Tag: heart attack

Categories : Cardiovascular DiseaseTags : Leave a comment

After Cardiac Event, Excessive Sedentary Time Led to Increased Risk of Another Event

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People who sit or remain sedentary for more than 14 hours a day, on average, may have a higher risk of a cardiovascular event or death in the year after treatment at a hospital for symptoms of a heart attack such as chest pain, according to new research published today in the American Heart Association’s peer-reviewed scientific journal Circulation: Cardiovascular Quality and Outcomes.

Previous research from the study authors found that people who had experienced a heart attack were spending up to 12 to 13 hours each day being sedentary, defined as any awake activity that involved little-to-no physical movement. In this study, the researchers used a wrist accelerometer to track the amount of time each participant spent moving or being sedentary for a median of 30 days after discharge from a hospital’s emergency department. 

Wrist accelerometers measure the acceleration of motion in three directions: forwards and backwards, side-to-side, and up and down. These measurements allowed the researchers to infer the intensity of a participant’s physical activity, and they provide more accurate measurements of the participants’ time spent moving, rather than asking participants to remember. Some examples of moderate intensity physical activities are brisk walking, water aerobics, dancing, playing doubles tennis or gardening, and examples of vigorous-intensity activities are running, lap swimming, heavy yardwork such as continuous digging or hoeing, playing singles tennis or jumping rope.

”Current treatment guidelines after a cardiac event focus mainly on encouraging patients to exercise regularly,” said study lead author Keith Diaz, Ph.D., the Florence Irving Associate Professor of Behavioral Medicine at Columbia University Medical Center in New York City, a certified exercise physiologist and a volunteer member of the American Heart Association’s Physical Activity Science Committee. “In our study, we explored whether sedentary time itself may contribute to cardiovascular risk.”

Researchers followed more than 600 adults, ages 21 to 96, treated for a heart attack or chest pain in the emergency department at a single hospital system in New York City. Participants wore a wrist accelerometer for a median of 30 consecutive days after hospital discharge to measure the amount of time they spent sitting or being inactive each day. Additional cardiac events and deaths were evaluated one year after hospital discharge via phone surveys with patients, electronic health records and the Social Security Death Index. The study was focused on understanding the risk of sedentary behavior and identifying modifiable risk factors that may improve long-term outcomes in this high-risk group.

The analysis found:

  • Compared to participants in the group with the highest physical activity level, those in the group with the lowest activity level had a 2.58 times higher risk of having another heart problem or dying within the next year.
  • Replacing 30 minutes of sedentary time with 30 minutes of moderate to vigorous physical activity, daily, reduced the risk of adverse cardiovascular events or death by 61%; replacing the sedentary time with light-intensity physical activity reduced risk by 50%; and replacing the sedentary time with 30 minutes of sleep lowered risk by 14%.
  • According to accelerometer data, participants in the most physically active group had average daily physical activity measures of 143.8 minutes of light physical activity; 25 minutes of moderate-to-vigorous physical activity; 11.7 hours spent sedentary; and 8.4 hours of sleep.
  • Participants in the least physically active group had daily averages of 82.2 minutes each day of light physical activity; 2.7 minutes of moderate-to-vigorous physical activity; 15.6 hours spent sedentary; and 6.6 hours of sleep.
  • Participants in the group between most and least physically active had daily averages of 109.2 minutes of light intensity physical activity; 11.4 minutes of moderate-to-vigorous intensity physical activity; 13.5 hours spent sedentary and 7.8 hours of sleep.

“We were surprised that replacing sedentary time with sleep also lowered risk. Sleep is a restorative behavior that helps the body and mind recover, which is especially important after a serious health event like a heart attack,” Diaz said. “Our study indicates that one doesn’t have to start running marathons after a cardiovascular event to see benefits. Sitting less and moving or sleeping a little more can make a real difference. More physical activity and more sleep are healthier than sitting, so we hope these findings support health professionals to move toward a more holistic, flexible and individualized approach for physical activity in patients after a heart attack or chest pain.”

Physical activity and sleep are both key components of the American Heart Association’s Life’s Essential 8, a list of health behaviours and factors that support optimal cardiovascular health. Poor sleep is a known risk factor for cardiovascular disease, which claims more lives each year in the U.S. than all forms of cancer and chronic lower respiratory disease combined, according to the American Heart Association’s 2025 Statistical Update. In addition to sleep duration, a recent scientific statement from the Association highlighted the importance of sleep continuity, sleep timing, sleep satisfaction, sleep regularity, sleep-related daytime functioning and sleep architecture in cardiometabolic health.

The study had several limitations, including that the definition of sedentary behaviour was based only on the intensity level of physical movement, meaning that the study may have overestimated the time participants spent in sedentary behaviour. Additionally, there was no information about participants’ income and characteristics of the neighbourhoods where they live, which limits the study’s ability to account for social and environmental factors, including participants’ risk of one-year cardiac events and deaths. Also, hospital discharge information about whether patients were sent home, referred to rehabilitation or referred to other care centres such as skilled nursing facilities were not collected. This limited the study’s ability to fully assess whether the patients’ settings had an impact on their recovery.

Source: American Heart Association

Categories : Cardiovascular Disease Environmental EffectsTags :

Cardiovascular Disease Deaths Worldwide Linked to Widely Used Phthalates

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Phthalates are commonly used in plastic medical equipment

Photo by Marcelo Leal on Unsplash

Daily exposure to certain chemicals used to make plastic household items could be linked to the more than 356 000 global deaths from cardiovascular disease that occurred in 2018 alone, a new analysis of population surveys shows.

Although the chemicals, called phthalates, are in widespread use globally, the Middle East, South Asia, East Asia, and the Pacific bore a much larger share of the death toll than others – about three-fourths of the total.

For decades, experts have connected health problems to exposure to certain phthalates found in cosmetics, detergents, solvents, plastic pipes, bug repellents, and other products. These chemicals break down into microscopic particles and are ingested, and studies have linked such exposure to an increased risk of conditions ranging from obesity and diabetes to fertility issues and cancer.

Led by researchers at NYU Langone Health and published in eBioMedicine, the current study focused on a kind of phthalate called di-2-ethylhexyl phthalate (DEHP). This chemical is used to increase the flexibility and softness of food containers, medical equipment, and other plastic items. Exposure has been shown in other studies to prompt inflammation in the heart’s arteries, which over time is associated with increased risk of heart attack or stroke. In their new analysis, the authors estimated that DEHP exposure contributed to 356 238 deaths, or more than 13% of all global mortality from heart disease in 2018 among men and women ages 55 through 64.

“By highlighting the connection between phthalates and a leading cause of death across the world, our findings add to the vast body of evidence that these chemicals present a tremendous danger to human health,” said study lead author Sara Hyman, BS, an associate research scientist at NYU Grossman School of Medicine.

In a past study from 2021, the research team tied phthalates to more than 50 000 premature deaths each year, mostly from heart disease, among older Americans. Their latest investigation is believed to be the first global estimate to date of cardiovascular mortality, or indeed any health outcome, resulting from exposure to the chemicals, said Hyman, who is also a graduate student at NYU School of Global Public Health.

For the research, the team used health and environmental data from dozens of population surveys to estimate DEHP exposure across 200 countries and territories. The information included urine samples containing chemical breakdown products left by the plastic additive. Mortality data was obtained from the Institute for Health Metrics and Evaluation, a research group in the United States that collects medical information worldwide to identify trends in public health.

Among the key findings, the study showed that losses in the combined region of East Asia and the Middle East and the combined region of East Asia and the Pacific accounted, respectively, for about 42% and 32% of the mortality from ardiovascular disease linked to DEHP. Specifically, India had the highest death count, at 103 587 deaths, followed by China and Indonesia. The larger heart death risks in these populations held true even after the researchers adjusted their statistical analysis to take into account population size within the studied age group.

A possible explanation, the authors say, is that these countries face higher rates of exposure to the chemicals, possibly because they are undergoing a boom in plastic production but with fewer manufacturing restrictions than other regions.

“There is a clear disparity in which parts of the world bear the brunt of heightened heart risks from phthalates,” said study senior author Leonardo Trasande, MD, MPP. “Our results underscore the urgent need for global regulations to reduce exposure to these toxins, especially in areas most affected by rapid industrialisation and plastic consumption,” added Dr Trasande, Professor of Pediatrics at NYU Grossman School of Medicine.

Dr Trasande, who is also a professor in the Department of Population Health, cautions that the analysis was not designed to establish that DEHP directly or alone caused heart disease and that higher death risks did not take into account other types of phthalates. Nor did it include mortality among those in other age groups. As a result, the overall death toll from heart disease connected to these chemicals is likely much higher, he says.

Dr Trasande says that the researchers next plan to track how reductions in phthalate exposure may, over time, affect global mortality rates, as well as to expand the study to other health concerns posed by the chemicals, such as preterm birth.

Source: NYU Langone Health / NYU Grossman School of Medicine

Categories : Cardiovascular Disease Lab Tests and ImagingTags :

New Blood Test on a Chip Rapidly Detects Earliest Signs of Heart Attack

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Peng Zheng shows off the heart of the blood test, chip with a groundbreaking nanostructured surface on which blood is tested. Image: Will Kirk / Johns Hopkins University

With heart attacks, every second counts. A newly developed blood test on a chip diagnoses them in minutes rather than hours and could be adapted as a tool for first responders and people at home.

“Heart attacks require immediate medical intervention in order to improve patient outcomes, but while early diagnosis is critical, it can also be very challenging – and near impossible outside of a clinical setting,” said lead author Peng Zheng, an assistant research scientist at Johns Hopkins University. “We were able to invent a new technology that can quickly and accurately establish if someone is having a heart attack.”

The proof-of-concept work, which can be modified to detect infectious diseases and cancer biomarkers, is described in Advanced Science.

Zheng and senior author Ishan Barman develop diagnostic tools through biophotonics, using laser light to detect biomarkers, which are bodily responses to conditions including disease. Here they used the technology to find the earliest signs in the blood that someone was having a heart attack. Heart attacks remain one of the trickiest conditions to diagnose, with symptoms that vary widely and biological signals that can be subtle and easy to miss in the early stages of an attack, when medical intervention can do the most good.

Will be like ‘ Star Trek tricorder’

People suspected of having heart attacks typically are given a combination of tests to confirm the diagnosis – usually starting with electrocardiograms to measure the electrical activity of the heart, a procedure that takes about five minutes, and blood tests to detect the hallmarks of a heart attack, where lab work can take at least an hour and often has to be repeated.

The stand-alone blood test the team created provides results in five to seven minutes. It’s also more accurate and more affordable than current methods, the researchers say.

Though created for speedy diagnostic work in a clinical setting, the test could be adapted as a hand-held tool that first responders could use in the field, or that people might even be able to use themselves at home.

“We’re talking about speed, we’re talking about accuracy, and we’re talking of the ability to perform measurements outside of a hospital,” said Barman, a bioengineer in JHU’s Department of Mechanical Engineering. “In the future we hope this could be made into a hand-held instrument like a Star Trek tricorder, where you have a drop of blood and then, voilà, in a few seconds you have detection.”

The heart of the invention is a tiny chip with a groundbreaking nanostructured surface on which blood is tested. The chip’s “metasurface” enhances electric and magnetic signals during Raman spectroscopy analysis, making heart attack biomarkers visible in seconds, even in ultra-low concentrations. The tool is sensitive enough to flag heart attack biomarkers that might not be detected at all with current tests, or not detected until much later in an attack.

Though designed to diagnose heart attacks, the tool could be adapted to detect cancer and infectious diseases, the researchers say.

“There is enormous commercial potential,” Barman said. “There’s nothing that limits this platform technology.”

Next the team plans to refine the blood test and explore larger clinical trials.

Source: John Hopkins University

Categories : Cardiovascular Disease Neurodegenerative DiseasesTags :

Heart Attack Survivors at Lower Risk of Parkinson’s

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Credit: American Heart Association

Heart attack survivors may be slightly less likely to develop Parkinson’s disease later in life, according to new research published in the Journal of the American Heart Association.

Parkinson’s disease (PD) is a common neurodegenerative disorder. While a number of non-motor manifestations arise, the typical clinical features involve a movement disorder consisting of bradykinesia, resting tremor, and rigidity, with postural instability occurring at a later stage. The cause of PD is not known, but a number of genetic risk factors have now been characterised, as well as several genes which cause rare familial forms of PD. Secondary parkinsonism, which has symptoms similar to Parkinson’s disease, may be caused by stroke, psychiatric or cardiovascular medications, or other illness.

“We have previously found that following a heart attack, the risk of neurovascular complications such as ischaemic stroke or vascular dementia is markedly increased, so the finding of a lower risk of Parkinson’s disease was somewhat surprising,” said lead study author Jens Sundbøll, MD, PhD. “These findings indicate that the risk of Parkinson’s disease is at least not increased following a heart attack and should not be a worry for patients or a preventive focus for clinicians at follow-up.

“It is not known whether this inverse relationship with risk of Parkinson’s disease extends to people who have had a heart attack. Therefore, we examined the long-term risk of Parkinson’s disease and secondary parkinsonism among heart attack survivors,” Dr Sundbøll said.

Drawing on Danish National Health Service data, the researchers compared the risk of PD and secondary parkinsonism among roughly 182 000 patients who had a first-time heart attack between 1995 and 2016 (average age 71 years old; 62% male) and more than 909 000 matched controls. 

Over a maximum continual follow-up of 21 years, after adjusting for a wide range of potential confounding factors, the analysis found that, when compared to the control group:

  • there was a 20% lower risk of PD among people who had a heart attack; and
  • a 28% lower risk of secondary parkinsonism among those who had a heart attack.

“For physicians treating patients following a heart attack, these results indicate that cardiac rehabilitation should be focused on preventing ischaemic stroke, vascular dementia and other cardiovascular diseases such as a new heart attack and heart failure, since the risk of Parkinson’s appears to be decreased in these patients, in comparison to the general population,” Dr Sundbøll said.

Certain risk factors are common to both heart attack and PD, with higher risk found among elderly men and lower risk among people who drink more coffee and are more physically active. Interestingly, however, some classic heart attack risk factors – such as smoking, high cholesterol, hypertension and Type 2 diabetes – are associated with a reduced risk of PD.

In general, more heart attack patients smoke and have high cholesterol, either of which may explain the slightly reduced risk of PD among heart attack survivors.

“There are very few diseases in this world in which smoking decreases risk: Parkinson’s disease is one, and ulcerative colitis is another. Smoking increases the risk of the most common diseases including cancer, cardiovascular disease and pulmonary disease and is definitely not good for your health,” Dr Sundbøll noted.

One limitation of the study is that there was not enough information about smoking and high cholesterol levels among the participants, which may have influenced the findings. The study participants were almost entirely white, limiting the generalisability to other ethnic groups.

Source: American Heart Association

Categories : Cardiovascular DiseaseTags :

Eight Factors Predict Gastrointestinal Bleeding Risk after Heart Attack

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Using machine learning, researchers at Karolinska Institutet have identified eight primary factors that increase the risk of a common bleeding complication after heart attack.

Some of these factors had been known already, however, the researchers have found additional predictors, such as smoking, blood pressure and blood glucose. The study was published in the European Heart Journal – Cardiovascular Pharmacotherapy.

“If we can identify patients at high risk of upper gastrointestinal bleeding following heart attack, doctors will be able to take prophylactic measures to mitigate this risk,” said the study’s corresponding author Moa Simonsson, deputy consultant at Karolinska University Hospital and doctoral student. “There are, for instance, drugs that combat bleeding complications, gut bacteria tests that can be used on risk groups and other possibilities for personalised treatment for heart attack patients at high risk of bleeding complications.”

Upper gastrointestinal (GI) tract bleeding is one of the most common bleeding complications following acute myocardial infarction. The condition requires a lot of resources to treat, causes considerable suffering and increases mortality risk. Bleeding complications also limit antithrombotic use, which in turn can worsen the cardiovascular prognosis.

Over the past 20 years, a close focus on bleeding has resulted in several strategies for reducing the risk of upper gastrointestinal tract bleeding. However, few studies on this complication include a diverse population of heart attack patients.

For the current study, the researchers sourced data from the national SWEDEHEART registry on almost 150 000 patients with acute myocardial infarction between 2007 and 2016. Approximately 1.5 percent of these patients suffered GI bleeding within a year of their heart attack, and they also had an increased risk of death and stroke.
Several known factors that increase the risk of upper GI tract bleeding were confirmed by the analysis, including low levels of haemoglobin, previous upper GI tract bleeding, age and intensive antithrombotic treatment.

Using an algorithm, the researchers also identified additional risk factors, including smoking, blood pressure, blood glucose and previous treatment for stomach disorders, such as ulcers and acid reflux.

“If you combine traditional statistical models with machine learning methods, you can create unique opportunities to find key risk factors for previously unknown cardiovascular events,” explained co-author Philip Sarajlic, doctoral student at Karolinska Institutet. “This makes it possible for us to make effective use of valuable data from the medical quality registry by taking account of complex relationships between risk factors and outcomes in order to further optimise the current recommendations for patient care.”

The researchers will soon begin a major clinical study to explore the significance of diagnosis and treatment of a common infection in the upper GI tract.

“A pilot study last year showed a two-fold increase in the presence of Helicobacter Pylori in heart attack patients,” said last author Robin Hofmann, researcher and consultant at Karolinska Institutet. “We will now proceed with a large randomized study to ascertain whether a systematic screening of heart attack patients for Hp infection and, where relevant, its treatment, can reduce bleeding complications and improve prognosis after heart attack.”

Source: Karolinska Institute