Tag: cardiovascular disease

Categories : Cardiovascular DiseaseTags :

Nine in Ten Hypertension Cases Need More Treatment

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Image by Hush Naidoo from Unsplash
Image by Hush Naidoo from Unsplash

A series of studies has shown that in most cases, hypertension is not being adequately treated.

Hypertension is the leading treatable cause of illness and death worldwide. More than a billion people are hypertensive, defined as having diastolic blood pressure (BP) with 140mmHg or higher, or diastolic blood pressure (DBP) 90 mmHg or higher. Fewer than half of people with hypertension are aware of their condition.

This condition increases the risk of several dangerous illnesses, such as myocardial infarction (MI) and stroke, and of dying prematurely. For some patient categories, the most advantageous BP levels in terms of avoiding MI and stroke are uncertain.

In one of the studies in his thesis at Sahlgrenska Academy, University of Gothenburg, specialist doctor Johan-Emil Bager investigated the link between BP levels and the risk of MI or stroke in 5041 older patients.with hypertension but no history of heart attacks or strokes.
Risk for MI or stroke was found to be some 40 percent lower for the patients with systolic blood pressure (SBP) below 130 mmHg, compared with those in the SBP 130–139 range. In the latter group, 5.2 percent of the patients experienced a heart attack or stroke during the follow-up period, compared with 3.4 percent of those in the lower SBP group.

This pattern was repeated in another study, which investigated the risk of haemorrhagic stroke at different levels of BP in 3972 patients with atrial fibrillation (AF). These patients were receiving treatment with blood-thinning drugs, such as Warfarin or Eliquis.

The study showed that patients with SBP ranging from 140 to 179 mmHg had a haemorrhagic stroke risk roughly double that of patients with SBP of 130–139 mmHg. In the patient group with higher SBP, 1.4 percent suffered a hemorrhagic stroke during the follow-up period, compared with 0.7 percent of patients in the group with lower SBP.

A separate study with data on 259 753 patients also demonstrated insufficiency of hypertension treatment. Nine out of ten patients had either insufficient BP control or high blood lipids (cholesterol), or were smokers.

Johan-Emil Bager at the University of Gothenburg, said: “This means that an overwhelming majority of the patients with high blood pressure are exposed to at least one important, modifiable risk factor for cardiovascular disease and premature death.”

He concluded that an unnecessarily high number of people in Sweden suffer MI or stroke, or die prematurely, because of insufficiently treated hypertension.

“Health professionals and patients with hypertension alike need to aim higher when it comes to treating high blood pressure. The vast majority of patients with hypertension could reduce their MI and stroke risk by lowering their BP and blood lipids with more drugs, or through lifestyle changes.”

Source: University of Gothenburg

Categories : Cardiovascular Disease HospitalsTags :

Heart Failure Diagnoses Being Missed in Primary Care Settings

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Image by StockSnap from Pixabay
Image by StockSnap from Pixabay

A considerable number of heart failure diagnoses may be missed in primary care settings, a new Stanford University study suggests, with gender, racial and income disparities.

Black adults, women and individuals with lower net worth are significantly more likely to be diagnosed with heart failure in an acute care setting such as the emergency room or during a hospitalisation, according to a new study. This is true even if they reported symptoms of heart failure in a routine, outpatient health care appointment within the previous six months. The study was published in Circulation: Heart Failure, an American Heart Association journal.

“This national study raises concerns that many heart failure diagnoses may be missed in a primary care setting,” said Rebecca Tisdale, MD, MPA, co-first author and health services research and development fellow at the US Department of Veterans Affairs and Stanford University. “Our results suggest acute care diagnosis rates for heart failure may be reduced if signs and symptoms of heart failure are more closely assessed in a primary care setting, particularly among women and Black adults.”

According to the American Heart Association 2021 Statistical Update, an estimated 6 million Americans ages 20 and older have been diagnosed with heart failure, with mortality rates of over 20% within the first year after diagnosis. Previous studies have found that heart failure is frequently first diagnosed in an acute care setting.

“Patients diagnosed with heart failure in the emergency room or during inpatient hospitalisation often have more advanced heart failure and complications with worse prognoses than individuals diagnosed with heart failure in a primary care setting,” said Alexander Sandhu, MD, MS, lead author of the study, an instructor of medicine in advanced heart failure in the division of cardiovascular medicine and the Stanford Cardiovascular Institute at Stanford University. “Since earlier recognition and treatment may prevent some of the serious complications and costs of heart failure, our analysis focused on evaluating whether heart failure is identified before the patient is in the emergency room or the hospital.”

Drawing on a national database of health care claims from 2003-2019, the investigators evaluated if patients with new incidence of heart failure were diagnosed in an outpatient (primary care) or acute care (emergency room or urgent care) setting. The analysis included nearly one million adults ages 18 or older with a first-time heart failure diagnosis.

A large proportion of new heart failure diagnoses were found to have occurred in the emergency room or during hospitalisation, particularly among women and Black adults, yet many had potential heart failure symptoms in the months before their acute care visits. Delving further, the investigators found that:

  • Among patients with newly diagnosed heart failure, 38% were diagnosed in acute care settings.
  • Of patients diagnosed in the acute care setting, 46% had potential heart failure symptoms during primary care clinic visits in the previous six months, including oedema (15%), cough (12%), shortness of breath (11%), and chest pain (11%).
  • Heart failure diagnosis in an acute care setting was higher for women than men, and also higher for Black adults than white adults.
  • People with a net worth of under $25 000 had 39% higher odds of receiving heart failure diagnoses in an acute care setting compared to people with a net worth of over $500 000.

Disparities in heart failure diagnosis within clinical practices persisted nationally across race, gender and economic status, suggesting potential differences in either quality of care or local resource availability. In addition, acute care heart failure diagnoses increased by 3.2% annually during the 16-year study period.

Timely heart failure diagnosis can lead to earlier care with the slowing of heart failure progression and improved patient outcomes. However, previous research has shown that both women and Black adults are less likely to be referred to a cardiologist or to promptly receive advanced heart failure treatment.

“Further research is needed to better understand the factors influencing these disparities,” Dr Sandhu concluded. “It is important to note that we only analysed patients with health insurance, raising concerns that inequities may be even larger among people who are uninsured, marginally insured or those who have less access to care.”

Source: American Heart Association

Journal information: Sandhu, A.T., et al. (2021) Disparity in the Setting of Incident Heart Failure Diagnosis. Circulation: Heart Failure. doi.org/10.1161/CIRCHEARTFAILURE.121.008538.

Categories : Cardiovascular Disease Obstetrics & GynaecologyTags :

Heart Health Strongly Linked to Pregnancy Outcomes

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Photo by Anna Hecker on Unsplash
Photo by Anna Hecker on Unsplash

A strong and graded relationship between women’s heart health and pregnancy outcomes has been demonstrated by a study of more than 18 million pregnancies. 

Significant metabolic and haemodynamic changes occur to a woman’s body during pregnancy, some of which can later increase the risk of cardiovascular disease. Risk factors for cardiovascular disease also impact on pregnancy outcomes. The researchers examined the presence of four cardiovascular disease risk factors in women prior to pregnancy: unhealthy body weight, smoking, hypertension and diabetes. The risk of pregnancy complications – maternal intensive care unit (ICU) admission, preterm birth, low birthweight and foetal death – rose along with the number of pre-pregnancy cardiovascular risk factors.

“Individual cardiovascular risk factors, such as obesity and hypertension, present before pregnancy have been associated with poor outcomes for both mother and baby,” said study author Dr Sadiya Khan, Northwestern University Feinberg School of Medicine, Chicago, US. “Our study now shows a dose-dependent relationship between the number of risk factors and several complications. These data underscore that improving overall heart health before pregnancy needs to be a priority.”

The study, which was published in the European Journal of Preventive Cardiology, was a cross-sectional analysis of maternal and foetal data from the US National Center for Health Statistics (NCHS), which gathers information on all live births and foetal deaths after 20 weeks’ gestation. Individual-level data was pooled from births to women aged 15 to 44 years from 2014 to 2018. 

Information was collected on whether four cardiovascular risk factors were present before pregnancy: body mass index (BMI; under 18.5 kg/m2 or over 24.9 kg/m2), smoking, hypertension and diabetes. Women were categorised as having 0 to 4 risk factors. The researchers estimated the relative risks of maternal ICU admission, preterm birth (before 37 weeks), low birthweight (under 2500 g), and foetal death associated with risk factors compared with no risk factors (0). All analyses were adjusted for maternal age at delivery, race/ethnicity, education, receipt of prenatal care, parity, and birth plurality.

The analysis included a total of 18 646 512 pregnancies, with an average maternal age of 28.6 years. More than 60% of women had one or more pre-pregnancy cardiovascular risk factors, ranging from 52.5% with one risk factor and 0.02% with 4 risk factors.

Those with all four risk factors had an approximately 5.8-fold higher risk for ICU admission than those with none, 3.9-fold higher risk for preterm birth, 2.8-fold higher risk for low birthweight, and 8.7-fold higher risk for foetal death.

Graded associations were found between increasing numbers of pre-pregnancy risk factors and a higher odds of adverse outcomes. The risk ratio for maternal ICU admission compared to no risk factors was 1.12 for one risk factor, 1.86 for two risk factors, 4.24 for three risk factors, and 5.79 for four risk factors.

The analysis was repeated in women with their first pregnancy with consistent results. “We conducted this analysis since women with a complicated first pregnancy are more likely to have complications in subsequent pregnancies,” explained Dr Khan. “In addition, gestational weight gain can lead to a higher BMI going into the next pregnancy. We saw very similar results which strengthens the findings in the full cohort.”

She continued: “Levels of pre-pregnancy obesity and high blood pressure are rising and there are some indications that women are acquiring cardiovascular risk factors at earlier ages than before. In addition, pregnancies are occurring later in life, giving risk factors more time to accumulate. Taken together, this has created a perfect storm of more risk factors, earlier onset, and later pregnancies.”

Dr Khan concluded: “The findings argue for more comprehensive pre-pregnancy cardiovascular assessment rather than focussing on individual risk factors, such as BMI or blood pressure, in isolation. In reality not all pregnancies are planned, but ideally we would evaluate women well in advance of becoming pregnant so there is time to optimise their health. We also need to shift our focus towards prioritising and promoting women’s health as a society – so instead of just identifying hypertension, we prevent blood pressure from becoming elevated.”

Source: European Society of Cardiology (ESC)

Journal information: Wang, M.C., et al. (2021) Association of pre-pregnancy cardiovascular risk factor burden with adverse maternal and offspring outcomes. European Journal of Preventive Cardiology. doi.org/10.1093/eurjpc/zwab121.

Categories : Cardiovascular Disease Metabolic DisordersTags :

Are Lower Haemoglobin Levels Protective?

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Credit: Wikimedia CC0

A new study challenges the view that high haemoglobin levels are always desirable for health. 

A study based on two large human cohorts as well as experimental work supported the idea that lower haemoglobin levels may protect against both obesity and metabolic syndrome. The phenomenon may be related to the body’s adaptive response to low-oxygen conditions, which is exploited by endurance athletes in high-altitude training.

Haemoglobin levels vary from one individual to another, with normal levels in Finnish population ranging from 117 to 155 grams per litre in females and 134 to 167 grams per litre in males.

A recent study showed that individual differences in haemoglobin levels are strongly associated with metabolic health in adulthood. The haemoglobin levels were associated with body mass index, glucose metabolism, blood lipids and blood pressure. Subjects with lower haemoglobin levels were healthier in terms of metabolic measures. The study examined haemoglobin values within the normal range.  

“We found a clear association between hemoglobin levels and key cardiovascular traits, and the associations became more pronounced as the subjects aged,” said principal investigators Professor Juha Auvinen, doctoral student Joona Tapio and postdoctoral researcher Ville Karhunen.  

The effect of lower haemoglobin observed in the study is related to a mild oxygen deficiency in the body and the corresponding hypoxia inducible factors (HIF) response which is activated as a result. The research team of Professor Peppi Karppinen is internationally known for its studies on this phenomenon. The finding reinforces the understanding of the central role that the HIF response has in regulating the body’s energy metabolism.

“Haemoglobin levels are a good measure of the body’s ability to carry oxygen. A mild lack of oxygen activates the HIF response, which makes the body’s energy metabolism less economical and thus may protect against obesity and unfavourable metabolism,” explained study leader Prof Karppinen.

Prof Karppinen’s team has already shown in previous research that activation of the hypoxia response protects mice from obesity, metabolic syndrome, fatty liver and atherosclerosis. This is the first study to show the link between oxygen deficiency and a wide range of metabolic health markers in humans as well.

“Although this study uses multiple methods to establish links between lower body oxygen levels and metabolic health, it is very challenging to establish causality for the observed associations in human data. However, combining evidence from different components of the study, the results support that hypoxia response may also play an important role in peoples’ metabolic health,”explained co-leader of the study Professor Marjo-Riitta Järvelin.

“We also already know that in people living high above sea level, low oxygen levels in the habitat cause long-term activation of the HIF response. These people are slimmer, and they have better sugar tolerance and a lower risk of cardiovascular death,” said Prof Karppinen.

The study was based on a large cohort of people born in Northern Finland in 1966, which followed the health of 12 000 people since birth. The results were also replicated in The Cardiovascular Risk in Young Finns Study cohort material, which covers more than 1800 individuals. 

“Although this study uses multiple methods to establish links between lower body oxygen levels and metabolic health, it is very challenging to establish causality for the observed associations in human data. However, combining evidence from different components of the study, the results support that hypoxia response may also play an important role in peoples’ metabolic health”, explained study co-leader Professor Marjo-Riitta Järvelin.

Professor Peppi Karppinen said, “We also already know that in people living high above sea level, low oxygen levels in the habitat cause long-term activation of the HIF response. These people are slimmer, and they have better sugar tolerance and a lower risk of cardiovascular death.”

A question for future research is how to reduce the body’s oxidation levels if needed. This would be to achieve a permanent low-level activation of the HIF response and thus obesity protection. According to Prof Karppinen, the HIF enzymes that prompt a hypoxic response could potentially be used as targets of obesity and metabolism drugs in humans. Currently they are being used in Asia to treat renal anaemia.

Source: University of Oulu

Journal information: Auvinen, J., et al. (2021) Systematic evaluation of the association between hemoglobin levels and metabolic profile implicates beneficial effects of hypoxia. Science Advances. doi.org/10.1126/sciadv.abi4822.

Categories : Cardiovascular Disease General Interest PaediatricsTags :

Young Boy’s Triumph Over Rare Heart Condition

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Photo by Danijel Durkovic on Unsplash
Photo by Danijel Durkovic on Unsplash

Hannah Lewis was expecting to learn the sex of her first child at 20 weeks of her pregnancy. Anxious about becoming a mother at just 19, Lewis was thrilled when she learned she was having a boy.

However, with a worried look on her face, her doctor told her that the baby’s organs looked healthy – except for his heart.

The baby was diagnosed with hypoplastic left heart syndrome, or HLHS, a rare condition where the heart’s left side is underdeveloped, doubling the workload for the right side. Days later, doctors at a children’s hospital in Nashville, Tennessee, confirmed the diagnosis.

But Lewis said her faith gave her the strength to believe she was meant to raise this child as a single mother, as well as her own experiences being raised by a single mother herself.

The rest of the pregnancy was filled with checkups and tests but remained uneventful. Then, at 37 weeks, doctors realised he was developing foetal hydrops, a life-threatening condition in which an abnormal amount of fluid accumulates in the tissue around the lungs, heart or abdomen, or under the skin.

Even in shock from induced labour followed by a caesarean, she remembers hearing her son’s first cries:

“They let me see him for just a second,” she said. “I loved him at first sight obviously, but I was super scared because they took him directly to the heart cath lab and for like 12 hours, we didn’t know what was going on. I was very sick so they wouldn’t let me go see him.”

She named him Bennett after learning the moniker means “God’s gift of hope” or “little blessed one”.

“It was so fitting for what he was about to face,” Lewis said.

HLHS is usually treated with either three different surgeries at certain stages of development or a heart transplant.

Because of the complications introduced by foetal hydrops, Bennett Sayles was 6 days old when he underwent his first open-heart surgery. Although the procedure went well, Bennett remained in critical condition on a ventilator. Then, when he was 2 months old, he had a stroke.

After three open-heart surgeries, 9 month old Bennett had stabilised enough to go home. But shortly before he was discharged, he went into cardiac arrest, and was without a heartbeat for six minutes.

“Then, out of nowhere, his heartbeat came back and it was strong,” Lewis said.

Two weeks later, days before his first Christmas, Bennett went home for the first time. After he turned 2, Bennett underwent the second HLHS surgery, which didn’t work and days later, he needed a fifth open-heart surgery.

Some weeks later he went home, but in hours, Bennett was back in the emergency room with staph infection in his chest. However, Bennett made it home again in time for Christmas. And ever since that series of setbacks, things have improved for him.

“His mental capacity is anywhere from 3 to 5 years old, but he’s got this amazing personality,” Lewis said. “He’s just got such a caring heart. When he’s in the room, he really does light it up and he changes the way you see things. I’m inspired every day because of how amazing he is and he doesn’t let anything hold him back or stop him.”

Two years ago, Bennett’s doctors determined that he would never be a candidate for the other surgeries needed to treat HLHS. He could, however, become eligible for a heart transplant.

“It’s debatable whether he’ll get there, but having known Bennett for the last nine years is not surprising at all that he has progressed to this point,” said Dr. Gerald Johnson, the boy’s paediatric cardiologist. “One of the beauties of working with kids is that they fight and they work to get better, and they work through things in ways that we as adults don’t necessarily do. Bennett’s been a particular fighter on that score and his mother is very proactive and in tune with his needs.”

Raising Bennett has taught Lewis and her family to focus on the present. “We don’t know what’s in store for Bennett,” Lewis said. “He could live his whole life like this or we can have him just a few more years. We love every minute we get to have with him.”

Source: American Heart Association

Categories : Cardiovascular DiseaseTags :

Cardiac Surgery Guidelines Updated with Emphasis on Patient Blood Management

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Photo by JAFAR AHMED on Unsplash

Newly updated multi-society cardiac surgery guidelines have shifted to a comprehensive blood management approach, with no longer simple recommendations on transfusion.

An update to the 2011 recommendations from the Society of Thoracic Surgeons and the Society of Cardiovascular Anesthesiologists, now in collaboration with the American Society of ExtraCorporeal Technology, and the Society for the Advancement of Patient Blood Management (SABM), has been put out. It is available online in the Annals of Thoracic Surgery.

Since the last version, there has been so much new evidence that Pierre R. Tibi, MD, of Yavapai Regional Medical Center in Prescott, Arizona, and colleagues revised or added 23 recommendations and scrapped others.

Probably the biggest change is going from ‘blood conservation’ to the broader ‘patient blood management‘ (PBM) approach, Dr Tibi told MedPage Today.

“Basically we’re considering blood as another vital organ,” he said. “Why that is important is because now we look at a patient’s blood system as an organ that needs to be assessed and treated for the sake of that organ and not simply to decide when or when not to transfuse.”

Recommendations range from preoperative assessment of bleeding risk and anaemia to intraoperative perfusion and blood salvage practices to postoperative treatment with human albumin for volume replacement.

“Most hospitals around the U.S. are acutely aware of patient blood management and, to some degree or another, are implementing many of the things we are talking about,” noted Tibi, who is the most recent past president of SABM. Nationwide, the amount of blood transfused in cardiac surgery has dropped 45% in the past 10 to 15 years but still ranges widely across centres.

A broadly endorsed guideline like this emphasising the importance of a whole-patient strategy should hopefully standardize effective practices and move insurers to cover them, he suggested.

The guideline, for example, gives preoperative assessment of anaemia and its treatment with IV iron and erythropoietin-stimulating agents, if there is time, a class IIA endorsement. Anaemia is widespread, with possibly as many as 40% of patients having it, with one in 10 being under the 8 mg/dL haemoglobin threshold.

“There is a distinct correlation between preoperative anemia and worse clinical outcomes in most studies,” the guidelines note. “Usually, the greater the anemia, the more severe the complications.”

However, preoperative anaemia is “very, very underrecognised and undertested,” Dr Tibi said. While there isn’t always time to reverse anaemia that is found before cardiac surgery, he pointed out that “most of the factors in elective heart surgery have to do with insurance and Medicare. … Oftentimes the treatment for anaemia is not covered by various entities and is too expensive for patients to cover themselves.”

Other notable updates included a class IA recommendation for red blood cell salvage with centrifugation when patients are on cardiopulmonary bypass and the addition of recommendations for the assessment and treatment of patients on anticoagulants.

The guideline, for example, says to withdraw ticagrelor (Brilinta) at least 3 days, clopidogrel (Plavix) 5 days, and prasugrel (Effient) 7 days prior to elective cardiac surgery, while other non-vitamin K oral anticoagulants (NOACs) should be stopped at least 2 days in advance.

“Despite their advantages, NOACs present some periprocedural challenges for operations with a high-risk bleeding profile,” the document says. “Available measurement assays to assess anticoagulation for NOACs are imprecise, and the availability of reversal agents is limited.”

If point-of-care testing with thrombin clotting time is available for dabigatran (Pradaxa), or anti-factor Xa assays for apixaban (Eliquis) and rivaroxaban (Xarelto), in the case of emergent surgery, the guidelines recommend their use.

Source: MedPage Today

Journal information: Tibi P, et al “STS/SCA/AmSECT/SABM update to the clinical practice guidelines on patient blood management” Ann Thor Surg 2021; DOI: 10.1016/j.athoracsur.2021.03.033.

Categories : Cardiovascular DiseaseTags :

Medical Device Warning for Certain Apple Devices

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Apple has released a list of its products that it advises should be kept a “safe distance” away from sensitive medical devices such as pacemakers and implanted defibrillators. These products are iPhone 12 models, Apple Watch and MacBook Pro. 

A number of consumer-electronic devices contain components, such as magnets, which are known to interfere with medical devices. A number of other manufacturers, for example Samsung and Huawei, have issued similar guidance for some of their products.

Heart health is a promoted feature of some Apple products; certain Apple Watches can make electrocardiogram tests and display the results to the user, as well as recording the data for later medical examination. A number of studies have shown that Apple watches can detect cardiovascular problems such as atrial fibrillation with a fairly high degree of sensitivity. However, the current notice warns of the risks posed by components in some products.

“Under certain conditions, magnets and electromagnetic fields might interfere with medical devices,” Apple wrote, noting “implanted pacemakers and defibrillators might contain sensors that respond to magnets and radios when in close contact”.

Implanted defibrillators send electrical pulses to regulate abnormal heart rhythms. Apple said the listed products should be kept more than 15cm away from medical devices, double that if they are wirelessly charging.

The support page that listed the devices, had said earlier this month that iPhone 12 models were “not expected to pose a greater risk of magnetic interference to medical devices” than other iPhones.

However, the website MacRumours, which first noted the list, pointed to research suggesting that the iPhone 12 could interfere with implanted devices.

A study published June 2 in the Journal of the American Heart Association found that “Apple’s iPhone 12 Pro Max MagSafe technology can cause magnet interference”, and so had the potential “to inhibit life-saving therapy”.

The researchers acknowledged the study’s small scale as a limitation, though in a press release lead investigator Dr Michael Wu wrote that they were surprised by the strength of the magnets in the iPhone 12.

“In general, a magnet can change a pacemaker’s timing or deactivate a defibrillator’s life-saving functions, and this research indicates the urgency for everyone to be aware that electronic devices with magnets can interfere with cardiac implantable electronic devices.”

However Marie Moe, a computer security consultant for Mnemonic, told the BBC she was not worried.

“These Apple gadgets are generally not emitting large magnetic fields, unlike heavy machinery, big concert speakers or welding equipment that anyone with a pacemaker should be more concerned about getting in close proximity to,” she said. She is a pacemaker user herself and studies their use.

Ms Moe added that magnets as strong as those in the iPhone 12 could only put the pacemaker into “a kind of safety mode where the pacing is constant”, which would revert back once the device was removed.

Jo Whitmore, senior cardiac nurse at the British Heart Foundation, agreed that devices kept at a safe distance were not cause for concern. “It’s perfectly OK to use a smartphone when you have a pacemaker, and they’re designed to return to normal settings once the magnet is moved away,” she said.

She added that patients should check the device instructions or talk to the manufacturer if they are concerned, and they could also contact their doctor or pacing clinic.

Source: BBC News

Categories : Cardiovascular DiseaseTags :

Do Heart Hormones Drive Nighttime Hypertension?

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Photo by Marcelo Leal on Unsplash

In a new series of studies, University of Alabama at Birmingham researchers have described the reasons behind low levels of natriuretic peptides (NPs) in obese individuals. 

First reported six decades ago, NPs are beneficial hormones produced by the heart, and are responsible for blood pressure regulation and the overall cardiovascular and metabolic health of humans. This study also addresses how the disturbance of an individual’s diurnal rhythm of these hormones contributes to poor cardiovascular health in obese individuals.

High blood pressure at nighttime is seen commonly in obese individuals, who already have higher risk of hypertension and poor cardiovascular outcomes. This can contribute to outcomes such as stroke, heart failure, heart attack and cardiac death. But why this impairment of this day-night blood pressure rhythm is not well understood — however, scientists believe that part of the reason lies with NPs.

“All the hormones in the human body have a day-night rhythm,” noted Vibhu Parcha, MD, a clinical research fellow in the Division of Cardiovascular Disease and the first author of both the studies. “It has been hypothesised the NP hormones should also have this rhythm, but this had not yet been demonstrated in humans. Our clinical trial assessed the 24-hour cycle of the NP hormones and compared it to the 24-hour cycle of blood pressure. We also studied how these cycles differ between lean and obese individuals and studied the reasoning behind why obese individuals experience lower levels of NPs.”

Following a rigorous clinical trial of healthy individuals, researchers found that NP hormones have a diurnal rhythm with higher levels in the afternoon and lower levels at nighttime — similar to the 24-hour cycle of blood pressure. In obese individuals however, researchers observed that the relationship between NPs and blood pressure does not function the same way. This leads to higher nighttime blood pressure and increased risk of cardiovascular disease. The low production of NPs combined with a relatively higher elimination of NPs from an obese individual’s system leads to low levels of these beneficial hormones in circulation, which may explain the NP deficiency.

“This is the first time we have seen that NPs, like other hormones, have a 24-hour rhythm,” said senior author Pankaj Arora, MD, a physician-scientist in UAB’s Division of Cardiovascular Disease. “These studies give us a better understanding of NPs and of the reasoning behind the NP deficiency in obese individuals. We now have an FDA-approved medication (LCZ696) that improves circulating NP levels. This medication is considered a first-line treatment for heart failure and may be used to increase NP levels.”

This medication could specifically target NPs and blood pressure if given at the right time of day and could control hypertension with precision, Dr Arora added. These findings point to using a physiologically-driven precision ‘chronopharmacotherapy’ approach to improve the diurnal blood pressure profile in obese individuals.

Source: University of Alabama at Birmingham

Journal information: Vibhu Parcha et al, Chronobiology of Natriuretic Peptides and Blood Pressure in Lean and Obese Individuals, Journal of the American College of Cardiology (2021). DOI: 10.1016/j.jacc.2021.03.291

Categories : Diseases, Syndromes and Conditions HIV UncategorizedTags :

High Burden of Uncontrolled Disease in KwaZulu-Natal

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A comprehensive health-screening program has found a high burden of poorly controlled or uncontrolled disease KwaZulu-Natal, along with a high incidence of undiagnosed diseases.

The study, published in The Lancet Global Health, found that four out of five women over 30 had a chronic health condition, and that the HIV-negative population and older people had the highest burden of undiagnosed or poorly controlled non-communicable diseases such as diabetes and hypertension. The study was conducted at the Africa Health Research Institute (AHRI).

Study co-leader Emily Wong, MD, at AHRI in Durban, said: “The data will give AHRI researchers and the Department of Health critical indicators for where the most urgent interventions are needed,” Dr Wong said. “The research was done before COVID, but it has highlighted the urgency of diagnosing and treating people with non-communicable diseases — given that people with uncontrolled diabetes and hypertension are at higher risk of getting very ill with COVID.” 

HIV-associated tuberculosis infections are particularly prevalent in Durban. Dr Wong of the University of Alabama works there to understand the impact of HIV infection on tuberculosis pathogenesis, immunity and epidemiology. In sub-Saharan Africa, 15 years of intense public health efforts that increased access to antiretroviral therapy has resulted in decreased AIDS mortality and raised life expectancy. As a result, there is an increasing priority to address other causes of disease, including tuberculosis and non-communicable diseases.

Over 18 months, health workers screened 17 118 people aged 15 years and older via mobile camps within 1 kilometre of each participant’s home in the uMkhanyakude district. They found high and overlapping burdens of HIV, tuberculosis, diabetes and hypertension among men and women.

While the HIV cases were largely well diagnosed and treated, some demographic groups  still had high rates of undiagnosed and untreated HIV, such as men in their 20s and 30s. In contrast, the majority of people with tuberculosis, diabetes or hypertension were either undiagnosed or not well controlled. Of particular concern was the high rates of undiagnosed and asymptomatic tuberculosis discovered, as it remains one of the leading causes of death in South Africa.

“Our findings suggest that the massive efforts of the past 15 years to test and treat for HIV have done very well for that one disease,” Dr Wong said. “But in that process, we may have neglected some of the other important diseases that are highly prevalent.”

The mobile camps screened for diabetes, high blood pressure, nutritional status (obesity and malnutrition), and tobacco and alcohol use, as well as HIV and tuberculosis. The tuberculosis screening component included high-quality digital chest X-rays and sputum tests for people who reported symptoms or had abnormal X-rays. Clinical information was combined with 20 years of population data from AHRI’s health and demographic surveillance research. Using a sophisticated data system combined with artificial intelligence to interpret the chest X-rays, AHRI’s clinical team examined the information in real time, referring people to the public health system as needed.

The study found that: 

  • Half of the participants had at least one active disease, and 12 percent had two or more diseases. Diabetes and hypertension incidences were 8.5 percent and 23 percent, respectively.
  • One-third of the people were living with HIV, but this was mostly well diagnosed and treated. A particularly high burden of HIV, high blood pressure and diabetes was seen in women.
  • For tuberculosis, 1.4 percent of the people had active disease, and 22 percent had lifetime disease. About 80 percent of the undiagnosed tuberculosis was asymptomatic, with higher rates of active tuberculosis seen in men.
  • Several disease patterns varied by geographical location — eg, the highest HIV burden was seen near main roads, while higher rates of tuberculosis and non-communicable diseases were seen in more remote areas.

Source: University of Alabama at Birmingham

Journal information: Wong, E. B., et al. (2021) Convergence of infectious and non-communicable disease epidemics in rural South Africa: a cross-sectional, population-based multimorbidity study. The Lancet Global Health. doi.org/10.1016/S2214-109X(21)00176-5.

Categories : Cardiovascular Disease COVIDTags :

Drop in Heart Attacks Linked to COVID Pandemic

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A sharp drop in heart attacks in Finland last year seems to be a result of the COVID pandemic, doctors believe.

Cardiologist Mika Laine noticed a roughly 30 per cent reduction in the number of patients suffering myocardial infarction at Helsinki University Central Hospital in April and May 2020. But what was even more surprising was that this was not an isolated occurrence.

“When we started to study this further, we noticed that exactly the same phenomenon happened everywhere else in Finland and also in other countries in Europe and in the United States. So it was a kind of global phenomenon that happened during the COVID pandemic,” he told Euronews.

What was behind the drop?

Dr Laine is of the opinion that the fall in heart attack patient numbers results from changes made in response to the COVID outbreak.

“We have the exact same genes that we had a year ago, two years ago. So it has to be something in the environment that has changed,” he said. One major factor could be the massive global shift to remote working for many people, as a result of the lockdowns.

“People are at home, they are less stressed because they don’t need to go through morning traffic, hurry to work and so forth,” Dr Laine added.

EU Science Hub data shows that even before the pandemic, Finns worked remotely more than almost any other EU country. Last May, EU labour research body Eurofound revealed that Finnish workers made the fastest switch to teleworking in the EU, with nearly 60 per cent switching over.

“We also see this decrease in those people who are retired, who don’t go to work, so it cannot be just because you’re commuting,” said Dr Laine.
He however cautioned that there could be other factors behind the fall in heart attack patients.

Was there a real fall in heart attacks in 2020?

“We know that many people stopped smoking because smoking was associated with severe COVID mortality,” he said.

Better air quality in urban areas as a result of the lockdown could be another cause, Laine said, since airborne particles are known to be a risk factor for heart disease.

However not all are convinced that the pandemic had a positive impact on patients with all types of heart conditions.

Research published in the Journal of the American College of Cardiology in January found that, during the early phase of the pandemic, deaths due to ischaemic heart disease and hypertensive diseases increased in some parts of the US. Some patients may have died as a result of avoiding hospital visits due to infection fears, the researchers noted. 

A temporary or permanent effect?

With Finland, however,Dr Laine believes that was not the case.

“We haven’t seen any increase in mortality in cardiac diseases and so currently we think that it’s a true decrease in the number of cases and not because patients are not seeking help,” he said. “People were not dying at home to myocardial infarction”.

According to Dr Laine, the number of heart attack patients in Finland remains about 5 per cent lower than average, despite the easing of COVID restrictions.

“I think this is a typical example that environmental factors can have profound effects on myocardial infarction. And I think it’s motivating us to change our lifestyle healthier,” Dr Laine said.

Source: EuroNews