Cardiovascular disease
Walkable neighbourhoods may pave the way to less cardiovascular risk.
Neighborhood walkability, a measure of how easy and safe it is to walk to reach resources for daily living, such as a grocery store, pharmacy, school, work and church, is associated with lower cardiovascular disease burden and risk, according to two preliminary studies to be presented at the American Heart Association’s Scientific Sessions 2022. The meeting, held in person in Chicago and virtually, Nov. 5-7, 2022, and is a premier global exchange of the latest scientific advancements, research and evidence-based clinical practice updates in cardiovascular science.
Cardiovascular disease is the number one cause of death in the U.S. and globally, according to the American Heart Association’s Heart Disease and Stroke Statistics—2022 Update. A key component for achieving optimal cardiovascular health and reducing cardiovascular risk is physical activity, and less than 1 in 4 U.S. adults have reported achieving the recommended amount of physical activity, according to the 2018 U.S. Department of Health and Human Services’ Physical Activity Guidelines for Americans. It recommends adults engage in at least 150 minutes a week of moderate-intensity activity or 75 minutes a week of vigorous-intensity aerobic physical activity for substantial health benefits. Physical activity is one of eight essential components of ideal heart and brain health, according to the American Heart Association’s 2022 Presidential Advisory, Life’s Essential 8.
“When a person’s environment is conducive to walking, there is a greater likelihood of engagement in physical activity such as walking,” explained Elizabeth A. Jackson, M.D., M.P.H., FAHA, past chair of the American Heart Association’s Committee on Social Determinants of Health. “Ample data support the cardiovascular benefits of regular physical activity including walking, therefore, designing neighborhoods to be walkable may assist residents in improving their cardiovascular health.”
Two new studies, by separate research groups, explored how more walkable neighborhoods may lower cardiovascular disease prevalence and cardiovascular disease risk.
Neighborhood walkability and cardiovascular risk in the United States (Abstract MP91)
In a nationwide study, more than 70,000 U.S. census tracts were analyzed to explore the potential association among neighborhood-level walkability and cardiovascular disease and cardiovascular disease risk factors.
“The way communities are designed is increasingly recognized to have an important role in cardiovascular disease and its risk factors,” said study lead author Issam Motairek, M.D., a research associate at the University Hospital Cleveland Medical Center in Cleveland. ”Walkability is a neighborhood metric reflecting how easy it is to walk in that neighborhood. Whether walking to stores, jobs or local parks, a walkable neighborhood encourages people to be more physically active and helps them stay healthy.”
Motairek and colleagues reviewed the Centers for Disease Control and Prevention’s (CDC) PLACES dataset, which tracks the prevalence in the U.S. of coronary artery disease and cardiovascular risk factors, such as high blood pressure, high cholesterol, obesity and Type 2 diabetes by census tract. Researchers matched the health information from the PLACES database with data from a census tract walkability index from the Environmental Protection Agency’s smart location database to categorize census tracts into four levels of walkability, from the least walkable to the most walkable.
The analysis found:
- Cardiovascular disease prevalence was notably lower, at 5.4%, in the most-walkable neighborhoods compared to 7% in the least-walkable neighborhoods.
- About 36% of adults living in the least-walkable neighborhoods had high blood pressure, high cholesterol or obesity, compared to about 30% in the most-walkable neighborhoods.
- Type 2 diabetes prevalence was 11.6% in the least-walkable neighborhoods compared to 10.6% in the most-walkable neighborhoods.
“Assessing walkability for each neighborhood from least-walkable to most-walkable, we found that even after considering other factors, such as sex, age, race and social vulnerability of the neighborhood, walkability alone, was associated with about a 0.1% decrease in cardiovascular disease for each one-point increase in walkability score,” Motairek said. “It’s important that public health officials consider the health implications of urban designs that encourage walkability.”
SIGNS THAT YOU HAVE A HEART DISEASE
OUR HEART PUMPS BLOOD NON-STOP 24/7 THROUGHOUT OUR LIVES. EVERY ORGAN DEPENDS ON THE HEART TO DELIVER FRESH OXYGENATED BLOOD TO THEM. THAT’S A LOT OF ACTIVITY AND PRESSURE. SO, WEAR AND TEAR IS BOUND TO HAPPEN, AND CERTAIN ACTIVITIES CAN CAUSE THE HEART TO FACE PROBLEMS AT SOME POINT OR THE OTHER. IN THIS VIDEO, WE WILL TALK ABOUT WHAT SIGNS AND SYMPTOMS THESE PROBLEMS MIGHT PRESENT WITH. THIS WILL HELP YOU BE MORE VIGILANT REGARDING HEART DISEASES AND IDENTIFY THEM EARLY ON.
More older adults should be checking blood pressure at home
Only around half of those who have hypertension or conditions linked to blood pressure regularly monitor, but health care providers’ recommendations increase older adults’ monitoring at home
Only 48% of people age 50 to 80 who take blood pressure medications or have a health condition that’s affected by hypertension regularly check their blood pressure at home or other places, a new study finds.
A somewhat higher number – but still only 62% — say a health care provider encouraged them to perform such checks. Poll respondents whose providers had recommended they check their blood pressure at home were three and a half times more likely to do so than those who didn’t recall getting such a recommendation.
The findings underscore the importance of exploring the reasons why at-risk patients aren’t checking their blood pressure, and why providers aren’t recommending they check — as well as finding ways to prompt more people with these health conditions to check their blood pressure regularly. This could play an important role in helping patients live longer and maintain heart and brain health, the study’s authors say.
Past research has shown that regular home monitoring can help with blood pressure control, and that better control can mean reduced risk of death; of cardiovascular events including strokes and heart attacks; and of cognitive impairment and dementia.
The findings are published in JAMA Network Open by a team from Michigan Medicine, the University of Michigan’s academic medical center. The data come from the National Poll on Healthy Aging and build on a report issued last year.
The poll, based at the U-M Institute for Healthcare Policy and Innovation and supported by Michigan Medicine and AARP, asked adults aged 50 to 80 about their chronic health conditions, blood pressure monitoring outside of clinic settings, and interactions with health providers about blood pressure. Study authors Mellanie V. Springer, M.D., M.S., of the Michigan Medicine Department of Neurology, and Deborah Levine, M.D., M.P.H., of the Department of Internal Medicine, worked with the NPHA team to develop the poll questions and analyze the findings.
The data in the new paper come from the 1,247 respondents who said they were either taking a medication to control their blood pressure or had a chronic health condition that requires blood pressure control – specifically, a history of stroke, coronary heart disease, congestive heart failure, diabetes, chronic kidney disease or hypertension.
Of them, 55% said they own a blood pressure monitor, though some said they don’t ever use it. Among those who do use it, there was wide variation in how often they checked their pressure – and only about half said they share their readings with a health provider. But those who own a monitor were more than 10 times more likely to check their blood pressure outside of health care settings than those who don’t own one.
The authors note that blood pressure monitoring is associated with lower blood pressure and is cost-effective. They say that the results suggest that protocols should be developed to educate patients about the importance of self blood pressure monitoring and sharing readings with clinicians.
Study finds higher complication rate after a heart attack in people with autoimmune disease
After a heart attack, people with an autoimmune disease were more likely to die, develop heart failure or have a second heart attack compared to people without an autoimmune disease, according to new research published today in the Journal of the American Heart Association, an open access, peer-reviewed journal of the American Heart Association.
Autoimmune diseases, such as rheumatoid arthritis, systemic lupus erythematosis and psoriasis, are known to increase risk of cardiovascular disease, likely due to multiple factors. People with an autoimmune disease have a higher prevalence of traditional cardiovascular risk factors (such as high blood pressure, Type 2 diabetes or kidney disease), in addition to aspects of autoimmune disease that are also linked to higher cardiovascular risk, such as chronic inflammation, autoimmune antibodies and long-term use of steroid medications. A new study examined whether having an autoimmune disease, compared to not having one, affects a person’s health status after a heart attack.
“The evidence about the risk of adverse events after heart attack for people with autoimmune disorders is less robust than evidence for people without these disorders, and mainly from small or single-center studies,” said Amgad Mentias, M.D., M.Sc., senior author of the study and an assistant professor of medicine at the Cleveland Clinic Lerner College of Medicine in Cleveland. “We conducted our study to examine, in a large cohort, whether there is any difference in the treatment of heart attack patients with versus without autoimmune diseases, and whether there is a difference in risk of death, heart failure or recurrent heart attacks over the long-term.”
The researchers identified 1,654,862 people in the U.S. ages 65 and older in the Medicare Provider Analysis and Review (MedPAR) File who were admitted to the hospital with a heart attack diagnosis between 2014 and 2019. MedPAR is a government database of every hospital inpatient bill in the U.S. submitted to Medicare for payment. Of those records, 3.6% (60,072) had an inflammation-causing autoimmune disease noted in their charts within the previous year. The most common condition was rheumatoid arthritis, followed by systemic lupus, psoriasis, systemic sclerosis and myositis/dermatomyositis. They found several important differences among people with vs. without autoimmune disease who had heart attacks:
- People with an auto immune disease were slightly younger – average age was 77.1 years vs. 77.6 years for those without an autoimmune disease.
- More of those with an autoimmune disease were women (66.9% vs. 44.2%).
- Those with autoimmune disease were more likely to have had a non-ST-elevation myocardial infarction (NSTEMI) heart attack (updated from 77.1 to 77.3) (77.3% vs. 74.9%), and they were less likely to have an ST-elevation myocardial infarction (STEMI) heart attack (18.7% vs. 22.1%).
An NSTEMI, the most common type of heart attack recorded in the database, is caused by partial blockage of one of the coronary arteries that feeds oxygen-rich blood to the heart muscle. A STEMI heart attack, usually more dangerous, is from a complete blockage of one or more of the heart’s main arteries.
The researchers matched each heart attack patient record with autoimmune disease to records of three heart attack patients without autoimmune disease based on age, sex, race and type of heart attack. After matching (and excluding people who had not been enrolled in Medicare for at least one year prior to their heart attack), the investigators compared health outcomes for about 2 years. The final dataset included 59,820 heart attack records of people with an autoimmune disorder and 178,547 of those without an autoimmune disorder.
The analysis found that people with an autoimmune disease were:
- 15% more likely to die from any cause;
- 12% more likely to be hospitalized for heart failure;
- 8% more likely to have another heart attack; and
- 6% more likely to have an additional artery-opening procedure (if they had received one at the time of their heart attack).
“Patients with autoimmune disease and cardiovascular disorders are preferably managed by a cardio rheumatologist in conjunction with a rheumatologist to optimize cardiovascular health. Traditional CVD risk factors are accentuated in this population and how these risk factors manifest is also unique,” said lead study author Heba Wassif, M.D., M.P.H., an assistant professor of medicine at the Cleveland Clinic Lerner College of Medicine and director of cardio-rheumatology at the Cleveland Clinic.
“For example, cholesterol levels are affected by inflammation, therefore patients with active inflammatory disease have lower levels of cholesterol, a phenomenon known as the lipid paradox,” Wassif said. “Physical activity, which is highly recommended to improve cardiovascular outcomes, may be limited by joint pain. Furthermore, some disease modifying agents may increase cardiovascular risk. Knowledge of these nuances and a team-based approach may improve outcomes.”
The researchers also found that people with an autoimmune disease were less likely to have heart catheterization to assess narrowed coronary arteries or to undergo an artery-opening procedure or bypass surgery regardless of the type of heart attack.
“It is possible that the people with an autoimmune disease were not healthy enough to undergo those procedures, or their coronary anatomy was less amenable to interventions to reopen narrowed or clogged vessels,” Mentias said. These issues may place them at higher risk of procedure-related complications. “When feasible, however, if someone is a suitable candidate, these procedures should be considered as options. The presence of autoimmune disease by itself should not preclude someone from potentially life-saving procedures.”
The researchers did not have information on the anatomy of patients’ coronary arteries, which limited the ability to assess whether anatomical differences may have influenced decision-making about vessel-opening procedures. The analysis is also limited by not having laboratory data on the severity and activity of patients’ autoimmune disease, making it impossible for the researchers to assess whether the risk of complications and death following heart attack is higher in patients with severe forms of autoimmune disease compared with those who have a milder form or disease in remission.
“Future research is needed on medications and interventions that might reduce the heightened risk for poor outcomes in heart attack patients with autoimmune disease,” Wassif said, “such as investigating whether different immune modulators and immune-suppressant therapies used to control and treat the autoimmune disease have any impact in improving post-heart-attack outcomes.”