Wood Street Clinic Blog

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Stress management may enhance cardiac rehab, improve recovery

Heart patients may benefit from cardiac rehabilitation (rehab) programs even more when stress management is added, according to new research in the American Heart Association's journal Circulation.

"Cardiac rehabilitation programs do not routinely offer stress management, but this may change should demand increase. And because patients may be reluctant to ask for the programs themselves, the onus is on the physicians to recognize that stress management is important for the optimal medical management of patients," said James A. Blumenthal, Ph.D., professor of Psychiatry and Behavioral Sciences at Duke University School of Medicine in Durham, North Carolina.

After a median follow up of more than three years, researchers found that patients who underwent cardiac rehab plus stress management achieved greater benefits than rehab alone. Cardiac events such as heart attack, stroke, recurrent chest pains requiring hospitalization, or even death were observed in:

18 percent of patients in the rehab plus stress management group; 33 percent of patients in the cardiac rehab only group; and 47 percent of patients in those who had no rehab.

Researchers also note that stress reduction was linked to a 50 percent lower risk of cardiac events in the rehab plus stress management group, compared to the rehab group without stress management.

In the study called ENHANCing Cardiac rEhabilitation with stress management training in patients with heart Disease, or ENHANCED, 151 patients (ages 36 - 84) from two centers in North Carolina were randomized into two groups. The first group received 12 weeks of comprehensive, exercise-based cardiac rehabilitation. The second group received the same cardiac rehabilitation plus they participated in weekly 1.5-hour group stress management program for 12 weeks. Stress management included small group discussions, relaxation training, and training in coping skills and stress reduction.

An additional group of 75 patients, matched for age and medical conditions who chose not to participate in cardiac rehabilitation, served as a comparison group. All rehab participants completed standard questionnaires measuring levels of depression, anxiety, anger and general feelings of stress or distress.

Overall, patients in both rehab groups experienced improved levels of blood lipids, lower heart rates during exercise and better exercise tolerance, as well as improvements in other cardiac biomarkers of risk following 12 weeks of rehab.

Blumenthal estimated that only 20 percent to 30 percent of patients eligible for cardiac rehabilitation participate, possibly because of accessibility and cost, or low rates of referrals. Some also may try to rehabilitate on their own. "Despite their good intentions, making lifestyle changes is not an easy thing to do without assistance," he said.

Blumenthal explained that the results of ENHANCED contradict those of a recent British study which found that cardiac rehabilitation did not add value to the medical management of heart patients, and that the stress management program was not effective. In the British study, however, cardiac rehabilitation was performed weekly or biweekly for 6-8 weeks. In ENHANCED, rehab participants engaged in aerobic exercise three times a week for 12 weeks, took classes in nutrition, and were counseled on smoking cessation.

Co-authors are Andrew Sherwood, Ph.D.; Patrick J. Smith, Ph.D.; Lana Watkins, Ph.D.; Stephanie Mabe, M.S.; William E. Kraus, M.D.; Krista Ingle, Ph.D.; Paula Miller, M.D. and Alan Hinderliter, M.D. Author disclosures are on the manuscript.

The National Heart, Lung and Blood Institute supported the study.

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Hundreds of lives lost due to variations in common heart procedure

Despite the successful adoption of modern techniques, new research from the Universities of Keele and Manchester suggests more can be done to reduce fatalities following a non-surgical treatment for blocked arteries.

Data collected from a national cardiovascular database has highlighted that changes in the practice of interventional cardiology have led to improved patient outcomes - although these changes have not been applied universally across England and Wales.

Health data scientists from The University of Manchester's Health eResearch Centre and Keele University analysed the results of 448,853 patients who had received a percutaneous coronary intervention (PCI), a treatment in which stents are used to treat narrowed or blocked arteries, between 2005 and 2012. This non-surgical treatment can be delivered by inserting a catheter into either a patient's leg (the transfemoral route) or wrist (the transradial route).

The research team found that procedures undertaken through the wrist rapidly increased from 14% to 58% and that this change in practice has contributed to an estimated 450 lives saved over the seven year study window. Further, adoption of PCI through the wrist varies significantly in different parts of the UK.

By geographically mapping the data the health informaticians were able to further drill down into statistics and identify where utilisation methods varied the most. The team found that an additional 264 lives could have been saved if the transradial route was more frequently adopted and were able to identify the South East of England as the region with the lowest uptake in transradial PCI delivery.

Lead researcher and Professor in Cardiology, Mamas Mamas said: "It is clear from the research that performing PCI through the transradial route is safer and less invasive for patients. Current research uses large, often national databases to compare different ways of doing the same operation, however, these reports don't explain why the complication rates vary so much across sub-national regions.

"One reason that has been suggested is a lack of training opportunities for more experienced operators. Certainly a recent survey of 204 cardiologists identified an association between newly qualified surgeons and practitioners using the safer transradial route."

These findings build on previously published research by the team which showed that performing PCI via the wrist is associated with a 30% reduction in the risk of mortality in high risk groups undergoing these procedures.

For any corrections of factual information, or to contact our editorial team, please see our contact page.

Please note: Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a health care professional. For more information, please read our terms of use.

Copyright Medical News Today: Excluding email/sharing services explicitly offered on this website, material published on Medical News Today may not be reproduced, or distributed without the prior written permission of Medilexicon International Ltd. Please contact us for further details.

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Insulin-secreting cells report on insulin resistance

Diabetes researchers at Sweden's Karolinska Institutet have developed a novel technique that makes it possible to monitor insulin resistance in a non-invasive manner over time in mice. The new method, presented in the journal Scientific Reports, can be used to assess insulin resistance during progression and intervention of metabolic diseases.

Insulin resistance is a key contributing factor to a variety of metabolic diseases, including cardio-vascular disease, the metabolic syndrome and Diabetes type 2. A major challenge in the field of insulin resistance is to be able to monitor this process dynamically in individual cell types of insulin target tissues, such as fat, liver, brain, kidney or pancreatic islets in the living organism.

The researchers behind the new study have previously shown that the insulin-secreting beta-cell, situated in the pancreatic islet of Langerhans, not only produces the hormone insulin but is also a target for insulin signaling. Consequently, beta-cell insulin resistance can contribute to the development and progression of type 2 Diabetes.

"The problem is that the islets are embedded in the pancreas and therefore not accessible for direct monitoring", says lead author Meike Paschen, doctoral student at the Rolf Luft Research Center for Diabetes and Endocrinology, Department of Molecular Medicine and Surgery at Karolinska Institutet. "However, by equipping beta-cells with a fluorescent biosensor that reports on insulin resistance and transplanting these reporter islets into the anterior chamber of the eyes of mice, we are now able to study beta-cell insulin sensitivity over months in the living mouse."

This novel technique utilizes the cornea as a natural body-window to allow the investigators to non-invasively monitor insulin resistance in islet of Langerhans transplanted to the anterior chamber of the eye. The biosensor expressed by the engrafted islets makes it possible for the researchers to differentiate insulin-resistant cells from those that have a normal response to insulin. The biosensor signal is measured non-invasively by fluorescence microscopy at single-cell resolution in the living animal.

"This technique allows monitoring of cell type specific insulin sensitivity or resistance in real-time in the context of whole body insulin resistance during progression and intervention of disease", says Professor Per-Olof Berggren, who led the current study together with Associate Professor Ingo Leibiger at the Rolf Luft Research Center for Diabetes and Endocrinology.

For any corrections of factual information, or to contact our editorial team, please see our contact page.

Please note: Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a health care professional. For more information, please read our terms of use.

Copyright Medical News Today: Excluding email/sharing services explicitly offered on this website, material published on Medical News Today may not be reproduced, or distributed without the prior written permission of Medilexicon International Ltd. Please contact us for further details.

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Pre-pregnancy heart abnormalities may predict recurrent preeclampsia risk

Women who had pregnancy-related high blood pressure multiple times had recognizable heart abnormalities between pregnancies that could help predict their risk for heart and blood vessel disease during subsequent pregnancies and even later in life, according to new research in Hypertension, an American Heart Association journal.

Pregnancy-related high blood pressure, or preeclampsia, is a serious disease that affects 3 percent to 8 percent of pregnancies. This study showed how cardiovascular abnormalities detected in non-pregnant women with a history of preeclampsia might identify the recurrent preeclampsia in subsequent pregnancies.

When preeclampsia develops before 32 weeks of pregnancy, it is considered early. When preeclampsia occurs, the baby may need be delivered early to prevent harm to the mother and baby.

"Women who have early preeclampsia in their first pregnancy should be informed of their risk and should be carefully followed," said Herbert Valensise, M.D., Ph.D., study lead author and associate professor of obstetrics and gynecology at Tor Vergata University School of Medicine in Rome, Italy.

Previous research showed that women who have had preeclampsia are 7 times more likely than women with normal pregnancies to develop the disease in later pregnancies and are more likely to have heart and blood vessel disease later in life. What is unclear is how to predict who is at greater risk for these complications.

In this study, participants included 75 women who had preeclampsia and 147 women who did not have the disease during their previous pregnancy. None were pregnant at the start of the study and all participants underwent heart-imaging tests 12 to 18 months after their first delivery. All participants became pregnant again within 24 months and were followed until the end of their pregnancies. Of the 75 women who had preeclampsia in a previous pregnancy, 22 women (29 percent) developed it again. Participants' average age at the beginning of the study was 34 years.

Researchers found that women who had preeclampsia once and then developed it again in a subsequent pregnancy had pre-pregnancy abnormalities in one of the heart's four chambers. Compared to women who never had preeclampsia or who had it once, these women had abnormal changes in the size and function of the left ventricle, which pumps blood throughout the body. Specifically, the left ventricle was unusually thick and had to work harder while pumping significantly less blood.

"Physicians have to look at the complicated pregnancy history as a potential risk factor for cardiovascular complications later in life, and in a subsequent pregnancy," Valensise said. "When we ask about heart risk factors such as smoking, high cholesterol, family history of heart and blood vessel disease, we should also ask about possible high blood pressure during pregnancy, especially early preeclampsia."

This was a small study. Researchers said larger studies are necessary to confirm their findings.

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Doctors say 40,000 deaths a year linked to air pollution

A new landmark report from the Royal College of Physicians (RCP) and the Royal College of Paediatrics and Child Health (RCPCH) starkly sets out the dangerous impact air pollution is currently having on our nation's health - with around 40,000 deaths a year linked to air pollution. 'Every breath we take: the lifelong impact of air pollution' presents that the harm from air pollution is not just linked to short term episodes but is a long term problem with lifelong implications.

The report notes examples from right across an individual's lifespan, from a baby's first weeks in the womb through to the years of older age. Examples include, the adverse effects of air pollution on the development of the fetus, including lung and kidney development, and miscarriage, increases in heart attacks and strokes for those in later life; and the associated links to asthma, diabetes, dementia, obesity and cancer for the wider population.

In relation to asthma, the report stresses the significant point that after years of debate, there is now compelling evidence that air pollution is associated with both reduced lung growth in childhood and new onset asthma in children and in adults - whilst highlighting that air pollution increases the severity of asthma for those with the disease.

In recent years the dangers of outdoor air pollution have been well documented however, the report highlights the often overlooked section of our environment - that of indoor space. Factors such as, kitchen products, faulty boilers, open fires, fly sprays and air fresheners, all of which can cause poor air quality in our homes, workspaces and schools. According to the report indoor air pollution may have caused or contributed to 99,000 deaths annually in Europe.

Although government and the World Health Organization (WHO) set 'acceptable' limits for various pollutants in our air, the report states that there is in fact no level of exposure that can be seen to be safe, with any exposure carrying an associated risk.

As a result, the report offers a number of major reform proposals setting out what must be done if we are to tackle the problem of air pollution.

These include:

Put the onus on polluters. Polluters must be required to take responsibility for harming our health. Political leaders at a local, national and EU level must introduce tougher regulations, including reliable emissions testing for cars. Local authorities need to act to protect public health when air pollution levels are high. When these limits are exceeded, local authorities must have the power to close or divert roads to reduce the volume of traffic, especially near schools. Monitor air pollution effectively. Air pollution monitoring by central and local government must track exposure to harmful pollutants in major urban areas and near schools. These results should then be communicated proactively to the public in a clear way that everyone can understand. Quantify the relationship between indoor air pollution and health. We must strengthen our understanding of the key risk factors and effects of poor our quality in our homes, schools and workplaces. A coordinated effort is required to develop and apply any necessary policy changes. Define the economic impact of air pollution. Air pollution damages not only our physical health, but also our economic wellbeing. We need further research into the economic benefits of well designed policies to tackle it. Lead by example within the NHS. The health service must no longer be a major polluter; it must lead by example and set the benchmark for clean air and safe workplaces.

The working party for the report was chaired by Professor Stephen Holgate. On the report, Professor Holgate said:

'We now know that air pollution has a substantial impact on many chronic long term conditions, increasing strokes and heart attacks in susceptible individuals. We know that air pollution adversely effects the development of the fetus, including lung development. And now there is compelling evidence that air pollution is associated with new onset asthma in children and adults. When our patients are exposed to such a clear and avoidable cause of death, illness and disability, it our duty to speak out'

Dr Andrew Goddard, the Royal College of Physicians lead for the report said:

'Taking action to tackle air pollution in the UK will reduce the pain and suffering for many people with long term chronic health conditions, not to mention lessening the long term demands on our NHS. This is not just a job for government, local authorities or business - as individuals we can all do our part to reduce pollutant exposure.'

Professor Jonathan Grigg, Professor of Paediatric Respiratory and Environmental Medicine at Queen Mary University of London and the Vice Chair of the working party and representing the Royal College of Paediatrics and Child Health, said:

'There is clear evidence to suggest that long term exposure to air pollution has a wide range of adverse effects in childhood, and exposure during early life can lead to the development of serious conditions such as asthma. As NHS costs continue to escalate due to poor public health - asthma alone costs the NHS an estimated £1 billion a year - it essential that policy makers consider the effects of long term exposure on our children and the public purse.

'We therefore call on Government to monitor exposure to air pollution more effectively to help us identify those children and young people who are most at risk. We also ask the public to consider ways of reducing their own contribution to air pollution by taking simple measures such as using public transport, walking and cycling, and not choosing to drive high-polluting vehicles.'

The report also emphasises how the public can do their part to reduce pollutant exposure. Noting the impact collective action can have on the future levels of air pollution in our communities.

Suggestions include:

trying alternatives to car travel or preferably taking the active option: bus, train, walking and cycling aiming for energy efficiency in our homes keeping gas appliances and solid fuel burners in good repair learning more about air quality and staying informed.

Other key points from the report note:

Estimated cost of air pollution in the UK is £20 billion annually (in Europe €240 billion) A need to develop new technologies to improve air pollution monitoring More research to determine how social and economic trends are affecting air quality and its twin threat climate change.
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Pre-pregnancy heart abnormalities may predict recurrent preeclampsia risk

Women who had pregnancy-related high blood pressure multiple times had recognizable heart abnormalities between pregnancies that could help predict their risk for heart and blood vessel disease during subsequent pregnancies and even later in life, according to new research in Hypertension, an American Heart Association journal.

Pregnancy-related high blood pressure, or preeclampsia, is a serious disease that affects 3 percent to 8 percent of pregnancies. This study showed how cardiovascular abnormalities detected in non-pregnant women with a history of preeclampsia might identify the recurrent preeclampsia in subsequent pregnancies.

When preeclampsia develops before 32 weeks of pregnancy, it is considered early. When preeclampsia occurs, the baby may need be delivered early to prevent harm to the mother and baby.

"Women who have early preeclampsia in their first pregnancy should be informed of their risk and should be carefully followed," said Herbert Valensise, M.D., Ph.D., study lead author and associate professor of obstetrics and gynecology at Tor Vergata University School of Medicine in Rome, Italy.

Previous research showed that women who have had preeclampsia are 7 times more likely than women with normal pregnancies to develop the disease in later pregnancies and are more likely to have heart and blood vessel disease later in life. What is unclear is how to predict who is at greater risk for these complications.

In this study, participants included 75 women who had preeclampsia and 147 women who did not have the disease during their previous pregnancy. None were pregnant at the start of the study and all participants underwent heart-imaging tests 12 to 18 months after their first delivery. All participants became pregnant again within 24 months and were followed until the end of their pregnancies. Of the 75 women who had preeclampsia in a previous pregnancy, 22 women (29 percent) developed it again. Participants' average age at the beginning of the study was 34 years.

Researchers found that women who had preeclampsia once and then developed it again in a subsequent pregnancy had pre-pregnancy abnormalities in one of the heart's four chambers. Compared to women who never had preeclampsia or who had it once, these women had abnormal changes in the size and function of the left ventricle, which pumps blood throughout the body. Specifically, the left ventricle was unusually thick and had to work harder while pumping significantly less blood.

"Physicians have to look at the complicated pregnancy history as a potential risk factor for cardiovascular complications later in life, and in a subsequent pregnancy," Valensise said. "When we ask about heart risk factors such as smoking, high cholesterol, family history of heart and blood vessel disease, we should also ask about possible high blood pressure during pregnancy, especially early preeclampsia."

This was a small study. Researchers said larger studies are necessary to confirm their findings.

Co-authors are Damiano Lo Presti, M.D.; Giulia Gagliardi, M.D.; Grazia Maria Tiralongo, M.D.; Ilaria Pisani, M.D.; Gian Paolo Novelli, M.D., Ph.D.; and Barbara Vasapollo, M.D., Ph.D. Author disclosures are on the manuscript.

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Macrolide antibiotics 'do not increase risk of heart arrhythmia, death'

Macrolide antibiotic use appears not to increase the risk of serious heart rhythm disturbances or death, contrary to warnings issued by the US Food and Drug Administration. These are the findings of a large study published in the CMAJ.
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Macrolide antibiotics are commonly prescribed for respiratory tract infections.

Some previous research has suggested that macrolides, such as azithromycin, clarithromycin and erythromycin, increase the risk of ventricular arrhythmia or serious heart rhythm disturbances and possibly death, but other studies had reached conflicting conclusions.

Macrolides are commonly prescribed in cases of respiratory tract infections. In 2010, over 57 million outpatient prescriptions for the drugs were written in the US.

Due to the concerns raised, in 2013, the Food and Drug Administration (FDA) warned that risks were associated with the antibiotics.

Dr. Amit Garg, director of the Institute for Clinical Evaluative Sciences (ICES) Western facility in London, Ontario, Canada, and colleagues studied over 600,000 adults aged 65 years and above.

The data were taken from the ICES and universal prescription drug coverage data from the Ontario Health Insurance Plan (OHIP).

The researchers compared people who were taking macrolides with people who were taking non-macrolide antibiotics. All participants were of similar age, health status and other characteristics.

The average age of participants was 74 years, and 57% were women.

Findings showed that the 30-day risk of ventricular arrhythmia for both groups was similar, but that the group using macrolides had a slightly lower risk of all-cause mortality.

In patients with congestive heart failure, coronary artery disease and chronic kidney disease, there did not appear to be any higher risk of adverse events when taking macrolides.

However, other studies have suggested that a combination of major risk factors, such as existing arrhythmia, older age, heart disease, bradycardia, hypokalemia or hypomagnesemia, particularly among females, may put patients at a higher risk of adverse events.

Some experts have proposed that for such patients, the risk could be minimized by carrying out electrocardiography before and after initiating therapy.

One limitation of the study was that the researchers did not know exactly why each patient was taking the antibiotics, although the specialty of the prescribing physician was mentioned.

The researchers comment:

"In contrast to prior studies, we found that these variables did not significantly alter the association between macrolide antibiotic use and our outcomes. Nonetheless, these findings should be interpreted with caution, and physicians should always consider a patient's baseline risk for adverse events before prescribing macrolides or other antibiotics."

They conclude that "the findings are reassuring for health care providers who prescribe macrolide antibiotics to a wide range of patients in routine care."

Medical News Today recently reported that antibiotics can cause delirium among patients, particularly the elderly.

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Supply of GPs and detection of hypertension in England associated with premature mortality rates, study suggests

University of Leicester researchers examine associations between mortality under 75 years and general practice characteristics

General practitioner numbers appear to have a small but important influence on premature mortality rates in England, according to research by the University of Leicester.

The study, published in the journal BMJ Open, records lower levels of premature mortality in less deprived practices - which could support the case for strengthening general practice throughout England.

Professor Richard Baker from the Department of Health Sciences who led the study explained: "We have conducted a study using data on 7,858 general practices in England for 2010 to investigate associations between mortality under aged 75 years and population and general practice characteristics.

"The findings show the importance of population characteristics such as deprivation, but also show associations between general practice characteristics and mortality. Better detection of hypertension was associated with lower mortality, and more general practitioners per 1,000 patient population were associated with lower mortality. Although the study only demonstrates associations, it supports the case for strengthening general practice."

The team set out to investigate whether a conceptual model representing some of the proposed mechanisms of primary care could explain variations in premature mortality in general practice populations, taking particular account of deprivation among population characteristics.

The researchers undertook a cross-sectional study in which population and primary care variables reflecting the model were used to explain variations in mortality of those aged under 75 years.

The number of GPs per 1,000 members of the population and detection of hypertension were negatively associated with mortality - and in less deprived practices, continuity of care was also negatively associated with mortality.

The study suggests that population variables, particularly deprivation, were the most powerful predictors of mortality and that practices with greater levels of diabetes, more smokers, more white patients and greater deprivation had higher levels of premature mortality overall.

Professor Baker added: "Greater supply of primary care is associated with lower premature mortality even in a health system that has strong primary care, such as England. Health systems need to sustain the capacity of primary care to deliver effective care, and should assist primary care providers in identifying and meeting the needs of socioeconomically deprived groups."

Dr Tony Bentley, GP Leicester City CCG has said of the study: "These findings support our plans to recruit more GPs into primary care in Leicester City to improve the health of our deprived populations and reduce health inequalities."

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Patients with no schooling benefit least from blood thinning medications

Atrial fibrillation patients with low education miss treatment targets more often.

Patients with no schooling benefit least from blood thinning medications, reveals a European Heart Rhythm Association (EHRA) / European Society of Cardiology (ESC) survey published in Europace. The poll of more than 1100 patients with atrial fibrillation found those with no schooling missed treatment targets more often, were less aware of bleeding risks, and did not know they could continue normal daily activities.

80% of university educated patients knew they could drive, play sports and travel by plane compared to 52% without schooling.

Atrial fibrillation is the most common cardiac rhythm disorder and affects 1.5-2% of the general population in the developed world. Atrial fibrillation substantially increases the risk of stroke. When strokes occur in patients with atrial fibrillation they are associated with more death and disability, longer hospital stays, and less chance of returning home.

EHRA President Professor Gerhard Hindricks said: "Blood thinning medications, also called oral anticoagulants, are the most effective way of preventing strokes in patients with atrial fibrillation and risk factors for stroke. We asked patients what they knew about their drugs and analysed whether this differed by gender, age, education level, and country of residence."

A total of 1147 patients with atrial fibrillation and taking oral anticoagulation completed 40 questions online. Oral anticoagulation included the vitamin K antagonists (such as warfarin) and the non-vitamin K oral anticoagulants (also called NOACs). Responses were collected over three months. Patients were 66 years old on average and 46% were women. Patients were from eight countries: France (33.6%), Denmark (26.6%), Sweden (20.9%), Spain (7.7%), Norway (4.5%), Germany (3.7%), the UK (2.2%) and Italy (0.8%).

The responses reveal disparities between patients with differing levels of education in terms of the benefits of anticoagulation and knowledge about the medication. Patients taking vitamin K antagonists such as warfarin are advised to keep their international normalised ratio (INR) level, which indicates how long it takes blood to form a clot, between 2 and 3. Patients with no schooling were more likely to exceed the upper limit several times a month than those with college or university education (5.1% vs 2.8%, p

Awareness of the bleeding risks associated with anticoagulant drugs was lowest in patients without schooling (38.5%) and highest in those with college and university education (57.0%) (p

Professor Carina Blomström-Lundqvist, who led the survey and is final author of the paper, said: "The survey shows that differences in patient education level may compromise the safety and efficacy of anticoagulants. Patients unaware of the importance of being compliant have a higher risk for both bleeding events and stroke. The findings underline the importance of providing user-friendly education about risk factors for stroke and adequate use of anticoagulants, and the importance of tailoring the educational message to the target population so that it is understood irrespective of the patient's level of schooling."

The impact of anticoagulation on quality of life differed by education level. The majority (80.2%) of patients with university education knew that they could continue their normal daily activities such as travelling by plane, sports, driving a car, or having a job, compared to just 51.8% of patients without schooling (p

Taking the patient group as a whole, when asked about the purpose of their anticoagulation medication, the majority (91-94%) correctly understood that it was to "thin the blood" but 6-9% incorrectly said it was to control the arrhythmia. Professor Blomström-Lundqvist said: "The survey demonstrated that a significant percentage of patients (around 8%) did not even understand the purpose of anticoagulation correctly and surprisingly, the number of patients who were aware of NOACs was still quite small."

She added: "This survey has important implications as it shows not only the need for more education in general about the indication and use of anticoagulants in patients with atrial fibrillation, but importantly also that differences in educational level among patient populations may significantly compromise the safety and efficacy of anticoagulants."

Professor Blomström-Lundqvist concluded: "We believe that associations and societies like EHRA and the ESC have an important task to provide more user-friendly educational tools to improve knowledge about anticoagulation use - when and how to take it and the importance of taking it - for both atrial fibrillation patients and their physicians. We also need to increase the awareness of NOACs, so that all patients, independent of their educational level, can have access to the most optimal therapy."

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First European advice launched for deadly acute heart failure

Death risk higher than heart attack but care lags 30 years behind.

The first European advice on emergency care for patients with acute heart failure is published in European Heart Journal: Acute Cardiovascular Care. Acute heart failure carries a higher risk of death than heart attack but care lags 30 years behind.

"Only half of patients discharged with acute heart failure are alive in three years."

"Mortality from acute heart failure is even higher than from a heart attack so it is an urgent situation," said Professor Christian Mueller, chair of the Acute Heart Failure Study Group of the Acute Cardiovascular Care Association (ACCA) of the European Society of Cardiology (ESC).

"Only half of patients discharged from hospital with acute heart failure are alive in three years, even though they felt fine," he continued. "Despite the severity of the condition there are no standard treatment pathways, whereas these were agreed across Europe for heart attack 30 years ago. The paper published today is the first step towards catching up with heart attack care and establishing similar standards for acute heart failure."

Acute heart failure is a chronic disorder that flares up and leads to emergency visits. The vast majority of patients present to an emergency department with sudden and severe shortness of breath (called acute dyspnoea) at rest. In 50% of patients the underlying condition is chronic heart failure. The other 50% could have had a heart attack ten years ago, or their underlying heart condition is undiagnosed.

"Most patients with acute heart failure cannot be cured," said Professor Mueller. "We can effectively treat the acute flare ups of dyspnoea with vasodilators or diuretics that remove the extra fluid on the lungs. But the underlying progressive disease remains and patients need long term follow up to make sure they are on the correct medication at the right dosages."

The paper published today focuses on the pivotal decision of whether to discharge patients with acute heart failure from the emergency department and see them as outpatients, or to admit them to hospital. Until now there was no guidance on this issue. The result is that emergency physicians have tended to act conservatively and admit patients to hospital.

"The hospital is not always the best place to care for acutely ill patients," said Professor Mueller. "While in hospital, patients with acute heart failure - who are 78 years old on average - are at risk of developing infections and they have problems sleeping. There is also pressure on hospitals to avoid expensive admissions when possible. But patients do benefit from more intense follow up while in hospital."

The paper outlines criteria to help clinicians select patients that can be safely discharged from the emergency department. A novel algorithm shows the order of decisions to be made and what to consider at each step.

Professor Mueller said: "The paper aims to kick start the process of emergency medicine physicians and cardiologists joining forces to apply or adjust the algorithm so that it works locally. The patient pathway and decisions on place of treatment will vary depending on reimbursement policies and logistics."

The importance of long term follow up is emphasised, regardless of whether patients are discharged directly from the emergency department or spend a period in hospital before being sent home. Follow up planning should be done by the emergency team in collaboration with the general practitioner (GP), cardiologist, and others involved in the patient's long term care.

"It's never ever possible to treat acute heart failure sufficiently in 24 hours in the emergency department," said Professor Mueller. "Intense follow up will always be needed. It's the task of the emergency department physician to either make the first follow up appointment or to ensure that this will occur. Patients should be seen by their GP within 48 hours to fine tune the number of drugs and their doses, and assess vital signs, blood pressure, electrolytes and kidney function."

He concluded: "Ultimately we hope this guidance will improve the management of patients with acute heart failure and make some inroads towards giving them a better outlook."

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Viagra relieves life-threatening condition in swimmers and divers

A small dose of Viagra could save the lives of swimmers and divers who experience an abrupt and potentially life-threatening form of pulmonary edema on entering cold water, says research published in Circulation: Journal of the American Heart Association.
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SIPE can affect divers and triathletes participating in cold water swims.

Viagra, or sildenafil, is best known for treating male impotence, but it can also help in cases of pulmonary arterial hypertension.

When athletes or scuba divers make a sudden entry into cold water, they can develop a condition called swimming-induced pulmonary edema (SIPE).

When this happens, the blood vessels in the arms and legs constrict, leading to a pooling of blood in the heart and lungs. Symptoms include coughing up blood, difficulty breathing and low blood oxygen.

Although the symptoms often dissipate over 24 hours, the condition can kill. Not everyone is prone to it, and those who are tend to be unaware until they are in the water and rapidly developing symptoms. Those who experience SIPE should seek medical attention.

Small dose of sildenafil reduces pressure in lungs

Dr. Richard Moon, an anesthesiologist and medical director of the Duke Center for Hyperbaric Medicine & Environmental Physiology in Durham, NC, and colleagues studied 10 athletes who had experienced SIPE while exercising or competing in triathlons.

The team monitored the participants carefully as they exercised under conditions similar to those likely to trigger the SIPE response. They then compared the 10 athletes with 20 participants who had no history of SIPE.

None of the participants had heart abnormalities, but those who were prone to SIPE experienced higher pulmonary arterial pressure and pulmonary artery wedge pressure during the exercise.

This confirmed that SIPE is a form of pulmonary edema caused by high pressure in the blood vessels within the lungs.

The SIPE participants then repeated the exercise after taking sildenafil. This time, the pressures were reduced.

Lead author Dr. Moon explains: "During immersion in water, particularly cold water, susceptible people have an exaggerated degree of the normal redistribution of blood from the extremities to the chest area, causing increased pressure in the blood vessels of the lungs and leakage of fluid into the lungs. Some cases of SIPE appear to have been the result of cardiac problems."

Dr. Moon believes that as the blood vessels dilate in the arms and legs, there is less tendency for blood to redistribute to the thorax, and the pressure in the blood vessels of the lungs is relieved.

How one athlete controlled pulmonary edema

One of the participants is triathlete Katherine Calder-Becker, aged 51 years. Her susceptibility to SIPE threatened to end her competitive career because of debilitating shortness of breath and distress during colder open-water swims in competitions.

On coughing up blood, she was hospitalized and diagnosed with SIPE.

After participating in studies at Duke in 2011, her cardiologist prescribed her a low dose of sildenafil that she now takes shortly before competitions.

Calder-Becker says:

"I have successfully raced in 20 triathlons since I started taking sildenafil, including five ultra events that require 10-kilometer swims. I have not had an incident since then. I didn't want to give up racing. This is something my husband and I do together, and we travel together to competitions, so it has meant everything to me to continue."

The researchers would like to see larger studies to replicate the results and to learn about any potential adverse side effects of the drug. They hope that ongoing research will reveal more about what triggers SIPE and how to obtain an early diagnosis.

Medical News Today reported last year on research suggesting that Viagra increases the risk of skin cancer.

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Moderate drinking could lower heart attack, heart failure risk

Good news for those who like a drink after a hard day's work: consuming three to five drinks a week could lower the risk of heart attack and heart failure. This is according to two new studies by researchers from Sweden and Norway.
[A person pouring a glass of wine]
Drinking three to five alcohol beverages weekly may benefit heart health.

According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), almost 87% of adults in the US have consumed alcohol at some point in their lifetime, and more than 56% have had a drink in the past month.

While there is no doubt that excessive alcohol use is detrimental to health, studies are increasingly suggesting that moderate drinking may have its benefits.

In December 2015, for example, Medical News Today reported on a study suggesting moderate alcohol intake may lower death rates from early-stage Alzheimer's, while another study suggested that consuming up to seven drinks weekly may lower heart failure risk.

The two new studies further support the link between moderate alcohol intake and better heart health, after finding that drinking three to five alcohol beverages a week may reduce the risk of heart attack and heart failure.

33% lower heart failure risk with moderate drinking

Both studies were conducted by the same team, including Imre Janszky, a professor of social medicine at the Norwegian University of Science and Technology (NTNU).

For the first study, published in the International Journal of Cardiology, the team analyzed the data of 60,665 individuals free of heart failure who were enrolled in the longitudinal HUNT 2 Nord-Trøndelag Health Study between 1995-1997.

The researchers assessed the self-reported drinking habits of the participants and assessed the incidence of heart failure up until 2008. During follow-up, 1,588 of the participants developed heart failure.

The team found that compared with participants who never or rarely consumed alcohol, those who consumed around three to five drinks a week had a 33% lower risk of heart failure.

Additionally, the researchers found that heart failure risk was reduced with more frequent drinking; subjects who drank alcohol five times or more a month had a 21% lower risk of heart failure, compared with non-drinkers and those who rarely drank, while participants who drank one to five times monthly had a 2% lower risk of heart failure.

But there is no need to drink daily to have a healthy heart

In the second study, published in the Journal of Internal Medicine, Janszky assessed the data of 58,827 participants who were also part of the HUNT study and enrolled between 1995-1997. None of the subjects had a history of heart attack.

Once again, the team assessed the participants' self-reported drinking habits and monitored their incidence of heart attack up until 2008. During follow-up, 2,966 subjects had a heart attack.

Compared with non-drinkers and rare drinkers, those who consumed three to five drinks a week had the lowest heart attack risk, with the risk reducing by around 28% with every additional drink consumed, up to five drinks.

However, the researchers note that they did observe an increased risk of death from certain forms of cardiovascular disease with the consumption of at least five drinks weekly, and high alcohol consumption was also linked to greater risk of death from liver disease.

As such, the authors recommend against high alcohol intake and stress that their findings do not suggest people should take up frequent drinking in order to improve their heart health.

Janszky says:

"I'm not encouraging people to drink alcohol all the time. We've only been studying the heart, and it's important to emphasize that a little alcohol every day can be healthy for the heart. But that doesn't mean it's necessary to drink alcohol every day to have a healthy heart."

But for those who do like to indulge in a drink, Janszky recommends that it is best to consume "moderate amounts relatively often," noting that drinking larger amounts in one sitting can raise blood pressure.

Study strengths and limitations

While these studies are not the first to associate moderate drinking with better heart health, the team says they may be more accurate, noting that previous studies have looked at such associations among populations in which alcohol consumption is very common.

In Norway, however, drinking is not as popular. In the second study looking at the association between alcohol consumption and heart attack risk, for example, 41% of participants reported that they did not drink at all or only consumed less than half an alcoholic drink weekly.

"The relationship between alcohol and heart health has been studied in many countries, including the USA and southern European nations," says Janszky. "The conclusions have been the same, but the drinking patterns in these countries are very different than in Norway. In countries like France and Italy, very few people don't drink."

"It raises the question as to whether earlier findings can be fully trusted, if other factors related to non-drinkers might have influenced research results," he adds. "It may be that these are people who previously had alcohol problems, and who have stopped drinking completely."

There are some limitations to these latest studies, however. For instance, the authors note that the alcohol consumption of participants was self-reported, meaning alcohol intake could have been underestimated.

Contrary to these new findings, research reported by MNT last May suggested that moderate drinking may increase the risk of heart damage for elderly women.

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Blood test detects all known genes for inherited heart conditions

Researchers believe they have made a breakthrough in the diagnosis of inherited heart conditions, after developing a rapid, simple blood test that accurately can detect all known genes associated with such disorders.
[Blood in a test tube]
The new blood test can detect 174 known genes for inherited heart conditions, say researchers.

In the Journal of Cardiovascular Translational Research, researchers from the UK and Singapore reveal how the test - called the TruSight Cardio Sequencing Kit - can identify 174 genes related to 17 inherited heart conditions.

These conditions include aortic valve disease, structural heart disease, long and short QT syndrome, Noonan syndrome, familial atrial fibrillation and most cardiomyopathies.

Inherited heart conditions are caused by gene mutations that have been passed down from relatives. If a mother possesses one of these faulty genes, there is a 50% chance that they will pass the mutation on to their child.

While it is possible to have one of these gene mutations and never develop the associated heart condition, the gene significantly increases risk for the disorder.

Genetic testing is key to identifying such mutations, enabling early diagnosis of inherited heart conditions and allowing patients to take steps to lower their risk of sudden death from such disorders.

But according to lead researcher Dr. James Ware, of the National Heart and Lung Institute at the MRC Clinical Sciences Centre at Imperial College London, UK, current genetic tests are only capable of identifying small numbers of genes, which means they often overlook gene mutations that could be key for diagnosing an inherited heart condition.

Could the TruSight Cardio Sequencing Kit address this problem?

Blood test identified all gene mutations with up to 100% accuracy

The new test used next-generation sequencing to simultaneously identify 174 genes known to increase the risk of 17 inherited heart conditions. It works by analyzing the DNA in patients' blood samples.

Dr. Ware and colleagues assessed the effectiveness of the test in the new study by using it to analyze the blood samples of 348 participants from the National Heart Centre Singapore.

The team found that the test was able to quickly identify all gene mutations in the blood samples that were associated with the 17 inherited heart conditions with up to 100% accuracy.

The researchers say their study shows the new test is faster and more reliable than current genetic tests and will allow quicker, more reliable and more cost-effective diagnosis of inherited heart disorders.

Commenting on the findings, Prof. Peter Weissberg, medical director of the UK's British Heart Foundation - which helped fund the study - says:

"As research advances and technology develops, we are identifying more and more genetic mutations that cause these conditions. In this rapidly evolving field of research the aim is to achieve ever greater diagnostic accuracy at ever-reducing cost.

This research represents an important step along this path. It means that a single test may be able to identify the causative gene mutation in someone with an inherited heart condition thereby allowing their relatives to be easily tested for the same gene."

Test 'increasing number of families who benefit from genetic testing'

The new test has already been implemented at the Royal Brompton & Harefield National Health Service (NHS) Foundation Trust in the UK, where the researchers say it is successfully assessing 40 patients per month for an inherited heart condition.

In the US alone, around 100,000 people die from sudden cardiac arrest each year as a result of inherited heart conditions.

The researchers hope that their new test will soon be in clinical use across the globe, aiding the early diagnosis and treatment of inherited heart conditions for some patients and providing peace of mind for others.

"Without a genetic test, we often have to keep the whole family under regular surveillance for many years, because some of these conditions may not develop until later in life. This is hugely costly for both the families and the health system," notes Dr. Ware.

"By contrast, when a genetic test reveals the precise genetic abnormality causing the condition in one member of the family, it becomes simple to test other family members," he continues.

"Those who do not carry the faulty gene copy can be reassured and spared countless hospital visits. This new comprehensive test is increasing the number of families who benefit from genetic testing."

Last September, Medical News Today reported on the development of a genetic test that can identify which breast cancer patients can avoid chemotherapy.

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Red meat compound linked to worse outcomes in heart failure patients

A new study finds that worse outcomes in patients with acute heart failure are linked to higher levels of TMAO - the major source of which is thought to be L-carnitine, a compound that is metabolized by gut bacteria during the digestion of red meat.
Diagram of chest showing heart and blood vessels
Heart failure develops when the heart muscle is unable to pump enough blood to meet the body's needs for nutrients and oxygen.

The new study - from the University of Leicester in the UK - is published in the journal Heart.

Previous studies have linked TMAO (trimethylamine N-oxide) with higher risk of death in chronic heart failure, note the researchers, but their study appears to be the first to find such a link in patients with acute heart failure.

Heart failure is a serious condition that carries a higher risk of death and developing other serious medical problems. It occurs when the heart muscle is unable to pump enough blood to meet the body's needs for nutrients and oxygen. The condition can be ongoing (chronic) or it can develop suddenly (acute).

Although not limited to seniors, heart failure is one of the most common reasons for hospital admissions among people aged 65 years and older.

In the new study, led by Toru Suzuki, a professor in the cardiovascular sciences department at Leicester, the researchers measured circulating levels of TMAO in 972 patients admitted with heart failure to University Hospitals of Leicester National Health Service (NHS) Trust.

The team looked for links between blood TMAO levels and events occurring within 1 year of obtaining the samples. These events included deaths during hospitalization (72 events), deaths due to any cause (268 events) and a composite of death or rehospitalization due to heart failure (384 events).

The results showed that acute heart failure patients who had higher levels of TMAO at the start of the period were the ones most likely to die or be rehospitalized with heart failure in the following 12 months.

Prof. Suzuki says:

Our study shows that higher levels of TMAO, a metabolite of carnitine derived from red meat, is associated with poorer outcomes associated with acute heart failure, one of the main diseases of the heart. This metabolic pathway provides a possible link between how red meat is associated with heart disease."

L-carnitine is one of a group of compounds with the generic name carnitine that are derived from an amino acid and are found in nearly all cells of the body. The name comes from the Latin for flesh - carnus - because it was first isolated from meat.

Red meat is not the only dietary source of carnitine - for example, milk, cheese, whole-wheat products and asparagus also contain it, but in much smaller concentrations. It is also a common ingredient of energy drinks.

Some research suggests the effect of bacteria metabolizing carnitine into TMAO and influencing heart risk appears to be more pronounced in people who consume meat than in vegans or vegetarians.

But it is early days, and the implications of these findings are not well understood and require more research.

For example, one area that is not clear is that while we know the process of converting L-carnitine into TMAO is different from person to person (depending on the microbe metabolism of their gut), does that mean we can say how much of the link to disease is due to diet (e.g. the red meat) and how much is due to the gut?

In a 2013 article, Medical News Today mentions how Cleveland Clinic researchers raise this point when they discuss their discovery of how the link between red meat and heart risk involves gut bacteria turning L-carnitine into TMAO.

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Hidradenitis suppurativa and risk of adverse cardiovascular events and death

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease marked by painful abscesses that develop in areas where there are large numbers of sweat glands. These ooze pus and have an unpleasant smell. The disease has been associated with cardiovascular risk factors, such as smoking and obesity, but the risk of cardiovascular disease in patients with HS is unknown. Alexander Egeberg, M.D., Ph.D., of the University of Copenhagen, Denmark and coauthors investigated cardiovascular risk in patients with HS.

Their study included 5,964 Danish patients with a hospital-based diagnosis of HS and 29,404 individuals from the general population without HS. The study analysis also compared patients with HS to 13,093 patients with severe psoriasis. The authors suggest HS was associated with increased risk of adverse cardiovascular outcomes and death from all causes; the risk of cardiovascular-associated death also was higher in patients with HS compared to the risk for patients with severe psoriasis.

The study suggests HS may be a risk factor for adverse cardiovascular outcomes. "The results call for greater awareness of this association and for studies of its clinical consequences," the study concludes.

Research: Risk of Major Adverse Cardiovascular Events and All-Cause Mortality in Patients With Hidradenitis Suppurativa, Alexander Egeberg, MD, PhD; Gunnar. H. Gislason, MD, PhD; Peter R. Hansen, MD, PhD, DMSc, JAMA Dermatology, doi:10.1001/jamadermatol.2015.6264, published 17 February 2016.

For any corrections of factual information, or to contact our editorial team, please see our contact page.

Please note: Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a health care professional. For more information, please read our terms of use.

Copyright Medical News Today: Excluding email/sharing services explicitly offered on this website, material published on Medical News Today may not be reproduced, or distributed without the prior written permission of Medilexicon International Ltd. Please contact us for further details.

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Science on salt is polarized, study finds

Slightly more than half of papers support the idea that salt is bad for your health.

An analysis of scientific reports and comments on the health effects of a salty diet reveals a polarization between those supportive of the hypothesis that population-wide reduction of salt intake is associated with better health and those that were not. In all, 54 percent were supportive of the hypothesis; 33 percent, not supportive; and 13 percent inconclusive.

The new article in the International Journal of Epidemiology is co-authored by Ludovic Trinquart, Columbia University Epidemiology Merit Fellow at the Mailman School of Public Health; David Johns, a doctoral student in Sociomedical Sciences at the Mailman School of Public Health and an affiliate of the Data & Society Research Institute; and Sandro Galea, dean of the Boston University School of Public Health and adjunct professor of Epidemiology at the Mailman School.

The researchers systematically reviewed 269 academic reports published between 1979 and 2014, including primary studies, meta-analyses, clinical guidelines, consensus statements, comments, letters, and narrative reviews. Each was classified according to whether it supported or refuted the link between reduced sodium intake and lower rates of heart disease, stroke, and death. More than half of the reports were published since 2011--suggesting an increasing level of interest in the question, even if there was no emerging consensus.

A citation analysis found papers on either side of the hypothesis were more likely to cite reports that drew a similar conclusion than to cite reports drawing a different conclusion. Dominating the literature were a small number of influential papers that presented strong evidence for and against.

"There are two almost distinct bodies of scholarship--one supporting and one opposing the claim that salt reduction in populations will improve clinical outcomes," says Johns. "Each is driven by a few prolific authors who tend to cite other researchers who share their point of view, with little apparent collaboration between the two 'sides.'"

"We pay quite a bit of attention to financial bias in our work," says Galea. "We seldom pay attention, however, to how long-held beliefs bias the questions we ask and the results we publish, even as new data become available."

An analysis of systemic reviews revealed very little consistency in the selection of primary studies. If a primary study was selected by a review, the chance that another review would select the same study was less than a third. The finding points to uncertainty and disagreement about what should count as evidence, the authors argue. Moreover, choices about which studies to cite as primary evidence directly influenced the conclusions of systematic reviews.

Even while the scientific debate over salt continues, public health officials, from the local to the global level, have enacted policies to lower consumption. World Health Organization guidelines recommend limiting salt intake. In December 2015, New York City became the first U.S. city to require chain restaurants to label foods high in sodium.

"Decision-makers often must choose a course of action in the face of conflicting, uncertain evidence," says Trinquart. "Both the misuse of uncertainty and the exaggeration of certainty can shape the outcomes of public health decision-making processes."

The authors say the citation analysis method used in the study represents a new way of understanding the relationships between academic research papers and authors. In the future, the same method could be applied to other topics, including controversial issues such as e-cigarettes as well as topics on which there is greater agreement.

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Researchers reveal new links between heart hormones, obesity and diabetes

Natriuretic peptide receptors proposed as new target for metabolic disorders.

A new research study has revealed an important relationship between proteins secreted by the heart and obesity, glucose intolerance, and insulin resistance. The findings, published in Obesity, offer a new approach to treating metabolic disorders, including type 2 diabetes, by targeting the pathway that controls the proteins' concentration in the blood.

"Our results illustrate how the regulation of cardiac natriuretic peptides (NPs) is altered in obesity, insulin resistance, and type 2 diabetes," said study co-author Sheila Collins, Ph.D., professor in the Diabetes and Obesity Research Center at Sanford Burnham Prebys Medical Discovery Institute (SBP). "When we examined fat (adipose) tissue from patients with these metabolic conditions, we found higher levels of the receptor that clears NPs from circulation, suggesting that if we can boost NP levels and/or reduce the level of its clearance receptor, we may be able to correct some of these conditions."

The double life of NP hormones

NPs are hormones produced by the heart that are primarily known for their ability to influence blood pressure. When the heart senses elevated pressure, it releases NPs, which go to the kidneys, triggering the body to release salt and water from the bloodstream to lower blood pressure. NPs prompt the response to blood pressure by signaling through an active receptor (NPRA), and are removed from the blood by a clearance receptor (NPRC). Both receptors contribute to the level of NP activity.

Almost two decades ago, NP receptors were unexpectedly found in human adipose tissue, suggesting that NP levels may play an additional role in metabolism and obesity. Indeed, subsequent studies have shown that circulating NP levels are lower in obese individuals and those with metabolic risk factors, including high glucose levels. More recently, research has shown that obese individuals have higher levels of the clearance receptor in adipose tissue.

Study findings

"We examined levels of NPRA and NPRC in adipose and skeletal tissue in individuals with a range of body mass index (BMI) values and insulin sensitivity," said study co-author Richard Pratley, M.D., director of the Florida Hospital Diabetes Institute and senior scientist at the Florida Hospital-SBP Translational Research Institute for Metabolism and Diabetes (TRI). "We found that higher BMI values are associated with elevated levels of the clearance receptor in adipose tissue.

"We also looked at NP receptor levels in patients with type 2 diabetes after taking pioglitazone, a drug used to improve insulin sensitivity and control blood sugar in patients with type 2 diabetes. Interestingly, we found that these patients had a significant reduction in the level of the clearance receptor in adipose tissue, further reinforcing the link between NPs, insulin resistance, and obesity.

Next steps

"Overall, our results suggest that drugs that target the pathway(s) that lead to increased NP levels may be a new way to treat metabolic disorders, including obesity, insulin resistance, and potentially type 2 diabetes.

"Since we already have access to FDA-approved drugs to control blood sugar, and we know that these drugs impact NP levels, we may be able to redesign these drugs to specifically target other metabolic conditions including obesity," said Collins.

"This project is a great example of taking research from bench to beside, and highlights the strength of the partnership between SBP and TRI--a partnership that accelerates the delivery of lab discoveries to the clinic," added Pratley.

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Insulin Resistance: Causes, Symptoms and Prevention

An idea emerging from the fields of diabetology, cardiology and public health medicine, the science of insulin resistance has developed relatively recently.

It was not until the beginning of this millennium that insulin resistance and prediabetes began to receive heavy medical research focus.

There has been the terminology of insulin resistance syndrome, metabolic syndrome and even syndrome X, to denote the cluster of risk factors that is associated with insulin resistance.

By contrast, the classic urination and thirst of full diabetes have been understood since the 1600s, and the discoveries were made over a century ago for the roles of the pancreas and insulin in full diabetes.

Insulin resistance is now established as what lies behind the development of type 2 diabetes, but this is a bit more complex than it sounds. What is insulin resistance exactly, and why does it develop?

This page will look at the current understanding of insulin resistance and explain how it is a risk factor for both diabetes and other conditions. The article will also outline what can be done about it.

Fast facts on insulin resistance

Here are some key points about insulin resistance. More detail and supporting information is in the main article.

Insulin resistance is a "silent" risk factor alongside other risk factors for diabetes and cardiovascular problems Insulin resistance remains a problem when it is no longer silent but behind the raised blood sugar levels of type 2 diabetes The phenomenon is complex and has only relatively recently become better understood in the science of diabetes Insulin resistance itself does not present any signs or symptoms when it appears alone without the development of prediabetes or diabetes Blood sugar levels with insulin resistance alone are also normal The process is instead assumed to be a risk factor for people who are also obese or overweight, have hypertension or a history of diabetes in the family, among others in a "cluster" of diabetes and cardiovascular risk factors Insulin resistance alone is not treated, but prevention of the 5-year and 10-year risks can be achieved through lifestyle and medical measures.
What is insulin resistance? [heart and vessels diagram]
Diabetes shares some of the risk factors for cardiovascular disease.

Insulin resistance happens well before type 2 diabetes is diagnosed but it is still part of the full condition.1

It is a relatively new idea in medical science - insulin resistance is the phenomenon that is thought to raise the chances of developing prediabetes, the raised blood sugar level that can in turn eventually become high enough for type 2 diabetes to be diagnosed.2-5

There are estimates that around 15-30% of people with prediabetes go on to be diagnosed with full diabetes within 5 years, according to figures from the Centers for Disease Control and Prevention (CDC).6

The American Heart Association (AHA) highlights a longer outlook - the 10-year risk. They say that about half of people with high blood sugar go on to develop type 2 diabetes within a decade. But the AHA also point out that this means half of these people do not develop diabetes - "your choices make a difference."7

What the public health experts and specialist doctors mean by these statistics is that anyone with high blood sugar, insulin resistance, prediabetes, obesity or "metabolic syndrome" can reduce their future chances of developing full type 2 diabetes by taking some preventive steps.

These preventive steps, outlined on the next page, are a combination of lifestyle measures and medical help and monitoring that can reduce the established risks for diabetes. Not only that, but these steps can also reduce the risk of a range of other potential problems grouped under cardiovascular disease.

How does insulin resistance develop? While there have been the developments of the past 10-15 years, the question of how and why insulin resistance develops (the pathogenesis of it) remains complex and not fully understood.1,4 What is established is that people with risk factors, including genetic and lifestyle factors:1,4 Might develop a resistance to the effects of the hormone insulin, which is secreted from the pancreas Insulin is essential for the regulation of the glucose circulating in the blood - it induces glucose to be taken up by the cells Insulin is also the chemical messenger that signals to the liver to hold on to its glucose rather than release it into the blood (glucose is packaged up for liver storage in the form of glycogen) Insulin normally maintains a fine balance that is just right for the amount of energy we need at the right time, and so keeps a predictable blood sugar level at different times between eating and activity, never allowing the blood level to rise too much for too long However, resistance to the hormone can develop Resistance initially results in the pancreas simply secreting more insulin, however, to maintain safe blood glucose levels and keep symptoms at bay - this is the picture when insulin resistance is unaccompanied by additional illness However, insulin resistance can eventually be accompanied by the persistently higher glucose levels of prediabetes, and then the persistent hyperglycemia of full diabetes; the release of extra insulin cannot be maintained in compensation for the increasing insulin resistance. There is great complexity in how insulin resistance develops, and especially for why it develops, but the good news is that there are plenty of ideas about how to prevent it. And when type 2 has not been prevented, it can be managed. On the next page, we look at the signs of insulin resistance, associated risk factors and methods of prevention.
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Older mothers may face increased risk of stroke, heart attack

Having a baby at a later age has been linked to increased risk of complications for both mother and child. Now, a new study suggests there may be other downsides to a later pregnancy: having a baby aged 40 or older may increase the risk of heart attack, stroke and cardiovascular death later in life.
[A pregnant woman holding her back]
Researchers say women who have a later pregnancy should be aware of the cardiovascular risks.

Lead researcher Dr. Adnan I. Qureshi, director of the Zeenat Qureshi Stroke Institute in St. Cloud, MN, and colleagues say their findings are of great importance, given that more women are opting to have children after the age of 40.

A 2013 report from the Centers for Disease Control and Prevention (CDC) revealed that the pregnancy rate in the US for women aged 40-44 increased from 11 per 1,000 women in 1990 to 19 per 1,000 in 2009.

"We already knew that older women were more likely than younger women to experience health problems during their pregnancy," says Dr. Qureshi. "Now, we know that the consequences of that later pregnancy stretch years into the future."

To reach their findings - recently presented at the American Stroke Association's International Stroke Conference 2016 in Los Angeles, CA - the team analyzed data of 72,221 women aged 50-79 who were part of the Women's Health Initiative Study.

Of these women, 3,306 reported becoming pregnant at the age of 40 or older.

Rates of stroke, heart attack and death from cardiovascular diseases were assessed over a period of 12 years and compared between women who became pregnant aged 40 and older and those who had children at a younger age.

Compared with women who had a pregnancy at a younger age, those who became pregnant at the age of 40 or older were found to have a 1.4% higher risk of ischemic stroke and a 0.5% higher risk of hemorrhagic stroke.

Ischemic stroke - where blood flow to the brain is blocked - is the most common form of stroke, accounting for around 87% of all cases. Hemorrhagic stroke accounts for the remaining 13% of cases, occurring when a blood vessel in the brain ruptures and bleeds.

Fast facts about stroke

Each year, more than 795,000 people in the US have a stroke Around 610,000 of these are first-time strokes Stroke costs the US approximately $34 billion every year.

Learn more about stroke

Additionally, the researchers found that women who had a later pregnancy had a 0.5% greater risk for heart attack and a 1.6% greater risk of death from all forms of cardiovascular disease.

Other risk factors for cardiovascular disease - including high blood pressure, high cholesterol and diabetes - could account for the increased risks of ischemic stroke, heart attack and cardiovascular death among women with later pregnancies, according to the team.

However, they note that such risk factors were unable to explain the increased risk of hemorrhagic stroke among women with later pregnancies, suggesting that the link between the two warrants further investigation.

At present, later pregnancy is not considered a risk factor for cardiovascular problems. But Dr. Qureshi says their findings should make women aware of the possible increased risks they face and encourage them to take steps to improve their cardiovascular health.

"And their doctors need to remain vigilant years later in monitoring these women's risk factors through physical examination and, perhaps more tests and earlier interventions to prevent stroke and other cardiovascular events," he adds.

Earlier this month, Medical News Today reported on some good news for expectant mothers; a study suggested that eating chocolate daily during pregnancy may benefit fetal growth and development.

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Closing PFO "hole in the heart" may prevent strokes linked to this heart defect

Stroke survivors who also have patent foramen ovale (PFO), a hole in the heart, could benefit from a device that closes the PFO to help prevent future strokes, according to research presented at the American Stroke Association's International Stroke Conference 2016.

Researchers studied 980 stroke survivors, ages 18 to 60, who had strokes that were determined to be of unknown cause (cryptogenic) but had a PFO. A PFO results when a hole between the heart's chambers does not close at birth. It is thought that blood clots from a vein may travel through the PFO, block an artery in the brain and cause a stroke. Researchers implanted a PFO closure device in half the patients and prescribed blood thinning medications to the other half to determine which treatment might be better for preventing subsequent strokes.

In a long-term follow-up, researchers found:

Forty-two patients had recurrent strokes, including 18 in the group that received the device and 24 in the medicine group. 56 percent of the device group's recurrent strokes were cryptogenic and the remainder were unrelated to their PFO. 79 percent of the medication group's recurrent strokes were cryptogenic. The size and location of the recurrent strokes also tended to be different. Those without the device tended to have large strokes more often than those with the device, and they were more often on the edges of the brain than deep inside.

Researchers said the device can only prevent strokes related to PFO. PFO-related strokes tend not to have another cause, are larger and on the edge of the brain. There were fewer such strokes in the device group than in the medical group, lending support to the probability that the PFO device prevents PFO recurrences.

For any corrections of factual information, or to contact our editorial team, please see our contact page.

Please note: Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a health care professional. For more information, please read our terms of use.

Copyright Medical News Today: Excluding email/sharing services explicitly offered on this website, material published on Medical News Today may not be reproduced, or distributed without the prior written permission of Medilexicon International Ltd. Please contact us for further details.

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