OR 2.53) all had very high risk increases.

Those using four or more substances had the greatest risk at nearly nine times normal. Women also had much stronger effect sizes for premature ASCVD than men.

In an accompanying editorial Anthony Wayne Orr, PhD, and colleagues at LSU Health Shreveport, wrote: “Substance use disorders have been associated with an acceleration of the ageing process. We are only young once, and we should do everything in our power to maintain that state as long as we can.”

The editorialists suggested a nationwide ASCVD education campaign targeting people with substance use disorders.

“In addition, clinicians and primary care providers should begin screening their adult and young adult patients with a history of a substance use disorder for symptoms of premature or extremely premature ASCVDs at earlier stages in their patients’ lives,” suggested the editorialists.

Limitations included it being an observational study, lack of socioeconomic data and the cohort being mostly white males, as well as not being able to discern between prescription and recreational amphetamine use.
“Retrospective studies are limited by the available data. While this study supports the association between substance use disorder and early-onset ASCVD, the effect of substance use frequency, dose, and duration cannot be reliably ascertained in this patient sample,” the editorialists stated.

The editorialists recommended that specific biomarkers for substance use-associated cardiovascular disease be identified, and therapeutic window characterised to limit these chronic effects of substance use disorder.

Source: MedPage Today

Journal information: Mahtta D, et al “Recreational substance use among patients with premature atherosclerotic cardiovascular disease” Heart 2021; DOI: 10.1136/heartjnl-2020-318119.

Editorial information: Scott ML, et al “Young at heart? Drugs of abuse cause early-onset cardiovascular disease in the young” Heart 2021; DOI: 10.1136/heartjnl-2020-318856.