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Category: CMHC

Cardiometabolic Health Congress

Cardiovascular Morbidity and Mortality in Pregnancy

More than one fifth of all pregnancy-associated deaths during a 10-year period in Illinois were the result of cardiovascular causes, and the mortality rate resulting from cardiac causes rose with maternal age, new data study show.

Further, of the cardiac-associated deaths, 28.1% of them were potentially preventable, Joan Briller, MD, from the Division of Cardiology, Department of Medicine, and the Center for Research on Women and Gender at the University of Illinois at Chicago, and colleagues report in an article published online April 4 in Obstetrics & Gynecology.

Recent research has shown that the maternal mortality rate in the United States has risen substantially in recent years, with one study of national trends reported by Medscape Medical News indicating a relative increase of more than 25% between 2000 and 2014.

Because cardiovascular disease is recognized as a leading contributor to US maternal mortality, Dr Briller and colleagues sought to identify the most common etiologies of maternal cardiac death in Illinois and to assess their potential preventability.

The investigators reviewed data on pregnancy-associated cardiovascular deaths in the state from 2002 to 2011. Data were collected by a network of regional perinatal centers and recorded in the Illinois Department of Public Health maternal mortality review database. Illinois requires the reporting and review of all deaths to women within a year of pregnancy.

During the period of study, there were 636 deaths in women who were pregnant or within 1 year of pregnancy, reflecting an overall death rate of 37.1 per 100,000 live births. Of the deaths, 140 (22.0%) were cardiac-related, predominantly (97.1%) resulting from acquired heart disease. The most common etiology was cardiomyopathy (27.9%), followed by stroke (22.9%), hypertension-related death (12.9%), arrhythmias (10.7%), and coronary artery disease (9.3%). Of the 39 women who died of cardiomyopathy, 30.8% (n = 12) developed the condition during the peripartum period.

Of the cardiovascular deaths, those attributed to cardiomyopathy “were significantly more likely to be considered directly related to pregnancy (P<.01) than other cardiac etiologies,” the authors write, and women with cardiomyopathy “were more likely to be younger than women who died of other cardiovascular causes,” they observe. The cardiomyopathy mortality rate in women younger than 20 years was nearly three times that of women aged 20 to 29 years (rate ratio [RR], 3.38; 95% confidence interval [CI], 1.38 – 8.27).

More than half of the cardiovascular deaths in this patient population occurred during the first 6 weeks postpartum compared with deaths from noncardiac causes (56.7% vs 49.2%; P < .01). This suggests that women with hypertension, preeclampsia, or other cardiac risk factors or symptoms should receive more extensive postpartum care, the authors write.

“[T]he preponderance of cardiovascular deaths in the older population is especially striking given that only 40.1% of births occurred in women older than age 30 years of age,” the authors write. “Increasing cardiovascular death as women aged is partly explained by the rising prevalence of cardiovascular disease in the older population,” they explain.

Of the cardiac deaths, 28.1% were determined to be potentially preventable and point to aspects of care that are “amenable to change such as monitoring patients at risk for several weeks postpartum,” the authors write.

The Illinois findings “add to our understanding of cardiovascular disease as a leading contributor to maternal mortality by addressing risk factors to be assessed and that a large proportion of maternal mortality is potentially preventable by addressing issues such as the importance of monitoring patients at risk for several weeks postpartum while hemodynamic changes are still in flux,” the authors conclude. “Our data support the need for more investigations into cardiovascular maternal mortality, organized communication between obstetricians and cardiologists, and the need for systems designed to better educate and communicate cardiovascular risk factors and warning signs to pregnant women and medical care providers.”

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Higher Risk Factors for Women

Fewer women who suffer a heart attack each year in the UK would die if they were simply given the same treatments as men, according to new research.

Scientists at the University of Leeds and the Karolinska Institute in Sweden used data from Sweden’s extensive online cardiac registry, SWEDEHEART, to analyze the outcomes of 180,368 patients who suffered a heart attack over a 10 year period to December 2013.

After accounting for the expected number of deaths seen in the average population, the researchers found that women had an excess mortality up to three times higher than men’s in the year after having a heart attack.

While the analysis uses Swedish data, the researchers believe that the situation for women in the UK is likely to be worse than in Sweden, which has one of the lowest mortality rates from heart attacks anywhere in the world. The study, published yesterday in the Journal of the American Heart Association, was co-funded by the British Heart Foundation.

Professor Chris Gale, Professor of Cardiovascular Medicine at the University of Leeds, who co-authored the study, said: “We need to work harder to shift the perception that heart attacks only affect a certain type of person. Typically, when we think of a heart attack patient, we see a middle-aged man who is overweight, has diabetes and smokes. This is not always the case: heart attacks affect the wider spectrum of the population, including women. Sweden is a leader in healthcare, with one of the lowest mortality rates from heart attacks, yet we still see this disparity in treatment and outcomes between men and women. In all likelihood, the situation for women in the UK may be worse.”

Analysis of the Swedish data found that women who had a heart attack resulting from a blockage in the coronary artery were 34 per cent less likely than men to receive procedures which clear blocked arteries and restore blood flow to the heart, including bypass surgery and stents.

The paper reported that women were also 24 per cent less likely to be prescribed statins, which help to prevent a second heart attack, and 16 per cent less likely to be given aspirin, which helps to prevent blood clots. Critically, when women received all of the treatments recommended for patients who have suffered a heart attack, the gap in excess mortality between the sexes decreased dramatically.

Professor Gale, from the Leeds Institute of Cardiovascular and Metabolic Medicine, added: “The findings from this study suggest that there are clear and simple ways to improve the outcomes for women who have a heart attack – we must ensure equal provision of evidence-based treatments for women.”

Previous British Heart Foundation research has shown that women are 50 percent more likely than men to receive the wrong initial diagnosis and are less likely to get a pre-hospital Electrocardiogram (ECG) which is essential for swift diagnosis and treatment.

Professor Jeremy Pearson, Associate Medical Director at the British Heart Foundation, said: “Heart attacks are often seen as a male health issue, but more women die from coronary heart disease than breast cancer in the UK. The findings from this research are concerning – women are dying because they are not receiving proven treatments to save lives after a heart attack.”

This year, attend our 13th Annual CMHC conference, taking place from October 24-27 in the heart of downtown Boston. We are hosting our first pre-conference Women’s Health Summit on October 24th: highlighting the latest research unique to women’s healthcare. Expand your therapeutic options to enhance and optimize your female patients’ health, while learning tangible solutions to complex medical problems. This day is designed for you to become well-versed in integrative practices and protocols, and understand the unique challenges faced by women.

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Cardiovascular Mortality Rates Vary by Geography

It’s a testament to modern medicine that death rates from heart disease around the nation have been cut in half, yet new research sheds light on the wide disparities in cardiovascular death rates depending on geography. Using death certificate data, a research group led by University of Washington Medical Center cardiologist Dr. Gregory Roth conducted the most comprehensive analysis of deaths due to cardiovascular diseases in history.

Their findings indicated that cardiovascular death rates have been cut in half since 1980, though cardiovascular disease still represents the cause of death in the United States. In 2014, for instance, cardiovascular diseases accounted for more than 846,000 deaths, according to the research, which was published in the Journal of the American Medical Association.

But death rates can vary widely: for example, cardiovascular death rates are twice as high in Richmond, Martin and Columbus counties as they are in Chatham County. “This kind of variation occurs on a really small geographic level. So even from one county to the next we see these huge gaps in health related to heart disease,” said Roth. “We clear see higher rates of cardiovascular deaths in places that are poor, and we know that health care quality is worse in locations with lower incomes and lower levels of education.”

Moreover, there are early warning signs. Across the state and nation, cardiovascular death rates have begun to creep up again. “Cardiovascular disease is down on average in the United States, but the rate that it’s been going down has really flattened and in the last year or two we’ve seen very little decline at all. And in some states and counties we are actually seeing it go up again for the first time in 50 years,” said Roth.

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Mental Stress: The Enemy for Women’s Hearts

New research published in Arteriosclerosis, Thrombosis and Vascular Biology Indicates that mental stress has a greater effect on peripheral vessels in women than in men. The additional constriction of blood vessels seen in women may increase their risk of heart-related events and death.

Stress is a normal part of life and our body has a range of responses designed to help us react accordingly. These include physical, mental and emotional adjustments intended to be a positive reaction to keep us alert and ready to avoid danger. However, with the ever-increasing challenges of life today, some people experience a continuous stress response that can have negative consequences.

One of the common physiological responses to mental stress is constriction of peripheral blood vessels to free up more blood to support increased activity in the brain. In healthy people, this increases alertness and concentration. However, if a person has heart disease the constriction of peripheral blood vessels can also result in less blood reaching the heart, which can cause cardiac ischaemia. Previous research reported that stress-induced reduction in cardiac blood supply was more common in women aged <50 years compared with men and older women.

The Mental Stress Ischemia Mechanisms Prognosis study was designed to evaluate the extent of the effects of stress-induced vasoconstriction.

Dr Viola Vaccarino, professor of epidemiology and medicine at Emory University’s Rollins School of Public Health in Atlanta explained “This research is important because previous studies have shown that a reduction in blood supply to the heart (ischaemia) during mental stress doubles the risk of heart attack or death from heart disease. This increased risk of adverse cardiovascular events is about the same level as that seen in people who develop reduced blood flow in the heart muscle during a conventional test, such as a treadmill stress test.”

During the study of 678 patients with coronary artery disease, the constriction of tiny arteries supplying blood to the fingers was measured using myocardial perfusion imaging and heart rate and blood pressure recorded before and during a public speaking stressor.

The results showed that in women the reduced blood supply to the heart observed during mental stress was a consequence of constriction of peripheral blood vessels. In contrast, in men it was an elevation in blood pressure and heart rate during mental stress that led to a reduction in blood supply to the heart.

Vaccarino commented “Our findings in the peripheral circulation also could reflect what occurs in the arteries in the heart. Instead of dilating and increasing blood flow to the heart during stress, in women the tiny blood vessels are constricted, leading to areas of reduced blood flow. Constriction of peripheral vessels can also induce ischemia in the heart indirectly, because the heart has to pump against increased resistance.”

This research highlights the importance of finding effective means of combating mental stress, such as relaxation techniques and physical exercise, especially among people with heart disease. Furthermore, the observed gender differences suggest that health professionals need to pay particular attention to the burden of mental stress among their female patients with heart disease.

Future research will examine whether these cardiovascular responses to mental stress are reflected in an increased incidence of heart attacks or other indicators of worsening heart disease.

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Stroke & Dementia Risk Grows with Intake of Artificial Sweeteners

Diet sodas are gaining negative attention yet again, and for good reason. A recent study found that consuming a daily can of sugar-free soda is associated with higher risks of suffering a stroke or developing dementia. Heavily sugared drinks already had a bad rap for causing a myriad of health issues such as weight gain, liver damage, kidney stones, diabetes, and heart disease. This study has refreshed the concern for disease risk in those that believe diet soda is a suitable replacement.

Researchers found that drinking one diet soda a day is associated with a 2.96 times more likely chance of suffering an ischaemic stroke and a 2.89 times higher chance of developing Alzheimer’s. While it would be irresponsible to imply that artificial sweeteners actually cause stroke or dementia (proving causation is very difficult in health studies) it is important to acknowledge the study’s warning. There is a correlation between artificial sweeteners and the increased risk of dementia and stroke that’s very concerning. It’s certainly an added consideration that keeps me far away from diet sodas.

Artificial sweeteners have also been associated with health concerns besides stroke and dementia. A 2009 study found that people who consumed diet drinks daily had a 67 percent higher risk for type 2 diabetes and a 36 percent higher risk of metabolic syndrome.

It has been found that artificial sweeteners can dangerously impact your gut microbiome. One study suggests that artificial sweeteners favor bacteria that pull energy from food and convert it into fat. Meaning, If you are consuming zero calorie sweeteners specifically to cut down on weight gain, you aren’t doing yourself any favors. Additionally, studies suggest that fake sugar can induce glucose intolerance, which can be a precursor of increased risk for liver and heart disease.

It has also been shown that artificial sweeteners can have a more potent taste and flood your sugar receptors. Meaning if you are regularly using artificial sweeteners you may find naturally sweet foods less appealing making it more difficult to satisfy your sweet craving. It can also contribute to making bitter foods such as vegetables taste downright disgusting. This can contribute to a vicious cycle of increased sugar intake, which can cause a cascading effect on your overall health.

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Early Baldness: Higher Risk Factor Than Obesity?

Male pattern baldness and premature greying are more of a risk factor for heart disease than obesity in men under 40, new research suggests. A study of more than 2,000 young men in India showed more who had coronary artery disease were prematurely bald or grey than men with a full head of hair.

Dr Mike Knapton, associate medical director at the British Heart Foundation, told the BBC: “This study suggests that identifying men with premature hair loss and greying may help identify those with an increased risk of developing heart disease. However, this isn’t something that people can change, whereas you can modify your lifestyle and risk factors such as high cholesterol and blood pressure. These are far more important things to consider.”

The research, to be presented at the CSI’s 69th annual conference in Kolkata, studied 790 men under 40 who had coronary artery disease and 1,270 healthy men of a similar age, who acted as a control group.

A clinical history was taken of all the participants, who were then marked on their levels of male pattern baldness – the common type of hair loss that develops in most men at some stage – and hair whitening. The researchers correlated the findings with the severity of heart disease symptoms, and discovered that the men with the heart condition were more likely to have gone prematurely grey – 50% compared with 30% of the healthy group – more than five times the risk of the control group.

The heart condition group were also more likely to have male pattern baldness – 49% against 27% of those in the healthy group – a 5.6 times greater risk. Yet obesity was associated with only a fourfold increased risk of the disease.

Dr Kamal Sharma, the principal investigator on the study, said: “The possible reason could be the process of biological aging, which may be faster in certain patients and may be reflected in hair changes.”

Prof Alun Hughes, professor of cardiovascular physiology and pharmacology at University College London, said similar correlations had been made before. “People have speculated that it may be an indicator of DNA damage associated with aging,” he said. “Also, since hair follicles are a target for androgens – for example testosterone – it has been suggested that early male pattern baldness could reflect differences in responses to androgens that might influence the risk of heart disease.”

A study of nearly 37,000 people in Japan in 2013 said balding men were 32% more likely to have coronary heart disease. Prof Hughes said a study of 10,885 Danish people in 2014 reported that grey hair predicted future heart disease, but said it could be explained by taking account of other cardiovascular risk factors.

Lead study author Dr Dhammdeep Humane, of the UN Mehta Institute of Cardiology and Research Centre in Ahmedabad, said men with male pattern balding or premature greying “should receive extra monitoring for coronary artery disease and advice on lifestyle changes, such as healthy diet, exercise, and stress management.”

Another study author, Dr Sachin Patil, said there was an increase in coronary disease in young men which could not be explained by traditional risk factors and added that the hair conditions were “plausible risk factors”.

Prof Marco Roffi, head of the Interventional Cardiology Unit at Geneva University Hospital, said: “Assessment of risk factors is critical in the prevention and management of cardiovascular disease. “Classical risk factors, such as diabetes, family history of coronary disease, smoking, sedentary lifestyle, high cholesterol levels and high blood pressure, are responsible for the vast majority of cardiovascular disease. “It remains to be determined whether potential new risk factors, like the ones described, may improve cardiovascular risk assessment.”

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African-Americans More Likely to Die from Cardiovascular Disease

According to the American Heart Association, African Americans experience significantly worsened cardiovascular health, and thus face greater mortality rates from heart disease. African Americans die an average of 3.4 years before white Americans, a gap largely attributable to prevalent cardiovascular disease and risk factors. Recent publication of a scientific statement from the organization reads: “The burden of cardiovascular disease in the African American community remains high and is a primary cause of disparities in life expectancy between African Americans and whites.”

Dr. Mercedes R. Carnethon from Northwestern University Preventive Medicine in Chicago states that traditional cardiovascular risk factors—including high blood pressure, diabetes, obesity, and atherosclerosis—are not only more common among African Americans, but also manifest at relatively young ages. Data indicates that high blood pressure is diagnosed in 13.8 percent of black children, compared to 8.5 percent in white children. The risk of persisting hypertension in black adults, throughout adulthood, is 1.5 times higher than in whites. “Interrupting this process by preventing the early onset of cardiovascular diseases is one strategy to reduce disparities in cardiovascular disease mortality,” Dr. Carnethon writes.

The research team at the American Heart Association notes that circumstances have remained fairly stagnant since 2005; relatively little has changed since 2005, when the same journal pointed to disparities in the rates of cardiovascular disease, disease management, and outcomes for African Americans. While genetic differences between African Americans and other groups do not account for the disparities in cardiovascular disease rates and outcomes, many of the variances arise from “unhealthy behaviors, lower implementation of guidelines shown to improve cardiovascular health, ingrained cultural preferences and attitudes, and lack of persistence in following lifestyle changes that need to be lifelong.”

While Dr. Carnethon’s team notes that cardiovascular disease is often preventable through the implementation and continued practice of a healthy, nutritious lifestyle, she discusses the difficulties faced by many African Americans—particularly those in lower income groups—in accessing the necessary resources to lead healthy lifestyles: specifically, access to healthful foods, safe spaces for physical activity and exercise, and homes that allow for restorative sleep. Moreover, she argues that despite the strides our country has made in broadening access to healthcare, many African-Americans are still unable to afford and prioritize preventive care visits.

Dr. LaPrincess Brewer from the Mayo Clinic in Rochester, Minnesota has continuously worked to promote cardiovascular health in African-American communities, promotes “culturally relevant, community-based cardiovascular health interventions that focus more on positive motivation towards promoting cardiovascular health rather than the negative impact of cardiovascular disease.” Through increased awareness, and a collective, collaborative effort on the part of clinicians, public health workers, researchers, social services, and community stakeholders, the high burden of traditional risk factors among African Americans can be addressed—in tandem with the inherent social and environmental contextual barriers faced by this specific population.

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Trick-Or-Jump

A recent article[1] revealed what happens if you frequently visit your office’s Halloween candy stash, or you eat your kid’s leftover Trick-Or-Treat candies…

Jumping Jacks. 

Lots and lots of them, if you want to burn off what you ate! Although Halloween candies often come in smaller, “mini” versions of the regular candy sizes, they are all still packed with calories and sugar.

The article provided this handy but SCARY chart* (how appropriate for Halloween), which shows us just how many minutes of jumping jacks you need to do in order to fight off the evil Halloween candy you consume…

*Calculations based on a 150-pound woman

[1] Popsugar. Sugar, Jenny. “This Is How May Jumping Jacks You Need to Do to Work Off Halloween Candy.” https://www.popsugar.com/fitness/How-Burn-Off-Halloween-Candy-42393489?utm_source=facebook.com&utm_medium=social&utm_campaign=popsugar.com. October 29, 2017. Accessed October 30, 2017.

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Stopping Cholesterol-Lowering Drugs Could be Deadly

A new study confirms that stopping a cholesterol-lowering drug can be critically dangerous. Researchers found that people who stopped taking statins, after reporting a side effect, were 13% more likely to die, or have a hear attack or stroke over the next four years.


Statins work by inhibiting the liver’s ability to produce cholesterol, while simultaneously helping the organ remove existing fats in the blood. These drugs are ‘almost universally prescribed’ to people with cardiovascular disease; moreover, the U.S. Preventive Services Task Force recommends the drugs to people ages 40-75, who have no history of heart disease, if they have one or more risk factors.

While there is extensive literature and clinical studies surrounding the efficacy of statins, a quarter to a half of patients stop taking the drugs within six months to a year, according to Dr. Alexander Turchin of Brigham and Women’s Hospital in Boston. In order to determine whether people who continue taking statins fare better than those who do not, researchers analyzed data from two Boston hospitals between 2000 and 2011.

During that period, over 200,000 adults were prescribed and treated with statins; almost 45,000 of those people reported a side effect that they thought might be from the medication: generally muscle or stomach aches. The researchers focused on 28,266 people from those 45,000 with possible side effects: most of them, 19,989 individuals, continued to take the statins.

Approximately four years after the side effects were reported, 3,677 patients had died, or suffered a heart attack or stroke. Overall, researchers found that people who stopped taking statins were 13 percent more likely to die or have a heart attack, or stroke. According to Dr. Robert Rosenson, a professor of cardiology at the Icahn School of Medicine at Mount Sinai in New York City, these new findings further confirm and expand on previous studies that demonstrated the benefits of continuing to take statins.

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Ozone Exposure Tied to Higher Cardiovascular Risk

Research findings recently published in the journal JAMA Internal Medicine, conducted by researchers from Duke University with colleagues from several educational institutions in China, indicate that exposure to high and harmful ozone levels can increase blood pressure: a primary risk factor for cardiovascular disease.

Senior author Junfeng Zhang, a professor in global and environmental health at Duke University, stated: “We know that ozone can damage the respiratory system, reduce lung function, and cause asthma attacks.” While exposure to ozone has been correlated with reductions in lung function, this new study of adults in China reveals that it is also strongly correlated with increased risks of heart attack and stroke. The study monitored 89 health adults in China from December 2014 to January 2015, measuring indoor and outdoor ozone levels, in addition to other pollutants. Other measured markers included levels of inflammation, oxidative stress, stiffness in arteries, blood clotting, blood pressure, and lung function.

After analyzing the data, the researchers confirmed that ozone exposure was “linked to markers of blood platelet activation and raised blood pressure;” the former is a high risk factor for blood clotting. The ozone exposure levels during the study were lower than levels that have been associated with impaired lung function: “The main basic for the current air quality standard set by the Environmental Protection Agency.”

Professor Zhang has said that in 2015, a third of the entire U.S. population (approximately 108 million people) lived in geographic regions in which ozone levels were higher than the set EPA standard. Moreover, as global ozone levels will increase due to climate change and the increasing warmth of the atmosphere, there will likely be an increased trend in these findings.

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