Tag: cardiovascular disease

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Benefits of Cutting Cholesterol for Elderly Increase with Age

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A pair of new studies in The Lancet found that the effects of low-density lipoprotein (LDL) lowering agents reduced the number of serious cardiovascular events in geriatric patients.

Taking data on over 90 000 individuals in Denmark, an observational study followed patients for 7.7 years, with LDL cholesterol levels as well as first heart attacks or strokes recorded.

The researchers found that people aged 70-100 without a previous cardiovascular event benefited more from taking cholesterol-lowering medications in terms of preventable cardiovascular events.

People aged 80-100 had the highest incidence of heart attacks, at 8.5 per 1000 person-years.

Børge Nordestgaard, joint author of the first study, of the Copenhagen University Hospital, said, “Our study provides further evidence for the cumulative burden of LDL cholesterol over a person’s lifetime and the progressive increase in risk for heart attack and cardiovascular disease with age. With the proportion of people living beyond 70 years of age worldwide rapidly increasing, these data point to the huge potential for primary prevention strategies aimed at lowering LDL cholesterol levels to reduce the population burden of heart disease. The findings should guide decision making about whether older individuals will benefit from statin therapy.”

A separate review and meta-analysis revealed that cholesterol-lowering therapies are as effective as preventing heart attacks in older patients as they are in younger ones. Analysing data from 29 randomised controlled trials, they found that for every reduction of 1mmol/L of HDL cholesterol, the relative risk of major cardiovascular events in patients over 75 years was reduced by 26%. For patients under 75 years, the reduction was 15% per 1mmol/L of HDL-cholesterol.

Source: HCP Live

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Reduced Fat Mass but Not Lean Mass Lowers Heart Failure Risk

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Simple reduction in weight may not result in improved cardiovascular health, according to a new study from University of Texas Southwestern (UTSW).

Fat mass is the weight of fat in different parts of the body, while lean mass is the weight of muscle. Senior author of the study, Ambarish Pandey, MD, and assistant professor of internal medicine at UTSW explained, “We have long counseled patients to lower their body-mass index into the ‘healthy’ range. But that doesn’t tell us whether a patient has lost ‘fat mass’ or ‘lean mass,’ or where the weight came off. We didn’t know how each of these factors might affect patients’ risk of heart disease.”

The study, using calculated lean and fat mass from the data of 5103 participants in the Look AHEAD (Action for Health in Diabetes) Trial, showed that the more fat mass and waist circumference were lowered, the lower their risk of developing heart failure. A 10% reduction in fat mass led to a 22% lower risk of heart failure with preserved ejection fraction and a 24% lower risk of heart failure with reduced ejection fraction, two subtypes of this condition. Reduced waist circumference lowered the risk of heart failure with preserved injection fraction, but not heart failure with reduced ejection fraction. Reduction in lean mass had no effect on heart failure.

Study author Kershaw Patel, MD, study author and a cardiologist at Houston Methodist Hospital, said, “We showed that reductions in specific, not all, body composition parameters are linked to heart failure.”

Further research is needed to see whether, for example, gains in lean muscle mass is linked to reduced rates of heart failure.

Source: Medical Xpress

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Inflammatory Foods Raise Cardiovascular Risk

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A pair of studies have examined the effect that the dietary inflammatory index has on cardiovascular health, and found that inflammatory foods increase cardiovascular risk.

It is known that inflammatory biomarkers such as interleukins, chemokines and adhesion molecules are associated with atherosclerosis, and proinflammatory foods such as red meats are also associated with cardiovascular risk. The study examined 210 000 participants over 32 years, who filled out a dietary survey every four years, and controlled for variables such as overweight.

“Using an empirically-developed, food-based dietary index to evaluate levels of inflammation associated with dietary intake, we found that dietary patterns with higher inflammatory potential were associated with an increased rate of cardiovascular disease,” said Jun Li, MD, Ph.D., lead author of the study and research scientist in the department of nutrition at Harvard T.H. Chan School of Public Health. “Our study is among the first to link a food-based dietary inflammatory index with long-term risk of cardiovascular disease.”

The other study looked at the beneficial effects of walnuts, which have a strong anti-inflammatory effect. Participants who were assigned to eat 30-60gm of walnuts a day showed significantly reduced inflammation in 6 of 10 biomarkers used.

“The anti-inflammatory effect of long-term consumption of walnuts demonstrated in this study provides novel mechanistic insight for the benefit of walnut consumption on heart disease risk beyond that of cholesterol lowering,” said Montserrant Cofán, Ph.D., lead author of the study and a researcher at the August Pi i Sunyer Biomedical Research Institute in Barcelona, Spain.

Source: Medical Xpress

Categories : Cardiovascular Disease GenderTags :

Women’s Heart Attack Death Risk Higher than Men’s

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Compared to men, women have a 20% higher risk of death or heart failure after their first serious heart attack, according to an article in the journal Circulation. Prior research was unclear as to the difference in vulnerabilities to heart attack between the sexes.

The research focused on two types of heart attack; ST-segment elevation myocardial infarction (STEMI) and a less serious but more common type referred to as Non-STEMI or NSTEMI. Women were found to be at greater risk of death after either STEMI or NSTEMI attacks, although accounting for confounding variables narrowed this difference.

Women tended to be older (72) than men (61) at the age of their first serious heart attack, and had more complicated medical histories.

In the hospital setting, women were seen less frequently by a cardiovascular specialist (72.8%, versus 84% for men), prescribed fewer drugs and had fewer surgical procedures.

Lead author Justin A Ezekowitz, MBBCh, MSc, cardiologist and co-director of the Canadian VIGOUR Centre at the University of Alberta in Canada said, “Identifying when and how women may be at higher risk for heart failure after a heart attack can help providers develop more effective approaches for prevention. Better adherence to reducing cholesterol, controlling high blood pressure, getting more exercise, eating a healthy diet and stopping smoking, combined with recognition of these problems earlier in life would save thousands of lives of women—and men.”

Padma Kaul, PhD, co-director of the Canadian VIGOUR Centre, said that the next step is to address inequalities in provision of care: “Close enough is not good enough. There are gaps across diagnosis, access, quality of care and follow-up for all patients, so we need to be vigilant, pay attention to our own biases and to those most vulnerable to ensure that we have done everything possible in providing the best treatment.”

Source: Medical Xpress

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Hypertension at Night Raises Cardiovascular Disease Risk

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An eight year long study conducted in Japan added to the evidence that hypertension during the night raises cardiovascular disease risk, especially compared to the daytime. 

Hypertension levels are usually assessed during the day, and do not give an accurate snapshot of a person’s circadian rhythm.  According to lead author of the study, Kazuomi Kario, MD, PhD, hypertension at night, especially when blood pressure is lower during the day, raises cardiovascular disease risk and is increasingly being recognised as a risk factor. Kario said, “This study provides much more in-depth information about the cardiovascular risk associated with high nighttime blood pressure and different nighttime blood pressure phenotypes than have been reported previously.”

The Japan Ambulatory Blood Pressure Monitoring Prospective (JAMP) study enrolled 6359 patients and measured daytime and nighttime levels using an at-home, wearable, ambulatory monitor. They were told to conduct their daily routine as normal, and to rest or sleep during the night. The results showed that elevated blood pressure during the night compared to the day was a significant indicator of raised cardiovascular disease risk. Patients who were hypertensive and then had a large dip in systolic pressure had a greater risk for stroke.

“Results indicate that nighttime systolic blood pressure was a significant, independent risk factor for cardiovascular events,” said Dr Kario. “The study highlights the importance of including nighttime blood pressure monitoring in patient management strategies and will hopefully encourage physicians to ensure that antihypertensive therapy is effectively lowering blood pressure throughout the 24-hour dosing period.”

Source: Medical Xpress

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Research Suggests Vitamin C Beneficial for Severe COVID

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According to Associate Professor Anitra Carr of Otago University in New Zealand, research provides evidence that large doses of Vitamin C is beneficial for severe COVID. A 2019 study previously showed that giving Vitamin C to patients with Acute Respiratory Distress reduced mortality rates.

“A recent study that came out of the US showed that patients with coronavirus in ICU with Covid-19 also had very low vitamin C levels,” Carr said. “That’s because the body chews through a lot more of it when you get an infection – and your requirements increase significantly. But the standard doses given in the intensive care unit aren’t enough to compensate, given a severe case of the disease comes with a huge inflammatory response and oxidative stress.”

 Carr said that delivering the drug intravenously was critical to supplying the high levels of Vitamin C needed. One study from Wuhan, China showed Vitamin C conferred a survival benefit to placebo, though Carr noted that many more studies are needed and will come throughout the next year.

However, besides its normal dietary role, there was little research to show that Vitamin C had much of a preventative role. Carr said, “Some research has shown that, if you’re under enhanced stress, your risk for infection increases, so in those people vitamin C may decrease the risk of getting it. But in the general everyday population, who aren’t under extreme physical stress, it may not decrease your chances of catching the disease.”

Source: NZ Herald

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Standing Protects against Heart Failure in Older Women

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A study examining elderly women’s amount of time spent sitting or standing has shown a marked increase in the risk for hospitalisation for heart failure.

The Women’s Health Initiative Observational Study followed 81 000 postmenopausal women for 9 years. None of the women had been diagnosed with heart failure and could walk at least one block unassisted, and they self-reported the amount of time they spent sitting or lying down. Over this time, 1402 women were hospitalised with heart failure.

The researchers graded the amount of sedentary time (sitting or lying down) into three categories: 6.5 hours or less; 6.6-9.5 hours; and more than 9.5 hours. Those who sat 9.5 hours or more experienced a 42% increase in the rate of heart failure compared to those who sat for 6.5 hours or less.

Lead author of the study,  Michael J LaMonte, PhD, MPH, research associate professor of epidemiology in the School of Public Health and Health Professions at the University at Buffalo in Buffalo, New York, said that there was a lack of data on sedentary time and heart failure, and even less so in elderly women.

“Our message is simple: sit less and move more. Historically, we have emphasised promoting a physically active lifestyle for heart health—and we should continue to do so! However, our study clearly shows that we also need to increase efforts to reduce daily sedentary time and encourage adults to frequently interrupt their sedentary time.” 

He added, “This does not necessarily require an extended bout of physical activity; it might simply be standing up for 5 minutes or standing and moving one’s feet in place. We do not have sufficient evidence on the best approach to recommend for interrupting sedentary time. However, accumulating data suggest that habitual activities such as steps taken during household and other activities of daily living are an important aspect of cardiovascular disease prevention and healthy aging.”

Source: Medical Xpress

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Algorithm-driven Treatment Lowers LDL-c, Blood Pressure

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Clinicians working at Brigham and Women’s Hospital in the US treated patients with the aid of digital tools and an algorithm which calculated the titration of medication for pharmacists.

Over 5000 patients were enrolled into the study, entering either the cholesterol control program, the hypertension program, or both. Of those in the cholesterol program, 35% had established atherosclerotic cardiovascular disease (ASCVD); 25% had diabetes without ASCVD; and 31% had a low-density lipoprotein cholesterol (LDL-c) >190 mg/dL. 

Study lead author Benjamin Scirica, MD, MPH, a cardiologist at Brigham and Women’s Hospital and associate professor of medicine at the Harvard School of Medicine, said, “To better control cholesterol and blood pressure, both of which are major cardiovascular risk factors, we need new end-to-end treatment solutions that improve patient identification, data collection, education and care delivery, including standardizing medication regimens. We are redefining treatment pathways to address persistent gaps in health care, overcome clinical inertia and address the problems of limited access to physicians by expanding remotely-delivered care.”

Patients with high LDL-c and/or hypertension were identified using electronic patient records, and received a digital blood pressure cuff for at-home monitoring. With the aid of the algorithm, pharmacists and support staff initiated and titrated medication.

For patients who completed the titration phase of the program, a 52mg/dL (42%) decrease in LDL-c was observed, while for all patients, LDL-c levels dropped by 24mg/dL (18%) and 14mmHg systolic and 6mmHg diastolic blood pressure drops were recorded. Patients in high-risk categories saw significant drops in LDL-c.

The research showed that efficient, effective care was possible, while simultaneously reducing the need for physical consultations. Such enabling technology allows access to care delivery to be significantly expanded.

Source: Science Daily

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Major Cardiovascular Events Cut by Use of Polypills

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Results presented in a late-breaking clinical trial presentation at the American Heart Association’s Scientific Sessions 2020 reported that large randomised trial demonstrated that a simple polypill (containing cholesterol and blood pressure control medication) could significantly reduce cardiovascular risk.

In the International Polycap Study (TIPS)-3, 5700 participants in 9 countries were given either the polypill, aspirin, the polypill plus aspirin or Vitamin D and monitored for five years for major cardiovascular events.

The polypill contained atenolol 100mg, ramipril 10mg, hydrochlorothiazide 25 mg, and simvastatin 40 mg.

The combination of polypill and aspirin reduced cardiovascular events by 31%, whilst aspirin alone had a 14% reduction and 21% with polypill alone.

Salim Yusuf, MD, BS, D Phil, co-author of the study said, “Aspirin should be prescribed with a polypill in primary prevention for patients at intermediate risk of heart disease. Our study results provide important data regarding the role of the polypill in preventing the development of heart disease.”

Source: News-Medical.Net

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A Bad Rap? Statins Have “Nocebo” Effect

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According to an article by the BBC, new research funded by the Imperial Heart Foundation indicates that a significant portion of statins’ adverse side effects are attributable to the “nocebo” effect. 

Statins are one of the most prescribed tablets in the UK, used to lower low-density lipoprotein (LDL) cholesterol and triglycerides levels, and raise high-density lipoprotein (HDL) cholesterol. The effects help prevent heart attacks and stroke, but nearly a fifth of patients stop taking them due to side effects such as joint pain, muscle ache, fatigue and nausea. In 60 patients were recruited, who had all stopped taking statins due to their adverse effects. On a scale of 0 to 100, those taking placebo tablets reported a similarly high score (15.4) to those taking statins (16.3), compared to a group receiving no tablets (8).  The effect was so strong that many patients discontinued the dummy pills. 

The nocebo effect is the inverse of the placebo effect, where patients experience adverse effects even when they are taking a placebo. This is thought to explain why there is such a high prevalence of penicillin allergies when testing proves otherwise. 

Once the patients were talked through the nocebo effect, most were able to resume statins. It is not known as to why statins have such a powerful nocebo effect, although some attribute this to media creating a “self-fulfilling destiny”.

“If you stopped a man in the street and asked how do you feel about an aspirin or a statin a day, I think people would be much more positive about the aspirin,” said one of the researchers, Dr James Howard.