Wood Street Clinic Blog

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Apple- or pear-shaped? Your answer may affect your heart disease risk

Are you an apple or a pear? New research being presented at the American College of Cardiology 2016 Scientific Session in Chicago, IL, adds to the evidence that where you carry your weight is more likely than weight or body mass index to tell you whether you will have heart disease.
[man measuring waist]
Fat around the waist appears to indicate a risk of heart disease.

Any form of obesity can put pressure on the heart, and studies have associated weight gain with left ventricular function problems.

People who are apple-shaped, carrying their weight around the abdomen, appear to be at greater risk than those who are pear-shaped, whose excess fat gathers around the hips.

Apple-shaped bodies have been linked with metabolic syndrome, which involves high blood pressure, high sugar levels, high cholesterol, coronary heart disease and heart failure.

People with diabetes tend to have an elevated risk of heart disease.

One in three people will have cardiovascular disease at some point, and about a third of them will die from a heart attack or similar event without ever receiving a diagnosis of heart disease.

Researchers from Intermountain Medical Center Heart Institute in Salt Lake City, UT, and Johns Hopkins University in Baltimore, MD, examined data for 200 men and women with type 1 or type 2 diabetes who did not have symptoms of coronary disease.

The participants underwent computed tomography (CT) screenings and echocardiography to assess the function of their left ventricle, the chamber of the heart responsible for pumping oxygen-rich blood to the brain and the body.

Dysfunction of the left ventricle results in blood backing up into the lungs and lower extremities. This exacerbates the risk of sudden cardiac arrest and heart failure.

Regardless of total body weight and body mass index (BMI), abdominal obesity appears to be a strong predictor of regional left ventricular dysfunction, a common cause of heart disease, including congestive heart failure.

Brent Muhlestein, co-director of research at the Intermountain Medical Center Heart Institute, says:

"This study confirms that having an apple-shaped body, or a high waist circumference, can lead to heart disease, and that reducing your waist size can reduce your risks."

In a prior study called faCTor-64, the same team studied patients with diabetes who were considered at high risk for heart attacks, strokes or death but who had no apparent symptoms of heart disease.

The researchers screened participants for coronary artery disease using CT coronary angiography. Based on the results, they gave patients advice about whether to change their care or their lifestyles or to continue routine standard diabetes care.

A follow-up to track any adverse heart events suggested that a higher BMI correlates with an increased risk of heart disease.

Principal investigator, Dr. Boaz D. Rosen, of Johns Hopkins, says that more research will be needed to confirm the findings of the present study.

Recent research published by Medical News Today suggests that women who have endometriosis may have a greater risk of heart disease.

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Immunology: An alternative route to inflammation

Using a combination of newly developed methods, researchers led by Ludwig-Maximilians-Universitaet (LMU) in Munich immunologist Veit Hornung have defined a previously unknown pathway that triggers inflammation.

The immune system in vertebrates is capable of distinguishing "self" from "non-self" components, which enables recognition and destruction of invasive pathogens and aberrant cell types such as tumor cells. Adaptive immune reactions, e.g. based on antibodies, are powerful and highly specific, yet require tedious and time-consuming gene rearrangements. For effective immediate defense, intruders must be detected rapidly, and this task is performed by the so-called innate immune system. Innate immune cells express a relatively small set of receptors on their surfaces, which recognize molecular structures that are uniquely associated with pathogens. Binding of these structures triggers an inflammatory response that kills the pathogen or the infected cell. In order to analyze the signal pathways that mediate these processes, researchers led by Veit Hornung, who holds the Chair of Immunobiochemistry at LMU's Gene Center, combined two different methodologies. They first utilized a novel cell culture system that mimics the function of monocytes, a class of immune cells involved in regulating inflammation. Then they systematically deleted single genes to determine their role in initiation of the inflammatory response - and uncovered a previously unknown signaling pathway. The findings appear in the journal Immunity .

Hornung and his group began their study of a protein complex called the NLRP3 inflammasome at Bonn University Hospital before he moved to the LMU in October 2015. This complex is found in monocytes, and plays a key role in inducing inflammation, as well as being implicated in diseases associated with chronic inflammatory reactions, such as gout, Type 2 diabetes and arteriosclerosis. However, our knowledge of its mode of action is primarily based on studies carried out in mouse cells. In mouse monocytes, two stimuli are required to cause the NLRP3 inflammasome to trigger secretion of the pro-inflammatory signal protein interleukin 1beta (IL-1), while freshly isolated human monocytes were found to produce IL-1 in response to a single signal, which acts via a receptor called TLR4. However, no established human monocyte-like cell lines react to this signal. This is why Hornung and his colleagues had to employ the new human monocyte-like cell line in order to understand the basis for the species difference.

"We developed a procedure which allowed us to specifically delete single genes in cultured human immune cells that closely resemble human monocytes. Using this system, we were able to identify, at the genetic level, the components responsible for signal transmission to, and activation of the NLRP3 inflammasome," explains Moritz Gaidt, a doctoral student in Hornung's group and first author of the new study. In this way, the team was able to analyze the secretion of IL-1 by human monocytes in unprecedented detail - and to define the mechanism that enables human NLRP3 to be activated in response to a single signal.

The researchers activated the TLR4 receptor by exposing their monocytes to bacterial lipopolysaccharide (LPS) - a complex molecule made up of sugars and fats, which is found on the surface of many pathogenic bacteria. They then showed that binding of LPS triggers the secretion of IL-1 via a previously unrecognized signal relay. "The activation of this new pathway explains why human monocytes do not need a second signal to secrete IL-1. Conversely, in mouse monocytes this particular pathway is not activated, so a second stimulus is required," Veit Hornung explains. Moreover, while inflammasome activation in the mouse induces programmed inflammatory cell death, the pathway used in human monocytes does not. "We refer to this signal pathway as the alternative inflammasome, in order to distinguish it from previously described pathways," says Hornung. "We believe that this signal pathway plays a critical role in inflammatory processes in humans."

The new study underlines the fact that results obtained in mice are not always translatable to humans. So far, only human monocytes have been found to react directly to contact with LPS by releasing interleukin 1, without the need for a second signal. The researchers now intend to analyze the in-vivo function of the TLR4 receptor in other model organisms. Using Hornung's monocyte-like cells, it should be possible to identify further signal pathways in vitro. "Our results refute some of the classical tenets of inflammasome research. We hope that our new method will also enhance our understanding of the cell biological basis of immune disorders," Hornung concludes.

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Minimally invasive mitral valve surgery offers viable option for select heart patients

First multi-institutional study shows mini-MVR patients experienced shorter hospital stays, fewer blood transfusions.

Patients undergoing minimally invasive mitral valve repair or replacement (mini-MVR) have similar outcomes as patients undergoing conventional surgery and also experience shorter hospital stays and fewer blood transfusions, according to an article posted online by The Annals of Thoracic Surgery.

MVR is a common treatment for mitral valve disease, including mitral stenosis (when the valve doesn't allow enough blood flow) and mitral regurgitation (when blood leaks backwards out of the valve).

"Our research is the first multi-institutional study of patients undergoing mini-MVR as compared to traditional surgery," said Emily A. Downs from the University of Virginia in Charlottesville, who led the study. "We believe our results are important as they may facilitate further adoption of mini-MVR and provide patients with more options when faced with surgery."

Dr. Downs, Gorav Ailawadi, MD, and researchers from a statewide consortium of 18 hospitals in the Virginia Cardiac Surgery Quality Initiative examined records for 1,304 patients who underwent isolated MVR from 2011 to 2014. This included 425 (32.6%) who underwent mini-MVR.

During traditional MVR, a cardiothoracic surgeon makes a 6- to 8-inch long incision down the center of the sternum (breastbone) to open the chest and provide direct access to the heart. In mini-MVR, the surgeon makes a 2- to 3-inch incision between the ribs on the right chest.

The researchers found that patients undergoing mini-MVR had similar rates of mortality, stroke (in contrast to previous research), and other complications compared with conventional MVR. They also found that mini-MVR patients experienced shorter intensive care unit and hospital lengths of stay, as well as fewer blood transfusions. Total hospital costs were similar between the two groups, despite previous assumptions by the researchers that mini-MVR might lead to higher costs.

"In our experience, mini-MVR is suitable for many patients and is particularly useful in both elderly patients with mobility issues and in young, healthy patients who desire quicker recovery and return to work," said Dr. Ailawadi. "Patients who are not ideal candidates for mini-MVR include those with severe mitral annular calcification, right ventricular dysfunction, or considerable aortic calcification."

Adoption of mini-MVR has been slow; however, procedural volume is expected to increase as more results on outcomes and costs become available.

"Mini-MVR may not be appropriate for all centers, surgeons, or patients; however, it should be an essential approach to consider in the armamentarium of an advanced mitral valve center," said Dr. Ailawadi.

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Study: fertility treatments do not increase cardiovascular deaths in women

Women undergoing fertility treatment are not at greater risk for future cardiovascular complications or death, according to a new study by Ben-Gurion University of the Negev (BGU) and Soroka University Medical Center.

The study was recently presented at the 36th Society for Maternal-Fetal Medicine (SMFM) in Atlanta, Georgia and has just been accepted for publication in the American Journal of Perinatology.

In the United States, fertility treatments account for about 1.5 percent of 3.9 million annual births, according to the Society for Assisted Reproductive Technology. In Israel, 8,123 pregnancies in 2010 were the result of IVF treatment, according to the Israel Health Ministry.

"Now these women can relax and not worry about any cardiovascular implications from their treatment," says Prof. Eyal Sheiner of BGU's Department of Obstetrics and Gynecology, Faculty of Health Sciences.

"It's important to note that IVF effects on health is disputed in medical literature and it's difficult to publish results that show there is no difference between women who undergo IVF and women who don't. But at the same time, because of the risks to women undergoing fertility treatment, our study was chosen to be presented at the recent SMFM conference," Sheiner explains.

The population-based, long-term study included close to 100,000 patients over a 25-year period who had delivered babies from 1998 to 2013. In the study, 2,976 women had received medication to stimulate ovulation, known as "ovulation induction." Additionally, 1,177 women had IVF treatments, which involves removing a woman's egg and fertilizing it with sperm in a laboratory. In the study, these 4,153 women receiving fertility therapies were compared to 95,138 women who had successfully given birth without fertility treatments.

After comparing rates of cardiac events such as angina and congestive heart failure with cardiac-related hospitalization and procedures frequency, BGU researchers concluded that fertility treatments did not put women at added risk for heart problems.

Other researchers that participated in the study include Prof. Ilana Shoham-Vardi and Mr. Ruslan Sergienko of BGU's Department of Public Health, as well as Dr. Djaoui Ben-Yaakov, M.D. and Dr. Roy Kessous, M.D. of BGU's Department of Obstetrics and Gynecology.

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Statin use differs among Hispanic adults at risk for heart disease

In the United States, adults of different Hispanic/Latinobackgrounds, at high risk for heart disease, varied significantly in their use of widely-prescribed cholesterol-lowering medications known as statins, according to new research in the Journal of the American Heart Association. The difference was based on whether or not they had health insurance.

"These findings have important implications for preventing disparities in cardiovascular outcomes within the growing U.S. Hispanic/Latino population," said study lead author Dima M. Qato, Pharm.D., M.P.H., Ph.D., assistant professor of pharmacy systems, outcomes and policy at the University of Illinois in Chicago. "Efforts to increase the use of statins, particularly targeting individuals that have already suffered a heart attack or stroke, should include expanding health insurance for all Hispanic/Latino adults that currently lack coverage, regardless of their heritage."

In one of the first studies to document differences in the use of statins and aspirin among diverse Hispanic/Latino populations in the United States, investigators found statin use was highest among high-risk study participants of Puerto-Rican heritage at 33 percent followed by those of Dominican heritage at 28 percent. The range was 22 percent for participants of Cuban and South American heritage and lowest among those of Central American backgrounds at 20 percent. However, lacking health insurance was associated with a lower likelihood of statin use in all groups.

Results were from 4,139 patients at high risk for heart disease enrolled in the larger Hispanic Community Health Study/Study of Latinos, in the Bronx, New York; Chicago, Illinois; Miami, Florida; and San Diego, California between March 2008 and June 2011. All participants (average age 52, about half women) were at high risk for heart disease, defined in the study as ever having had a heart attack, stroke, or diabetes. At enrollment, participants underwent medical examinations and answered questionnaires about medication use and heart disease history.

Overall, researchers noted that one-fourth of study participants took statins and less than half (44 percent) took aspirin. The use of aspirin (available over-the-counter without a prescription) was comparable among all Hispanic/Latino groups.

"Efforts to improve statin prescribing in patients likely to benefit are particularly important in patients with history of heart disease," Qato said. "Healthcare providers and policy makers should be aware of the role of insurance in the underuse of preventative cardiovascular medications in specific Hispanic/Latino populations."

Heart disease is the No. 1 killer for all Americans and stroke is the fifth leading cause of death. Hispanics and Latinos, however, face even higher risks of cardiovascular diseases because ofhigh blood pressure, obesity and diabetes. Lifestyle changes outlined in the American Heart Association's Life's Simple 7® - controlling cholesterol, managing blood pressure and blood sugar, getting active, eating better, losing weight, and quitting smoking - can help lower these risks. But when lifestyle changes are not enough, medication also may be necessary.

Co-authors are Todd A. Lee, Pharm.D, Ph.D.; Ramon Durazo-Arvizu, Ph.D.; Donghong Wu, M.S.; Jocelyn Wilder, M.P.H.; Samantha A. Reina, M.S.; Jianwen Cai, Ph.D.; Franklin Gonzalez II, M.S.; Gregory A Talavera, M.D., M.P.H.; Robert Ostfeld, M.D., M.S. and Martha L. Daviglus M.D., Ph.D.

The National Heart, Lung, and Blood Institute; National Institute on Minority Health and Health Disparities; National Institute on Deafness and Other Communication Disorders; National Institute of Dental and Craniofacial Research; National Institute of Diabetes and Digestive and Kidney Diseases; National Institute of Neurological Disorders and Stroke and the NIH Institution-Office of Dietary Supplements supported the study.

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Gene transfer shows promise for treating heart failure

Use of intracoronary gene transfer among heart failure patients resulted in increased left ventricular function beyond standard heart failure therapy, according to a study published online by JAMA Cardiology.

Heart failure affects more than 28 million patients worldwide and is the only cardiovascular disease that is increasing in prevalence. Despite improvement in drug and device therapy, hospitalization rates and mortality have changed little in the past decade; new therapies are needed. The use of gene transfer for heart failure has rarely been tested in randomized clinical trials.

Gene transfer is a process by which genes are introduced into cells and the cells then produce the specific protein that the gene directs, in the case for this study, a protein known as adenylyl cyclase type 6 (AC6). The gene is carried into the heart cells by a modified virus (adenovirus [Ad5]). Preclinical studies have shown benefits of increased cardiac AC6 content on heart muscle cells. The amount and function of AC6 are reduced in failing hearts.

H. Kirk Hammond, M.D., of the Veterans Affairs San Diego Healthcare System, San Diego, and colleagues randomly assigned 56 patients with symptomatic heart failure and an ejection fraction (EF; a measure of how well the left ventricle of the heart pumps with each contraction) of 40 percent or less to receive 1 of 5 doses of intracoronary (via the coronary artery) adenovirus 5 encoding adenylyl cyclase 6 (Ad5.hAC6) or placebo, and were monitored for up to 1 year.

The researchers found that AC6 gene transfer provided a dose-related beneficial effect on cardiac function. Among the results, two end points showed significant between-group differences: (1) AC6 gene transfer increased left ventricular (LV) peak pressure decline; and (2) AC6 gene transfer increased EF in participants with nonischemic heart failure.

Heart failure admission rate was 9.5 percent in participants who received AC6 and 29 percent in those who received placebo. The rates of serious adverse events were similar in both groups.

"AC6 gene transfer safely increased LV function beyond optimal heart failure therapy through a single administration. Larger trials are warranted to assess the safety and efficacy of AC6 gene transfer for patients with heart failure," the authors write.

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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Endometriosis may raise women's heart disease risk

Women's risk for heart disease may be increased if they have endometriosis. This is the conclusion of a new study published in the journal Circulation: Cardiovascular Quality and Outcomes.
[A woman with period pains]
Researchers suggest women with endometriosis - particularly younger women - may be at greater risk for heart disease.

The research was led by Fan Mu, who was a research assistant at Brigham and Women's Hospital and Harvard Medical School in Boston, MA, at the time of study.

Endometriosis is a condition in which the tissue that normally lines the uterus grows on the outside of the reproductive organ or other areas of the body, including the ovaries and the fallopian tubes.

In the US, it is estimated that at least 11% of women - or 6 million - aged 15-44 have endometriosis, with the condition most common among those in their 30s and 40s.

While painful menstrual cramps can be a sign of endometriosis, many girls and women are unaware of this, meaning the condition often goes undiagnosed.

Mu and colleagues set out to investigate whether women with endometriosis are at greater risk for heart disease - the leading cause of death for both men and women in the US.

The team analyzed the health records of 116,430 women who were part of the Nurses' Health Study II. Through surgical examination, endometriosis was diagnosed in 11,903 women over 20 years of follow-up.

Fast facts about endometriosis

Other than pain, symptoms of endometriosis include bleeding or spotting between periods, digestive problems and infertility The exact causes of endometriosis are unclear However, researchers believe it is most likely caused by the displacement of tissue that is shed during menstruation.

Learn more about endometriosis

The researchers found that women with endometriosis were 1.91 times more likely to develop chest pain, or angina, 1.52 times more likely to have a heart attack and 1.35 times more likely to require surgery or stenting to open blocked arteries, compared with women free of endometriosis.

Furthermore, women under the age of 40 who had endometriosis were found to be at three times greater risk for all three conditions, compared with women of the same age group who did not have endometriosis.

The findings remained even after accounting for use of oral contraceptives, hormone replacement therapy and numerous other factors that may influence heart disease risk, according to the researchers.

They note that the large study size and length of follow-up strengthen the findings. However, they were unable to account for other hormonal treatments and note that including women with suspected endometriosis that was not confirmed with surgery had no effect on the results.

The team admits that surgical treatment for endometriosis - which can include removal of the uterus or ovaries - may partly explain the increased risks identified; surgically induced menopause may raise heart disease risk, and this greater risk may be stronger for women of a younger age group.

Still, Mu says the findings suggest that women with endometriosis should be aware they may be at greater risk for heart disease, especially when younger.

Senior study author Stacey Missmer, director of epidemiologic research in reproductive medicine at Brigham and Women's Hospital, adds:

"It is important for women with endometriosis - even young women - to adopt heart-healthy lifestyle habits, be screened by their doctors for heart disease, and be familiar with symptoms because heart disease remains the primary cause of death in women."

Medical News Today recently reported on a study suggesting women's heart health may be overlooked by doctors.

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Clinical decision tool may help predict risks of dual antiplatelet therapy following coronary stent placement

In a study published online by JAMA, Robert W. Yeh, M.D., M.Sc., of Beth Israel Deaconess Medical Center, Boston, and colleagues conducted a study to identify factors that would predict whether the expected benefit of reduced ischemia would outweigh the expected increase in bleeding associated with continued dual antiplatelet therapy (aspirin plus thienopyridine) more than one year after coronary stent placement.

Dual antiplatelet therapy after percutaneous coronary intervention (PCI; commonly known as coronary angioplasty, a non-surgical procedure used to open narrow or blocked coronary arteries) reduces ischemia (inadequate blood supply to an area due to blockage of blood vessels leading to that area) but increases risk of bleeding. It remains unclear which patients are at high risk for late ischemic events and may thus benefit most from longer-term dual antiplatelet therapy vs those who are at high risk for late bleeding events and may be harmed.

Among 11,648 randomized DAPT (Dual Antiplatelet Therapy) Study patients from 11 countries, a prediction rule was derived stratifying patients into groups to distinguish ischemic and bleeding risk 12 to 30 months after PCI. The clinical prediction score was validated among 8,136 patients from 36 countries randomized in the PROTECT (Patient Related Outcomes With Endeavor vs Cypher Stenting) trial.

After adding or subtracting points for patients for factors such as heart attack at presentation, prior heart attack or PCI; diabetes; smoking; and older age, the researchers developed a clinical prediction score that showed modest accuracy assessing ischemic and bleeding risks.

"Use of this prediction score should be cautious until further validation is performed, and optimal clinical and procedural care to reduce overall bleeding and ischemic risks should be practiced independent of score," the authors write.

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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Wearable defibrillator may be an alternative to ICD for some patients

A wearable automatic defibrillator may be an option for patients who are at risk for life-threatening heart rhythm abnormalities but are not good candidates for an implantable cardiac defibrillator (ICD), according to an advisory from the American Heart Association, published in its Circulation journal.

The light-weight device is worn under street clothes, and, like an ICD, it is designed to provide around-the-clock monitoring of erratic heart rhythms that could result in sudden cardiac death, and when appropriate, provide an electric shock to return the heart to a normal rhythm.

This is the American Heart Association's first science advisory on wearable defibrillators. Heart rhythm abnormalities, which can increase the risk of sudden cardiac death, are common in people who have recently had a heart attack, undergone procedures to open blocked blood vessels or have cardiomyopathies, which are diseases of the heart muscle.

"For many of these patients, the risk for life-threatening rhythm abnormalities may be temporary, so the wearable cardiac defibrillator could be a short-term alternative to an ICD, which is permanently implanted in patient's chest," said Jonathan Paul Piccini, M.D., lead author of the advisory and a cardiac electrophysiologist at Duke University Medical Center in Durham, North Carolina.

Other patients who might benefit from a wearable cardiac defibrillator are those who have life-threatening arrhythmias who are in need of an ICD but may not be able to undergo the surgery to implant the device because they have an infection or another contraindication for surgery.

Heart failure patients waiting for a heart transplant may also be candidates for the wearable cardiac defibrillator, particularly if the wait until transplant is expected to be short.

The advisory also notes that there is very little evidence to support systematic use of the wearable defibrillator and randomized clinical trials (like the VEST trial) are needed to determine if wearable defibrillators lead to improved outcomes.

"Although a growing number of patients are being prescribed wearable cardiac defibrillators by their doctors, there have been very few well-designed and completed studies of these devices. Wide spread use of the wearable defibrillator is not advisable because there isn't enough clinical evidence to support its use, except in a small number of patients with known life-threatening arrhythmias but for whom surgery to implant an ICD is not advised in the short-term," said Piccini.

The wearable defibrillator, which resembles a fishing vest with defibrillator electrodes, can be adjusted to fit most body types, and if prescribed by a physician, is usually covered by insurance. If the wearable defibrillator detects a life-threatening heart rhythm problem it emits an alarm and vibrates. If the wearer feels normal, they must respond within one minute by pressing a button to indicate they don't need to be shocked. If they don't respond, the wearable defibrillator delivers a shock through electrodes that attach to a patient's chest to help the heart's rhythm return to normal.

"Unfortunately, patients often find the wearable defibrillator uncomfortable," Piccini said, adding that this is likely to change as the technology improves.

"As with most new medical technologies, biomedical engineers are working to make them smaller, more lightweight and less burdensome. One company is already developing a self-contained system in a large, self-adhesive plastic bandage that a wearer just sticks on their chest," Piccini said.

In the meantime, larger, randomized and controlled clinical trials of the wearable defibrillator and similar technologies are critically needed before they are used widely in clinical practice, he said.

Sudden cardiac death is caused by a malfunction in the heart's electrical system that disrupts its rhythm and suddenly causes the heart to stop beating. It's not the same as a heart attack, which is caused when blood is blocked from flowing into the heart, damaging heart muscle.

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All-out sprints may do more harm than good

An active lifestyle may be a healthy lifestyle, but some more extreme forms of workout are best left to those who are already fit, according to new research in the journal of The Federation of American Societies for Experimental Biology (FASEB) Journal.
[A man jumping]
Work out to keep fit, but build up gradually.

Whether it is the desire for a "super-lean body" or the lure of burning calories quickly - some researchers have claimed that a person "can burn an extra 200 calories per day by putting in only 2.5 minutes of work" - high-intensity "sprint training" has been gaining popularity at gyms.

Intense exercise training can stimulate the growth of mitochondria and increase the body's capacity to use oxygen, enhancing cardiovascular fitness and strength and keeping cardiovascular disease and obesity at bay.

However, working out without short-term preparation, such as warming up, or long-term preparation, such as building up intensity over time, can cause damage to the body.

Canadian and European researchers, led by Robert Boushel, director of the University of British Columbia's School of Kinesiology in Canada, analyzed tissue samples from 12 male volunteers in Sweden.

All the participants were healthy but described themselves as either untrained or only moderately active.

The men took part in high-intensity training over a 2-week period. The exercise regimen involved repeated 30-second all-out sprints, followed by rest periods.

The researchers observed signs of stress in the muscle tissues of the participants after carrying out ultra-intense leg and arm cycling exercises.

Tests showed that their mitochondria, the "powerhouse of cells," were only functioning at half their capacity after training, reducing their ability to consume oxygen and to defend against damage from free radicals.

Free radicals are molecules that can modify DNA and cause harm to healthy cells. High levels of free radicals appear to be a risk factor for a range of medical conditions, including premature aging, organ damage and cancer.

Boushel says the findings raise questions about what constitutes appropriate dosage and intensity of exercise for the average individual. He urges caution when encouraging the general population to participate in sprint training.

Boushel explains that experienced and well-trained athletes accumulate antioxidant enzymes in their bodies, and these offer protection against free radicals.

For beginners, however, he recommends starting slowly and building up intensity over time. Exercise should also take place under the eye of a trained professional or kinesiologist.

He warns:

"If you're new to going to the gym, participating in high-intensity sprint classes may increase your performance but might not be healthy for you."

The potential long-term adverse effects of high-intensity sprint training are unknown, but ongoing studies are looking at different levels of exercise and evaluating quantities and intensity of training against different biomarkers for health.

Medical News Today reported last year that aerobic exercise does not offset the health effects of obesity.

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Same symptoms, different care for women and men with heart disease

Despite messages to the contrary, most women being seen by a doctor for the first time with suspected heart disease actually experience the same classic symptoms as men, notably chest pain and shortness of breath, according to a study led by the Duke Clinical Research Institute.

But other differences between the sexes are evident in the diagnosis and risk assessment for coronary artery disease, according to findings published online March 23 in the Journal of American College of Cardiology--Cardiovascular Imaging. The study will also be reported at the American College of Cardiology's 65th Annual Scientific Session.

"Our findings suggest there might be need for heart-health resources specifically aimed at women, because much of what is provided is for men, and there are significant sex-based differences," said lead author Kshipra Hemal of the Duke Clinical Research Institute.

In one of the largest studies of its kind enrolling patients with suspected coronary heart diseases but without a prior history of the condition, Hemal and colleagues compared the experiences of more than 10,000 patients, evenly split between women and men, in the Prospective Multicenter Imaging Study for Evaluation of Chest Pain (or PROMISE).

The Duke-led research team found that women have more risk factors for heart disease than men. But women are typically assessed to have lower risk. In addition, commonly used predictor models exclude issues such as depression, sedentary lifestyle and family history of early heart disease, which women report more often than men.

Women are also more likely to be referred for imaging stress tests compared to men, particularly nuclear stress testing, but they are less likely to have a positive test.

Seventy-three percent of women and 72 percent of men complained of chest pain when presenting to their physicians with suspected heart disease. Men were more likely to characterize their chest pain as a dull ache or a burning sensation, while women most often described their pain as crushing pressure or tightness.

Women were also more likely than men to have back, neck or jaw pain, and palpitations as the primary presenting symptoms, whereas men were more likely to have fatigue and weakness, although such symptoms were unusual in both sexes as the primary complaint.

Women were more likely than men to be taking beta blockers and diuretics; men were more likely than women to be taking angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers, statins, and aspirin.

"Previous studies have compared differences in demographics, risk factors, and symptom profile between men and women, but most of these focused on patients with an existing diagnosis of heart disease," said senior author Pamela Douglas, M.D., the Ursula Geller Professor for Research in Cardiovascular Disease at Duke University School of Medicine and member of the Duke Clinical Research Institute.

"Our study is the largest of its kind looking at patients with stable chest pain or other symptoms suggestive of coronary artery disease, which is a much more common occurrence," Douglas said. "Establishing a diagnosis is arguably more difficult among these patients. Our findings should help clarify that there are differences between men and women that we need to take into account."

Heart Disease Risk Factors Weigh Differently for Men, Women
Despite messages to the contrary, most women being seen by a doctor for the first time with suspected heart disease actually experience the same classic symptoms as men, notably chest pain and shortness of breath, according to a study led by the Duke Clinical Research Institute.
Credit: Mark Dubowski for Duke Health
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Digital mammography can help predict heart disease

Mammography could help predict heart disease in women by detecting signs of calcium in the arteries of the breast. This could make early treatment possible, with potential benefits, especially for young women.
[woman and heart disease]
Women who have calcifications in the breast arteries are likely to have calcification in the coronary arteries too.

The findings are being presented at the American College of Cardiology's 65th Annual Scientific Session in Chicago, IL, and will also be published in JACC: Cardiovascular Imaging.

Heart disease causes 22.4% of deaths among women in the US; cancer, particularly breast cancer, is responsible for 21.5% of fatalities. According to the Centers for Disease Control and Prevention (CDC), these are two leading causes of death among women in the US.

Around 37 million mammograms a year take place in the US. The American Cancer Society recommend yearly mammography for women aged 40-54 years and those at high risk for breast cancer, and every 2 years for those aged 55 years and older.

Digital mammography, used in 96% of mammography units in the US, can detect calcifications. This information could help to indicate how much calcium is building up in the coronary arteries too.

Coronary arterial calcification (CAC) is a very early sign of cardiovascular disease (CVD), and previous research has associated CAC with breast arterial calcification and atherosclerotic disease, heart attack, stroke and other cardiovascular conditions.

Breast arterial calcification correlates with CAC

Current findings suggest that breast arterial calcification could be an equal or stronger indicator of future heart disease than high cholesterol, high blood pressure and diabetes.

Fast facts about women and heart disease

Heart disease killed 292,188 American women in 2009 64% of women who died of heart disease have no prior symptoms Heart disease affects 7.6% of black women, 5.8% of white women and 5.6% of Mexican American women.

Learn more about heart disease

Dr. Harvey Hecht, professor at the Icahn School of Medicine at Mount Sinai in New York City, NY, and director of cardiovascular imaging at Mount Sinai St. Luke's Hospital, and colleagues compared data for 292 women who underwent mammography and a non-contrast computed tomography (CT) scan of the chest within 1 year. None of the participants had a previous diagnosis of CVD.

Breast arterial calcification and CAC were both evaluated on scales from 0-12, where 12 was the highest.

Results showed that 124 women, or 42.5% of the participants, showed signs of breast arterial calcification, and 70% of these women also had CAC, while 63% of those whose CT scan showed CAC also had breast arterial calcification.

Half of the women aged under 60 years had both CAC and breast arterial calcification. In younger women with breast arterial calcification, 83% had CAC.

CAC was more likely in older women with high blood pressure and chronic kidney disease, but results indicate that in those with breast arterial calcification, CAC is three times more likely.

When evaluated against the Framingham Risk Score and the 2013 Cholesterol Guidelines Pooled Cohort Equations, outcomes were similar, but when researchers included 33 asymptomatic women with CAD, the tool appeared to be a more effective indicator than the others.

The findings suggest that subclinical atherosclerosis may predict the risk of heart disease more effectively than other risk factors.

Call for reporting of calcification levels alongside breast cancer results

One benefit of using mammography to predict heart disease is that each screening provides a readily available score without extra cost or intervention. Such reporting would enable patients and physicians to start working on prevention, maybe by taking a statin, say the authors.

Dr. Hecht says:

"Many women, especially young women, don't know the health of their coronary arteries. Based on our data, if a mammogram shows breast arterial calcifications, it can be a red flag, an 'aha' moment, that there is a strong possibility she also has plaque in her coronary arteries."

The researchers point out that atherosclerosis in breast arterial calcification is different from those in CAC, and they do not yet know how they are related. The team calls for further research to validate the findings. A study involving 39,000 subjects is currently underway in the Netherlands.

Hecht urges clinicians to start reporting the presence and amount of breast arterial calcification on a regular basis.

In an accompanying editorial due to appear in JACC: Cardiovascular Imaging, Dr. Khurram Nasir and John McEvoy, from the Center for Healthcare Advancement and Outcomes at Baptist Health South Florida, say the research "provides impetus to document breast arterial calcification in mammography reports, to improve education of primary care and radiology providers on the link with heart disease, and other actions to establish best practices for incorporating this research into care."

Medical News Today recently reported on research suggesting that heart disease is falling in the US, but that disparities across states are growing.

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Serious heart attacks affecting younger people

Serious heart attacks are affecting younger and more obese individuals, and rates of high blood pressure, diabetes and chronic obstructive pulmonary disease remain elevated, according to findings due to be presented at the American College of Cardiology's 65th Annual Scientific Session in Chicago, IL.
[man holding chest]
Smoking and other lifestyle factors continue to jeopardize heart health.

Factors that increase the risk of heart attack include age and family history, which are beyond the individual's control.

However, heart health can also depend on dietary habits, exercise and smoking, lifestyle choices that are within the individual's control.

Awareness of cardiovascular disease has increased dramatically in recent years, and people are more aware than ever of the need to address preventable causes.

ST-elevation myocardial infarction, or STEMI, is the most severe and deadly type of heart attack, which occurs when one of the heart's main arteries becomes completely blocked by plaque, stopping the flow of blood. The risk of death and disability is high.

According to the American Heart Association (AHA), STEMI can be treated with clot-busting medications, effective if used within 30 minutes of the attack, or percutaneous coronary intervention (PCI), a mechanical method for opening the arteries.

PCI must be performed within 90 minutes, but in 2013, only 39% of hospitals had the capability to deliver this, and many people in rural areas will not be able to access it.

Average STEMI patients younger and more obese

In the current study, researchers, led by Dr. Samir Kapadia, professor of medicine and section head for interventional cardiology at Cleveland Clinic, examined the risk factors for heart disease in patients who were treated for STEMI at the Clinic.

Fast facts about heart attack

Every 43 seconds, someone dies of a heart attack in the US Heart attacks kill around 735,000 Americans a year 1 in 5 heart attacks are "silent": there is damage, but the person does not know it happened.

Learn more about heart attack

The scientists apportioned over 3,900 STEMI patients from 1995-2014 into four quartiles of 5 years each.

The average age of STEMI patients fell from 64 to 60 years. Rates of obesity among these patients rose from 31% to 40%, of diabetes from 24% to 31%, of high blood pressure from 55% to 77%, and the percentage of patients with chronic obstructive pulmonary disease (COPD) went up from 5% to 12%.

All of the changes are significant and in keeping with national trends.

Meanwhile, the proportion of smokers in this population rose from 28% to 46%, despite an overall decline nationwide over the last 2 decades.

In addition, the percentage of patients with three or more major risk factors rose from 65% to 85%.

The authors say these are "strong messages" for health care professionals and the public.

Prevention must remain key

Dr. Kapadia calls for primary care practice to stay focused on prevention. Not only the cardiologist but also primary care physicians and patients must "take ownership of this problem," he says.

Dr. Kapadia adds:

"On the whole, the medical community has done an outstanding job of improving treatments for heart disease, but this study shows that we have to do better on the prevention side. When people come for routine checkups, it is critical to stress the importance of reducing risk factors through weight reduction, eating a healthy diet and being physically active."

The authors urge patients to start early on a heart-healthy lifestyle, with appropriate levels of exercise and healthy dietary choices, rather than waiting until a heart problem is diagnosed.

Limitations include the fact that because a relatively high number of patients were transported to the hospital by helicopter from rural areas, the trends may not be applicable to the wider population. However, the authors do not believe this factor makes a significant difference.

Medical News Today reported recently on the need to recognize symptoms more quickly.

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Signs of stress in the brain may signal future heart trouble

Study uses imaging to gain a first look into the mechanisms behind stress response and CV risk.

New research shows that individuals with a greater degree of activity in the stress center of the brain also have more evidence of inflammation in their arteries and were at higher risk for cardiovascular events, including heart attack, stroke and death, according to a study scheduled for presentation at the American College of Cardiology's 65th Annual Scientific Session.

While there has been mounting evidence of the strong link between stress and heart disease, relatively little is understood about the mechanisms behind this stress response and what might put someone at risk for cardiovascular disease. This is the first study to use medical imaging to show a possible association between biochemical activity in the brain and arterial inflammation. Arterial inflammation is a key component of atherosclerotic disease - the buildup of plaque in the artery walls that restricts blood flow through the body and is highly predictive of future cardiovascular events and stroke.

"Our study illuminates, for the first time, a relationship between activation of neural tissues - those associated with fear and stress - and subsequent heart disease events," said Ahmed Tawakol, M.D., co-director of the cardiac MR PET CT program at Massachusetts General Hospital and co-author of the study. "There is a need to develop greater knowledge in terms of the mechanism that translates stress into cardiovascular disease risk, given the prevalence and potency of stress as a risk factor."

Data show the more activity occurring in the amygdala - the stress center of the brain - the more inflammation patients had in their arteries and the greater the likelihood of having cardiovascular events. There was also a corresponding activation of the bone marrow. Bone marrow releases immune cells called monocytes that can trigger inflammation in other parts of the body.

Researchers examined PET/CT scans for 293 patients (average age of 55 years) who originally received the test between 2005 and 2008 for cancer evaluation but were found to be free of active disease. The scans allowed researchers to objectively measure activity in regions of the brain, as well as the bone marrow and arteries. Patients were excluded if they had evidence of cancer, established cardiovascular disease or were younger than 30 years old. An hour before the scan, patients were injected with a radioactive atom attached to a glucose molecule as a tracer; tissues that were more active would metabolize more of the glucose and glow more brightly on the scan. A radiologist who had no knowledge of the patient's history or identifying characteristics measured the images. Activity in the amygdala was compared to other regions in the brain. Researchers then grouped patients based on the relative magnitude of brain stress activity.

After correcting for age, gender and other cardiovascular risk factors using the Framingham Risk Score, there was a 14-fold greater risk of cardiovascular events for every unit increase in measured brain stress activity. Over the approximately five-year study period, 35 percent of the patients in the high stress center activity group later suffered a cardiovascular event, compared to just 5 percent of the low stress center activity group.

The researchers further observed that activation of the brain's fear centers, bone marrow activation and arterial inflammation may together contribute to a mechanism that provokes cardiovascular events. Tawakol said this points to the need for future studies to test whether interrupting this mechanism reduces the burden of cardiovascular disease associated with stress.

"Over the past several years, it's become clear that stress is not only a result of adversity but may itself also be an important cause of disease. The risks of heart disease linked to stress is on par with that for smoking, high blood pressure, high cholesterol and diabetes, yet relatively little is done to address this risk compared to other risk factors," Tawakol said. "We are hopeful studies like this bring us closer to understanding how stress may lead to heart disease."

While researchers were able to objectively measure stress activity in the brain, the retrospective nature of the study meant that they could not compare it to subjective measures of patients' stress levels. Additionally, the patient population is limited to individuals who received PET/CT scans to screen for cancer.

Still, Tawakol said the study findings prompt the question of whether treating stress and reducing the activation of the fear center of the brain may lead to less atherosclerotic inflammation and, ultimately, reduce cardiovascular events. Larger prospective studies are needed.

The study, "Greater Activity of the Brain's Emotional Stress Center Associates With Arterial Inflammation and Predicts Subsequent CVD Events," will be presented on April 4, 2016, at 10 a.m. CT/11 a.m. ET/4 p.m. UTC at the American College of Cardiology's 65th Annual Scientific Session in Chicago. The meeting runs April 2-4.

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Daytime sleepiness could predict metabolic disease

If you take long naps or feel particularly sleepy during the day, you could be on the way to developing high blood pressure, high cholesterol, excess fat around the waist and high blood sugar, all of which increase the risk of heart disease. These symptoms are collectively known as metabolic syndrome.
A short nap may be healthy, but sleeping longer than 30 minutes may mean problems are on the way.

These are the findings of research being presented at the American College of Cardiology's (ACC's) 65th Annual Scientific Session in Chicago, IL.

Sleep is important for health, and statistics suggest that many people do not get enough sleep. The Centers for Disease Control and Prevention (CDC) estimate that over 25% of people in the US lack sleep, and that 10% experience chronic insomnia.

In 2015, Dr. Tomohide Yamada, PhD, a diabetologist at the University of Tokyo in Japan, and colleagues produced evidence linking naps of 60 minutes or more to an 82% increase in cardiovascular disease and a 27% greater risk of all-cause mortality.

They also demonstrated that the risk of diabetes was 46% higher among those who napped for longer than 1 hour - and 56% higher among those who felt excessively tired.

However, the likelihood of each condition dipped when people napped for less than 30 minutes.

Steep rise in metabolic syndrome in those who nap for over 40 minutes

In the current study, Dr. Yamada led a meta-analysis of 21 studies involving 307,237 participants from Asia and the West.

They collected data about daytime sleepiness and napping through questions such as, "Do you have a problem with sleepiness during the day?" or "Do you take a daytime nap?" or "Do you sleep during the day?"

They compared the responses with the subjects' history of metabolic syndrome, type 2 diabetes and obesity.

A J-shaped relationship emerged between napping and metabolic syndrome risk. People who spent less than 40 minutes napping had no increased risk for metabolic syndrome, but beyond 40 minutes, the odds increased sharply.

Napping for 90 minutes correlated with a 50% higher chance of metabolic syndrome, as did excessive daytime tiredness. Napping for less than 30 minutes appeared to decrease the risk.

No relationship has emerged between time spent napping and obesity, although obesity is linked to diabetes and metabolic syndrome.

Dr. Yamada says:

"Sleep is an important component of our healthy lifestyle, as well as diet and exercise. Short naps might have a beneficial effect on our health, but we don't yet know the strength of that effect or the mechanism by which it works."

Further study needed

The researchers call for further studies to confirm the findings and to gain a better understanding of how sleep habits influence metabolic syndrome and cardiovascular disease.

They suggest focusing on how short naps could improve cardiovascular health and on the interaction between long naps, daytime sleepiness and metabolic syndrome.

They hope that in future, napping habits could help predict other health problems.

Limitations include the fact that the subjects were not representative of the global population and that napping times were self-reported. The authors propose measuring sleep time in a lab or with a sleep tracker.

The National Sleep Foundation suggest that naps of 20-30 minutes can improve alertness without leading to further tiredness.

Medical News Today has previously reported that waking early on working days may increase the risk of metabolic disease.

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Depression after heart disease diagnosis tied to heart attack, death

Data prompts researchers to call for more discussions and screening around depression.

New research shows patients with a history of chest discomfort due to coronary artery disease - a build up of plaque in the heart's arteries - who are subsequently diagnosed with depression are much more likely to suffer a heart attack or die compared with those who are not depressed. The study, scheduled for presentation at the American College of Cardiology's 65th Annual Scientific Session, additionally showed that nearly 1 in 5 people with coronary artery disease (CAD) in the study were identified as being depressed.

These results are in line with previous research showing that depression is associated with worse outcomes after a heart attack or bypass surgery. But this is the first large population study to look at how a new diagnosis of depression might affect people with coronary heart disease, according to researchers.

The study included 22,917 patients from 19 medical centers in Ontario, Canada, who received a diagnosis of stable coronary artery disease following coronary angiogram for chest pain (chronic stable angina) between Oct. 1, 2008, and Sept. 30, 2013. Individuals with CAD who were found to be depressed were 83 percent more likely to die of any cause compared with those with the same condition who were not depressed during follow-up (average of three years). They were also 36 percent more likely to present at a hospital having a heart attack during the same time period. Depression did not, however, impact the likelihood of needing bypass surgery or coronary stent placements.

"Patients who develop depression after being diagnosed with heart disease have a much worse prognosis," said Natalie Szpakowski, M.D., an internal medicine resident at the University of Toronto and lead author of the study. "Our findings suggest that these patients may need to be screened for mood disorders, whether it's by their family doctor or cardiologist."

She said that because there was no interval of time within which these patients were more likely to develop depression, any screening should be done at regular intervals of time to avoid missed opportunities to intervene.

Patients diagnosed with depression were more likely to be women and report more severe chest pain based on a validated angina scale. Other factors that predicted depression included smoking, diabetes or having a greater number of co-existing medical conditions.

"This is consistent with the literature in that women are more prone to depression, whether it's due to sex hormones or social roles we don't fully know," Szpakowski said. "Other studies have also found that more severe chest pain has been linked to depression, and we know people with more medical illnesses are more susceptible to being depressed."

To be included in this study, patients had to show evidence of more than 70 percent narrowing in the arteries of the heart and more than 50 percent in the left main coronary artery. Researchers excluded patients if they had a history of depression or ever had a heart attack, other cardiac event requiring hospitalization, bypass surgery or a stent placed. Physician billing codes and hospital admissions were used to determine new diagnoses of major depression. Data was collected for all-cause mortality and time to readmission for heart attack and revascularization, and analyses controlled for other cardiovascular risk factors.

"Based on these findings, there may be an opportunity to improve outcomes in people with coronary heart disease by screening for and treating mood disorders, but this needs to be further studied," Szpakowski said. "Stable chronic angina due to narrowing of the coronary arteries is common, and our findings show that many of these patients struggle with depression. Our follow-up was at most five years, so many more might be affected."

Szpakowski said she cautions that the study design may have captured patients with psychosocial distress in addition to major depressive disorder. She said this could have diluted the findings, meaning that the impact of depression on outcomes could be even stronger in patients with true depression. The research is also restricted to patients who had a coronary angiogram, who may have had more severe disease or symptoms.

Additional studies are needed to evaluate the utility of screening for and treating depression in this population. The study was funded by the Canadian Institute of Health Research and the Sunnybrook Health Sciences Centre.

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Women's heart health: is it being ignored?

Women visiting their doctor are less likely to be advised regarding heart health and more likely to be told to lose weight, according to a recent study that will be presented at the upcoming American College of Cardiology's 65th Annual Scientific Session.
[Woman doctor holding a heart]
Are women being given the right advice about heart disease?

Although heart disease tends to strike women 7-10 years later than men, it is still a leading cause of death.

The risk of heart disease is often underestimated because of a misconception that women are somehow "protected" from heart disease.

In fact, over the last 20 years, the number of myocardial infarctions in 35-54-year-olds has increased in women but decreased in men.

Among women aged 35-44, the rates of coronary heart disease rose 1.3% each year between 1997-2002.

A new study carried out by the Barbra Streisand Women's Heart Center at Cedars-Sinai Heart Institute in California delves into some of the issues underlying this worrying trend.

Study lead Dr. C. Noel Bairey Merz says:

"Women's heart awareness has stalled, despite almost three decades of campaigning by numerous women's heart health advocacy groups. We wanted to understand what the roadblocks were and why women and their physicians were not taking action to monitor their heart health."

Anyone who displays risk factors for heart disease, according to medical guidelines, should receive frequent cholesterol and blood pressure checks. They should also be given advice on stopping smoking and information regarding healthy lifestyle changes.

Women's cardiac health awareness

The team carried out questionnaire research to uncover whether this help and counseling was indeed being provided to women in the same way that it is for men.

GfK KnowledgePanel, a group who organize national polls, set up an Internet survey. The questionnaire was answered by more than 1,000 women across a full range of socioeconomic strata, races and geographical regions. The researchers designed a set of questions asking about any care or advice they had received regarding heart disease while visiting the doctors.

The survey found that 74% of the respondents displayed at least one risk factor for heart disease, including irregular menstruation, a family history of heart disease, diabetes and high blood cholesterol.

Just 16% of respondents had been told by their doctor that heart disease could be a risk, but 34% had been told to lose weight.

The women found to be least aware of the dangers of heart disease and its key symptoms were those from lower socioeconomic groups, younger women and non-whites.

Dr. Bairey Merz is concerned about the findings:

"Women feel stigmatized. They are most often told to lose weight rather than have their blood pressure and blood cholesterol checked.

If women don't think they're going to get heart disease, and they're being told by society and their doctors that everything would be fine if they just lost weight, that explains the paradox of why women aren't going in for the recommended heart checks. Who wants to be told to lose weight?"

The findings suggest that, although obesity is a risk factor for heart disease, by solely concentrating on this one facet of women's health, their chances of receiving the appropriate monitoring and counseling is reduced.

75% of women do not discuss heart disease

Although this study focused purely on women, other research has shown that men in similar circumstances are more likely to get heart health advice and are less commonly advised to lose weight.

The findings fit neatly alongside research carried out in 2015 by the same team. The previous work asked cardiologists and primary care physicians about how they advise female patients with risk factors for heart disease.

Dr. Bairey Merz says that the earlier findings confirmed that physicians "seem to prioritize weight loss over pretty much everything else." The recent study also found that more than 75% of women do not discuss heart disease, perhaps partly due to the stigma surrounding weight.

The team believes that evidence-based communication to help dispel the stigma surrounding weight and improve knowledge about heart disease risk factors will be key to altering these concerning patterns.

Medical News Today recently covered research pinpointing a gene that increases the risk of heart attack in women.

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Statewide initiative associated with improved cardiac arrest outcomes

Bystander CPR and defibrillation increased for cardiac arrests at home and in public.

Statewide efforts to equip family members and the general public with the know-how and skills to use cardiopulmonary resuscitation (CPR) and automated external defibrillators (AEDs) in the home or in public coincide with improved survival and reduced brain injury in people with sudden cardiac arrest. The data, collected over a five-year period, is scheduled for presentation at the American College of Cardiology's 65th Annual Scientific Session.

The statewide program, part of the HeartRescue Project, trained family members and bystanders to recognize the signs of sudden cardiac arrest, quickly call emergency responders, and use CPR or AEDs. The study is the first to separately track the effects of such interventions on cardiac arrests in public places and private homes.

"Survival is notoriously worse in private homes, where the majority of cardiac arrests occur. Little is known about whether broader efforts to teach people to recognize cardiac arrest and act quickly also impact home cardiac arrests, where the bystander is typically a family member," said Christopher B. Fordyce, M.D., co-chief fellow at the Duke Clinical Research Institute and lead author of the study. "What's interesting about this study is it's the first time a statewide intervention has improved both public and residential cardiac arrest outcomes."

The researchers analyzed 8,269 cases of cardiac arrest between 2010 and 2014 collected from the North Carolina Cardiac Arrest Registry to Enhance Survival. In 2010, bystanders administered CPR in 61 percent of public cases and 28.3 percent of in-home cases. In 2014, the rate of bystander CPR rose to 70.6 percent of public cases and 41.3 percent of in-home cases. The rate of AED use in private homes by non-EMS first responders (police, firefighters, etc.) also rose from 42.2 to 50.8 percent over the same period. There was not a statistically significant increase in non-EMS first responder AED use in public places, which Fordyce attributes to timely defibrillation by EMS.

While the researchers did not directly compare survival rates and neurological outcomes with whether individual patients received bystander CPR or defibrillation, they did find increases in both over the duration of the study. The rate at which cardiac arrest patients survived until their discharge from the hospital rose from 10.8 to 16.8 percent for public cardiac arrests and from 5.7 to 8.1 percent for cardiac arrests in the home. The rate at which patients only suffered minor losses in brain function or regained it fully increased from 4.9 to 6.1 percent at home and from 9.5 to 14.7 percent in public.

"The absolute rates are small, but the relative changes were pretty large," Fordyce said. "That's only over five years, so if we continue to educate the public, we can continue to improve outcomes."

Prior studies have shown a correlation between bystander-initiated CPR and survival rates for cardiac arrests that occur outside a hospital. A 2015 study of the same HeartRescue Project initiatives in North Carolina, published in the Journal of the American Medical Association, showed that survival rates for out-of-hospital cardiac arrests more than doubled when bystanders used both CPR and an AED before emergency medical services arrived.

The area from which the cases of cardiac arrests were drawn is a collection of urban, suburban and rural counties that account for approximately a quarter of North Carolina's population but included all EMS agencies. Thus, the researchers were able to analyze every cardiac arrest in the sample area from 2010 to 2014.

There are more than 420,000 out-of-hospital cardiac arrests in the United States each year, according to the American Heart Association. Fordyce said the results of this study were encouraging, but considering how low the absolute survival rates are, there is still room for improvement. Future research in this area could include interventions such as deploying AEDs into more private homes when cardiac arrests occur and using mobile technology to notify nearby citizens trained in CPR who can initiate this care quickly.

There are several resources related to CPR and AED training available from the American College of Cardiology at CardioSmart and from the HeartRescue Project.

"You can do something," Fordyce said. "You don't have to just call 911 and stand while your loved one is on the floor. Start chest compressions immediately. Your actions actually make a difference."

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Digital health tool helps cardiac rehab patients shed more pounds

Study shows smartphone app, Web portal help patients adhere to diet, exercise plans post-heart attack.

Adding a digital health tool to traditional cardiac rehabilitation appears to help people recovering from a heart attack lose significantly more weight in a relatively short period of time, according to research scheduled for presentation at the American College of Cardiology's 65th Annual Scientific Session.

In fact, patients using specially designed health tools on their smartphones and through a Web-based portal lost four times as much weight compared with those undergoing 12 weeks of cardiac rehabilitation alone. This randomized controlled trial is the first in the U.S. to look at how adding the use of mobile and wireless devices concurrently with cardiac rehab might improve health outcomes, according to researchers.

"We were surprised by the magnitude of difference between the two groups," said Robert Jay Widmer, M.D., Ph.D., of the Mayo Foundation for Medical Education and Research, and lead author of the study. "These results are exciting because they demonstrate improvement in cardiovascular risk factors over and above guideline-based cardiac rehabilitation."

While the actual weight loss observed in this study was small - an average of 2 pounds in the cardiac rehab group compared with 9 pounds in the digital health intervention group - experts say every bit matters for these patients as previous research has shown that people who lose weight tend to have fewer cardiac events in the future.

Widmer said the trend in weight loss in the intervention group is likely explained, in part, by significantly improved dietary habits and frequent reporting via the program. These patients also exercised for an average of 40 more minutes a week, a difference that was not statistically significant.

The study included 80 patients - 68 years old, on average - who were eligible to take part in cardiac rehab at Mayo Clinic following acute coronary syndrome, including heart attack and unstable angina. Patients were randomly assigned to usual care or cardiac rehab coupled with a digital health intervention that included semi-weekly educational messages, videos and articles with accompanying quizzes about heart healthy lifestyles, tips and platforms to track and log exercise and dietary habits. Researchers collected participants' weight and dietary habits at baseline and after 90 days.

Study participants attended 30- to 90-minute cardiac rehab sessions, focused mainly on exercise, three times per week. Those in the intervention group were asked to log in twice a week to record their exercise and dietary habits and retrieve educational information on healthy lifestyles, but many did so daily.

Instead of using commercially available mobile health solutions, cardiologists at Mayo Clinic compiled information and recommendations typically given during cardiac rehab to help patients strengthen their heart health and improve cardiovascular risk factors to prevent subsequent events. They then partnered with Mayo Clinic's Information Technology department to incorporate it into an app and Web-based program that patients could use remotely.

"It's an example of how clinical expertise and know-how can be married with IT, which is important especially amid consumers' rapid uptake of apps," Widmer said. "It may be that these patients felt more connected to their care, as if someone had a finger on their pulse, figuratively."

The health tool essentially functions as an extension of a patients' heart team, helping to hold them accountable for eating right and staying active outside of the clinic. Overall, it seems that by adding digital health tools, there is a trend toward better adherence to recommendations.

"With the poor rates of adherence to cardiac rehabilitation and increasing use of mobile/digital technologies, it is plausible that digital health and mHealth could offer a proven preventative solution to help patients with cardiovascular disease," Widmer said. "The integration of technology into the clinical practice has the potential to affect rehospitalizations of these patients too."

Cardiac rehab programs - long recommended by the American College of Cardiology and other groups - are offered in many hospitals and medical centers in the U.S. and elsewhere. These 12-week programs are tailored to the individual patient to help lower the risk of future heart problems. Cardiac rehab includes a mix of supervised exercise, nutrition counseling, stress management, smoking cessation assistance and education about the disease process, including how heart patients can take control of their own health and improve their outcomes.

This study is limited in that it is a single center trial with only 80 patients who had to have access to the Internet. In addition, any trials that use digital health platforms need to keep pace with advancing technologies, Widmer said.

Larger clinical trials are needed to further validate these findings, and to determine the sustainability of the results.

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Missed opportunities to avoid painful shocks by deactivating ICD's in final days of life

Many patients who have a common medical device known as an implantable cardioverter defibrillator (ICD) are unaware that the device can be deactivated to prevent painful shocks in their final days of life, according to two studies scheduled for presentation at the American College of Cardiology's 65th Annual Scientific Session.

The Heart Rhythm Society and the European Society of Cardiology have issued recommendations encouraging physicians to inform patients about the benefits of deactivating an ICD when death is near, yet recent studies show that up to 31 percent of people with an ICD receive shocks in their last day of life. Two new studies add further evidence that doctors are not consistently implementing these recommendations, which the authors said may reflect a reticence to engage in difficult discussions about end-of-life decisions.

"When you reach the stage of palliative care, sometimes the ICD doesn't have a role in caregiving anymore," said Dilek Yilmaz, M.D., a Ph.D. fellow in cardiology at the Heart and Lung Center of Leiden University Medical Center in the Netherlands and lead author of one of the studies. "If a person is dying of a terminal cancer, for example, the ICD is not going to prolong their life, but it is fairly likely to cause pain in their last hours and prevent them from having a peaceful death."

ICDs are battery-powered, surgically implanted devices used to prevent sudden death in people with certain conditions, such as sustained ventricular tachycardia or fibrillation, that put them at risk for life-threatening heart rhythms. If the device detects a dangerous heart rhythm, it issues a shock to restore a normal heartbeat. ICDs are extremely common, with 10,000 implanted each month in the United States alone, according to the American Heart Association.

The device can be deactivated using a computer in any cardiologist's office, with no need for additional surgical intervention. Because ICDs do not maintain the heart rhythm on an ongoing basis like a pacemaker does, deactivating the device does not actively hasten death. However, if a patient experiences a dangerous heart rhythm - a common occurrence during the natural course of death from any cause - a deactivated ICD will not intervene to rescue the patient.

"These shocks are often much more frequent on the patient's last day than any other day of their life," said Silvia del Castillo, M.D., a cardiologist at Hospital Universitario de Fuenlabrada in Madrid and lead author of the second study. "I think it's cruel in many cases to leave the ICD on until the very end, and when doctors don't provide enough information about deactivation or delay that conversation until the final hours, it undercuts the patient's right to make their own decisions."

The two studies, conducted independently in the Netherlands and in Spain, revealed similar patterns. Study authors said the situation in the United States is likely to be similar, as well.

For the study conducted in Spain, del Castillo and her colleagues surveyed 243 patients with ICDs during clinic visits at three Spanish hospitals. While most respondents showed a high level of understanding about what an ICD is and what it does, far fewer demonstrated a clear understanding of the option to deactivate the ICD or what would happen if it were to be deactivated. Sixty-eight percent assumed shocks were inevitable in the presence of an abnormal heart rhythm, and 21 percent incorrectly believed that deactivation would lead to immediate cardiac arrest. Just 38 percent were aware that they could decide to deactivate their ICD after consulting with their doctor, and only 37 percent knew that ICD deactivation is ethically appropriate and recommended by major scientific societies.

In the study conducted in the Netherlands, Yilmaz and her colleagues surveyed 328 patients with ICDs during a patient educational symposium. Although 73 percent were aware that their ICD could be deactivated, just 12 percent had consulted with their doctors about the matter. Neither of the studies revealed trends in terms of factors such as gender or level of education playing a role.

Both study authors attribute the findings to communication gaps and cultural challenges around end-of-life planning.

"As doctors, we are focused on healing the patient and saving lives," del Castillo said. "It's hard to talk about death and to explain that this therapy that can save their life now could be harmful to them later. Because we have a hard time talking to patients about this, in the end doctors often make the decision about ICD deactivation alone or with the family, instead of with the person who should be the real decision-maker, the patient."

The best time to begin the conversation about ICD deactivation, according to the studies' authors, is around the time when the ICD is being implanted, which is often many years before a patient's death. Then it can be mentioned again during follow-up visits or when someone receives a terminal diagnosis.

"These shocks are painful for the patient and also painful for their family to witness," Yilmaz said. "As a doctor, if you don't even discuss it with your patient, you could be denying them the opportunity for a peaceful death."

Because many people spend their final days in hospice or under the care of a medical team that does not include their cardiologist, there is often no opportunity to deactivate an ICD before death unless the patient or the patient's family has previously been made aware of that option and decides to actively pursue it. This context underscores the need for cardiologists to inform patients of the option of deactivation and its benefits early on, the researchers said.

del Castillo's study was funded by the Víctor Grifols i Lucas Foundation. The Leiden University Medical Center Department of Cardiology receives unrestricted research and fellowship grants from Medtronic, Biotronik and Boston Scientific.

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