Cardiovascular disease

Posted on Cardiovascular disease

Secondhand smoke linked to higher odds of heart failure


Breathing in secondhand cigarette smoke may leave you more vulnerable to heart failure, a condition where the heart isn’t pumping as well as it should and has a hard time meeting the body’s needs, according to a study being presented at the American College of Cardiology’s 70th Annual Scientific Session.

The data showed that nonsmokers with recent exposure to secondhand smoke had a 35% increased odds of developing heart failure compared with those who hadn’t been around tobacco. The association between tobacco exposure and heart failure remained, even after controlling for other factors known to heighten the risk for heart failure such as a history of other heart conditions, high cholesterol and diabetes.

While previous studies have demonstrated the impact of secondhand smoke exposure on people with existing heart failure–for example, on outcomes such as mortality, quality of life and exercise tolerance–this is the first to show an association between tobacco exposure and developing heart failure.

“It adds to overwhelming evidence that secondhand smoke is harmful,” said Travis Skipina, MD, resident physician in the department of internal medicine at the Wake Forest School of Medicine and the study’s lead author. “[Secondhand smoke] has been associated with stroke and heart attacks, but what really hadn’t been reported before was its association with heart failure, which is a very debilitating and costly disease.”

The analysis included 11,219 participants from the U.S. Third National Health and Nutrition Examination (NHANES) survey who reported being nonsmokers. Participants in this NHANES cohort were followed from 1988-1994. They were 48 years old on average, just over half were women (55.9%) and most (70.5%) were white. Nearly 1 out of 5 had evidence of secondhand smoke exposure.

The association of secondhand smoke and heart failure was stronger in men (compared with women) and among those who had reported a prior heart attack or stroke. The findings were similar across other subgroups, including different ethnic/racial groups and individuals with obesity and diabetes.

“For whatever reason, in males, the impact of secondhand smoke appears to be more likely to put them at risk of heart failure,” Skipina said. “Males, in general, tend to get [cardiovascular] disease at a younger age and overall, they were younger, so that may be why they were predisposed.”

Skipina and his colleagues defined secondhand smoke as having a serum cotinine level ?1ng/mL, the recommended cutoff for heavy exposure used by the Centers for Disease Control and Prevention. Serum cotinine is a metabolite of nicotine that is used to measure levels of smoke exposure and usually signifies that someone has been breathing in tobacco smoke in the environment within the last one to two days (half-life of 18-20 hours). To assess dose-response, cut-off points of serum cotinine ?3ng/mL and ?6ng/mL were also used. Whether someone had heart failure was defined as answering “yes” to the survey question, “Has a doctor ever told you that you have congestive heart failure?”

Because this is a cross sectional study, it only gives a snapshot in time and cannot establish cause and effect. It is also based on an older data set. Still, Skipina said the association of secondhand smoke exposure with prevalent heart failure persisted even in a contemporary comparison of 3,796 participants followed between 2003-2006, which comes after many public smoking efforts had taken effect.

“Even with the decrease in background secondhand smoke exposure, it was still found to have a positive association with heart failure,” Skipina said. “Active and secondhand smoke induces a proinflammatory state, and higher levels of inflammation affects all body tissues, and it can lead to maladaptive changes in the heart structure and damage to the blood vessels.”

More research is needed to unravel the link between secondhand smoke, especially with the advent of vaping, and heart failure. Still, Skipina said the findings are a reminder for people who have heart failure or are at high risk of developing it that “they should be aware that secondhand smoke exposure may play a role.” He notes this is even more relevant for lower income communities and countries where rates of tobacco use are often much higher and stringent health policies are less likely to be in place and/or enforced.

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Posted on Cardiovascular disease, Diabetes, Exercise

Study finds obese people with pattern of later waking and peak activity later in day at higher risk of type 2 diabetes and cardiovascular disease

People who experience disrupted 24-hour cycles of rest and activity are more likely to have mood disorders


New research presented at this year’s European Congress on Obesity (held online, 10-13 May) shows that people living with obesity with the so called ‘evening chronotype’ – that is, a pattern of later waking and peak activity later in the day – have a higher risk of developing type 2 diabetes (T2D) and cardiovascular disease (CVD) than those who both wake and have their peak activity levels earlier (morning or intermediate chronotypes). The study is by Dr Giovanna Muscogiuri, Assistant Professor in Endocrinology at University Federico II, Naples, Italy, and colleagues.

This study (carried out at University Federico II, Naples) compared people living with obesity with morning chronotype (MC), evening chronotype (EC) and intermediate chronotype (IC). Previous studies have shown that people with EC have disruptions to their body clock (known as circadian rhythm) that can alter their metabolic processes, due to over-activation of the hypothalamus-pituitary-adrenal axis, which is a collection of linked body systems that control our reaction to stress, digestion, the immune system and various other functions. EC is also often associated with sleep disturbances. The aim of this study was to investigate if EC contributes to the risk of developing T2D and CVD in people living with obesity, beyond sleep disturbances and other clinical characteristics.

In this cross-sectional study, 172 middle-aged adults (72% females; mean age 52 years; mean body mass index (BMI) 32 kg/m2) were consecutively enrolled during a campaign to prevent obesity called the OPERA (obesity, programs of nutrition, education, research and assessment of the best treatment) PREVENTION project that was held in Naples on October 11-13, 2019. Body measurements and personal data were collected, and sleep quality was assessed by a common score known as the Pittsburgh Index. Chronotype was evaluated by a standard assessment called the Horne-Ostberg Morningness-Eveningness Questionnaire. Based on their scores, individuals were classed as being a morning (score 59 -86), neither (42-58), or evening (16 -41) type.

Chronotype was classified as MC in 58% of subjects, EC in 13% and IC in 29%. Subjects with EC, when compared to IC and MC, reported a tendency to follow an unhealthy lifestyle, performing less regular physical activity and being more frequently smokers. Across the whole population, a lower chronotype score was associated with a higher BMI. All results were statistically significant.

Although subjects belonging to MC, IC and EC categories had similar BMI values, subjects with EC had a significant higher prevalence of CVD and T2D compared to other categories (see Table 1 and 2 of full abstract). Statistical analysis was performed to evaluate the associations of chronotype with T2D and CVD. After adjusting the analysis for age, gender, BMI and sleep quality, people with EC had a 6 times higher risk of having T2D and a more than four times increased risk of CVD compared to the MC. EC also showed a 19 times higher risk of having T2DM and a four times higher risk of CVD compared to IC, with all results again statistically significant. However, no statistically significant differences in risk of T2D or CVD were found between MC and IC.

The authors conclude: “Our study found that evening chronotype represents an independent risk factor for cardiometabolic diseases beyond sleep disturbances, age, gender and BMI. Hence the assessment of chronotype should be taken into account in the management of obesity because promoting an alignment of daily activities according to the body clock or ‘circadian rhythm’ of people living with obesity might reduce their risk of developing metabolic diseases such as type 2 diabetes and cardiovascular disease.”

Posted on Cardiovascular disease, Diet

One cup of leafy green vegetables a day lowers risk of heart disease

New Edith Cowan University (ECU) research has found that by eating just one cup of nitrate-rich vegetables each day people can significantly reduce their risk of heart disease.

Kale in shape of a human heart

New Edith Cowan University (ECU) research has found that by eating just one cup of nitrate-rich vegetables each day people can significantly reduce their risk of heart disease.

The study investigated whether people who regularly ate higher quantities of nitrate-rich vegetables, such as leafy greens and beetroot, had lower blood pressure, and it also examined whether these same people were less likely to be diagnosed with heart disease many years later.

Cardiovascular diseases are the number one cause of death globally, taking around 17.9 million lives each year.

Researchers examined data from over 50,000 people residing in Denmark taking part in the Danish Diet, Cancer, and Health Study over a 23-year period. They found that people who consumed the most nitrate-rich vegetables had about a 2.5 mmHg lower systolic blood pressure and between 12 to 26 percent lower risk of heart disease.

Lead researcher Dr Catherine Bondonno from ECU’s Institute for Nutrition Research said identifying diets to prevent heart disease was a priority.

“Our results have shown that by simply eating one cup of raw (or half a cup of cooked) nitrate-rich vegetables each day, people may be able to significantly reduce their risk of cardiovascular disease,” Dr Bondonno said.

“The greatest reduction in risk was for peripheral artery disease (26 percent), a type of heart disease characterised by the narrowing of blood vessels of the legs, however we also found people had a lower risk of heart attacks, strokes and heart failure.”

Forget the supplements

The study found that the optimum amount of nitrate-rich vegetables was one cup a day and eating more than that didn’t seem to give any additional benefits.

“People don’t need to be taking supplements to boost their nitrate levels because the study showed that one cup of leafy green vegetables each day is enough to reap the benefits for heart disease,” Dr Bondonno said.

“We did not see further benefits in people who ate higher levels of nitrate rich vegetables.”

Smoothies are ok

Dr Bondonno said hacks such as including a cup of spinach in a banana or berry smoothie might be an easy way to top up our daily leafy greens.

“Blending leafy greens is fine, but don’t juice them. Juicing vegetables removes the pulp and fibre,” Dr Bondonno said.

The paper “Vegetable nitrate intake, blood pressure and incident cardiovascular disease: Danish Diet, Cancer, and Health Study” is published in the European Journal of Epidemiology. It is a collaboration between Edith Cowan University, the Danish Cancer Society and The University of Western Australia.

The research adds to growing evidence linking vegetables generally and leafy greens specifically with improved cardiovascular health and muscle strength. This evidence includes two recent ECU studies exploring cruciferous vegetables and blood vessel health and green leafy vegetables and muscle strength.

Posted on Cardiovascular disease, Rheumatoid arthritis

Physical activity reduces cardiovascular risk in rheumatic patients

People with diseases such as rheumatoid arthritis and lupus are more likely to have heart attacks, angina, and strokes. Regular exercise improves vascular function CREDIT Diego Rezende

The risk of developing atherosclerosis – a narrowing of the arteries as cholesterol plaque builds up, leading to obstruction of blood flow – is higher for people with autoimmune rheumatic diseases than for the general population. As a result, they are more likely to have heart attacks and other cardiovascular disorders. 

The good news, according to a new study published in Rheumatology, is that regular exercise is a powerful weapon against vascular dysfunction in these patients.

In the article, researchers working in Brazil and the United Kingdom report the results of a systematic review of the scientific literature on the subject. The review, which was supported by FAPESP, covered ten studies involving 355 volunteers with various diseases, such as rheumatoid arthritis, lupus, and spondyloarthritis (inflammation of the spine). The subjects took exercise programs such as walking in a park or on a treadmill, stationary cycling, high-intensity interval training, and muscle building. Most of the programs lasted 12 weeks.

“Our analysis of the results showed that exercise improved small and large vessel endothelial function to a clinically significant extent. Accordingly, we suggested that exercise can be considered ‘medication’ for these patients because of its potential to reduce the incidence of cardiovascular events,” said Tiago Peçanha, first author of the article. Peçanha is a postdoctoral fellow at the University of São Paulo’s Medical School (FM-USP) in Brazil.

These rheumatic diseases, he explained, are the result of an imbalance in the immune system that leads to the production of antibodies against the subject’s own organism, especially joints, muscles, ligaments and tendons. While there is no definitive cure for these diseases, they can be controlled by treatment with anti-inflammatory drugs, immunosuppressants, and biologics (drugs from living sources).

“Treatment doesn’t prevent patients from developing certain co-morbidities. Cardiovascular disease is the most worrisome,” Peçanha said. “The risk of heart attack is twice as high for people with rheumatoid arthritis as for healthy people. For people with lupus or psoriatic arthritis, the incidence of ischemic events [heart attack, angina and stroke] is between twice and five times as high.” 

Atherosclerosis develops rapidly in these patients owing to the chronic inflammation associated with rheumatic disease and continuous use of anti-inflammatory drugs. “It all begins with changes in blood vessel structure and function,” Peçanha said. “The arteries gradually harden and stop being able to dilate when necessary. Changes occur above all in the endothelium [the layer of cells lining the interior surface of blood vessels]. Alterations in vascular function, especially endothelial function, are considered initial markers of atherosclerosis for this reason.”

The systematic review showed that exercise improved small and large vessel vascular function in patients with autoimmune rheumatic diseases. However, the authors note that given the small number of studies reviewed the evidence is not sufficient to state categorically that exercise also promotes a structural recovery of damaged arteries.

“This area [physical activity in rheumatology] is still new, so more research is needed to identify the best exercise protocols and investigate such aspects as safety and adherence,” Peçanha said. “In any event, the data in our study underlines the importance of regular exercise to prevent and treat cardiovascular disease in these patients.”

For people with rheumatic disease, as indeed for everyone else, Peçanha recommends at least 150 minutes of moderate to vigorous exercise per week. Aerobic exercise should predominate and be complemented by activities that foster strength and balance.

Posted on Cardiovascular disease, Diabetes, Obesity

DIABETES WARNING Study estimates two-thirds of COVID-19 hospitalizations due to four conditions

A modeling study suggests a majority of adult COVID-19 hospitalizations nationwide are attributable to at least one of four pre-existing conditions: obesity, hypertension, diabetes, and heart failure, in that order.

The study, published today in the Journal of the American Heart Association (JAHA) and led by researchers at the Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy at Tufts University, used a mathematical simulation to estimate the number and proportion of national COVID-19 hospitalizations that could have been prevented if Americans did not suffer from four major cardiometabolic conditions. Each condition has been strongly linked in other studies to increased risk of poor outcomes with COVID-19 infection.

“While newly authorized COVID-19 vaccines will eventually reduce infections, we have a long way to go to get to that point. Our findings call for interventions to determine whether improving cardiometabolic health will reduce hospitalizations, morbidity, and health care strains from COVID-19,” said Dariush Mozaffarian, lead author and dean of the Friedman School. “We know that changes in diet quality alone, even without weight loss, rapidly improve metabolic health within just six to eight weeks. It’s crucial to test such lifestyle approaches for reducing severe COVID-19 infections, both for this pandemic and future pandemics likely to come.”

The researchers estimated that, among the 906,849 total COVID-19 hospitalizations that had occurred in U.S. adults as of November 18, 2020:

  • 30% (274,322) were attributable to obesity;
  • 26% (237,738) were attributable to hypertension;
  • 21% (185,678) were attributable to diabetes; and
  • 12% (106,139) were attributable to heart failure.

In epidemiological terms, the attributable proportion represents the percentage of COVID-19 hospitalizations that could have been prevented in the absence of the four conditions. In other words, the study found the individuals might still have been infected but may not have had a severe enough clinical course to require hospitalization. When numbers for the four conditions were combined, the model suggests 64% (575,419) of COVID-19 hospitalizations might have been prevented. A 10% reduction in national prevalence of each condition, when combined, could prevent about 11% of all COVID-19 hospitalizations, according to the model.

The four conditions were chosen based on other published research from around the world showing each is an independent predictor of severe outcomes, including hospitalization, among people infected with COVID-19. The specific risk estimates for each condition were from a published multivariable model involving more than 5,000 COVID-19 patients diagnosed in New York City earlier in the pandemic. The researchers used other national data to model the number of COVID-19 hospitalizations nationally; the distributions of these hospitalizations by age, sex, and race; and the estimated distribution of the underlying comorbidities among adults infected with COVID-19. They then estimated the proportions and numbers of COVID-19 cases that became severe enough to require hospitalization owing to the presence of one or more of the conditions.

“Medical providers should educate patients who may be at risk for severe COVID-19 and consider promoting preventive lifestyle measures, such as improved dietary quality and physical activity, to improve overall cardiometabolic health. It’s also important for providers to be aware of the health disparities people with these conditions often face,” said first author Meghan O’Hearn, a doctoral candidate at the Friedman School.

The model estimated that age and race/ethnicity resulted in disparities in COVID-19 hospitalizations due to the four conditions. For example, about 8% of COVID-19 hospitalizations among adults under 50 years old were estimated to be due to diabetes, compared to about 29% of COVID-19 hospitalizations among those age 65 and older. In contrast, obesity had an equally detrimental impact on COVID-19 hospitalizations across age groups.

At any age, COVID-19 hospitalizations attributable to all four conditions were higher in Black adults than in white adults and generally higher for diabetes and obesity in Hispanic adults than in white adults. For example, among adults age 65 and older, diabetes was estimated to cause about 25% of COVID-19 hospitalizations among white adults, versus about 32% among Black adults, and about 34% among Hispanic adults.

When the four conditions were considered combined, the proportion of attributable hospitalizations was highest in Black adults of all ages, followed by Hispanics. For example, among young adults 18-49 years old, the four conditions jointly were estimated to cause about 39% of COVID-19 hospitalizations among white adults, versus 50% among Black adults.

“National data show that Black and Hispanic Americans are suffering the worst outcomes from COVID-19. Our findings lend support to the need for prioritizing vaccine distribution, good nutrition, and other preventive measures to people with cardiometabolic conditions, particularly among groups most affected by health disparities,” Mozaffarian said. “Policies aimed at reducing the prevalence of these four cardiometabolic conditions among Black and Hispanic Americans must be part of any state or national policy discussion aimed at reducing health disparities from COVID-19.”